cooking with gas

butane to be exact. this morning was the first time i made my own hot breakfast, oatmeal and orange juice. we finally got the table-top range working, so i’m trying it out. things are looking up. hard to believe we’re half-way through our time here. the initial gi distress and mystery cough have subsided at last. either i’m building up immunity or harboring chronic diseases. regardless, i’ve been here long enough to write a bit about the hospital scene.
patients must be accompanied by a guardian. this is true for the adult patients, too. the guardian cooks for, cleans up after, washes the clothes of, and takes the temperature of the patient. they have to bring their own dishes, linens, thermometer, and carnet de santé. the carnet de santé is actually a little piece of genius when used the right way. it is essentially a medical chart that the patient keeps. when the doctor sees the patient, he automatically has a record of recent hospitalizations and vaccination record with growth chart. prescriptions also get written into the carnet.
la pédiatrie is basically one long corridor. when you walk in the front door, the waiting area is to your right and the two consultation rooms for clinic are to your left. you walk farther down the corridor and find the aforementioned salle de soins to your right and the head nurse’s office to your left. two more steps and you’re on the inpatient ward. there are 20 rooms with curtained entrances and 2-3 beds apiece. i have to prepare myself when i enter the room with the very emaciated marasmus baby. i was embarrassed the day i turned around and nearly jumped with fright at the sight of this baby staring at me like a hollowed out chocolate easter bunny. there are two private rooms that have 2 beds each, but their own bathrooms unlike everyone else who shares one. right now there’s a 34-year-old mom in one of the private rooms who just reached a dozen kids with her new twins. for the fragile ones, we have 3 incubators shared between the 4 beds in the 2 incubator rooms. unfortunately, most deaths happen there. lastly, there are 2 isolation rooms for particularly contagious illnesses. currently, we are in the process of moving our 2 isolated patients to other rooms since the isolated room may be reinfecting these babies who continue to spike fevers.
the hospital is not a dull place. in the morning, you will almost always hear the call, “poisson, poisson” (fish, fish) just outside the window. this is a fishing kind of place, so it’s fresh and always for sale. my favorite is the gâteau kid who has to be all of five years old hauling a basket of small cakes for cent francs, cent francs (100 francs (20 cents)). there are other hubs of culinary free enterprise if you know where to look. there’s also a convenience store on the hospital grounds where patients/guardians can purchase food and incidentals like the ever-present celtel phone card.
we spent a great part of this morning trying to work out payment arrangements for patients who need to be discharged, but cannot afford the cost of hospitalization. i don’t think anyone pays the full fee. just getting to the hospital is often expensive enough because patients come from all over. i know many don’t fill their prescriptions due to financial reasons. we try to give out samples if we can. our two-doctor team has been working out a lot better than when there was only one doctor for inpatients, outpatients, er visits, and cesarean sections. tomorrow i’m gonna try to set up shop in the salle de soins and practice phlebotomy. wish me luck...

sunday in sindara

do you know the way to sindara? if you do, then you wouldn’t wear a white tank top and white hooded sweater like me. you wouldn’t have labored four hours washing, setting, drying, and styling transiently flawless hair. lol. i thought it was beautiful in an antique photo kind of way. the rusty color that tinged the roadside foliage. i didn’t realize i was looking into my future. you see, after you head south from lambaréné and pass tchad, it’s all over. the road that is. there is no more. you get a dirt path with the characteristic iron-laden red soil. well, after some time on this dirt path, you begin to notice that your white shirt is not so white anymore and your face looks like a one-sided foundation mismatch nightmare. you have to keep the windows down in the taxi or you’ll suffocate from the heat. and thusly, my friends, is how we made our way to sindara.
once we get there, though, the notion of beauty returns. sindara is the opposite of sin. its claim to fame is a catholic mission, l’église des trois epis. rachel, olivier, and i met up with sophie and benoit (more hospital folk) for a 30-40 minute walk to see the waterfalls. there was a lot of water and a little falls. i drew pictures in the coarse grain sand, chatted with sophie, and extracted the huge ant with its fangs enmeshed in my pant leg while the others played some soccer. one of the mission guys was nice enough to cook us up a speedy meal since there was nowhere to get a hot plate of food. our new mission friends made a paparazzi of themselves in sending us off in a hale of camera flashes, god’s blessings, and requests for emailed pics. after the day’s events, it was actually comforting to come back to brochettes and d’jino (“grapefruit” soda) at la référence in lambaréné.

typical clinic day

my weekdays begin at 6:30 am to a chorus of every little birdie, every chickadee, every rooster in the mango tree. the mango tree frequently drops premature mangos like bricks on the roof, but i digress. to the réfectoire by 7 am for bread and choice of coffee, tea, hot cocoa. rounds start any time from 7:45 am to 8:30 am. usually, i’ll find at least one dehydrated kid with diarrhea receiving iv fluids in the salle de soins (er/procedure room) who came in overnight. sometimes an asthma kid is there getting a nebulized medication. we check out the premies, then the rest of the inpatients followed by newborns over in maternité. this is usually done by 10:30 or 11 am.
consultations go until noonish. we commonly see scabies, malaria, gastroenteritis, otitis media, bronchitis, buruli ulcer, anemia, and sickle cell with the rare varicella, hepatitis, and appendicitis. we triage quite a number of patients over to surgery who have hernias and abscesses and less common issues like vaginal atresia. sixth fingers get tied off in maternité and regress of their own accord. frenula (tongue anchor) that venture near the tip of the tongue get clipped by the head nurse. anybody who needs labs gets blood drawn and returns for the afternoon session of consultations.
we enjoy a rather generous lunch break usually 12:30 to 2:30 pm. i copy lab results into charts before we see the patients. i cringe every time i copy blood group results fearing i’ll write the wrong thing and some transfused baby will die. the potential for human error is immense. we see the patients from the morning first and then everyone else. the day finishes anywhere from 5 to 7 pm. dinner is at 7pm, another family style affair. initially it was awkward sharing meals and social life with the doctors and administrators of the hospital, but they have become a kind of family. the food at the réfectoire has been getting better and better as far as lunch and dinner are concerned. all i have to say is crêpe aux champignons (mushrooms) and île flottant...mmm mmm good. makes up for the eggplant two days in a row. if it’s a quiet night, i.e. there are no goodbye parties to attend, rachel and i will enjoy an episode of six feet under, our latest favorite entertainment featuring a dysfunctional family in the funeral business. lights go out around 10:30, 11pm. then it all starts again...

city of freedom

libreville is the capital of gabon. it was our very first stop in gabon, but the lethargy of travel prevented full appreciation. consequently, we decided to spend a weekend getting to know this libreville people seemed to always be sneaking off to. my other goal was to find a salon with clean water, reliable electricity, and some expertise. people who received my i’m-going-to-gabon celebratory email know i’ve been pondering the hair thing from the beginning. so if i wasn’t apprehensive enough about that, the harrowing ride into town only added to the anxiety. rachel and i were crunched into the front passenger seat like siamese twins with the unbucklable seat belt wound around us like a full-body noose. we were frequently face-to-face with drivers in the oncoming lane as we sped around the slower-moving traffic. the repeated soundtrack of reggae, hip-hop, and chipmunk voices singing “i’m so lonely” had a hypnotic effect that helped take the edge off.
once civilization reappeared, we were relieved to find a clean room with an adjoining bathroom at the maison liebermann. we roamed around a bit where i sampled one of my favorite gabonese treats, the beignet. it’s just like the new orleans one (sugary, doughnut-like) except it’s shaped like a ball. the government buildings were artfully done and local markets similar to those we left in lambaréné. then we wandered into mbolo and were mbowledover by its vastness and lavish variety of fineries we’d long stopped dreaming of. it’s essentially a very expensive super wal-mart. yes, i did buy seven-dollar cheerios and soy milk. eating bread every morning is not my thing. c’est pas mon truc, as they say here. that’s when we started a new expression: ici, c’est le luxe! (it’s luxurious here). no wonder folks like libreville...
we visited the national museum which was chiefly filled with masks of the different gabonese ethnic groups. the associated ceremonies and traditional medicine added great depth to my understanding of the culture. we browsed at the open-air artisan market and stumbled upon a decent salon where i made an appointment for the next day. the rest of the weekend is filled with good eating from dolce vita’s pizza and hazelnut/pistachio gelato (yummy) to middle eastern falafel to pain au chocolat and the wacko owner of the chinese restaurant. when we discovered the exorbitant price of the chinese buffet (roughly $28) we gulped down the water we had already ordered and prepared to find cheaper eats. well, the waiter had us talk to the owner who was determined to make us happy. he was hyper and ingratiating in an ultimately likeable way. he literally ran back and forth shuttling our à la carte meals and reheating things before we asked. he brought left-over buffet desserts and gave us discount coupons when we left.
other entertainment included matthias, our austrian travel buddy and piano player extraordinaire. we talked our way into piano privileges at the swanky meridian hotel. rachel and i followed up his schubert and bach masterpieces with our “heart and soul” duet. i played the only song i still remember, “heart of gold,” and this ugandan guy offered me a drink to hear me play it again. apparently he hadn’t heard matthias because later he joked that he should have given it to him. ha ha. we also went to butterfly where the earthy decor and techno beats were only upstaged by the ceiling-to-floor mirror that let people dance with their own reflections. we called it a night pretty early.
finally, i did succeed in my quest for a coiffeur. mathieu was middle-aged, white-bearded, and english-speaking. there is a science to the use of relaxing chemicals, so i brought my own products and explicit instructions. happily, it’s over and i still have hair on my head. even though i was sick, the 3.5-hour ride back to lambaréné was more comfortable. jazzy gershwin looped every 45 minutes. i kept waiting for a voice to say “a customer service representative will be with you any minute...” yep, libreville is full of services...for a price. everything you can imagine. i guess it’s true that freedom is never free.

infection prevention in action

our french friends, cecile and delphine, work in the atelier d'expression (art therapy worksop). with the help of the kids and a local comedian/director, they put together a lovely theatrical piece on aids (sida) prevention that started its tour on hospital grounds and ended at the carrefour d'isaac (as pictured). the other picture shows maman sophie doing what she does best, telling the mothers all about malaria at another session of the pmi (protection maternelle-infatile).