the purple elephant: twenty one days

Becoming fearless isn’t the point. That’s impossible. It’s learning how to control your fear. And how to be free from it.”

There’s a purple elephant in the room. One that I promised I would address. The twenty one days are up.

Though there was anticipation in the Canadian customs line…

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We were welcomed back to Canada with only a few curious questions and a raise of the eyebrow. “So what were you doing in West Africa? You were volunteering in a hospital?

There was no forced isolation. It was Ghana, not Liberia, Sierra Leone, or Guinea. We were about the distance between Vancouver and northern Saskatchewan. When there was a SARS outbreak, did we leave Canada? Vacate Saskatchewan because we were ‘near’ Vancouver?

A friend shared that her preschool son was praying we wouldn’t get Ebolum. Cute. Whatever you call it, it’s nasty. I will tell you all now that I wasn’t the face of courage.

I know you all were worried, or ‘wondering’ at our choice. It was the looks on the faces, the questions, or the ‘discussions’ in the OR and hospital wards. If you don’t know me, then I’ll tell you, I’m not the picture of fearlessness. I might appear confident, but it’s learned–because like more than enough people, I’ve fought a planeful of fears. The words, West Africa, caused a few mini-meltdowns for me, no matter how close or distant it was.

I’ve been watching this epidemic unfold since last winter, before most people knew it existed. It was all over the news. I knew I was going to WEST AFRICA. I didn’t think bringing my family of six into Ebola territory was such a clever idea, even if we were relieving pressure of some seriously busy third world medical staff. Even if we made a commitment over a year and a half ago. Even if our lives were meant to be spent living, and sharing, and not whiling away in luxury. I’m not an extremist looking for a suicide mission. I hoped, and expected, the Ebola epidemic would decline–not spiral internationally. (And I might have been quoted to say that it wouldn’t land in the US. I politely clear my throat…I was wrong).

I might not have let on that I was ‘concerned’. A small handful knew. It wasn’t just a discussion with my husband. I think I can confidently suggest I’ve had an argument with my husband that most haven’t. I did more than argue it out with him a handful of times. Mini-meltdowns that he had to accept–I didn’t instinctively think that heading closer to the flame was a great idea. Not everyone is as instinctively brave, and rationally-minded, or as confident in gloves, masks and handwashing techniques, or calm, cool and collected under pressure as he is.

We prayed a lot, occasionally for perspective, definitely for courage. Coded prayers with kids, and many prayers without. We didn’t tell them much about Ebola. We told them too much about cholera and malaria, since we were definitely heading into a cholera outbreak, and heavily-saturated malaria zone. I thought it would be useful to show them a couple animated YouTube videos, get them serious about not walking outdoors without long sleeves and a full-body cover of DEET. We hadn’t left Calgary before our five year old was requesting long sleeves for bedtime. Later, the long sleeves in plus 40 slippery sweaty heat was a bit much to handle. The bedtime mosquito nets were suffocating for some.

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And the super high DEET concentrations I now own cannot be purchased in Canada. My oldest declared this bottle to be her African best friend…

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World Health Organization expected first spread transmission to enter Ghana, not Spain, not Mali, not the States, primarily because it is the regional airport hub in West Africa–Accra, Ghana’s capital city. I wondered if I would see an empty airport waiting room–the six of us on a plane by ourselves. Nope, not so.

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Did I take a few deep breaths as I walked through the extra KLM security check? Yes.

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Hesitated before I stepped over the plane’s threshold? Uh huh.

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Seven hours later, we landed, blasted by the heat as I stepped over the threshold again. I expected to see the signs when we first arrived at the Accra airport. But when I actually saw them, I had to take a deep breath, (illegally photograph them), and move into the temperature scanning line-up.

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There might be talk of Ebola on North American television, but we weren’t in North American hype-ville anymore–the land of CNN, MSN, and tweeting feeds; instead, there were signs for handwashing, bottles of hand sanitizer, and people in medical uniforms and masks welcoming us (no it’s not airborne–this is more a statement of the country’s public health training).

We landed in West Africa’s destination airport–a travel artery that collects folks from all over that zone and sends them on to other international destinations. And this Airport was doing what it could to prevent it from entering their country. If you think eye temperature checks are a useful prevention strategy (it really isn’t), well, each of us patiently waited to be checked.

There’ll be no bathroom breaks in this Airport, no bottles of water purchased, no snacks at the snack bar, no stopping to touch anything. Keep your hands in your pockets. Don’t breathe heavily. Don’t brush past people’s jacket sleeves. Dorothy, we are not in Kansas anymore. Okay, I exaggerate, mildly. I’m sure you’ve been told that the disease is transmitted by visibly sick people, not healthy, handsomely dressed travelers toting a piece of Ralph Lauren luggage.

Oh, you say, but what about that fellow who flew to Dallas? Yep, there’s that exception. That one out of two million Monrovia, Liberia residents exception that found his way onto North American soil. The many thousands of others infected couldn’t imagine purchasing a taxi ride, let alone a plane ticket. At a buck a day income for much of African slum citizens, a plane flight is an unobtainable purchase.

I won’t say that I’m thankful that Ebola found its way to the States. That wouldn’t really be what I think. Affecting and infecting many people on American soil isn’t a good thing. Affecting and infecting and killing thousands of West African people isn’t a good thing either. But now that it’s in the States, you can guarantee that whatever can be done will be done to change the tsunami wave of Ebola infection.

Jim was worried that our family couldn’t handle the seven hour flight from Amsterdam to Accra, then only sleep a few hours and take another hour flight to travel three hours to Nalerigu. I was just happy to get out of that West African hub.

Bye bye Accra.

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Despite driving three hours north from the center of the country in the hospital’s Land Rover, I felt awfully safe wandering into the nether regions of Ghana. I felt relieved when we drove past farms and farms and farms and small towns and more small towns. It made you realize how VERY far away we felt from the potential of Accra, and the difficulty it would be to travel that far north for almost everyone.

So when we settled into our three week location, it unnerved me to hear a discussion about potential Ebola transmission travelling through the northern border Burkina Faso, despite Cote d’Ivoire’s closed border, to this well-known, reliable hospital.

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It also unnerved me to hear that earlier in the summer a threat of hemorrhagic fever, query Ebola, created panic and induced volunteers to leave suddenly. It definitely unnerved me to hear that only weeks before we arrived, another threat of hemorrhagic fever forced one of the doctor’s and his wife, baby and toddler, into isolation in the capital city. Query, Ebola? It wasn’t Ebola. The mother of those two kids questioned whether the hospital would be equipped to deal with Ebola if, or when, it came. I know what I think. A resounding no. Two American doctors can’t maintain sterile procedure for the entire hospital. It did not help my frame of mind to see the state of the hospital. That hospital wasn’t clean, smears of different colours covering the walls, sterile fields optional, gloves optional.

Jim performing a lumbar puncture, gloves brought from home…

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It unnerved me when we were told the recently visiting American doctors were on isolation for three weeks from their work back at home, just in case, despite not being exposed to Ebola. It unnerved me when a nighttime knock on the door, two nights before we were to fly home, we were told that our flight was grounded. Were we even going home?

Need I say that I wouldn’t share that information with family and friends when I was there? Why let them know that we felt threatened, recognizing that the potential was larger than originally expected?

So despite my being there, feeling awfully close, there’s still that discussion: Should African borders be closed? My response: Do people know how large Africa is? It isn’t a country. It’s a continent, with presently fifty five countries. A continent that swallows North and South America easily. Should we close the borders to North America now that Ebola is in Texas? We wouldn’t just be preventing the illness from travelling, but not bringing any essential protective gear, food, medical assistance from the western-able world? Shutting down already faltering, fragile African economies? It would be like a cruel military strategy to starve it out. Cruel.

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In the end, you could call it crazy or risky. You could call it worthwhile and helpful. We wanted to follow through with our commitment we’d made over a year earlier, especially as we were one of the last volunteers in that area willing to still go despite the Ebola threat.

I’m certain it was helpful. I’m certain it was an adventure. And I’m certain that by looking into the face of my fear, sometimes it’s the fear itself that I’m most afraid of.

I learned that courage was not the absence of fear. But the triumph over it“. NM

 

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kids thoughts from the hospital

A partial strike at the hospital this afternoon again. Yes, I’m serious. A strike. Nurses and translators want to invest their pensions without the government doing it for them. But I wouldn’t know what was going on for the last couple days because Jim has been treating me for malaria. My head still swimming in artesunate, I will attempt to blog.

For the last few days Jim has suggested the kids not come with him to peds, because there’s just too much illness going on there…and too many people not covering their mouths. How he has made it through so many years without frequent illness, I will never understand. He says he washes his hands. Like a surgeon. Religiously.

The kiddos and I have had an interesting crash course in hospital care and tropical medicine over the last three weeks. An education that we aren’t allowed to experience in Canada, unless we’re in nursing or medical practicums. Perhaps some of us one day will, and some of us won’t. I’ll bet you can decide what they think…

Rachel, nine…

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I got to sit on dad’s chair in pediatrics. Dad was sitting too. Women were lined up with their babies. The worst thing I saw was this little baby who was pale white and her arms were in the air. But then she sat like this in her mother’s lap and somehow when she was born she had white skin instead. She was one year old and the size of my heads and arms together.

Dad was so concentrating because he really doesn’t have time to tell me what’s going on. Some of them are old but mostly they’re new people that came in to the hospital. There’s more and more and more people that came into the hospital today.

It wasn’t very fun. The smell was bad. I’m not allowed to touch anything. It was kind of disgusting.

 

Zach, five…

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I saw this guy who had fillings that looked like mustard and ketchup. It goes on his arms and places because he got hurt really a lot. Here, here, here and here and a little on his chest (the man with burns–the ‘ketchup’ was blood, the ‘mustard’ was iodine).

One of the different people I saw couldn’t breathe.

And two people couldn’t walk. But we didn’t do one of them because one person was sleeping, but one of the people we did wake up.

Some of the people couldn’t walk or breathe. That’s really all I saw.

I thought it was scary at the last person. The last person was the bloody one. The one with the fillings. (aka burn dressings)

So what’s pediatrics like?

It’s essentially like clinic but it’s more to the details and people waiting on the side.

A couple people on the back wall, babies crying. Waiting for Tim (another Samaritan’s Purse doctor) to come around and check them and you keep walking and go to the right. There’s a couple seats and a table where the African people do something with the folders. There are many people waiting for dad to come.

There’s nothing I really like about it. I get to learn what illnesses people have.

What do you not like about it?

I don’t like the smell. There’s a fan except in the back room, but it wasn’t on.

Do you like dad’s work?

No. It’s not very cleanly.

Some of the people asked what my name is and what my age is. They asked if I was related to dad.

So that’s pretty much it, you’re going to go into medicine.

No. I never want to go into medicine. Sorry. Probably cause it’s not very cleanly and it’s not very fun. I would love to get paid to watch him though.

 

Madelyn, eleven…

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We got through four patients, that’s all.

Why?

One of the ladies took us a long time because the guy couldn’t find scissors. Dad was trying to cut a bandage off this ladies foot and it hurt her too much so he admitted her to the ward. Dad also saw a lady. She was in the female ward. Big blisters on her lips.

What was it?

They think that one of the drugs she was taking was the cause.

I also saw a guy that had blood all over his finger and forearm and he said that he fell on the road. So dad got him to get some bandages.

So why didn’t you stay?

I just got tired and dad will probably be there till dusk. It was really busy. Dad let me look through another patient’s ear. Her left ear was fine, literally white, which dad said was white. And her right ear had plaque. She said it was hurting.

It was a little gross sometimes. Different. When dad prescribed a medicine, he wouldn’t just say ‘Give it to him’. He would say, ‘Give it to him if we have it’. That was different than what we do in Canada.

How is clinic different than Canada? different illnesses?

Three doctors in a 7×7 room. Nine or ten people, counting me, in that room.

I would say it is sad, but it’s very interesting at the same time. Some things are also disgusting. Other kids you see that are sad and you just feel sad for them. But to wrap it up in three words, I would say “Interesting. Depressing. Compassion”.

 

Hannah, thirteen…

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You walk into a huge rectangular room. There are beds all along the edges, filled with sick kids and their moms who are either sleeping or watching the little TV in the far corner of the room. You are directed to sit on a wooden chair in the middle of the room. You share this seat with your Dad’s medical bag. You are sitting beside your Dad and beside your Dad is a nurse and then there’s another nurse beside the first one, but this one looks like he doesn’t need to be there, he’s just interested in the girl nurse. And then, of course, sitting beside him is the translator.

The translator’s name is Veronica, old and has a mean edge to her. Now all the people that I just described are in a semi-circle in front of us in a small desk, and before that is a line of stools that goes horizontally through half the room. About 20 adults are sitting on the stools and their sick children are sitting on their laps.

The next child’s mom puts her son’s folder on the table. My father looks at it and asks if the child has been vomiting, a common question. The lady says something in Mamprulli and the translator says “Yes, the child vomited three times yesterday”. My father asks the translator if the child has a fever. The answer again is “yes” and then the questions continue until my father is absolutely sure that the child has malaria.

The people move up the stool methodically and my dad is presented with the next case. This goes on for about 30 minutes when I get bored and start to look around. I look behind me and see a bed with a child laying still, a man with white gloves is applying CPR to the boy. Doctor Tim, a doctor from the US, is watching. There are about three other nurses–one is pumping air into the boy and the other two are just watching.

I hope that the boy lives, but it’s pretty clear he’s dead. When I turn back, I see almost all the parents on the stools watching the resuscitation. I decide to turn back again. One of the male nurses is wrapping the dead body in the sheet that was covering the mattress. The body is stiff.

You turn around again to see a lady with a boy on her lap shielding his bum while he pees on the ground, and also her feet. She’s looking in all directions trying to act innocent. But you know she doesn’t want to have to leave the line so her child can go to the bathroom. The room has been gradually getting hotter, but now it’s unbearably hot. Luckily my Dad asks if I want to leave–I do. He wants to stretch for two minutes and to top it off, I don’t know how to get out of the hospital without getting lost.

It’s nice to go to pediatrics, for the experience. If I had a big list of jobs I would check “Doctor” off the list right away.

Home Office: Top 10 Medical Facts Dr. Jim has Learned

I spent the summer of 1995 in the Greater Toronto Area on an internship for a corporate comprehensive health organization project.  I rode the subway, went to the Skydome and visited Stratford for King Lear.  But the highlight of my summer was visiting Wahoo, Nebraska.  I drove the Trans Canada there and decided to go home via Denver to sight see a bit.

Wahoo you say?  Or Wahoo you knew!  I am 43. I grew up thinking a certain late night host was amusing for his acerbic wit.  He’s grown old, I have grown old and the schtick got tired.  But in 1995 the home office for Late Night with David Letterman was in a small Midwestern town in the USA so I detoured off I-80 to visit.  As the joke with his home office went… there was nothing except a road sign and a slice of middle Americana.  The home office was a figment of imagination, just a place name to drop every Monday to Friday night at 2355 hours or so right before the TOP 10 list (the comedy gold for the night – better than his monologue for sure).

So from the home office in Nalerigu, Ghana, tonight’s Top 10.  The category tonight is top 10 Medical Facts Jim Learned While at Baptist Medical Centre….

#10.  Malaria isn’t funny.    Don’t get me wrong, I didn’t laugh about Malaria before but I have had a crash course in a boat load of outpatient and inpatient cases.   One of the few lab tests we have at our disposal here is a blood film where the lab tech looks at red blood cells to try to identify malaria parasites in the red cells.  But if the clinical story fits, you treat for malaria whether the test is positive or not.  Sometimes a repeat test helps but regardless, malaria or the secondary infections that coexist with it can be lethal especially to kids less than five.

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#9.  Pott’s TB isn’t funny either.  OK, OK I promise not to have ten items that go ‘X isn’t funny’ .  But TB spread to your lower thoracic spine and then possibly forming a big abscess nearby is an ugly way to be sick.

#8.  If you’re an old man and your prostate is big you might have problems passing your urine.   Actually not a big surprise cause I see that in Canada too, except we have more options in Canada for treatment. Here people often wait until they are retaining urine and obstructed and then need a suprapubic catheter through their abdominal wall.

#7.  If you are a young man and you have problems passing your urine it ain’t your prostate – it’s schistosomiasis.  Google away people – its a bug found in water and crosses your skin barrier and winds around until it blocks your bladder from the inside.  Fortunately, treatable with Praziquantel, a medicine.

#6.  Typhoid fever in a youngster often leads to intestinal perforations requiring surgery.  What else can I say?  Don’t ignore typhoid fever…don’t drink untreated water and the tummy pain might not just be cramps.

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#5.  We in Canada take for granted our diagnostic options on hand at home.  I saw two cases today that would be simple to diagnose precisely and fix if I had availability of certain lab tests.  We will treat on clinical ‘best guess’ grounds and it should work out but we are blessed in British Columbia.  Of course, people could travel to Tamale and Accra for the same availability but lack of $ limits and that kind of travel is beyond the reach of most.

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#4.  There is nothing like seeing and doing instead of reading.  Reading about cases matters but you get wise and comfortable treating and diagnosing by seeing lots.  I appreciate the opportunities here to help and do.

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#3.  Infant and toddler mortality is high.  Sad.  Many are saved, all are not.  Convulsions and neurological troubles often result from cerebral malaria.  Each week there are deaths from this.  Probably 90% are fixed but when 10-20 kids a day get that diagnosis…..you do the math.

#2.  In the outpatient clinic the most common presentation is “generalized body pain, headache, dry cough and nausea with fever”.  Malaria until proven otherwise.

#1.  Cerebral malaria isn’t funny.

Sincerely, Jim

I don’t want to be trite, so I can’t title this blog

So these people are Pentecostal, right?” Jim whispers to me after the service.

Um, no. These people are Afrikan“.

A tiny little schoolhouse of a church, yet there were a couple hundred packed inside. The half dozen teenage girls swayed and belted their Mampruli songs toward our front seat. A pastor praised God for his faithfulness.

Zach didn’t last the full two hours (a short service here;) So Jim took him outside. I could see them run after a few of the local kids past the open windows. How I envied that cool air. Eventually the open windows were clouded by outdoor guests leaning into every one of them.

We had come with the American ordained pastor/homeschool dad and his OB/GYN wife and two girls–I sat in the front of the truck while the rest took their Sunday best to the back for a bumpy half hour ride.

When Jim came back into the room, there was no room for him on the front bench, so he plopped Zach in the remaining space and kneeled on the floor ahead of me. Though he didn’t see it, the drummer trio giggled at him. What was he, a western man, doing on the floor? Quickly a space opened up beside Zach. Don’t know where that space came from, but there was space.

A few words of English were spoken as the pastor for the day was the homeschool dad that drove us. He told us not to worry, it really would be a half hour sermon, because he was delivering it. He spoke of Peter, afraid when the boat nearly capsized, afraid when he was called to walk on water toward Jesus. He spoke of his own experience fishing the day before, seeing a boat just across the water, he’d hoped to walk out to, until he saw the crocodiles coming his way. The pastor spoke of not being afraid when God calls us to something.

After the service, we had our family Christmas photo taken in front of the neighbouring huts. I saw a toddler crying, surprised that no one went to console her. So I walked to pick her up. As she turned, she burst into frightful tears, eyes wide with terror. Who was this washed out lady? Everyone just laughed at her.

The children approached me and I asked their names. Naturally, few could tell me, because few had any idea what I was saying. One boy would prompt each child in their local dialect what I was asking. They would then tell me their names, their ages and want to shake my hand, sneak a touch of my funny coloured hand.

As a middle aged woman held her arm to walk, the ninety year old woman giggled as she held out her hand to shake mine too. And the half dozen fifteen year olds that sang and danced up front, they’d shared a bench with Madelyn and her new American friend Sarah-Grace by the windows–they nearly threw themselves at me to shake my hand. Was it a dare?

On peds rounds today, the other doctor rounding with Jim told him that he had to go to the OR for an amputation. Jim’s line became much longer.

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One woman was moved up to the front of the line sitting a foot away from us. Her five month old son, cachetic. He did not look healthy. I wanted to photograph as Jim unwrapped the stethoscope around his neck. I paused. Somehow, it didn’t seem right.

The mother, wet tears down her face. The father standing beside her, concerned, in his stoic kind of way. I came around to put my arm around her as everyone watched me. This is not what is done. I did it anyway.

I sat down. There were no words. Just an energy I received from them that told me I should leave the camera in my lap and put my hand on her arm after her husband passed the folder to Jim. The infant was admitted within the last hour. Query pneumonia? Clearly the child was malnourished for a long time. I stroked his head: warm, rough and fuzzy.

Jim suggested there were no noticeable respirations, no heart sounds. He turned to the nurse, who looked unconcerned, expressionless. “Tell her that her baby is very unwell“.

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Jim would tell me later that he would be biding time, hoping to be certain that what he thought he was seeing was really happening. That the baby was in fact dead. That he wouldn’t say so, then the baby burst into tears or gasp for breath. In his mother’s arms still, Jim performed two finger CPR and listened again.

I am sorry. Your baby has passed.” She knew. Her eyes were wet. She said nothing.

I did my western best not to burst into tears, rather bite my lip hard and breathe deeply while I winced and cried.

They’re not Pentecostal. Well some of them are. And some of them are Catholic and Baptist and Muslim. Mostly they are Afrikan. God must be faithful. They must not be afraid. They must continue to rejoice. God is good.

Signs of encouragement are plastered on the hospital walls, in English and Mampruli. They are expressive in their joys because these people must repeatedly face their tragedies.

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pediatric rounds: now I lay me down to sleep

A solid day of malaise, closing my eyes as I drift in and out, listening to the occasional question on decimals or rising long enough to read Berenstain Bears “A Book on Manners” was all I could muster.

I could have guessed that Hannah’s afternoon nap yesterday was a sign of things to come, as she hasn’t done that for thirteen years (she’s thirteen). I could say it was a wasted day, but who am I to say. Jim’s bottle of Cipro has helped turn me in a different direction this afternoon though.

Since I live a parallel universe to really sick people, I won’t complain. Temporary discomfort. Since I have the capacity to complain more loudly than the mothers of just pronounced dead babies here, I will instead choose to be content.

And I don’t say that lightly, because there are many dreadful occasions to which that occurs each week.

Jim interrupted his rounds to come get me. He’d seen a few little ones recover over the last few days and discharged them. I didn’t see those.

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Sitting to his left, he sat in the pediatric ward, a large rectangular room filled with metal cribs, 50-60 mothers and their 67 children sleeping together each night. This room was designed for 25.

The mothers stay with their babies on those thin latex foam, crib length mattresses for their ‘comfort’ as long as their stay; the blue plastic covering the beds was for the nurse’s comfort, quick changes. Who knows how often the bedsheets are changed. Half of the moms and kids sleep on the tiled floor.

Jim sat at a simple desk where women and their children would line up on stools in a row. An American physician and a couple Ghanian Medical Officers had their desks too.

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Woman after woman held their flaccid child in their arms, supporting their floppy necks, holding them up for Jim to examine as each took their turn.

One was newly admitted that day. The three year old seized in front of me, mother watching, making sure I saw what she saw as Jim had been called away.

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One child was complaining to his mother of headaches. This one, five, my own son’s age. She looked two, small and vulnerable in her mother’s lap.

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One four year old had a puddle of blood under his lower lip. Probably from a seizure, Jim suggested.

Fatia, the student nurse and translator, passed patient folders on to the clerk behind her as she spoke in Mampruli to the mother. Your son has malaria in his brain.

He might have seizures, become limp and will have an IV of artesunate, if it’s stocked, or quinine, if it isn’t. If he can eat koko (watery oatmeal), he can. Unless he’s limp, then he takes only fluids.

Most mothers are inexpressive, but two. So irregular is the expression of sadness or pain, that I didn’t understand that one of the mothers was wiping her eyes of fear, or sadness, or disappointment that her child was this sick. And when she was told her child had cerebral malaria, she didn’t leave the line, but cried more. When I reached to touch her shoulder to show her the universal language of I’m sorry, a simple smile on my face and tears in my own eyes, then she, perhaps embarrassed?, quickly left the line.

The American doctor zoomed to the back of the room to look at a crying child. This would be the one ward where I would hear crying. This doctor’s two daughters, three and almost one, had just recovered from malaria. They were caught early, so their disease resolved quickly. Perhaps the key to preventing cerebral malaria is to bring these children in for early treatment. We’ll never know for sure whether they have been showing symptoms for a long time or not.

Though there have been efforts, perhaps if there was a malaria outbreak on American soil, malaria, too, would have a vaccine.

This sign found in the hospital…

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male medical rounds

There’s no air conditioning. It’s 104 degrees Fahrenheit. I’m melting like cheese on a radiator. The Florida-trained General Surgeon says it was hot in her Florida summers growing up, but not this kind of hot. As therapeutic as my cappuccinos were back home, my bi-daily showers are here.

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The walls are smeared with occasional orange or brown or…I don’t know what’s on there, but I’m not leaning back on the wall, or touching the beds, or opening the screen ward doors with my hands.

There are about a dozen steel framed beds with latex foam mattresses and fitted sheets for each patient.

Nurses and student nurses crowd in the 4×6 fanned room, sitting or standing, but as comfortably as they can under the only fan on the ward.

A sign on the wall shows a picture of a king, or a president, or a significant male character declaring: ” Tuberculosis is not a curse, there is a cure“.

On rounds with Patient #1…

He’s the really old fellow, thin and wiry, maybe 90 pounds that sits outside House #6. House #6 is where we’re served lunch and dinner. Generally healthy, but admitted for gastroenteritis or pneumonia. He sits with his skinny dog and sings songs. When he sees us he shouts, “Praise the Lord. Allelulia…” and he’s waiting for our “Amen“.

Jim puts the stethoscope in his ears and the man whips his shirt off. “You can leave it on,” Jim tells him, but he whips it off anyway. “He is well,” Jim tells the nurse. And the old fellow throws his shirt on and high fives me with “Amen, allelulia“. He knows who has healed him.

On rounds with patient #2…

A forty something year old man laying with his arms in the air. His face no longer a form that is familiar. A few days earlier he had spilled a boiling vat of oil onto his body. About 20 percent burns cover his face, his hands and arms and abdomen, and the tops of his feet.

The oil took a layer of his licorice skin off, so his abdomen looked like the colour of milk chocolate. His left hand was cherry red.

Jim gave him an IM of Ketamine before his dressing change. Just ketamine. Cause that’s all they had. Oh, and for his post-burn pain, Tylenol. Them there’s something that don’t happen in Canada.

He was frantically trying to explain something to me after he got his shot. Jim told me that he’d be more reactive, talkative.

The translator said, “He’s telling us to ask the guard to let his brother back into the hospital compound so he can gather supplies.” He’s worried about his brother.

Later, he’s to have a dressing change in the OR. The nurse is to let the OR know. Later on that night, he wants to ask why he didn’t go to the OR. Jim is perplexed; he should have. Off to the OR to ask; his name and procedure are written on the OR board, but the OR is quiet. Oops, someone didn’t look at the board, or forgot?

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On rounds with patient #3

Jim asked me to open the sharps package. I couldn’t figure it out and I didn’t want to use my mouth to do it, so I asked the nurse. She easily opened it. Not like back home. There would be no way I could keep that sterile.

Jim took off the cap and cut it partways. Then one handed, he slipped the cut plastic sheathe over the needle, attached to an ample syringe. He had me hold the penlight at the back of a man’s throat as Jim attempted to insert the syringe into a growing peritonsillar abscess. Puss. White thick tongue. The trachea has been pushed toward his right side. He couldn’t be intubated if he had to be in the OR. Jim hoped to extract some of that puss into his needle.

In laymen’s terms, it means that he’s had an infection around his tonsil, unknown cause, and it is puffing up the left side of his face, all the way to his temple, all the way down to his neck.

Jim had done this before. He laid hands on both sides of his face and squeezed his left cheek. This action forced an uncomfortable wincing on the patient’s face. And these people don’t wince. They don’t moan. Rarely do they cry. They are made of tough stuff. And if this was in North America, this guy would be under sedation.

I wince at Jim’s compression of this guy’s cheek. I can see this man is in tremendous pain. Jim knows this has to be done, and the OR isn’t an option. I notice that the student nurse is laughing at me…because I’m wincing.

Earlier, the American OB resident here says that women yelling during their labours are yelled at to stop yelling. Them there’s something that don’t happen in Canada. I asked about epidural usage. Mwahahaha.–

Jim had performed the attempt at releasing the fluid from this fellow’s abscess the day before. And he’d asked the nursing staff to continue applying pressure regularly so it would release. They didn’t.

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We are reminded that we aren’t in control of what happens here, that we just came to share. Without the help of skilled, organized assistants, what should be done, doesn’t always. What could be done, may or may not get done. An old Ghanian proverb says, Naawuni yi kabigi a gbali, o ni wuhi a ni yen kpahi shem. In English words: “If God breaks your leg, He will teach you how to limp“. So I will pray that we do the best we can, and share what we have.

Daily Life of Nalerigu

Wake up at 9’oclock sharp. Ha. Seriously, still…what time is it? Four of us have been fighting a cold virus. Our heads are not quite right. Hannah’s falling asleep at 8 and waking at 5–spooky. The humidity is an adjustment. Two brisk showers a day; I’m weaning myself.

Steve Demme, founder of Math-U-See, has been entertaining us each morning. That show must go on—math for all seasons, and all cultures. We don’t like to forget what we learned…PS My hubby corrected me on spelling of his last name, he’s like a family friend…

Though water preparation is much easier than the filtered water we bathed in the sun eight hours in Kenya, as much time is required here because we’re drinking a whole lot more of it than we were in the upper elevations of the Kenyan Rift Valley. And when the missionary kids from the ‘compound neighbourhood’ come for a visit, there’s even more water usage.

Love those kids! Who knew we were coming all this way to be a friend for those that haven’t seen anglo-kids for months. We’ve got a few to share. Our kids have created a gymnastics studio in a bedroom of this stone and mortar home. They do front rolls and plies and tables on stinky, mould-smelling pillows in a ten by thirteen steaming hot corner room. And they’re so happy.

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Another MK, less akin to girl play, amuses them with his ‘play like an animal’ antics. They have rules for this little guy. Both these families have mothers who are OB/GYN docs and whose dads homeschool them. One dad is a seminary-trained pastor and another is a pastor who was an MK in western Africa.

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We take our lunch and dinner meals at House 6, where the meal has been prepared by a local fellow. Groundnut stew yesterday…loved the sauce, but I think I detected liver in those cow-resembling chunks. I’ll do beans, but not liver. The kids didn’t catch me discretely spit that out in my napkin. (And yes, I still got dessert;)

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Much of our diet is conventional North American fare so I can’t complain about the food. Dressing-less coleslaw is much of our vegetable intake here. I can buy a few carrots for a 50 peswas (one cedi is equivalent to .40 cents Canadian).

The local teenage girls drop by every afternoon, with huge baskets of cabbages and carrots, or pineapples and bananas. Tis the season.

Still, I’m missing yoghurt, apples and hummus and dare I reveal my lack of heartiness, I’m really missing Pellegrino. Jim misses wholegrain breads and peanut butter. The bread here is white, dense and sweet—the kids LOVE it. I’m missing my cappuccino machine. I know, life is rough. Don’t laugh at me…

I get my exercise walking. I’m sure the first thing a newly planted African in a North American city would say is, “What are those machines?” (pointing to the treadmills and elipticals). Not much need for the YMCA here. Having said that, my dear husband is heading out for a run around the compound. He never knows when to stop…post-call 36 hours or a humidex of 42, he still runs.

We visited Jim at the hospital. I stood outside, my back dripping like the faucet was left on, the kids looking like they’ve just come out of the shower, waiting, waiting…fifteen minutes, just to get a glimpse, so I could photograph him as the door opens and someone else goes in.

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He’s limp, languid, sinking deep in the chair. There are two docs in a 6×8 space, two little desks, four chairs, seven people sitting, a few standing. It’s like speed dating, but add to that a language barrier, therefore translators present, and a variety of extended family members.

I’m impatient. The kids want to go already. I want to stand and wait for a pic, but also let these people become comfortable with my presence. They stare at me. I stare at them. I smile. I really want to take pictures of them. But I’d be kinda annoyed if they came to my doctor’s waiting lounge to take pictures of me. I finally give up after twenty minutes. Some of these people arrived last night to wait for this afternoon appointment.

I meet one of the first doctors who arrived in this area back in the 1980s. He came with his rehydratable bags of food. Things were much worse then. He brings me to the nutrition center, where kids under five are being fed with supplements and proteins. Kwashikor and marasmus are common. Kids can get forms of protein through beans and fish here but don’t necessarily get that. Earl tells me that an umbilical hernia is common here, but the toddler’s swollen belly is not. She’ll begin to leak fluids out of her skin.

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I am given a wee two month old baby boy to hold. I call “her” sweet, but my girls correct me. They can see that “he” is not a girl. A woman says his mother is dead. “No”, another woman corrects her, “not dead. Just crazy”. A two month old perfect little baby boy. When we have an English speaking mother translate, I share my kid’s ages. Then mine. 25. The ladies all laugh. Huh. Can’t pull that off anywhere.

Hannah caught their laughs at my age declaration…

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Hannah sneaks pics from my iPod, as photographing is not kosher. She doesn’t understand why. I am not sure I do entirely either. Is it that the wealthy neighbor at the other end of town is coming to ‘help’ the dilapidated house with unmown yard to really gawk and record it for her personal history? I don’t think I’d like that either.

One of my kids say she wishes they could understand that we’re used to being around people of all colours. I say, we might have been downtown Vancouver and seen someone from every nation, but these people haven’t. They are not “melting pot Canadians”; they are Afrikan.

We are not the same. But we share humanity. We want our kids to be healthy. We want to be happy. We want to have enough. To have a little more, for fun maybe, and to share.