This morning Liz was feeling a bit better and managed to eat a little bread at breakfast (then she went right back to sleep). On the way to the clinic I saw a little girl (maybe 4 years old) with a doll tied to her back, I guess she was playing mommy (though it probably won’t be too much longer before she’s carrying one of her younger siblings that way). At the clinic this morning I decided to hang out in the clinical lab. I got to observe more Widal et Felix tests (for typhoid), many of which were positive. There were also tests for toxoplasmosis, syphilis, sickle cell, urine tests. There was also one HIV test for a young woman (only 24 years old) and sadly it turned out to be positive. I asked Tolo what would happen to the woman; apparently here the medicine for HIV is free, but you have to go to Mopti to get it. I asked if a person usually tells there family or sexual partners when they find out they’re positive. He said sometimes they do, but many of them are scared and that if they tell sometimes their family or community make them leave. It’s also very sad because one of the ways HIV spreads here is actually due to the good social support system they have; if a woman is widowed typically her husband’s brother or other male relative take her in as their wife so that she doesn’t become destitute, but if the man died of HIV, than she may unknowingly spread that HIV into the rest of the family. Fortunately in Mali the HIV rate is very low compared to the rest of Africa, but it’s always possible that it could get worse (I do see a lot of public health ads about HIV though). This morning I also found out the significance of the little beaded necklaces that most of the small children where (they’re very plain, looks like hemp with a few evenly spaced white beads). First when I asked Tolo what it was for, he said it was nothing, just something pretty. But then I mentioned at all the children wear the same one, so he asked the mother; apparently the necklaces are traditional medicine for when a child is teething (and it seems that it just doesn’t get taken off after they’ve gotten their teeth).
On the way home for lunch we stopped so I could buy more bottled water for Liz and I, but I forgot to get some easy things for Liz to eat (I got them later though). After lunch I rested in the room for a while, mostly playing solitaire. At 3:30pm we went back to the clinic, but nothing was happen so I stayed in the office to read. A while later Tolo came back and we headed to the market so I could buy clothe to have a complet made, which is a pagne (traditional wrap skirt) and a top, plus a head wrap (we’ll see how that goes). After buying the fabric (Tolo haggled over the price for me for a while, though really the original price wasn’t that high) we walked back to the clinic (I think Tolo is getting a little annoyed that I refuse to ride a moto) and stopped on the way to buy some things for Liz to eat. The stores here certainly don’t have the same selection as the Fermi in Bamako, but I did manage to get a package of chocolate cookies (they don’t have crackers) and a can of mixed vegetables (they didn’t have any canned fruit).
After we got back to the clinic I got to enjoy my second goat feast. This time I couldn’t get away with eating just one small piece, they were all watching (just me in the guys). This time I actually enjoyed it, though I did have to politely (but firmly) refuse to eat the kidney. After enjoying my goat and washing my hands I decided it was time to post some new blogs (so here we are). A storm has just kicked up, temporarily knocking out the power, but fortunately the generators kicked in (as I’m still not bright enough to occasional save my typing). I think tonight after dinner I’ll just unwind and go to sleep early. Au revoir.
Monday, July 27, 2009
Bandiagara Day 11 (26/07/09)
This morning there didn’t seem to be much to do, which was ok because we were a bit tired from hiking on the escarpment yesterday. We hung out in the office for a while and then decided to go outside. It was a surprisingly nice day; I can’t say it was cool, maybe temperate (which means in the mid 90s instead of 100+). While were sitting out there a girl carrying a tray or what turned out to be Shea fruit on her head offered us each one to try (I never actually ate it because I was worried about washing it and then someone else ate it, oh well). A little while later Liz began to feel pretty ill (no she didn’t eat the fruit later) and she managed to get someone to take her back to the house early. After she left I went to help Tolo check for documentation errors in the study and file away papers. I was a bit shocked at the lack of organization in their paperwork, but I’m probably a bit rigid after working at a pharmaceutical company that was a bit anal in its documentation practices (I think if I were here longer and maybe if my French were better I could help them reorganize and save them a lot of time and errors).
When we came back from lunch Liz was laying down and still feeling pretty crummy; later Dembele and Dr Kone came in and checked her over (they wound up giving her some antibiotics). After lunch I stayed at the house; Badry left for the clinic before I could catch up with him, but that’s ok, I was pretty tired anyways. I spent the afternoon watching the end of the tour de France, playing solitaire and watching a movie on my computer. The team came back to the house for dinner and after eating I left with Tolo and Dembele to go to a bar/restaurant (we were going to a wedding party afterwards too, but never made it). At first Dembele didn’t want to come, but I was worried that going with Tolo alone might be misconstrued as a date, so I insisted he come too. We had an interesting conversation on the walk over; apparently here they see no problem with having a girlfriend one place and dating other girls somewhere else without informing their girlfriend (however, they argued that it wasn’t ok for their girlfriends to do the same thing). At this point I decided it was a good idea to make it ABUNDANTLY clear that I was not interested in dating anyone while I was here. That I didn’t think it was ok to lie to your boyfriend/girlfriend and that I tell my boyfriend everything (I think this is when the idea that this might turn into a date ended).
When we got to the bar (I think it was called Auberge Kanzaye) it was surprised that there seemed to be a whole group of toubobs there. Later I wound up talking to a few of them (an older British couple) who told me that it was a trip they signed up for on the internet and the group had started in Burkina and was traveling over land to Timbouctou. It sounded like a fun trip (28 days long I think they said), but they didn’t seem to have been able to mix with the locals and find out about the culture (which I think is quite a loss). I explained to them about malaria (they had no idea that pretty much ever African gets malaria as a child and develops immunity) and about the medical system here. They were very friendly and it was nice to have a conversation in English. The music was good, it was a local Dogon band and some of the African kids were surprisingly good dancers. I danced for a while and even got Tolo and Dembele to dance for a bit, but it was pretty hot so we only danced for a few songs. It started getting late, so I suggested we head back. On the walk back I got to check out the stars and even got to see the Milky Way (it was amazingly clear). After a shower I crashed.
When we came back from lunch Liz was laying down and still feeling pretty crummy; later Dembele and Dr Kone came in and checked her over (they wound up giving her some antibiotics). After lunch I stayed at the house; Badry left for the clinic before I could catch up with him, but that’s ok, I was pretty tired anyways. I spent the afternoon watching the end of the tour de France, playing solitaire and watching a movie on my computer. The team came back to the house for dinner and after eating I left with Tolo and Dembele to go to a bar/restaurant (we were going to a wedding party afterwards too, but never made it). At first Dembele didn’t want to come, but I was worried that going with Tolo alone might be misconstrued as a date, so I insisted he come too. We had an interesting conversation on the walk over; apparently here they see no problem with having a girlfriend one place and dating other girls somewhere else without informing their girlfriend (however, they argued that it wasn’t ok for their girlfriends to do the same thing). At this point I decided it was a good idea to make it ABUNDANTLY clear that I was not interested in dating anyone while I was here. That I didn’t think it was ok to lie to your boyfriend/girlfriend and that I tell my boyfriend everything (I think this is when the idea that this might turn into a date ended).
When we got to the bar (I think it was called Auberge Kanzaye) it was surprised that there seemed to be a whole group of toubobs there. Later I wound up talking to a few of them (an older British couple) who told me that it was a trip they signed up for on the internet and the group had started in Burkina and was traveling over land to Timbouctou. It sounded like a fun trip (28 days long I think they said), but they didn’t seem to have been able to mix with the locals and find out about the culture (which I think is quite a loss). I explained to them about malaria (they had no idea that pretty much ever African gets malaria as a child and develops immunity) and about the medical system here. They were very friendly and it was nice to have a conversation in English. The music was good, it was a local Dogon band and some of the African kids were surprisingly good dancers. I danced for a while and even got Tolo and Dembele to dance for a bit, but it was pretty hot so we only danced for a few songs. It started getting late, so I suggested we head back. On the walk back I got to check out the stars and even got to see the Milky Way (it was amazingly clear). After a shower I crashed.
Bandiagara Day 10 (25/07/09)
This morning Liz and I slept in a little and got up planning to go to Mopti for the day. However, shortly before we were expecting to leave we got a call from Badry asking if it would be ok if we went to Sanga instead (Ogo’s secretary was only going to be here for one more day and really wanted to see the falaise (escarpment)), no problem. I’m beginning to learn here the time and plans are really rather amorphous flexible things that could change at any moment. We headed over to the clinic and found out that the group would be Djigeba (driving), Iesha (Ogo’s secretary), Tolo, Dembele, Liz and me and we were all going to go in a pickup truck (yes it has a back seat, but we were fitting 4 people in it). We had to go back to the house so Iesha could change her shoes into something more suitable for hiking (she had sandals on). After a brief stop we got on the road . . . or at least it started out as a road.
The road to Sanga is more or less a dirt path with some occasional pavement (or what was once pavement); honestly the road reminded me a bit of the Appalachian Trail near Annapolis Rocks and I’m amazed that the car made it. There was some severe jostling in the back and some near knowing of heads. I was very glad we hadn’t eaten a large breakfast or it might not have been pretty. As we got further away from Bandiagara the landscape became surprisingly green (though we’re not talking about the green fields of home) and I realized that I had missed seeing green things. The rains seemed to have done a lot of good out here; I saw many people cultivating and the stream and tributaries to the Niger seemed to be flowing with a little more vigor. There were sometimes large puddles that the truck had to navigate around and there were often kids along the road selling some kind of fruit and yelling “toubob” upon seeing Liz and me in the truck. They said that Sanga was an hour away, though I imagine it’s not that far, you simply can’t drive that fast due to road conditions (though I think the driver was pushing it with the speed he was going). Closer to Sanga (and within Sanga itself) the houses were built of shaped rocks and mud (they looked much more stable and strong than the mud houses of Bandiagara). On the edge of Sanga we picked up Kene Dolo, our guide for the day and passed through the cities arched entryway. We drove through Sanga until we got to the edge of the village of Banani then got out of the truck and began our walk/hike.
Kene explained to us the divination table (which I managed to understand in French only because I read a Dogon book in Bamako), which realize on a visit by a fox (tempted with peanuts) to predict the future health, farm season, marriages or pregnancies of people seeking advice. We continued on into town and took a path that headed down the escarpment. Along the way we saw baobab trees, women pounding millet (we even gave it a shot), and many children who asked for gifts (unfortunately I didn’t bring any with me). We took a long and rock path down the escarpment (when we got to the bottom I could believe we had climbed down all that way) and wound up in another section of Banani; the village has 4 quarters, one each for the mother and 3 sons. Apparently the Dogon moved to the village after the founders had refused to convert to Islam and fled to the cliffs for safety. They took over the housing of the Tellem people (no one knows where they went, but they’re the ones that built the original houses in the cliffs) and then added on more living spaces as need. Once fighting and slave raiding ended the Dogon began to spread out onto the plains (with colonization it became safe to leave the security of the cliffs). Anyways, once we got to the bottom we passed through more of the town and eventually ended up down by a stream in the furthest reaches of the village; here the truck was waiting for us having taken another root. This was apparently the end of the short tour (which was good because Iesha is a bit of an older woman and though I was impressed by her managing of the decent I believe she was pretty tired by the bottom). We got in the truck and began driving back up the road towards Sanga and away from the escarpment. We dropped Kene off at his office and had a quick drink (it was past lunch time and I think everyone was a bit hungry), then we headed back towards Bandiagara. Somehow on the way back Tolo managed to fall asleep despite the rather rough ride.
We got back hot tired and dirty; I wasn’t particularly hungry, but we all ate lunch before heading for a rest. Later in the afternoon at around 6pm Liz and I headed over to the teams house to play frisbee with Tolo and Dembele, but when we got there no one was out. We waited for a minute until one of the guys that takes care of the house saw us and went to get Tolo and Dembele. Tolo had been sleeping and Dembele had gone to the clinic. We played frisbee for about an hour with Tolo and one of the younger guys that runs errands for the team. it seems we were quite a spectacle as a group of kids gathered to watch. The little boys were helpful with the younger guy threw the frisbee over a fence (which he did often; he didn’t seem to get the concept of keeping the frisbee parallel with the ground when throwing) and a group of girls watching would break out in squeals and laughter whenever the frisbee came within 5 yards of them. We played for a while and the guys even got a good bit better, but as it got dark we stopped and Tolo went in to pray. We walked back to the house together for dinner.
Tonight I think I ate something made from the same recipe as playdough (except without the coloring, so it was the most unappealing shade of gray), it was called tono and was made from millet. We also had peas, but I nearly broke my tooth on a piece of bone, so that soon became unappealing. Dinner’s saving grace was the green bananas we had afterwards. I must admit that I am looking forward to coming home and eating recognizable food again.
The road to Sanga is more or less a dirt path with some occasional pavement (or what was once pavement); honestly the road reminded me a bit of the Appalachian Trail near Annapolis Rocks and I’m amazed that the car made it. There was some severe jostling in the back and some near knowing of heads. I was very glad we hadn’t eaten a large breakfast or it might not have been pretty. As we got further away from Bandiagara the landscape became surprisingly green (though we’re not talking about the green fields of home) and I realized that I had missed seeing green things. The rains seemed to have done a lot of good out here; I saw many people cultivating and the stream and tributaries to the Niger seemed to be flowing with a little more vigor. There were sometimes large puddles that the truck had to navigate around and there were often kids along the road selling some kind of fruit and yelling “toubob” upon seeing Liz and me in the truck. They said that Sanga was an hour away, though I imagine it’s not that far, you simply can’t drive that fast due to road conditions (though I think the driver was pushing it with the speed he was going). Closer to Sanga (and within Sanga itself) the houses were built of shaped rocks and mud (they looked much more stable and strong than the mud houses of Bandiagara). On the edge of Sanga we picked up Kene Dolo, our guide for the day and passed through the cities arched entryway. We drove through Sanga until we got to the edge of the village of Banani then got out of the truck and began our walk/hike.
Kene explained to us the divination table (which I managed to understand in French only because I read a Dogon book in Bamako), which realize on a visit by a fox (tempted with peanuts) to predict the future health, farm season, marriages or pregnancies of people seeking advice. We continued on into town and took a path that headed down the escarpment. Along the way we saw baobab trees, women pounding millet (we even gave it a shot), and many children who asked for gifts (unfortunately I didn’t bring any with me). We took a long and rock path down the escarpment (when we got to the bottom I could believe we had climbed down all that way) and wound up in another section of Banani; the village has 4 quarters, one each for the mother and 3 sons. Apparently the Dogon moved to the village after the founders had refused to convert to Islam and fled to the cliffs for safety. They took over the housing of the Tellem people (no one knows where they went, but they’re the ones that built the original houses in the cliffs) and then added on more living spaces as need. Once fighting and slave raiding ended the Dogon began to spread out onto the plains (with colonization it became safe to leave the security of the cliffs). Anyways, once we got to the bottom we passed through more of the town and eventually ended up down by a stream in the furthest reaches of the village; here the truck was waiting for us having taken another root. This was apparently the end of the short tour (which was good because Iesha is a bit of an older woman and though I was impressed by her managing of the decent I believe she was pretty tired by the bottom). We got in the truck and began driving back up the road towards Sanga and away from the escarpment. We dropped Kene off at his office and had a quick drink (it was past lunch time and I think everyone was a bit hungry), then we headed back towards Bandiagara. Somehow on the way back Tolo managed to fall asleep despite the rather rough ride.
We got back hot tired and dirty; I wasn’t particularly hungry, but we all ate lunch before heading for a rest. Later in the afternoon at around 6pm Liz and I headed over to the teams house to play frisbee with Tolo and Dembele, but when we got there no one was out. We waited for a minute until one of the guys that takes care of the house saw us and went to get Tolo and Dembele. Tolo had been sleeping and Dembele had gone to the clinic. We played frisbee for about an hour with Tolo and one of the younger guys that runs errands for the team. it seems we were quite a spectacle as a group of kids gathered to watch. The little boys were helpful with the younger guy threw the frisbee over a fence (which he did often; he didn’t seem to get the concept of keeping the frisbee parallel with the ground when throwing) and a group of girls watching would break out in squeals and laughter whenever the frisbee came within 5 yards of them. We played for a while and the guys even got a good bit better, but as it got dark we stopped and Tolo went in to pray. We walked back to the house together for dinner.
Tonight I think I ate something made from the same recipe as playdough (except without the coloring, so it was the most unappealing shade of gray), it was called tono and was made from millet. We also had peas, but I nearly broke my tooth on a piece of bone, so that soon became unappealing. Dinner’s saving grace was the green bananas we had afterwards. I must admit that I am looking forward to coming home and eating recognizable food again.
Bandiagara Day 9 (24/07/09)
This morning we were in the clinical lab. I learned how to run tests for salmonella (which the Swiss med student tested positive for), as well as how to prepare slides for urine analysis (to look for parasites, bacteria, and anything else abnormal). We also got to observe the battery of tests done for all pregnant women (there were a few that came in so we got to see this more than once). For pregnant women they check blood type, Rhesus factor, test for syphilis and check for creatinine and sugar in the urine. We spent the whole morning in the lab doing different tests and trying to find out how they work (it seems that the lab techs know how to perform them, but are not exactly sure about the biochemistry of the tests). Here many of the tests involve precipitate reactions, which I’ve never seen preformed in a clinical lab in the US (we generally prefer closed reactions and often use for expensive antibody, colorimetric tests).
After lunch (and a short nap), we went on a walk to the market (there are 2 market days a week, Friday and Monday) with Poel (one of the caretakers of the house). On the way to the market we saw the towns first Togona, which is a very low ceilinged structure were men meet to talk about any conflicts in the community (the ceiling is low so that no one can stand up when they are angry and try to get an advantage in the discussion). The market was hot and dusty (and later I discovered I got a little sunburned), but there were all sorts of interesting things to see. Poel walked fast and it was a bit hard to stop him and ask questions or take pictures. But we were able to buy Dogon cloth (which is dyed in unique and interesting patterns with indigo) and we stopped at a pharmacy for Liz to get more tooth paste. Afterwards Poel walked us to the clinic (I had made a date to talk to Nathan on Skype in the afternoon). After talking to Nathan and Dad on Skype Liz and I were finally able to help with some work. We compiled some data from the vaccine study (which finished shortly before we got here) and in fact we did it do fast Tolo could hardly believe it (poor Sessoko had been working on it all by himself all day). While we were working one of the guides at the clinic brought us some coffee. I was really impressed by the quality because here they only use instant coffee. The guide explained that it was better than the coffee at the house because it was made in the US and the coffee at the house is made in Burkina Faso (it’s a little funny because they seem to feel that anything to do with the neighboring countries is somehow inferior). When we were done we headed back to the house for dinner (during the drive there was a lot of lightning in the distance, though I couldn’t hear any thunder) and met a new group of people who had arrived: there was Professor Ogo’s secretary from Bamako, and doctor who specializes in medical ethics (he had just returned from the US). After dinner (which was a rather boney fish and French fries) I was hanging out in the room when I began to hear some rumbling. It wasn’t long before a huge storm broke out, the power turned off and Liz and I went outside to watch the rain. This was some storm, the rain came down in torrents (I’m not even sure torrential could describe it) and the lightning was so bright and so often that we could see clear across the yard with no lights on. It seems here that the weather is really all or nothing; either no rain at all or just total down pours.
After lunch (and a short nap), we went on a walk to the market (there are 2 market days a week, Friday and Monday) with Poel (one of the caretakers of the house). On the way to the market we saw the towns first Togona, which is a very low ceilinged structure were men meet to talk about any conflicts in the community (the ceiling is low so that no one can stand up when they are angry and try to get an advantage in the discussion). The market was hot and dusty (and later I discovered I got a little sunburned), but there were all sorts of interesting things to see. Poel walked fast and it was a bit hard to stop him and ask questions or take pictures. But we were able to buy Dogon cloth (which is dyed in unique and interesting patterns with indigo) and we stopped at a pharmacy for Liz to get more tooth paste. Afterwards Poel walked us to the clinic (I had made a date to talk to Nathan on Skype in the afternoon). After talking to Nathan and Dad on Skype Liz and I were finally able to help with some work. We compiled some data from the vaccine study (which finished shortly before we got here) and in fact we did it do fast Tolo could hardly believe it (poor Sessoko had been working on it all by himself all day). While we were working one of the guides at the clinic brought us some coffee. I was really impressed by the quality because here they only use instant coffee. The guide explained that it was better than the coffee at the house because it was made in the US and the coffee at the house is made in Burkina Faso (it’s a little funny because they seem to feel that anything to do with the neighboring countries is somehow inferior). When we were done we headed back to the house for dinner (during the drive there was a lot of lightning in the distance, though I couldn’t hear any thunder) and met a new group of people who had arrived: there was Professor Ogo’s secretary from Bamako, and doctor who specializes in medical ethics (he had just returned from the US). After dinner (which was a rather boney fish and French fries) I was hanging out in the room when I began to hear some rumbling. It wasn’t long before a huge storm broke out, the power turned off and Liz and I went outside to watch the rain. This was some storm, the rain came down in torrents (I’m not even sure torrential could describe it) and the lightning was so bright and so often that we could see clear across the yard with no lights on. It seems here that the weather is really all or nothing; either no rain at all or just total down pours.
Bandiagara Day 8 (23/07/09)
This morning we went on rounds at the hospital; apparently the doctor strike is over (or at least here). There were so many people that it was difficult to hear the cases. There were more snakes bites (and the same little boy), 2 children with malaria; over in the maternity clinic there was one woman who delivered her baby but the cord came out first which cut off the circulation for the baby and it died before it could be completely delivered (it was a little upsetting because the doctors didn’t seem all that compassionate). After rounds Liz and I were back in the clinic with Dembele; there were the usually cases of vomiting, intestinal parasites, fevers, etc. I also got to feel a child with hepatomegaly (which sometimes happens after chronic malaria infection). Late in the morning a girl came by selling peanuts (a common snack here) and we all shared a bag. Liz asked Dembele for a Malian name (the French med student we had met a few days before had been given a Malian name). Dembele said he would think about it and talk it over with everyone so they could come up with a really great name. Before lunch we went back over to the hospital to watch the bandage being changed on my favorite little boy. I think he has a terrible fear of anyone in a white coat now (not that I blame him). This time his mother held him while the cut off the old bandage (which was very difficult as the skin had started to grow into it (I think if this had been in the us they probably would have used an artificial graft to cover the wound).
After lunch I brought a coloring book and box of crayons for the kids at the hospital (there’s nothing for them to do there and it must be very boring). The little boy with the snake bite was the only one in there at the time so I gave the gifts to him, maybe this will help ease his fear of white coats. After leaving from the hospital we went over to the maternity clinic to check on a woman there. This was a very sad case; the woman had begun having seizures some weeks ago at home, but her family refused to bring her to a doctor because they thought it was a mental problem or maybe epilepsy. She had three seizure fits before her husband went to get a doctor. The doctor came to the house and found the woman had a severe fever (over 105F). The doctor got an ambulance to take her to the hospital, but she slipped into a coma on the way. Apparently she was septic; she lost the baby and remained in a coma for several days. She’s conscious now and they believe she is able to hear and understand (she turns her head only to people speaking her language), but she won’t follow commands and she hasn’t spoken. I wonder if she is just sad and angry; it doesn’t seem like anyone is trying to council or comfort her. I’m also amazed at the lack of a doctor patient relationship here; Dembele started examining her without saying anything to her and made some rather delicate contact without telling her what he was doing or even looking her in the face (this is one of the few things I find significantly disappointing in the medicine here).
We went back to the clinic and Liz and I checked in on the lab. A Swiss medical student, who was doing a stage in a nearby village, was in to get some test done. She had a fever and had been ill, she wanted to be tested for malaria (though it was unlikely as she was taking prophylaxes); they also took blood to test for salmonella (though that wouldn’t be run till the following day). Back in the office we waited for Badry to be ready to return to the house and Dembele and Dialo mentioned that they would like to improve their English, so Liz and I offered to speak English with them while we were here.
After lunch I brought a coloring book and box of crayons for the kids at the hospital (there’s nothing for them to do there and it must be very boring). The little boy with the snake bite was the only one in there at the time so I gave the gifts to him, maybe this will help ease his fear of white coats. After leaving from the hospital we went over to the maternity clinic to check on a woman there. This was a very sad case; the woman had begun having seizures some weeks ago at home, but her family refused to bring her to a doctor because they thought it was a mental problem or maybe epilepsy. She had three seizure fits before her husband went to get a doctor. The doctor came to the house and found the woman had a severe fever (over 105F). The doctor got an ambulance to take her to the hospital, but she slipped into a coma on the way. Apparently she was septic; she lost the baby and remained in a coma for several days. She’s conscious now and they believe she is able to hear and understand (she turns her head only to people speaking her language), but she won’t follow commands and she hasn’t spoken. I wonder if she is just sad and angry; it doesn’t seem like anyone is trying to council or comfort her. I’m also amazed at the lack of a doctor patient relationship here; Dembele started examining her without saying anything to her and made some rather delicate contact without telling her what he was doing or even looking her in the face (this is one of the few things I find significantly disappointing in the medicine here).
We went back to the clinic and Liz and I checked in on the lab. A Swiss medical student, who was doing a stage in a nearby village, was in to get some test done. She had a fever and had been ill, she wanted to be tested for malaria (though it was unlikely as she was taking prophylaxes); they also took blood to test for salmonella (though that wouldn’t be run till the following day). Back in the office we waited for Badry to be ready to return to the house and Dembele and Dialo mentioned that they would like to improve their English, so Liz and I offered to speak English with them while we were here.
Bandiagara Day 7 (22/07/09)
When we got into the clinic this morning Badry was writing an email to Shelia (she’s from the Baltimore lab and is in charge of ordering and shipping supplies to the clinic here) to reorder some things for the lab. He asked if we could look the email over to perfect the English; he had done a fairly good job and only a few sentences needed tweaking. While helping him with the email we missed going on rounds, c’est la vie. After Dembele returned from rounds we joined him in the clinic. Today we had a few different cases on top of the usually colds, fevers and stomach upsets. We had a young teenage girl with a yeast infection, as well as a UTI. Apparently she doesn’t like to take pills, so she was given an injection of antibiotics for the UTI and told to come back the next two days for follow up doses. The next patient was an older woman with trichamonisis (I only knew what this was because a patient at UMMC had asked me before . . . in case you want to know it’s a vaginal parasite). She was given a prescription of a treatment for both her and her husband (like most STDs you need to treat both partners or they’ll just keep passing back and forth). After the flow of patients slowed down Liz and I started talking to Dembele about music, he seems very fond of eighties power ballads and to be honest bad American love songs. I had to apologize that I wasn’t familiar with many Malian musicians, but hopefully when I come home I can find some on iTunes (you can buy CDs here, but they’re usually bootlegged and of dubious quality).
After lunch we went to the post office with Tolo and Djigaba (I had written some postcards and still had the ones Mark Travasose had given me before he left). When we got to the post office the front shutters were closed (though it was still early in the afternoon); we went around with back and found the manager of the post office. He offered to open it up for us, though I think mostly because we were white (I guess there’s some benefit to looking so out of place here). Oh my goodness we had a baffling time at the post office. I wanted to buy stamps but also some more postcards, Liz also wanted a few stamps and a few postcards. Apparently the cash had already been sent to the bank or wherever for the day, so there was no change. I needed 22 stamps (or stamps for 22 postcards (6 I had written, 7 of Mark’s and 9 for new postcards). However, I didn’t have many small bills. First we tried putting Liz and my purchases together to see if that would work out better, we tried different combinations of stamps and postcards, but nothing seemed to come out to an amount that we could make with the bills we had. In the end Liz paid for hers separately and was able to somehow come up with the correct change. I on the other hand gave him my money and he wrote down the change I was owed so I could come back tomorrow. In the end I walked away with 9 new postcards (plus the 13 I had), and 3 pages of stamps (apparently it takes 3 stamps and 10 days to mail a postcard to the US). I decided to go back to the office and work on licking stamps (whoever invented self adhesive stamps was a genius). When putting on the stamps I learned that they take up a lot of space (so if you are getting one of my early postcards, sorry if the stamp is covering up half of sentences, I guess you can pull them off to read it).
After we got back to the office and I finished licking stamps (thank goodness Liz helped), I went back to the clinic to check in on some new patients that had come in and Liz went to the lab. The first patient was a woman with severe hypotension (80/60) and vertigo. She needed an IV to boost her blood volume and try to raise her pressure, so we walked her over to the hospital (I was really nervous while we were heading over there that she might just fall over, so I stayed next to her, which turned out to be a good plan because halfway there she grabbed on to me to stabilize herself). After getting her settled, the nurses started an IV and Dembele and I headed back to the clinic. After we got back there was a woman with her baby, who had been vomiting and unable to keep food down. This unlucky baby got to be the recipient of my first injection (other than frogs and fish in college mind you); I gave him and anti-emetic intramuscular injection, but he didn’t seem to appreciate it. The next patient was a rather interesting character, he claimed to be a friend of Badry and Dr Kone but he seemed like a bit of a space case. He was complaining of trouble hearing and some headaches; apparently Dembele thought he was a bit odd and began asking him if he was drinking a lot of alcohol or doing and illicit drugs (the answer was no, apparently the guys just a little off in the head). Although Dembele wasn’t convinced there was anything really wrong with this guy he decided that a prescription for vitamins couldn’t hurt (especially since pretty much everyone here has some sort of vitamin deficiency), and so I got to write my first prescription was well (though they don’t write them like we do at home). He is apparently an artist and after having finished his visit with the doctor he was insistent about wanting to show me his wears (I wasn’t particularly interested, but I’m not good at telling people no, so I told him I was going to go get my friend from the lab so she could look too). I found Liz in the lab with Tolo looking at slides. I asked her if she wanted to see the guys jewelry, but we both decided we weren’t interested, but instead of telling him I just hid out in the lab till he left (I know it wasn’t very nice, but oh well).
Tonight we had dinner with our friend Fredrick (who we met in Bamako and was in town to visit the Dogon country with his family) at the Cheval Blanc Restaurant (which is part of that giant hotel we had walked to before). Tolo and Dembele came to and was met Fredrick’s sister, her boyfriend and her daughter (who is studying to be an English teacher in Belgium). Dinner was nice, though the mosquitoes were a bit intense (good thing we were wearing repellent) and occasionally the power flickered out. As we talked the language fluctuated form Dogon to French to English and back. After finishing we said goodnight and goodbye to Fredrick (he will be leaving Bamako the day we’re driving back).
After lunch we went to the post office with Tolo and Djigaba (I had written some postcards and still had the ones Mark Travasose had given me before he left). When we got to the post office the front shutters were closed (though it was still early in the afternoon); we went around with back and found the manager of the post office. He offered to open it up for us, though I think mostly because we were white (I guess there’s some benefit to looking so out of place here). Oh my goodness we had a baffling time at the post office. I wanted to buy stamps but also some more postcards, Liz also wanted a few stamps and a few postcards. Apparently the cash had already been sent to the bank or wherever for the day, so there was no change. I needed 22 stamps (or stamps for 22 postcards (6 I had written, 7 of Mark’s and 9 for new postcards). However, I didn’t have many small bills. First we tried putting Liz and my purchases together to see if that would work out better, we tried different combinations of stamps and postcards, but nothing seemed to come out to an amount that we could make with the bills we had. In the end Liz paid for hers separately and was able to somehow come up with the correct change. I on the other hand gave him my money and he wrote down the change I was owed so I could come back tomorrow. In the end I walked away with 9 new postcards (plus the 13 I had), and 3 pages of stamps (apparently it takes 3 stamps and 10 days to mail a postcard to the US). I decided to go back to the office and work on licking stamps (whoever invented self adhesive stamps was a genius). When putting on the stamps I learned that they take up a lot of space (so if you are getting one of my early postcards, sorry if the stamp is covering up half of sentences, I guess you can pull them off to read it).
After we got back to the office and I finished licking stamps (thank goodness Liz helped), I went back to the clinic to check in on some new patients that had come in and Liz went to the lab. The first patient was a woman with severe hypotension (80/60) and vertigo. She needed an IV to boost her blood volume and try to raise her pressure, so we walked her over to the hospital (I was really nervous while we were heading over there that she might just fall over, so I stayed next to her, which turned out to be a good plan because halfway there she grabbed on to me to stabilize herself). After getting her settled, the nurses started an IV and Dembele and I headed back to the clinic. After we got back there was a woman with her baby, who had been vomiting and unable to keep food down. This unlucky baby got to be the recipient of my first injection (other than frogs and fish in college mind you); I gave him and anti-emetic intramuscular injection, but he didn’t seem to appreciate it. The next patient was a rather interesting character, he claimed to be a friend of Badry and Dr Kone but he seemed like a bit of a space case. He was complaining of trouble hearing and some headaches; apparently Dembele thought he was a bit odd and began asking him if he was drinking a lot of alcohol or doing and illicit drugs (the answer was no, apparently the guys just a little off in the head). Although Dembele wasn’t convinced there was anything really wrong with this guy he decided that a prescription for vitamins couldn’t hurt (especially since pretty much everyone here has some sort of vitamin deficiency), and so I got to write my first prescription was well (though they don’t write them like we do at home). He is apparently an artist and after having finished his visit with the doctor he was insistent about wanting to show me his wears (I wasn’t particularly interested, but I’m not good at telling people no, so I told him I was going to go get my friend from the lab so she could look too). I found Liz in the lab with Tolo looking at slides. I asked her if she wanted to see the guys jewelry, but we both decided we weren’t interested, but instead of telling him I just hid out in the lab till he left (I know it wasn’t very nice, but oh well).
Tonight we had dinner with our friend Fredrick (who we met in Bamako and was in town to visit the Dogon country with his family) at the Cheval Blanc Restaurant (which is part of that giant hotel we had walked to before). Tolo and Dembele came to and was met Fredrick’s sister, her boyfriend and her daughter (who is studying to be an English teacher in Belgium). Dinner was nice, though the mosquitoes were a bit intense (good thing we were wearing repellent) and occasionally the power flickered out. As we talked the language fluctuated form Dogon to French to English and back. After finishing we said goodnight and goodbye to Fredrick (he will be leaving Bamako the day we’re driving back).
Bandiagara Day 6 (21/07/09)
Today we began with rounds at the hospital, but when we got there we learned that the doctors are on strike (apparently other government paid workers got a raise, but healthcare workers didn’t). Despite that, rounds commenced with the nurses and the medical students (Dembele was in the lead). We saw more snake bites and fortunately the little boy from the other day was doing better. However I was not; again I managed to feel a little dizzy (and now I know exactly why: orthostatic hypotension) and headed back to the office before rounds were over (though I couldn’t hear anything anyways, so I guess I didn’t miss much). Dr Kone identified my problem and told me when it happens I just need to sit down, however it’s been a bit difficult to convince others that my problem isn’t from seeing blood or anything (I saw plenty of that growing up with two rather accident prone brothers). Anyways, after round we continued in the clinic and saw patients with various complaints (food poisoning, a baby with a cold, ears clogged with wax, etc) as well as two children with severe malaria who we then escorted to the hospital and observed the staff starting the IVs (I made sure to keep flexing my leg muscles this time to keep the blood moving).
When we returned to the clinic we were joined by a French medical student who is just finishing a short internship here, but who had nothing to do today with the hospital doctors being on strike. It was a bit helpful having them because he was very good at translating the French to English for us (I still find the French system of starting medical school right after high school a bit odd though). By about 11am there were no more patients and the French student left. Liz and I stayed at the clinic and talked to Dembele and Tolo about a whole gamete of topics. We talked about why they think it’s good that men here can marry more than one woman (though they didn’t manage to sway me), we talked about how kids in America are more independent and often live on their own before their married (they were surprised that my parents “allow” me to live with my boyfriend). We also somehow wound up on the topic of homosexuality and I was a little disappointed with the fact that they think it’s a mental disease and goes against nature. Liz and I tried to convince them that it was just another way to live, but they didn’t seem to see it that way (it was interesting because later in the afternoon I was reading an article on Time.com about how the AIDS epidemic in Africa is perpetuated by homophobia since that demographic is not being targeted for treatment of education campaigns; here’s a link to the article in case you have too much time on your hands: http://www.time.com/time/world/article/0,8599,1911757,00.html ). After coming to no resolution about or differing opinions we returned to the house for lunch (rice and sauce of course).
We stayed at the house for a bit to watch the tour de France (I don’t think they’ve every really paid attention to it before because somehow I was an expert on it and was doing a lot of explaining (thanks Nathan)). After the end of the stagxe we headed back to the clinic, but there wasn’t much to do except use the internet and look at pictures. As we were sitting in the office we began to hear a lot of wind and we could see everything blowing very hard outside. A storm perhaps (we thought)? It seems that rain does not come here easily. It has to be blown in on a fierce wind. I’m beginning to think that each rain is preceded by a mini dust/sand storm. The winds died down for a bit and in popped Fredrick (our entomologist friend from Chez Gwadz). He’s in Bandiagara with his sister and niece to visit Dogon country (he invited us to join them tomorrow and I think we might). After catching up with him he left during a lull in the rain (a second wave came through, though not as long as the first). I think people here will be very happy with the rains (they’ve been late this year and so the people haven’t been able to plant their crops).
When we returned to the clinic we were joined by a French medical student who is just finishing a short internship here, but who had nothing to do today with the hospital doctors being on strike. It was a bit helpful having them because he was very good at translating the French to English for us (I still find the French system of starting medical school right after high school a bit odd though). By about 11am there were no more patients and the French student left. Liz and I stayed at the clinic and talked to Dembele and Tolo about a whole gamete of topics. We talked about why they think it’s good that men here can marry more than one woman (though they didn’t manage to sway me), we talked about how kids in America are more independent and often live on their own before their married (they were surprised that my parents “allow” me to live with my boyfriend). We also somehow wound up on the topic of homosexuality and I was a little disappointed with the fact that they think it’s a mental disease and goes against nature. Liz and I tried to convince them that it was just another way to live, but they didn’t seem to see it that way (it was interesting because later in the afternoon I was reading an article on Time.com about how the AIDS epidemic in Africa is perpetuated by homophobia since that demographic is not being targeted for treatment of education campaigns; here’s a link to the article in case you have too much time on your hands: http://www.time.com/time/world/article/0,8599,1911757,00.html ). After coming to no resolution about or differing opinions we returned to the house for lunch (rice and sauce of course).
We stayed at the house for a bit to watch the tour de France (I don’t think they’ve every really paid attention to it before because somehow I was an expert on it and was doing a lot of explaining (thanks Nathan)). After the end of the stagxe we headed back to the clinic, but there wasn’t much to do except use the internet and look at pictures. As we were sitting in the office we began to hear a lot of wind and we could see everything blowing very hard outside. A storm perhaps (we thought)? It seems that rain does not come here easily. It has to be blown in on a fierce wind. I’m beginning to think that each rain is preceded by a mini dust/sand storm. The winds died down for a bit and in popped Fredrick (our entomologist friend from Chez Gwadz). He’s in Bandiagara with his sister and niece to visit Dogon country (he invited us to join them tomorrow and I think we might). After catching up with him he left during a lull in the rain (a second wave came through, though not as long as the first). I think people here will be very happy with the rains (they’ve been late this year and so the people haven’t been able to plant their crops).
Bandiagara Day 5 (20/07/09)
This morning I asked Badry about the rain. I had seen people cultivating the land, but Badry said they weren’t planting yet. They’re waiting for the rains to come. This year the rains are late (global warming?) and people are starting to worry; if they don’t come by the end of July there will be a lot of problems. Last year the rains were early and after the season started it rained about every three days.
Today we started in the clinic; there were the usually cases of fevers (which we have to check for malaria), colds, intestinal parasites (though they usually don’t bother testing, they just treat it). Things progressed as normal, but there weren’t many patients, so by midmorning I went to hang out with Tolo in the lab. There we did some thick smears to check for malaria and when a case was confirmed blood had to be drawn. I tried to help, but when I went to remove the tunicate the needle slipped out and I felt pretty bad because that meant the kid had to be stuck again. We wound up heading back to the house a bit early for lunch because there wasn’t much to do.
After lunch when we went back to the clinic we hung out in the office for a bit and then Tolo offered to take us on a walk over to the administrative quarter (where the post office is and where the government officials live) across the river. Shortly after we headed out the wind began to pick up (which meant the dust began to kick up a bit) and it looked like rain clouds we coming. Tolo asked if we would be ok or if we wanted to head back; there wasn’t much to do back at the clinic so we informed him that we wouldn’t melt and that it was ok to keep going. But after awhile the dust made it difficult to see and my eyes were becoming irritated, so we all decided it was a good idea to head back. Shortly after we got back we headed back to the house and Liz and I took desperately desired showers (or as close to a shower as you can get with a bucket and plastic teapot) to try to wash off as much dust as possible. After dinner we headed over to the team’s house to play Uno. On the walk over the stars were totally amazing (there’s hardly any light pollution here, as you would expect). I think I was able to find Orion, though the angle and location were a bit different. The guys weren’t familiar with Orion, but apparently they have a constellation of a Great Hen (but it’s a winter constellation). After playing cards for an hour or so we were pretty tired and walked back with Tolo and Dembele. On the way we wound up stepping on a few frogs by accident, but they seemed unhurt (or at least were well enough to run away when I chased them). After we got back it was straight to bed (it was a bit late and we were pretty tired).
Today we started in the clinic; there were the usually cases of fevers (which we have to check for malaria), colds, intestinal parasites (though they usually don’t bother testing, they just treat it). Things progressed as normal, but there weren’t many patients, so by midmorning I went to hang out with Tolo in the lab. There we did some thick smears to check for malaria and when a case was confirmed blood had to be drawn. I tried to help, but when I went to remove the tunicate the needle slipped out and I felt pretty bad because that meant the kid had to be stuck again. We wound up heading back to the house a bit early for lunch because there wasn’t much to do.
After lunch when we went back to the clinic we hung out in the office for a bit and then Tolo offered to take us on a walk over to the administrative quarter (where the post office is and where the government officials live) across the river. Shortly after we headed out the wind began to pick up (which meant the dust began to kick up a bit) and it looked like rain clouds we coming. Tolo asked if we would be ok or if we wanted to head back; there wasn’t much to do back at the clinic so we informed him that we wouldn’t melt and that it was ok to keep going. But after awhile the dust made it difficult to see and my eyes were becoming irritated, so we all decided it was a good idea to head back. Shortly after we got back we headed back to the house and Liz and I took desperately desired showers (or as close to a shower as you can get with a bucket and plastic teapot) to try to wash off as much dust as possible. After dinner we headed over to the team’s house to play Uno. On the walk over the stars were totally amazing (there’s hardly any light pollution here, as you would expect). I think I was able to find Orion, though the angle and location were a bit different. The guys weren’t familiar with Orion, but apparently they have a constellation of a Great Hen (but it’s a winter constellation). After playing cards for an hour or so we were pretty tired and walked back with Tolo and Dembele. On the way we wound up stepping on a few frogs by accident, but they seemed unhurt (or at least were well enough to run away when I chased them). After we got back it was straight to bed (it was a bit late and we were pretty tired).
Tuesday, July 21, 2009
Photos
Here's a link to my photo album that I'm trying to keep up to date. It's gotten a bit tedious to post pictures in the blog. My apologies.
Hope it works
Hope it works
Bandiagara Day 4 (19/07/09)
Today was the last day of monthly visits (until next month that is) for the incidence study. I went to help in the lab today, which was good because it was just me and Tolo (which meant I got to do more too). I labeled slides and filter papers, handed Tolo the supplies, made the thick smear and put the slides away. We were done pretty early though, but 1:30 or 11am because there were fewer kids scheduled for the last day. So Dembele took us on a tour of the hospital. Here the design seems to be that all the different departments are in separate buildings. First we went to the maternity center where women can get prenatal counseling from a “feme sage” and where they deliver about 15-20 babies per month. C-sections however must be delivered in the surgery center (we didn’t go in there though). For women who deliver by c-section there is a building for them to recover in and we met one such women who had delivered 9 days before but couldn’t leave yet because the baby was still too small (he was delivered prematurely because her membranes ruptured). After that we went into the main hospital where they had a few cases. We saw one elderly man who was there for severe anemia and had received 2 transfusions (when someone needs a transfusion there family is brought in to see who is a matching donor). We also saw two boys with viper bites. It was very sad because the younger boy (maybe 3 or 4 years old) had been taken to a traditional medicine doctor first and his parents waited 3 days before bringing him into the hospital, so the necrosis had set in and flies had lain eggs in the wound. I managed to embarrass myself by having a precipitous drop in blood pressure while we were watching them treat the wound (though I don’t think it was watching that bothered me so much as the little boys agonized screams. No one was comforting him and I wanted to hold him, but I wasn’t sure if that would be ok). Dembele took me back to the clinic and made me sit and take my blood pressure (I felt much better after walking outside) and it took me a bit to convince him that my blood pressure is normally low (he measured it at 96/60). After that we headed back to the house for lunch.
After lunch Badry told use to take it easy and hang out at the house because it’s Sunday and we should take at least a little break. We arranged to meet Tolo at 5pm to go for a walk around the town. Tolo came by to meet use and we walked over to meet Dembele. We walked though the residential parts of the town, we met a Fulani family (a different tribe distinguished by the fact that they live in reed huts instead of mud brick houses). We also went and checked out a new fancy hotel run by a Burkina woman (it was defiantly a fancy place; it had a restaurant, a conference room, a pool (quite a surprise), mini golf and even a pet tortoise. She gave us the grand tour. We continued on our way and even came across a wedding party (fête de marriage) and we watched the women dance for a bit. We continued into the commercial part of town and stopped by a few shops; one where apparently the “young people” by clothes (though I haven’t seen any girls here in the crazy night club ware being sold there), and another to by more credit for our phones. We also purchased a fruit that caught Liz’s attention from a woman selling them on the street (we tried it later and it was very bitter, though very interesting). We walked through almost the whole town except the administrative center. After walking through it all I guess I can agree that this is a city (albeit a small one, maybe the size of Annapolis proper).
We returned to the house as it was getting dark and commenced eating dinner (I was pretty hungry). Afterwards we taught Tolo and Dembele how to play Egyptian rat screw (if you don’t know the game don’t worry) and they picked it up pretty quick, though Tolo was an over eager slapper so it’s good we weren’t playing with penalties. We didn’t even finish a whole game (it wound up becoming rather long) before we were pooped and went to bed.
Bandiagara Day 3 (18/07/09 )
I was back in the lab again this morning and got to do a few more things than the day before, though nothing terribly exciting, just labeling slides, filling in paperwork and handing out candies. There was another surge of kids coming in the morning and then a slowing by 11am or so. There was one identified case of malaria, which means that blood has to be drawn so DNA, RNA and parasite extraction can be done later. The little girl (she was probably 3 years old) was by herself and very scared, so I held her hand and tried to calm her down. Amazingly enough she forgot that I was a stranger and started squeezing my hand and leaning into me (I felt pretty helpful and important at that point). It seems to be sort of an odd thing here; everyone clears cares about their kids but they don’t really feel the need to comfort them (not even in the doctor’s office where most American parents would be even more attentive). After we were done with the kids I went with Negaly (I still can’t pronounce it quite right) to see how to prepare the samples for extraction later. He needed to teach Tolo because Negaly was returning to Bamako the next day (apparently he’s the head of the parasite genetics lab there and then in October he’s beginning a PhD program at University of Maryland in Baltimore).
After the extraction we returned to the house for lunch (I was pretty hungry by this point). We ate lunch and then took a short break. Liz was very tired so she didn’t go back with us to the clinic in the afternoon. There wasn’t a whole lot to do, but I kept insisting I wanted to help so they let me help sort slides from the vaccine trial; they needed to send some slides to Bamako for QC. After that I read the news online and read my book until we headed back to the house. After dinner Liz and I went out with Tolo and Negaly; we wound up at a hotel bar (which was completely empty, apparently all the tourists come in December and January) where we played Uno for an hour or so. Afterwards we walked back to the house. The stars were amazing (there’s really no light pollution at all), though I think the change in my position on the globe made it pretty difficult for me to identify constellations. I wanted to wash off the bug spray before bed, but there really wasn’t any water. So we just crashed.
Bandiagara day 2 (17/07/09)
The rooster woke me up at 6am again this morning, but that’s ok, we have to get up at 6:45 anyways. Liz was feeling better so after breakfast we both went in with Badry to the clinic. Today I wound up in the “lab” or as I would call it “the crying room.” I helped the guys that do the fingersticks for the routine tests done during the monthly visit (thick smear, hemoglobin and a blooded filter paper that’s used for DNA extraction later). It was interesting watching the reactions of the different kids; one little girl made me laugh. Somehow she knew exactly what was going to happen even before she came into the room; she hid her hands behind her back and refused to give them to anyone. Other kids were cheerful until they were stuck and then the look of betrayal on their face was really sad. Then there were some kids who thought nothing much of it all. Most interesting though, was that there didn’t seem to be a rhyme or reason as to who would cry their little heart out and who wouldn’t make a peep. The kids sometimes came in large groups (I saw a man drive up on a motorcycle with 2 little kids sitting behind him and 2 in front. But we managed to get through them all before noon.
After lunch we went back to the clinic, but there wasn’t much to do so we read and spent some time on the internet (however the blog website is blocked until after 5pm, so I’ve been a little behind keeping this up). At 6pm everyone came in for a meeting. Thera explained their different kinds of contracts (NIH intramural, extramural and others) and how it would affect their pay. From what I could understand it was a bit confusing, but also kind of repetitive (it wound up being sort of a long meeting). The meeting ended at about 8:30 pm and we came back to the house for dinner.
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