Odds and Ends

It's so strange—you get used to everything!  I was standing in the lobby talking to people on my way home from dinner.  The power went out, its pitch black, nobody even mentioned it and we just kept up the conversation and the power came back on in a few minutes.  Three weeks ago, when the same thing happened, it was all we talked about and someone suggested that we carry our torches (flashlights) and we all thought that was a brilliant idea!

Talking to another team member,  I mentioned the lack of compassion and nurturing of the children here and she pointed out that they don’t have that luxury.  Getting through the day is hard and to be so emotionally involved can prove to be heartbreaking and would wear you out.  There is just too much to cope with here for women.

I went for a walk Sunday morning and the bumsters are out and about!  OMG, they are a persistent group of guys!  And they absolutely refuse to take “go away” as an answer to their constant harassment.  “White boss lady, you don’t think I harass you?”  “ I just want to be friends and just walk with you.”  “Why aren’t you nice?”   “It’s nice to be nice.”  That’s the motto of the bumsters—It’s nice to be nice!  .  I have found that I don’t make eye contact with people and sometimes feel like I’m missing part of the experience of Gambia.  It’s a shame, but it encourages the men that hound us constantly.  I can now walk from the hospital to the hotel and respond to “ hi, pretty lady, how are you?” with “fine, thanks” or just ignore them and never look anyplace except where I’m walking.  Now that everyone is used to Mercy Ships being in town, we hear requests for drugs that people can't afford to buy (for pretty legitimate reasons like asthma,  antibiotics and malaria), sidewalk consultations of all kinds of problems (some pretty funny!), and it really shows the lack of available health care in the country.

Tipping is not a custom here, but with all the tubabs, the Gambians have caught on to the fact that we do tip and what is a small amount to us is big money to them.  It’s almost time for our departure and our room cleaner and waiters have become very ingratiating. They make their presence known, smile, touch, smile, talk, smile, and hang around  more than usual.  I think it's demeaning to them and it bugs me and at the same time,  I feel so cheap to give the guy who's cleaned my room daily and served me coffee every morning the equivalent  of $3 for the month!   It used to be that the hotel was a refuge, now it just magnifies the have and have not-ness.  An Indian doctor from England said it is the residual of a colonial culture of master and servant--maybe.

Surgery in Gambia

End of my second day as a surgical nurse.  Anita and I are on different schedules.  I now eat at 7:30, go to work at 8:00 and get off about 4PM—4:30 today.  I miss my former schedule of getting to work at 7:00 when it's quiet, breakfast at 8:30 or so with Anita and another couple and getting off 1-2 PM.  We had lots of freedom in how we did our jobs and no one bugged us because the patients were always ready for surgery on time.  Now someone else determines my duties and there is a lot of “hurry up, get ready and then wait around” whether it’s waiting for surgery to start or during surgery, there is a lot of down time for the nurse doing the paperwork (circulating nurse—and that’s me)and  not assisting with the actual operation (scrub nurse are the ones who hand the dr instrument).  I do have to say, there's lots less paperwork here!

Coming from a place where you can’t put stuff on top of the cupboards because it might fall on someone,  there's lot to comment on.  The oxygen is in large tanks that are standing, upright, unsecured along the operating room wall.  You need to watch the gauge like in the old days and change the tank when it’s out.  I’ve never seen an anesthesia machine that looks as old as the one we use, but it sure looks simpler than the ones at home that resemble an airplane cockpit.   The suction we used to evacuate blood and saliva is so loud,  I sit behind the doctor and he kicks me to shut it off because I can’t hear him say, “off”.   People walk in and out of the surgery suite as the operation is going on.  Yesterday it was a couple missionaries, a couple nurses from Aberdeen, UK,  a couple doctors that are here to do urological surgeries,  and one philanthropist.  Our anteroom is where all OB patients go through on their way to the operating room for c-sections, of which today, we had two. (Only high risk pregnancies ever get to the hospital and many come in after many hours of labor in their homes with midwives or in remote village.) To empty the suction cannister between cases, I had to walk through an operating room where a patient's abdomen was cut wide open!  No one paid any attention to me. 

During surgery today, the electricity went off twice for about 5 minutes each time.  The doctor wears a high intensity headlamp that allows him a good view of the patient’s mouth and throat during cleft palate surgery.  All that could be seen during the power outage was the surgical headlamp shining in the patient’s mouth!  Surgery just goes on and you hope you don’t need anything that requires electricity during that time!  After the power was off, one of the fluorescent lights started flickering and one of our nurses managed to get someone to come up right away to change it.  They brought a ladder,  replacement tube,  and he started to pick up the dirty gown the doctor had just taken off and started to put on—at least he knows you can’t go into surgery without one!   I told him it was dirty and he said, “no problem”, I said, “no it has blood on it”,  he said,” it’s OK; I just need it for changing the light”.  The doctor at this point said, “ no, do not put on a dirty gown especially with blood on it.”  Finally I got him an old paper one, he replaced the bulb that required unconnecting two live wires and reattaching them.  He+ left oblivious to the danger of exposing himself to someone else’s blood!     

One of the staff told me that she was going to the toilet and I started laughing and got out my camera to take a picture—she had rolled up her scrub pants, had on the clogs she wears in surgery and had a flashlight.  I have deliberately never used the toilet!  Part of my orientation was viewing the bathroom and the reminder to take a flashlight.  The long scrub sink where the doctor scrubs before surgery, was a urinal in its last incarnation.

That’s the “OMG, it’s so third world”, but the other side is that the actual surgeries turn out fine, the patient’s are happy—more grateful than most patients I’ve seen at home--, the doctors and nurses seem to carry on no matter what the equipment or facilities are like.  One of the nurses told me that these operations at home would have more bleeding and more complications!  ” I asked our philanthropist visitor how much nurses make and she said they start at the equilevant of $100/month and in private practices, where everyone aspires to be, they can make $200-$300 with experience.   We’re just here for a month tolerating working conditions that are unbelievable to me and most Westerners, but there is a group of dedicated doctors and nurses who are college educated here in the Gambia—in fact, the campus of the University of the Gambia Medical and Nursing Schools are  on our street—that live with these conditions every day and they don’t get to go “home”.   

The Gambian Dress Code

I had my first day working in surgery today and am absolutely too tired to write, but Anita and I did  manage to pick up our new dresess that we had made.  We picked out the fabric at a local shop and took it to a tailor's shop. I found this article on the internet when I was looking for the name of the piece of fabric that women have made to match their dresses and thought you might enjoy reading it!!!  Good night all
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Dress is very important in The Gambia in both rural and urban settings. This is evident by the large number of tailor shops along the sidewalks, as well as by the wide variety of cloth sold in Banjul and local markets.

The bright colors and prints of imported cottons, local tie-dye and batik are stylishly and elegantly worn. In traditional Gambian society, a garment should cover most parts of the body. The garment should fit loosely so that the shape of the body is not revealed. Men wear “haftaans and warambas,” which are long gowns with elongated armholes worn over baggy trousers.

Women also wear haftaans as well as warambas worn with a wrapped skirt or blouse underneath. Younger women can be seen wearing a distinctive close fitting tunic with a plunging neckline and matching wrapped skirt made from cotton prints.

In the urban areas, European style clothing is commonly worn. Although certain dress styles may be unique to one ethnic group, these clothing styles are worn interchangeably by everyone.
Much of the imported cloth comes from Asia and Europe.

Warambas and haftaans are often made from tie-dye or batik damask and are embroidered in elaborate designs. Sarongs as well as shorter warambas are also made from the locally woven strip cloth that comes in multi-colored strips between four and eight inches wide. The white strip cloth woven up country is made with local cotton or imported thread.

While women usually wear head ties that match their dresses, men often wear wool hats, skullcaps or a fez, especially on religious occasions.

Hairstyles are a work of art in The Gambia.
Women braid and plait their hair, often using fiber extensions in intricate and ornate designs. Relaxed or straightened hairstyles will also be seen in the urban areas.

Gambian women wear earrings, necklaces and pearls. Gold and silver ornaments are also popular.
Gambian women are as modest as they are elegant.

Modesty in dress is very much an influence of Islam. The thighs of a woman are to a Gambian man what the breast is to a foreigner (tubab), and thus not exposed. Wearing pants, even long ones, is considered inappropriate by tradition. Although bare breasts are not considered immoral or provocative among Gambians, women do not normally walk with bare breasts outside their compounds unless they are working or breastfeeding.

The President

Yesterday was the opening of the National Assembly. We just happened to want to cross the street to go one street over to Bolangs restaurant. Not possible—the president would be coming soon. The entrance to the street was blocked by 3 soldiers armed with semi automatic guns. We walked up a couple blocks and ran across Independence Avenue through the crowds of people that appeared to be in rather organized groups. Women dressed in brightly-colored, large-print long dresses made of the same material in different styles marched by. We see this a lot— at the tailor's last week, we watched a bridesmaid have her dress sewed and she picked a style flattering to her out the fabric that all the bridesmaid’s dresses were going to be made. It’s has a nice look about it. There is a new fabric that I haven’t seen in the market-- the president’s image on a bright green fabric with writing I can’t read and 2011. Fula dancers and drummers with their loud, pounding rhythm passed by. Groups of young people in white T-shirt with logos like “Interior Children’s Culture”—what ever that means—and “Rid Gambia of Malaria”. We could see the National Assembly courtyard filling up with all kind of uniforms and traditional dress. They like big black SUVs and tear down the empty street at breakneck speed, turn a sharp corner and slam to a stop in front of the National Assembly. The door seem to fly open before cars even stop and it appears that people are ejected instead of getting out of their own free will. We ordered our dinner and came back out to watch. The crowds grew and grew. One of the police told us to stay on the steps of the restaurant—he seemed actually concerned something would happen to the tubabs (new spelling-each tribe spells and pronounces differently). I know to ask to take pictures—people DO NOT like having their picture taken-so I asked one of the police, he told me that I couldn’t without permission. “Who am I supposed it ask?” “Over there” and he pointed past me. I needed to ask the military. This went on—I gave up. Bagpipes and a high stepping, scepter-carrying, red-uniformed, brass-buttoned man led the Gambian High Court judges of 10 men and 2 women (I think I could tell sex by what they were wearing under their robes) marched down the street in long red robes with white lace cuffs. Heads were covered with English style wigs with a twist—they’re oversized, grey cornrows going horizontally around their heads in the style of a cap with earflaps, except for one man whose head was partially covered by a small animal pelt poised on top of his head like an overgrown Mohawk. I lifted my camera to take a picture and one of the soldiers lifted an assault rifle towards me. Don’t know how he noticed me—I was standing in the restaurant doorway with a friend surreptitiously holding the curtain open a bit. End of thinking about taking a photo, so this event exists only in Anita and my memory. 1. When we went inside to eat our dinner—the TV was showing inside coverage of the event we were observing from the outside. While we ate, the crowds grew and grew. We resumed our watch on the street just prior to the arrival of Madame Isatou Njie Saidy, VP of the Gambia dressed all in white flowing dress and a traditional white fabric head cover ornately tied into a large bow on her head. The scene resembled a mixture of parade, a fair, a military crackdown and was charged with energy. The armed military and police presence was impressive even by US standards. A rocket launcher lumbered up the street and continued past us. I’ve never quite seen a site like any of this. Trucks with armed soldiers positioned themselves everywhere. I loved it and was excited along with the other thousands of people! And finally, the biggest Hummer I’ve ever seen crawls into sight with 500-1000 green boys and girls running in front, beside and behind his car cheering and screaming. Standing up and plainly visible through the sunroof was the President, H.E. Sheikh Professor Alhaji Dr. Yahya Abdul-Azziz Jemus Junkung Jammeh, dressed in a white Muslim cap and flowing white robes accompanied by his second wife who is stunning standing by him waving to the crowd. He and his entourage threw biscuits (cookies) packages to the crowds and people scoop them up just like at a July 4th parade. He’s a very good looking man and we were told his approval rate among Gambians is about 98%. Most people we have met love him and think he’s doing a great job for the Gambian people with new roads and improving infrastructure and society as a whole. We would never have gotten that close to the President of the United States in an uncontrolled and unsecured area like a main street. Here we were 50 feet away and the crowd and President seemed to relish the closeness!

Eating in Gambia

Breakfast at our hotel is the Sunday buffet at the Hyatt every morning. It is quite a spread. Local food is “britainized” to create a very bland dish so I’m avoiding these as is Anita since she was here when the Gambian food was spicy and delicious. So each morning, we have a choice of custom made eggs, omelette, and pancakes from a man on a grill outside. He’s a farmer in his off time and seems quite anxious to go back to farming. The fresh papaya, mango, orange, pineapple, and mixed juices—whatever is fresh and in season—are made by a cute young women with a blender that doesn’t always work. One morning a Brit woman was yelling at her because she wasn’t getting her juice done fast enough-the blender had to be tipped to the side repeatedly to make electrical contact and pulverize the fruit. (There are days when you want to tell people they are idiots!) There is a table of fresh fruit, another of cereals, another of cold cuts, pastries and then the hot tables that hold bacon, sausage—not really edible—broiled tomatoes, potatoes, beans, and other hot dishes. Another section has several salads—it goes on and on. Like most buffets, it’s fun the first few times and I tended to overeat, then I started to pick the things that I especially liked. And now after 3+ weeks of exactly the same stuff, I’m a little tired of it and crave Fiber One with real milk! There is no fresh milk here--I'm sure there is no market or refrigeration outside of the tourist hotels.  Anita and I stop in every morning on our way to work, get a cup of coffee and come back from breakfast when the first patient goes to surgery.

Lunch is another story! Initially at breakfast, we made ourselves a sandwich from bread and cold cuts or tuna—stored them away in our room frig and when we got off work, we’d eat them. It’s hot outside and we weren’t very hungry, so that worked great. A new team of nurses arrived and a couple of them started bringing Tupperware, cutting up fruit, making sandwiches—you get the picture and spoiled for us who were discreet food-takers. In front of our entrance to the hospital are food vendors with a new sack of bread and they bring 3-4 pots of various foods to fill the bread. The first one I had was –I thought-spaghetti and meatballs, but was really spaghetti and fish. Other choices are lungs or lamb—I’ll ask “lung?” and she say yes. I’ll ask “lamb?” and she says yes. So it’s either lamb or lung!

Now for dinner. We have several places to choose from. Nefertiti is right on the beach, great view, close to the hotel and by US standards—cheap. Another, Bolangs is a seafood restaurant owned by a man who loves Mercy Ships and offered us any dinner on the menu and a drink for 150 dalasi. (He told us that the Gambian doctors said his younger daughter would die from a heart ailment. He took her to New Jersey and she had a 30 min. surgery for a patent ductus and she is now a 25 year old accountant here in Banjul.)  Bolangs a deal since some of the menu items, especially fish, are 300 dalasi ala carte. The hotel restaurant is just what you’d expect of a nice resort and the prices are reflective, but still cheap. 
There is a fine dining restaurant in the hotel that we treated ourselves to one night where it is peaceful, quiet, and one can have a relaxing dinner.  Anita had a pineapple that had been hollowed out to form a bowl for the curry with the pineapple mixed in and I had a sttuffed eggplant that we both thought ours was the best--that's successful ordering!  The Gambian dishes include chicken or lamb domodas (a stew with peanut sauce with rice), fish or chicken yasa (a stew with Gambian sauce with rice), casasava and beans (a stew with spicy sauce with rice). Anita said all of the Gambian food has become more bland since her last visit 2 years ago. Suppose that is to accommodate the taste of the Brits who can afford to eat in these restaurants. You can also have hamburger and fries, spaghetti bolognese, pizza and other American standard—haven’t had them so I can’t comment, but people continue to order them so guess they’re OK. My favorite is the fresh fish—don’t know if it has to do with being in season or if it’s available all the time, but lady fish, barracuda, and angelfishare on the menu now and I’ve tried all three. They are exceptional and cooked to perfection once in awhile. Last night, we were early for dinner, we ordered and went outside to watch the president arrive (more on that later). All dinners seem to take a couple hours and I just frustrate myself by thinking it will ever be different. I’ve also been in the kitchen of
Bolangs and know that everyone reading this has a better equipped kitchen—and much cleaner—than they are cooking multiple dishes for 10-20 people! Anyway, as we’re standing on the sidewalk in front of Bolangs, two people walked by carrying a fish that looked to be about three feet long. One grasp his tail and the other had the dead fish firmly gripped by the gill. Within minutes, we heard a cleaver hitting something and about 30 mins. later, our ladyfish was served. The waitress acknowledged that the fish traveling by us was indeed our dinner! That’s about as fresh as it comes and the fish last night was cooked perfectly and accompanied by a shrimp sauce. Yum, but that isn’t always the case.

All kinds of beer, wine, hard liquor are available—expensive and not always good. Jul Brew is the Gambian beer and is readily available in restaurants. I still haven’t figured out where to buy beer outside of the restaurants! I’ve discovered a new drink—a shandy—it’s half sprite and half beer—it’s refreshing and I like it. Other drinks include Fanta, Sprite, Coke, Malta (a vitamin rich drink that has a thick, sweet, malty taste), and lots of fruit juices that are more like smoothies than bottled drinks. The only diet drink I’ve seen is the Diet Coke in my mini bar that costs double what a regular Coke costs! I don’t think this is a place to worry about extra calories in your drink. In fact, during dinner at someone’s house, I swear we drank as many calories from various fruit drinks and soft drinks as we ate. 90% of the people are Muslim so drinking alcohol isn’t part of their culture. We are also around the Christian minority and drinking isn’t part of their culture either, so very little alcohol.

Even though it’s fun to try new foods and drinks and have someone else cook for you, I always get tired of eating out every meal and look forward to a sandwich or to cook something simple for myself!

Concrete and Potty

Our ward is on the second floor and we go up a flight of stairs to get there.  The steps are tile same as the floors in the halls and on the unit.  There are broken tile everywhere and repairs are made with whatever is a readily available and the front of many of the steps are broken off showing old tile, concrete and adhesive.  One day when we arrived in the morning, two workmen were busy filling these holes with fresh concrete.  They carefully leveled off the top of each stair and the front.  People continued to walk up and down the stairs and actually step in the fresh concrete!   Before they were finished with the entire job, the very sandy concrete started to crumble and fall off. As this crumbly mixture fell on the stairs and floor below, it mixed with water from mopping, leaky water bottles, and other liquids to make a muddy mess.  Gradually over a week or so, all the mud was mopped up and it was clean again. After walking on the stairs for another week, the steps look exactly like they did in the beginning—with big holes in them.  There is also one stair in the middle that is 2-3 inches deeper than all the others. That doesn’t seem like much, but just try getting used to the rhythm of going down a set of stairs and have one in the middle that’s out of whack!  Several people fell on the stairs and finally someone wrote in red, “caution, dangerous” on the vertical side below, but it wasn’t visible from above.  So going up was much safer than going down.  I solved the problem by using another set of stairs!  On the north side of the river are stone circles that date from the 3^rd century BC built by ancestors.  They are worn down, but still standing much like Stonehenge.  Too bad they didn’t keep the mortar recipe!!!!

There are about 60 people on the ward daily with lots of comings and goings.  Our ward is kept as clean as is probably possible by hospital personnel who come in daily, sweep up a mound of trash and the ever-present red dirt.  They then mop the floors by shooing us out of the way and within minutes, it’s dirty again—but it’s been cleaned.  The Gambians seem to have no sense of keeping the place clean.  
The bathroom is especially disgusting and I won’t go into detail, but they have stopped pooping in the shower thinking it’s a toilet!  (Apparently until recently food was served on banana leaves and when they threw them on the streets, goats would eat them—so no trash-and plastic bags for everything are relatively new.   Trash of all sorts is still thrown on the streets, beach and around their houses, but now instead of banana leaves, there are wrappers.  There is garbage everywhere and occasionally it is swept into piles that, when left by the side of the road to blow around and redistribute itself during the following days)   Our Wolof speaking missionary will occasionally come in and yell—I mean yell- at the patients and families to keep the hospital clean and keep themselves clean.  I can only imagine how they live at home and what their houses look like.  Which brings me to the point of my story—There are all different socioecomonic  levels to our patients.  Some have never been out of upriver villages and we also have an obviously well-off father who flew in to be with his daughter. But….

Amy was one of our first patients and is 2 ½ years old, looks 12-18 months, was so underweight and full of worms that her surgery had to be put off a week for feeding her and giving worm medicine.  She had her surgery last week and is doing fine.  Her anorexic, depressed mother, and overweight, friendly, but demanding grandmother and Amy have been on the ward for the last 3 weeks.  Like all patients and family, they all sleep in one twin bed.  Yesterday, several of the other women started yelling at Amy’s mother and grandmother and all I could see was a colorful throng surrounding their bed.  Apparently Amy urinates and poops on the floor by her bed whenever she wants and they don’t clean it up!  Other people have been doing it.  Several patients have been discharged and new patients are next to Amy and I guess they don’t find this acceptable.  It is amazing to me how these women control their own, feed the people who don’t have food and take care of each other’s babies.  This morning, one of the nurses presented Amy with a little potty seat of her own and we’ll see if she uses it!

A Day in My Life

I guess I should feel thankful that we had water today, but I left work today feeling like “God, I hope no one dies from what I did”!
Our jobs have evolved. Anita and I get to work at 7AM. Today, that was before the coffee was ready—big mistake. It’s much easier to tolerate chaos and confusion after caffeine! We’ve had lots of problems with the ward helpers and the patient feedings. Like, they’re not doing them or when they do get done, we don’t know who because they are inconsistent about charting it. I think it all boils down to –we speak two—or maybe 3 or 4 different languages. I talk, they agree and nod their heads talk (if they look at all vague, I talk more and confuse them). I suspect they really don’t understand. Anyway, so now when we arrive, the first thing, Anita and I make rounds with the helpers, stopping at the bed of each patient who is getting a tube feeding because some patients can’t eat after some of the surgeries. We also discuss the patients who are scheduled for surgery that day and make sure everything is done and they’re NBM ( for my nurse friends, that’s NPO and all others it means “nothing by mouth”). We have different terminology for many things from the Brits and medication names are different which can be a bit challenging at times, but it works both ways. All was just perfect this morning, except they had thrown out the extra Cerelac, that they made for the 6 AM feeding. No problem, let’s just make a bit more in case someone is hungry before the porridge comes. One of us goes to a local restaurant to make porridge for the kids at 9 AM when it opens for the day so no food is available until then .

We got the first patient ready for surgery. We usually get two done, but both were admitted over the weekend and didn’t have the right paperwork. Paperwork is not something we do, so it took awhile to find all the different papers we needed. At 8 AM the surgeon, surgery nurses, day nurses and new shift of Gambian ward helpers show up with the new anesthiologist ( old one went back to England). The new anesthiologist wanted different preop medication from the last, and she wants to see ALL the patient’s charts when she comes in the AM because she doesn’t want to come back over during the day. About then, our ward “cheerleader” start the group sing of “this is the day that the Lord has made,……” It pretty much went downhill from then on.

This is a typical day.

We have 2-3 nurses that take care of the patient’s surgical wounds and medications. There are people all over the place, children crying and with interpreter’s help, we need to find out why. We scare them—some have not seen white people before and one thought Anita was a ghost and screamed everytime she came near him! I’m sure to some, we’re associated with getting stuck with needles and generally made miserable, so the screaming starts before we even touch them. Some are so stoic that they don’t make a sound no matter what we do. The Gambian parents, grandparents , and the interpreters are not very patient or compassionate with the kids, which was a total surprise to me, but most people have lots of kids and don’t seem to pay much attention to them once they can fend for themselves.

All of our supplies are 25-30 suitcases in “the Hilton”—our break room that locks when no one is present. Anything left out will disappear, so the night shift locks everything I the Hilton before they leave at 9 AM and then we take it out in the morning. It is common for one of us to run to this storeroom once or twice during an admit to get a patient gown, diaper or even a writing pen! And then you have to remember which suitcase everything is in. The mosquitoes are so thick that I’ve added “bug sprayer” to my job description. We push our work cart out, and I spray the room so that by 8AM when the rest of the team arrives, it’s bug-free-more or less. We only do 3, rarely 4, surgeries a day and it takes both of us to do the patients, help the ward nurses, make sure all the feeding are done, and admit new patients.

Yesterday, we admitted a 24 year old woman with a cleft palate. She looks fine, talks funny because of the lack of a roof to her mouth, so she is quite reticent to talk. She was blood typed and needed family to come in to have their blood typed in case she needed blood inter-op or post surgery. We couldn’t find the family members and we didn’t have the results one hr. prior to surgery. The patient didn’t know where her family was. An interpreter is supposed to go to the lab with the patients. I don’t know what happened, but the interpreter walked the family members (and non members) to the lab and left them there. The lab is probably tired of us demanding to be done right away and made this family wait almost 4 hrs to send them back. All that time, we’re looking for them. I never did get a satisfactory answer from the interpreter as to why he didn’t stay. Anita chewed him and now he’s avoiding her. Back to the blood typing story- I was told she had a father and three brothers coming in, but there were only 3 lab slips. As I tried to determine who’d been typed, I realized that one of the men wasn’t even related to her. He was an “uncle”, an endearment for a close family friend or maybe he was real uncle—his blood did not match, but since we had two matches from whoever it was that got typed, I told them all not to leave in case we needed blood during the surgery!

We all have our favorite and least favorite patients and trade their care. I don’t like working with “the cryer”, but don’t mind the “Pink Princess” who is a spoiled brat—rather unusual for a child here and especially for a girl. Her Mother is 41 and this is her 5th child, but she has been divorced and some of the kids are with a previous husband. She is the second wife of this husband and “Pink Princess” treats her mother very rudely. Yesterday she was crying because her mother wouldn’t color for her! She hits at her mother and is generally obnoxious. The mother cannot go to breakfast or lunch until the father arrives because he doesn’t want “Pink Princess” left alone. Her husband comes in daily and “Pink Princess” does whatever he wants and is very cooperative. Since her nurse has such a difficult time, I do a lot for Pink Princess. I’ve also discovered that it’s best to do it when the father is there! Today, I was able to get her to drink from her cup, rinse out her mouth, I removed her feeding tube and she drank a bit of the feeding tube “meal”—all with her father’s help. She high-fived me at the end!

A Day on Oyster Creek

Sunday, Anita and I spent the day on a charity cruise for animal rescue in the quiet, mangrove-lined waterways  of Oyster Creek.   It was organized by Lady Jane,  which is not her real name, but I googled  her and there is way too much about her online to use her real name!  (You can’t make this stuff up!)  She is a friend of one of the women working with us and several of us felt pressured to go.  Lady Jane and her expat friends are nice, but I just don’t get it.  They live in the Gambia in what sounds like large homes with security guards, gardeners, maids, etc. and do good works with their hard earned money.  All have some kind of pied d’terre in England that they visit for varying periods of times. They are about my age, have brown leathery skin, wear bikinis and lie out in the sun—  it was 104 degrees Sunday.  For our pleasure, there was a yummy continental breakfast, a fabulous lunch and afternoon tea.  Lady Jane also provided a masseuse and a pedicurist which we just tipped the average of $3-- which is an extravagant tip!  That is me getting a pedicure  while writing on my computer.   A man on the cruise tried to surreptitiously take a video of me—just like we do to the Gambians—but like the Gambians, I was on to him very quickly and like the Gambians, I said he should ask permission.!  I do realize that I probably looked a bit strange!  Unfortunately I lost all the stuff I wrote, but it was very sarcastic, so just as well. 

The creek is excellent bird watching and as the tide went out, more and more birds appeared much to the delight of the birdwatchers among the  group.   As we were moored by the remote Lamin Lodge, a whimsical  stick-house on stilts in the creek, a group of 6 women in single canoes silently passed by on their way to pick oysters, which are abundant on the roots of the mangrove trees as the tide went out.  Some things I’ve learned about mangrove trees are:  they are some of the most unique trees in the world, as well as some of the most easily identifiable. They have a unique relationship with salt water and poor soil that allow them to thrive there. They are also responsible for keeping ecosystems together, and should be protected from deforestation at all costs.  Large roots holding the trees above the ground or water are characteristic of mangrove trees.  Leaves are light green, small and round. Mangrove trees survive salt water inundation by excreting it at the root level and by storing excess salt in leaves that later fall off.  And it make for bbeautiful scenery!

Back to my pedicure— the attractive young man—of which there are LOTS  around—chatted for a bit initially and then  I worked on my computer for awhile.  He finally said, “nice computer”.  I said, “thanks, I got it for this trip”.  He said, “Do you have another computer at home?”  Me, “yes”, but I added—not true—“an old one that doesn’t work very well.”  Him, “what kind of computer is it” pointing to my lap.  “An Acer netbook”.  He asked, “ how much does it cost?”  I decreased  the cost by $150. and said “ $220”.  Him, “that’s 6 or 7,000 dalasi.  Me, “I don’t think it’s that much, but yeah, maybe if ……..blah, blah, blah.  To have so much more than the people around me is uncomfortable.  I feel like I’ve done nothing to deserve the fortunate luck of being born in the US and being a middle class, working American which make me rich in their eyes.  I’m met so many people here who work harder than I’ll ever work and will never move beyond where they are now.  The average person in Banjul lives on between 30 to 250 dalasi (28 = $1) daily-depending on which source you chose to believe.  It’s one of the poorest, lowest income places in the world. 

How Lady Jane and friends live this sort of lifestyle is beyond me.  They feel they are providing jobs, setting up schools, providing an ambulance and a health care clinic to a remote area.  All very noble and commendable, but I don’t think I’ll ever get comfortable with the disparity between my world and theirs.  

  

The Embassy Party and a Day at Jufureh

The US Ambassador lives in a nice house with a beautiful view—but you already knew that, didn’t you? The party was full of interesting people that she invited in our honor, like the Methodist bishop of Gambia dressed all in white with purple trim—stole a page from the Catholics—who even knew there was a Methodist bishop? Two journalists from the Gambian paper which told me the paper was free press and is published Monday through Friday—(guess there is no news in Gambia on the weekend) Both are in a book club with two of the Embassy women and one actually had a copy of this month’s book with him, and told me he’s enjoying learning about Jeffersonian ideas—that was a bit heavy for cocktail talk so I moved on to the Minister of Something Else. The Peace Corps has a doctor to take care of the volunteers who assured me that malaria is harder to get than I think if I take my medicines and sleep under a mosquito net. I’m relieved! The Ambassador’s secretary is going home on leave for her son’s wedding in Burien, WA—it truly is a small world! I really liked her and we plan to get together when I’m back in Seattle. There are 30 US citizens and 70 Gambians working at the Embassy. The whole expat scene is very interesting. All the toubes (twobobs) hang together and I realize again what a unifying thing a common language is. I am so accustomed to speaking English and having it accepted everywhere that I forget that a tiny country like Gambia uses our language for the same reason—they cannot communicate with each other since the many language groups do not understand each other.
The next morning we met Abdouli, one of our ward helpers with whom I’ve become friends and I will give you his story later—it’s a long one. The walk from our hotel to the Banjul ferry terminal is a tour through the usual markets, garbage, and masses of people. I thought the Brits might have left a legacy of proper queuing, but not so. Pushing and shoving through the turnstiles to get to the ticket window proved undoable, so Abdouli motioned for us to wait and he maneuvered thru the line to get our tickets. It’s about $1.50 for the one way ticket from Banjul to Barra. The ferry is small by Washington state standards and held about 10 of the cars/truck that formed a long queue waiting to cross the river. I don’t know how they decide which truck/car goes first, but there is a ferry attendant who tries!
Everyone seems to have gone to school with Abdouli so we had “facilitators” everywhere. We went out of the terminal, around the back and down an alley to enter with the cars. Looking back at the main waiting hall resemble waiting to get into a rock concert more than a ferry queue! A mass of brightly dressed people were squished up against the iron gates that remained closed until the cars and privileged few (us included) got on the ferry. There are three ferries that cross the mouth of the Gambia River and two were running at 9 AM, the other one was parked off to the side broken down. There is no other way across the river that divides south (where we are) from north (where we wanted to go). The ferry is so overloaded that I know exactly how the Joola Ferry disaster happens and over 2000 people died. People, chickens, goats, a sack with holes cut so that duck heads could stick out, mattresses, a love seat and couch—you name it and it’s being transported across the river by men carrying them off and on the boat—there is no machinery—just donkey carts and men. The overloaded ferry chugged across the river at a snail’s pace and we reached the other side in an hour. Coming back, that ferry was out of commission and we repeated the same process in reverse with a bigger ferry and felt extremely grateful that we got on since it would be a long time until the one functional ferry got back to Barra for another run! There is another way to cross the river and it’s the picture I’ve included. They pulled up alongside our ferry and emptied onto the backs of waiting porters who carried them to shore!! We counted 7 life jackets in the bottom of the boat.
Thanks be to Allah that Abdouli speaks the language because even before we got out of the ferry terminal, men were vying for the privilege of taking us to Jufureh. ( Abdouli is a Fula, who doesn’t speak or understand Fula, speaks Wolof, and lives in the Mandinka area and also speaks Mandinka.) Also Abdouli paid the taxi driver much less than we would have for the trip. We cut off the paved road after a couple miles and had 21 km of rutted, red-dust roads that passed small villages and farms. Our destination was just another dusty, sleepy Mandinka village until Alex Hailey traced his ancestors there and then wrote Roots. A 50 dalasi ($1.80) development fee is collected before you get to the village, a charge of 100 dalasi to tour the museum, 500 to take the boat to James Island, pencils and sweets are hawked so that you can buy them and give them to the kids in the village, and the village itself is a little too “African” to be real. A tip is expected to take pictures of the babies or huts and for a fee you can have your picture taken with a Kinte relative. You can’t blame them for making a buck off the tourists!
Where we really wanted to go was James Island, which as of Feb 2010 has been renamed Kunta Kinte Island. The island is about a mile offshore and was originally built in the 1600’s by the Portuguese to take gold and ivory out, and over the centuries the French, Dutch, and English have owned and enlarged it. American procured slaves from the area for northern and southern plantations. The ruins are extensive and in sad shape. Except for a few markers stating “Governor’s Hall”, “dungeon”, “commissioner’s room”, there is nothing left except to imagine how it was. The island is slowly being eroded by the water of the Gambia River and is about half the size of models in the museum and on the island, but obviously has great historical and emotional significance to, not only the Gambians, but descendents of slaves taken all over the world, and all of us who find it hard to believe that something like slavery could even happen. Apparently there is a lot a debate over the facts of Roots, the number of slaves taken from Gambia, and how do you ever measure the impact on the remaining population? It’s not a place any of us would voluntarily live and it’s hard to think that Oprah or Michelle Obama would fit in. As awful as slavery was and unpolitically correct as this sounds, what would western culture be like without Aretha, Sam Cook, Morgan Freeman, Toni Morrison and many, many more black men and women who’s great-grandparents were enslaved and brought to the new world?

Busy Week

sWe’re getting busier!  Now that the cautery machine (in case you don’t know—that stops bleeding during surgery) works, the surgeon has started performing the cleft palate surgery (the roof of the month has a hole that prevents them from speaking or eating normally).  In addition to taking care of the kid’s post surgical incisions, all the cleft palates come back with a tube sutured to their nose and it goes into the stomach so we can feed them.  They cannot eat for a week after the surgery.  The staples of their diet are rice and bread and those are some of the worse things to eat since the grains of rice or bread get stuck in the incision and/or sutures in the roof of their mouth.  So we feed them a very thin mixture of porridge, vitamins, oil, sugar and dried milk and the bigger kids get a different kind of porridge with bananas added to the above ingredients.  Yesterday, we had an incident where the grandfather of our first patient, Abduman, who incidentally got an infection in his lip incision, was sneaking him out at night to feed him because he didn’t think we were feeding him enough.  That is probably where he picked up his infection!  Patients are kept in the hospital so long since their living conditions are not conducive to healing or getting the proper nutrition while they are healing.  Abduman and his grandfather live upriver about as far as one can go and still be in Gambia.  After a long talk with the surgeon and translators, the grandfather was assured that Abduman could eat all he wants, but it needs to be the porridge.  So today, he ate, ate, ate bowls of porridge that we put a special honey into since he likes it, and his grandfather seems OK.  I really don’t know why the Gambian helpers on the ward at night didn’t tell anyone that they were out foraging for food after the Mercy Ships staff left at night! (We are all out of the hospital from 9PM to 7AM.)

Abduman’s grandfather is a respected elder in his village and yesterday, there was also an incident with a young, female, Gambian helper. (Mercy Ships is an extremely well paying job for the helpers and there are lots of young English speaking people vying for the jobs!).  He became very angry and basically threatened her.  Number one, the Gambian men don’t treat women with much respect, and #2, village elders certainly aren’t used to taking orders from young Gambian females!  The young women we work with watch our “liberated ways”; not realizing what is accepted from older white women is not acceptable from them. 

Now that the kids are starting to feel better, we are encouraging them to play not only with us, but with each other.  In the US, any group of same age kids would be playing together.  Here that doesn’t seem to be the case.  They gladly interact with us or their families, but not each other.  They enjoy sitting around the table coloring, but don’t seem to know what to do with pencils/crayons/colored pens and paper that they can draw on. I played “puppets” with two of the kids and once they realized that the puppets were for everyone, they quickly lost interest in the game.  Anything that we’re playing with—crayons, stickers, pens, pencils, pencil sharpeners, coloring books (we now tear out pages for them to color) just disappear.  I put a bunch of crayons in a box to save them and they were all gone within a short period of time—I never saw anyone taking anything! This happens with the parents, too.   Each child is given a bag with toothbrush, toothpaste, bowl, cup, syringe, feeding syringe if needed, and bar of soap when they are admitted.  When I ask them to use for medication or feeding, some of the parents look at me like I must be mistaken and say, “no, I don’t have any”.  I would assume they come from such “want” that to possess something is a big deal.  Today, a parent wanted a purple crayon and her baby is 4 months old so I knew it wasn’t for her baby.  We had a very detailed coloring book of the cottages of the English countryside with color pencils and I gave this to her, telling her she didn’t have to share it—they were for her alone.  She spent the last 2 hours of my shift coloring and putting it under her blanket when she’d leave her bed so that it wasn’t visible to others!  She looks to be about 16 years old and probably has never really been a child herself!

 These girls grow up fast and accept a lot of responsibility early.  A 30 year old woman on the ward who had a nasal septum repair has a little girl who looks about 11 and a one year old staying with her.  The 11 year old is the primary care giver of the 1 year old, and she ties the baby to her back like all the mothers.  The baby is delightful and staff member will play with him to give the little girl a break sometimes.  Bonds are created along socioeconomic lines, but most of the mothers and grandmothers on the ward are a tight group—very different from the children.  They will give each other food, take care of each other’s babies, and help the new people on the ward know what to do.  Even though women aren’t treated very well in West African culture, they seem to be the glue that holds it together.

 

Bumsters

The beaches are warm sand, seashells galore, turquoise blue water and Bumsters. This is the name given to the young men who follow you everywhere with offers of walking with you, taking you on tours, helping you buy stuff at a good price, and offering the “real Gambian experience”. Their attention is NOT flattering, a bit scary and the first few days, we stayed away from walking into town oron the beach except in big groups. These young men, the bumsters, try to eke out a living by offering anything from tour guide to sex. The sex trade in the Gambia is flourishing, with a bit of a difference—you do see the usual gorgeous, young black woman smartly dressed in clingy clothes and high heels at breakfast or dinner with an older, portly, balding, white man, but they are the minority. Mostly it’s middle age British women who come here on holiday to seek the companionship of some very studly, young, African men. We see them in the hotel bars, by the pool or in the public areas of the hotel snuggled up to each other and holding hands. The men are paid for these services and after a week or so, the women resume their lives in England, but sometimes with a promise of marriage or a visa to England. Often the exploitation seems to be mutual because these men would love to go to England. Anita's seatmate told us that these men will occasionally marry these middle aged Brits and go to England where the men promptly dump the woman once they get the equilivant of the "green card". 

We were asked repeatedly when we first arrived if we wanted companionship. We were clueless as to what was going on but luckily we're not delusional enough to think that some gorgeous 25 year old stud is gaga over us!! These men are extremely annoying since they follow you everywhere and there are lots of them.  The young women got hassled because they were young and cute, and we got hassled because most of their business comes from women “of a certain age”! Anita and I were their target demogrpahic.

I was waiting to write about the” bumsters” because it was so annoying when we first arrived, and I figured that I’d have some really good stories by now, but it stopped. We now wear our scrubs as we walk on the beach, shop at the market or go to dinner. People say, “thank you Mercy Ships”. “You are very good” . “Thank you for helping us”, etc. The actual Mercy Ship was in the Gambia in 2003 for 9 months . When the ship is in port, there are 6 operating rooms going everyday with all kinds of surgeries, not just cleft lips and palates.  Everyone we've met is familiar with Mercy Ships and ask us if it's in port.  People with all kinds of health problems walk into our ward daily thinking the ship is in.  We have no choice but to turn them away after twelling them that "only cleft lip and palates"and tell them that the ship isn't here.  (Mercy Ships needs not only permission from the country, but an agreement to provide security, water, sewer, and garbage while the ship is in port--and it's a big ship so also the ports have to be able to accomodate it. This is no small thing!) 

This is not really Anita with her bumster, but Zigzag, a really nice guy who owns a bistro/bar on the beach. They aren’t hassling us anymore, but everyone has something for sale!!

Adelia and Shopping

I went shopping with Adelia a few days ago—what an experience!  Adelia is a missionary with ABWE (American Baptist World Evangelist) and has spent 20+ years in the Gambia with her husband Barney.  They have raised 4 children here, all adults living in the US now. She is fast talking, skipping from subject to subject, and almost manic.  She speaks fluent Wolof, which has become the lingua franca of both Senegal and the Gambia.  It is hard to talk about language or culture in Gambia without including Senegal.  They are part of the same ancient empires and language groups.  The European carved up the area and created countries that had no correlation to the tribes or culture of the countries they created.  Wolofs are the largest ethnic group in Gambia/Senegal, but only 16 % in Gambia.  . Historically the Wolofs were traders and are still very involved in commerce and I would assume that is another reason the language became so common.  Other ethnic groups complain about the “Wolifization” of their culture, especially via music and the increase use of the Wolof language officially.  But Gambians are also glad for a unifying tongue besides English, which is not only the official language, but taught in the schools and a common language that has enabled different ethnic groups to speak to each other. 

While I’m on the subject, the two other cultures that we see most commonly are Fula and Mandika.  The Mandika are the majority in Gambia and date back to the 13^th century Mali Empire that included most of West Africa.  Even today Mandika surnames still tell the social status of each family during the “great empire”.  The Fula comprise about 18% of Gambia’s population.  It is the most widespread group in W. Africa because they were nomadic herders and constantly looking for food for their animals.  There are about 6-8 other major ethnic groups including the Aku, a small, but important group of descendants of American slaves. (In English colonial times, the administration chose their civil servants from the Aku and social interaction can still be uneasy between Aku and other groups.) Taylor and Johnson are the most common American freed slave names and we see them on various businesses and the Anglican pastors at the church nearby are a "Johnson and a "Taylor".  In all of these major ethnic groups there are many different “castes” that are almost impossible to rise above—or below if anyone wanted to!  Adelia says she can tell the difference between ethnic groups by skin color, slash marks on their face, stature and several other features. I can’t.

Back to Adelia—she is a chubby, short white woman.  A toube—pronounced ” two bob”. As far as I understand, a toube means any wealthy or white or westerner or tourist.  It not a compliment!  Yesterday at the store, someone called her a toube, not realizing that she spoke their language fluently and she let go with a stream of angry dialogue in Wolof.  Someone also got mad at me for taking their picture and she stormed over to them, wagging her index finger in their face and said in Wolof, “they’re here to help you, you be nice to them, you be nice to all tourist, they’re helping you.”  She also started telling them what we are doing here and one of the women said her 9 year old son had the funny kind of lip.  Adelia told her to come to the hospital and see us!  This is how the word gets out to the locals.  This week, we've seen two people from our walk through the fish market! 

On our shopping trip, we went from a modern, clean, well stocked shopping center with prices on each item just like home, to roadside stands where everything was bargained for, to town shops that look like the generic third world store.  We went to three towns and about three hours trying to find everything on her list.  It is hard to shop amid the throngs of people, the jostling, and the smells go from enticing to stomach wrenching!  I cannot imagine every shopping trip being like that!  It is absolutely exhausting to have people pulling at you, pushing their wares in your face, and trying to persuade you to buy what they have not what you want! 

 Adelia  with fish people.

Patients are Going Home

Our first patients are starting to go home. They stay in the hospital long enough that the concern about infection is over and that they know how to take care of the incisions. I don’t think I can tell you enough how grateful people are. The patients, the parents, people on the street—they are so happy someone is here to help them. Several of the patients obviously have resources and are used to a better environment than they have in our hospital ward, but many are from outlying villages and have never seen beds, much less sheets.  (We have one patient that slept on her mat on the floor instead of in the bed.)  Surgery just is not readily available in the Gambia, and if it is and the doctor finds out that the patient has any money, they will charge an exorbitant fee making going abroad the only option.
Post surgery pain medication consists of Ibuprofen and Tylenol and most don’t even ask for any pain medication. They are very compliant and stoic except for one little boy that Anita knows from 2 years ago when he had a cleft lip repair—he’s now back for a cleft palate. We’ve nicknamed him “the cryer” and it has become background noise that is easy to overlook in all the confusion and chaos of the unit. Yesterday spontaneously, several people started pretending to be crying.  He stopped dead in his tracks and just looked at them before resuming. His Mom has another baby strapped to her back and ‘the cryer” tags along crying. The kids don’t get a lot of attention from parents once they move to the ground from the mother’s backs where they are tied like in the photo. Adelia, the missionary, said they have so many children, and women and children are expendable in this society.Wives are easily replaced.  Many lack basic parenting skills and the unit next door has a feeding program for these “failure to thrive” kids hoping to bring their weights up to a normal.
Amie went to surgery this morning –she is 2 ½ years old, weighs 15 pounds, and is listless. I’ve never seen her walk and she doesn’t talk at all. She’s been canceled for surgery twice before. First time, her lungs sounded terrible and she was placed on antibiotics, worm treatments and high nutrition-vitamin-rich food . Yesterday, her lungs still sounded a little congested, but she doesn't appear anymore alert. Her Mom is thin, depressed appearing and pays no attention to Amie. Mom’s also been treated for worms and I have never seen her eat anything. Amie’s grandmother is also there and does most of the childcare except for nursing Amie. Most of the women here have hard lives.
There are other parents who dote on their child and the husband is actively involved and spend time in the hospital with them. The picture above is one of those couples—they were just darling and oozed love for their little boy. Both played with him, he was alert and interested in what was going on around him.  He was discharged from the hospital today.  As Anita and I were going back to the hotel this afternoon, they stopped us on the street to thank us again. That is their picture above with their son. The white stuff above his lip is a strong antibiotic cream that prevents infection and keeps the lip moist so the incision will heal better. Couples like this are the minority!

A former Patient

I have just spent 90 mins writing a piece of brilliance only to have the internet go off for the umpteenth time tonight! It’s not like this is the first time—so what a dummy I am!! From now on, no matter what, it is going to become a word document first.

Anyway, as I was saying, this is Amadou. He came in 2 years ago when Anita was here before and had a cleft lip repair. He stopped in the hospital on Tues morning to say hi to everyone and thanks and also, I’m sure, to show how good his lip looks! He is driving a taxi and offered his services very cheap. Gas here is so $4 /liter so it costs lots of own a car. Amadou drove us out to the Makasutu Cultural Forest, “holy place” in Mandinka. $20 pays for the entrance fee, a guide for 6 hours, a river trip, a jungle/savannah walk and lunch. On the way to lunch, you have to pass the greek chorus of vendors. The park was started by two Englishmen, James and Lawrence. We met James today at Mandina River Lodge, the most extravagant place to stay in all of Gambia. (Look it up on the internet and you’ll know why!) In 1992 they acquired 1500 hectars of land. In the intervening years they have preserved 150 villages around the reserve and also helped advance the 150,000 people living in those villages. Probably the biggest thing is the Kubuneh Health Clinic that is now run by a Dutch couple that came on vacation 6 years ago and haven’t gone home yet. The reserve is sort of a “Best of West Africa” with mangrove swamps (red mangrove is salt water and white is fresh), savannah, river, jungle, giant termite mounds, baboons, lizards and hundreds of birds. The blue bellied roller is a shimmery royal blue/turquoise crow-sized bird that has a white fuzzy head that make it look a little daft and like it just got out of bed. To see one up close is exciting even for me, a non bird watcher. The land had been deforested of mahogany, laburnum, and malina, mostly due to male potency teas and medicines. James and friend planted 15,000 trees and dug 47 wells to water them. The wells are still there with a bit of fetid water, but only 4 are still functional since the trees have grown big and strong and can take care of themselves. When they were working on the reserve, they discovered a Maribo, a medicine man/fortune teller. Not only have they let him and his family stay there, built them a house, but he’s been turned into a tourist attraction. He is now 98 years old, sells jujus ( we have to cut lots of these off kids prior to surgery since most are around their necks). You can take his photo, but it cost 100 dalasi (3.50) to have him tell your fortune and if something bad is in your future, he will tell you how to prevent it or decrease the impact. Heck of a deal for $3.50!

Forgot to tell you

The Ambassador of the United States requests the pleasure of our company at a reception this Friday.  The dress will be smart casual. We've RSVP'd "yes".  It's not quite meeting the Queen, but exciting anyway.  I want to see what kind of house she lives in and what her neighborhood looks like!  Do they have an Embassy Row?

 There are 5 Americans, but  most of the staff is British.  We've heard nothing from the British Embassy. (really didn't expect to hear from either!)  Anyway, the US has offered to partner with Mercy Ships on this project, which is totally and pleasantly surprised Tony!  Her former US Aid background is showing.

Nothing like being a big fish in a small pond!

Saturday Night Meds

Well, Anita and I just got home from giving the kids their 8 PM medications.  No one else wanted Sat. night!  This should have been a quick visit, but we're the admit nurses and don't know nuthin' about what goes on there at night! It took a long time and was almost funny with mostly me asking Anita, where is the paracetamol (that's Tylenol in England)? Where's the syringes?  How do you give them 125 mg (tablets are 500 mg) Where do you get this and that?  The ward helpers saved us.  They are educated, local girls that speak English and Wolof (local language) and translate for us, but they also know what's going on and we don't.  Every day, Anita and I get in at 7 AM and get the patients ready for surgery and have never even been in the hospital at night!  In addition to not being able to find things and trying to figure out how their medication administration sheets work, first a mosquito net gets caught in the overhead fan and made some godawful noise (someone then turned it on to see if it was "OK"), then the lights go out three times--never for very long, and then the ward helpers tell us that  the water has been off since yesterday afternoon.  I didn't have the guts to even look at what was going on in the patient's bathroom!  This ward has 26 patients that have at least one family member, usually more, that sleep on the same twin bed as the patient. Most of these people live without mosquito nets, electricity, or running water so no big deal.  Hope we didn't over or under medicate anyone and that everyone is OK for another night.  The gratitude of the parents still amazes me.  They want to shake our hands, they smile and thank us and now since several kids have had their surgery, they want to proudly show us their children and their new faces.

I've not been so happy to have a job over in a long time.  It felt so good to put our cart away, take some cracker jacks and head back to our hi end hotel!

Mercy Ships

OK, to all of you that I told I was going to Africa with Mercy Corp.  It’s not true.  Mercy Corp is an American NGO based out of Portland.  I’m here with Mercy Ships.  Completely different organizations, but with basically the same mission.  Anyway, a little information about Mercy Ships.   I won’t go into a lot of detail because it’s so easy to google Mercy Ships and find out more information than anyone would possibly want to know, but the short story--  In 1978, Don Stevens had a dream of outfitting a ship as a hospital and taking her into poorer world ports to provide surgical and medical care. He borrowed one million dollars and bought his first ship, the Anastasis which only retired in 2007. The year she retired, he purchased the African Mercy.  Anita worked on that ship for 8 weeks in 2007.  Don Stephens is still the guiding force behind Mercy Ships, but it is now mainly in western Africa.  Over the years Mercy Ships have changed and evolved, but the mission has remained the same- to provide quality health care for the poorest of the world’s populations.

Everywhere we go, people love us! If we're wearing our scrubs and name tags, we're recognized on the streets and the hassling is much less.  In fact, men (who usually do the harassing) will tell other guys to leave us alone--that  we're with Mercy Ships.   In the market today,Anita and I were buying  new coffee mugs for our break room.  When the store owner realized that we were with Mercy Ships, he had his staff give us 5 dalasi back! ( 5 dalasi equal 15 cents, but this is a country where we bargain over that 15 cents--in fact, locals can eat dinner for that!)  He offered us anything else we buy at a special discount for Mercy Ship volunteers. He expressed what many people tell us daily, “thank you so much for coming to Africa to help us.  Mercy Ship is very good.”  It is so common for someone to thank us or recognize their appreciation for Mercy Ship-- it's so satisfying to be affiliated with this type of organization.  

This particular mission is run by Tony and Ann Giles, a doctor from England and his nurse wife.  They were on the Mercy Ship several years ago and it’s morphed into Tony and Ann doing these extra missions at local hospitals like RVTH here in Banjul.  With the support of Mercy Ships, Tony and Ann plan the entire project and recruit the medical, nursing and ancillary staff.  They also set up patient screening to get patients--this project is only cleft lips and palates.  Many people show up that are not appropriate candidates. Tony also appears on local TV, newspaper and radio ads to find patients.  Communication is so difficult in the entire country, but especially in the outlying villages which is where most of our patients have come from this time.  There are Christian missions and health care clinic dotted all over the country and Tony and Ann stay at these and can use the missionaries as a resource for patients, too.  In places where there are no missions, they talk to the village chiefs who are usually cooperative and provide help, food, and generally appreciate the help.  .  Bjorn and Anne Marie, the Norwegian MD and his wife, told us about going upriver with Tony and Ann to find patients.   In one place the village chief offered to house and feed them for the night--they slept on the bare, dirt floor in a hut—no blankets or pillows, just sleeping mats . The night was so dark that they couldn’t see anything, and they tried to go to sleep to the sound of rustling, scurrying and scratching!  It was a very long sleepless night!

Our living conditions are luxurious by comparison and I think I'll take advantage of that to sign off for the night.  It's been a very long first week.  Thirteen patients have repaired cleft lips, one 75 year old who is one of the important chief's relative now has a semi-normal looking lip after having a large non-malignant tumor removed and antibiotics for the week, and one, a repaired cleft palate (she was Nassim that the cautery quit working in the middle of her surgery and she bled.  Well, the cautery still isn't working and a part is coming in from England tomorrow, so the rest of the cleft palates have been put off until next week)   A very different week than I would have had at home!

US Ambassador to Gambia

We had a VIP guest this morning. The US Ambassador to Gambia, Pamela Ann White and her entourage. Everyday I realize more and more what Mercy Ships has done for Africa, and how appreciative everyone here in the Gambia is. Ambassador White arrived amid minimal fanfare--actually nothing like the President of Gambia who speeds by occasionally in his big, black, dark-windowed SUV followed by a parade of other black SUV. The streets are narrow and full of sand with multitudes of people walking both ways and vending stands set up on the sides of the road. It hard enough for two cars to pass, much less speeding SUVs. We were walking between the hotel and the hospital one morning when he came by--all you can do is scoot off the road and wait until they go by.

Except for one officer from the RVTH (hospital) security, she was alone with three female aides. She is a recent Obama appointee to the Ambassador position. Apparently she has had a long career with US African Aide, most recently serving in Liberia but has lived in Africa as an aid liason for many years. In other words, maybe she's qualified to be the Ambassador, not just another political appointment based on contributions. She and her aids seemed genuinely interested in the patients and what we were doing. In fact, after talking Tony Giles, the surgeon we are here to support and his wife, she wanted to meet some of the patients and spent quite awhile going from bed to bed talking to the patients and their families. She hung around after Tony went to surgery talking to various staff members, and our official photographer took a picture of all the Americans on the trip with the exception of himself. From left to right are Anita, me, Ambassador White, and Sue Brewster (her husband is the photographer and they live on Long Island, NY)

The white things hanging from the ceiling are mosquito nets. Some of us are liked more than others, but the patients have as much trouble with mosquitoes as we do! During the day, the mosquitoes nets are tied up out of the way and at night, the nets are lowered and tucked securely around the patient's bed. Every patient who has surgery has only two blood tests prior; a hemoglobin and a test for malaria. Most have had malaria at some time in their lives. The Gambians feel that the mosquitoes that are everpresent in the morning and during the day are NOT the mosquitoes that carry malaria. Those come out in the evening. Really don't know if that's true or not.

You are never immune to malaria and there is no vaccination, so we take daily dose of a drug called Doxycycline. Once we're home we'll take it for another month. Malaria is caused by parasites that it gets into your blood steam, settle in the liver where they hatch. As they hatch you need to kill them off, so even after getting home, we'll need to keep taking the Doxycycline. The best prevention is to use lots of bug spray on our bodies and also in our rooms. Most of the time, our room has a faint toxic smell that we seem to quickly get used to. We also sleep under the same type of mosquito nets that you can see in the picture. It's a cozy, cocoony feel at night to sleep under the nets.

Our Hotel

I feel like I’m at a Hawaiian or Mexican resort! The beach front hotels in Gambia primarily serve British tourist who rarely leave the hotel or Europeans who come here to bird watch. We’re right on a long, white sandy beach with some handsome young men to take care of our every want. More on that later. There is a large swimming pool with two hot tubs. An exercise center that I’ve never visited and a massage salon that I have! A ½ hr. neck massage was 200 dalasi (about $8). There are the usual outside bars to help you cool off. Our room has a lanai outside the sliding glass door and we face a bird sanctuary that at times sounds like a squabbling family, then others it’s calm and soothing. We have air conditioning that works most of the time. Occasional, especially at night about 10 PM, the power will go off for 3-5 mins and comes back on as suddenly as it went off. We usually take that as an omen to go to bed! Our room is checked by a variety of people daily. A cleaning person does the actual work of cleaning our room­. Someone else changes out the towel which they do by taking our dirty towel somewhere and then retrieving clean one, so there is a bit of time in between when there are no towels. In fact, today there was one bath towel when we got off work, another bath towel arrived shortly after and just now, a hand towel arrived with the promise of another “later”. Apparently there has been a big loss of towels by staff! Another person comes in about 10AM daily to check the minibar so we can’t steal from the minibar and replace it later. A supervisory person comes around late afternoon to make sure we're happy and have everything we need.

Another person sprays our room at night for mosquitoes—as of yesterday, I’ve taken over the job because he shows up at 8-9 PM and the room is uninhabitable for 30 minutes. Abdouli, one of the Gambians helping us at the hospital, calls the mosquitoes “Gambian soldiers”. Unfortunately, I’m one of those people who the mosquitoes and all other bugs love to bit. Anita can be standing right beside me and they always go for me. My ankle and arms are covered in spite of mosquito spray and mosquito wipes. There is standing water everywhere—including the hospital that has an open concrete drainage ditch going right through the middle. Historically it was where all water (and probably lots else!)was thrown, but now it is supposed to be just clean drainage water or rain water during the rainy season. It is quite a breeding site for mosquitoes. Our hospital ward isn’t much better. I picked up the mop yesterday and hundreds of mosquitoes flew out. Oops, got carried away on mosquitoes.

Back to the hotel-
Like most resort hotel there are ingratiating people everywhere to do whatever you want and there are local craftspeople selling necklaces, bracelets, wood carving, and leather goods in the lobbies and outside by the pool. These are bargained for –fiercely but good naturedly- and they expect it. The vendors seem disappointed if you don’t bargain. It’s almost like we don’t get it! In fact, in the market yesterday, one of the vendors told us that, unlike America, where prices are on items, he gives us a price and we come to a fair price for both of us. They think it’s a much fairer way than everyone paying the same.

Every morning is like Sunday brunch and would to do any American restaurant proud! It is loaded with salads, fresh breads, sweet rolls, cereals and cold cuts. Someone is making fresh orange juice and cutting fresh pineapple. Another person is making omelets or “to-order” eggs. In 5 days, the waiters have already figured out who wants coffee, tea, cream, sugar or black. It’s kinda nice! No Gambian food is served because it’s not to the taste of most English--or at least that's what I assume.

Take a look at our hotel at ­­­­­http://www.laicohotels.com/en/hotel/gambia/banjul/laico-atlantic.html or google Laico Atlantic Hotel, Banjul. We’re on our way to the pool and tea time.

Abduman and his grandfather before surgery

oops, this picture should be with the last post.  It's one of our patients today.