Desperate Housewives of Kabala

Identifying, getting used to and internalizing the mindset here has been difficult, but spending time almost exclusively with members of one's own gender is a big part of it. The new nurse the clinic has hired, Mariama, has been taking me to her second job at the government hospital. We also like to watch Nigerian soap operas at her house on the weekend. Before Nar Sarah clinic, she was head nurse of the maternity ward at the Kabala government hospital. Now she volunteers for the same position after work at our clinic. She has shown me all the wards: ante-natal, post-natal, the delivery area, the men's ward, and the TB/leprosy ward. I was like, "Oh Mariama, I've never seen a person with leprosy." She said they see it often and would find me one. The nurses don't really do rounds or anything so there is a lot of time spent chatting and napping in the wards. One of the nurses - who has the same name that they've given me, Kumba Kargbo - brought a man in and introduced him as Lansana. We shook hands and he left. Mariama came in as he was leaving and was like "Oh Charmaine did you see the leper?" I explained the handshaking but she is confidant that I don't have leprosy.
I see Peacemaker's wife, Merah, and her friend Fermah a lot as well. I sort of think of them as the Desperate Housewives of Kabala. The live in a nice part of town and are stylish and gossipy. They seem to always be fully decked out and headed to the market to stir something up. Merah and Peace were married when Merah was about 16 and Peace about 40. He keeps girlfriends which is the norm especially for a respectable son of a chief. Merah will tell you she only stays because of the kids.
Saio, a fifteen year old girl who lives with us, was examining my Environmentalists for Obama button. It has a picture of Al Gore. She was like, "Is this George?" I laughed til I cried because maybe George does look a little like Al Gore, but Saio hasn't seen a picture of him. It's just more reasonable than not that at my age I would be with a 55 year old man.
Hawa, Theresa's niece who does all of my cooking and cleaning, had a baby two weeks ago. No one was around to assist her. But apparently she had it very quickly with no problems in her room. I hear that happens a lot. It's her fifth. About a year ago - must have been shortly before or after Finah, her one year old, was born - her husband left her "for a very fat woman," Theresa tells me, who lives in Kono. But now she has left him so he is back living with the family. Hawa doesn't speak English because she didn't go to school, but she doesn't seem super thrilled with her husband. I haven't really noticed them interacting too much though they are both in the house most of the day. Even though it means even more financial hardship, I think many women feel a little relieved when their husbands leave.
Theresa likes to take me out in the evenings to have a drink with a friend or so of hers. I'm usually one of the few people in the bar drinking something alcoholic. Most people go with a non-alcoholic beer.
There is more to be afraid of in Kabala than I can keep track of. As each day is a little hotter than the last, one of my recent fixations is the idea of vipers and puff adders being in the house. The cement houses are usually maybe 20 degrees or more cooler than outside, often totally dark and a little damp. I don't see how they could be more specifically designed to attract snakes. Every night I'm more afraid that the cockroaches I hear scurrying around are actually vipers flicking their tongues in search for the most likely place for me to unknowingly step on them in the morning. At the bar recently, a video of a zoo with the lyrics to 'Happy Birthday' was showing. I was hoping this could be an opportunity for Theresa to tell me something about they ensure snakes don't get inside. "Theresa, are there snakes here?" "Oh yes." "Should I be afraid of them?" "Oh yes! They will bite you." "Do they come into the house?" "Oh yes, but someone will stand between you and the snake." It's a plan.

Patients

We had an old guy come into the clinic who was very weak, had a rattle in his chest, and low blood pressure. We told them to go to the government hospital or the private surgeon. Maybe four hours later our volunteer nurse from Canada went to the surgeon's on an errand. The old man was waiting there and in considerably worse condition. She recognized it this time as congestive heart failure. She asked the nurses why he hadn't been seen especially since his blood pressure had dropped to 60/40 (and at that point you can stop calling it blood 'pressure') and asked them to give him diuretics to force the fluid out of his lungs. They said the doctor was not in and they would not do anything without the doctor's order. The nurses had the professional knowledge and skill to help the man and just weren't doing so. He died later that day.
I've asked myself so many times here, "Why won't they take reasonable courses of action?" The clinic has received over 10 boxes of donations that sat - many for well over a year - unopened in the clinic - useful items taking up space, becoming termite-eaten and expiring. How could they not open them?
I have absolutely no idea. Just a sense that it's an important question. All I can figure is that these are people whose lives have been so brutal for so long that an old man's trouble breathing just doesn't seen urgent. And almost everyone's authority in any given situation is somehow severely mitigated. Women aren't quite fully people here; so for the female nurses to defy clinic policy and administer medicine without the male doctor's consent probably would've been quite extraordinary. Abd because they lived such brutal lives for so long, that actually would be more extraordinary than an old man dying needlessly suffocating in a doctor's waiting room. But why didn't his family advocate for the nurses to do something? The doctor's office is such a foreign place I doubt the family knew the nurses had the medicine to help. They may have fully accepted the need for a doctor's order as the nurses did. And living without any control of any aspect of their lives, arguing with the nurses would have possibly been the first instance in their lives that they stood up to a system and demanded their rights. Or even the first time they had witnessed such. And all Sierra Leoneans live with such a deeply felt sense of inferiority. They do not believe they have the capacity to do things for themselves.

Clinic

On busy days the clinic sees about 30 patients. It seems that most days are busy, but sometimes only 10 or so will come. Public health announcements over the radio make an astonishing difference. The Women's Health Program or some other NGO or government agency will announce something along the lines of 'everyone who experiences abdominal pain should see a doctor.' So people will show up that day saying they feel abdominal pain.
The clinic is equipped with one exam room, one room for births (which they use for exams), an injection room, and a waiting room. Everything is completely covered in a layer of dirt and the waiting room is accentuated with wasps. Patients come in, have their blood pressure and pulse measured and a patient card prepared by a nurse, and wait in plastic chairs for one of the two rooms to call them in.
Once in the exam room, the patient's experience differs dramatically from what I'm used to in a doctor's office. One of our nurses will stay behind his desk throughout the exam. He doesn't usually touch or examine the patient - just listens to their description and prescribes medicine. The other nurses tend to be more thorough. If you are called into the delivery room you will probably be asked to lie on a bed draped with a quilt that hasn't been washed in ages. Numerous pregnant women, women with STI's, and vaginal discharges, and other mysterious abdominal pains have lain on it before you. On one side of you lies a shelf stuffed with donated gauze, band aids, Q-tips, sutures, and soap - all in widely varying conditions. On the other side lies a bare exam table where women give birth. The woman's family is in charge of cleaning the table after the delivery - so it too may be in widely varying degrees of cleanliness. Other patients will wander in and out of the room whether you are dressed or not. The door may be kept open during your exam. It's hard to tell what patients' reactions are to everything. Going to the doctor is a novel mysterious experience for most people. There's definitely no sense of invasion if someone wanders in during their vaginal exam. I think I have yet to see someone ask a question to their nurse.
One of the volunteer nurses implemented hand washing stations - bowls of clean soapy water. I think she and I are the only people using them. I've seen mother bathe their children in them. I've also seen a nurse touch an infected eye and then palpate a pregnant woman. The underutilization of existing supplies and knowledge is stunning.
The clinic isn't set up to do basic lab testing, so diagnoses are made on a best assessment basis. They give out antibiotics like penicillin, flagyl, ACT for malaria, aspirins, anti-diarrheals, and iron for anemia. There is a government hospital and a private surgeon who we refer cases to.

On the Daily

So what do I do every day? That is something that has been somewhat of an obstacle so far. The planned roles for me were dependent on the new clinic facility being open, which it is not. The current clinic has only two exam rooms - so it is actually a bit overstaffed currently with two volunteer nurses and three regular nurses. Although since no one plans ahead in Kabala - including who will be at work the next day - it has been working out. I have shadowed Theresa's pre-natal exams to get a sense of how the clinic works. I might keep working with her doing health education with patients on a one to one kind of basis during their exams with her. I have undertaken an enormous project of unpacking, organizing, and cataloguing donations the clinic has received. It is difficult to understand why, but the clinic is not in the practice of unpacking and using the donations it receives. They are kept in boxes in the exam rooms or packed away in an extraordinarily musty basement. And they've been that way for years. With the help of another volunteer (a nurse from Canada who is with CITA for a year) I've unloaded quite a few boxes of musty bandaids, un-usable surgery equipment, toothbrushes, miscellaneous medicine samples and old prescriptions. There is far more than the clinic can actually hold. I'm in favor of burning much of it, but Theresa wants to keep most things.

I have also taken on grant writing sooner than planned. I've been working with a grant quite a bit - but there are some difficulties. The grant is mostly ready to submit but communication and planning are difficult to the point that I have no way of knowing if anyone wants to implement the project the grant has planned. We've in fact, already won another grant to do the project, but no one is doing big parts of it. The project involves a lot of education regarding health rights, which I could have come prepared to do, but didn't.

So my days are spent at the clinic in a combination of observing, considering grants, unloading, and other miscellaneous jobs.

The harder part is the evening. Which starts at 4 or earlier. People's work days end early in Kabala. If I haven't already, I will search out internet (I can only access it until about 5pm). After 7, reading and writing become significantly more difficult with no electricity, but unless I'm passing the time with some of the other 8 English speaking people in town, that's about all there is to do. I try to stay up until at least 10, but I'm often asleep by 9. There's random activities I get drawn into by Theresa's kids as well such as 'seeing a film in town*' or heading to the chief's house to watch CNN. *Seeing a film involves going to a building in the market and sitting down in front of your choice of 1 of 6 Nigerian soap operas or terrible American action movies. The play them continuously on a loop. The first time I went I saw the last half of a later Wesley Snipes movie and the first half of Half Past Dead.

Cooking

After being sick, I’ve spent some time with Theresa helping her make food that shouldn’t make me sick. I had been happily disengaged with the cooking process until this. It’s truly stunning nothing worse has happened to my health. I have yet to see a local clean their hands. In a place where every thing you touch is coated in dirt, that’s a big deal. We started the soup by peeling potatoes – and dropping them in the dirt once peeled. The same dirt chickens peck through and children urinate in. With no running water we can only clean them by dropping them into a somewhat clean bucket filled with somewhat clean water to rinse the dirt off. There are no cutting boards or tables around so you have to fully clasp whatever food you are peeling or slicing (and store the knife on the ground while not using it). And then everything gets boiled – I guess that’s been my saving grace. Just taking the food off the fire and transferring it to a bowl was really hard. There are no potholders. A soiled rag was laying in the corner so Theresa used it that to grasp the pot. By the time I managed to refocus her attention from the sick infants and back to my soup, all my broth had boiled away. As I write, a chicken is wandering into the house after pooping on the table. Since there is no money for feed, roaming around scavenging for bugs is the only way farm animals eat. There would need to be a radical re-zoning of the town for everyone to pin in their chickens and goats and ducks and still allow them enough room to scavenge. I’m supposed to be working with health education. I hadn’t realized the people I’d be working with would not be utilizing their own knowledge.

Home

But we managed to make it to Kabala. I am staying with one of the founders of the Nar Sarah clinic, Theresa Kargbo (who makes an appearance in the book The Land of Magic Soldiers which is worth finding). I am not sure how many other people live in the house. There are maybe about 12 adopted children living with Theresa; her husband lives in Freetown with his other wife (as in second of two current wives) but stays occaisionally in Kabala as well. They were kind enough to clear out a bedroom for me. There is a window that opens onto the yard making the room bright and breezy at times. The room is occupied solely by a bed and a table. Hawa, Theresa’s niece, takes care of me. She brings me boiled water to wash my face, washes my clothes, sweeps my floor, lights my lamp, brings my food, washes my dishes, fills a bucket of bathe water for me, and cooks my food. I sleep under a mosquito net feeling very much like a colonial queen.
I have recently been displaced from their house while the roof is being replaced. The thatching under the tin is rotting. I’m staying with Theresa’s brother, Peacemaker, the clinic’s medical director, for about a week. While also full of children, their house is quite a bit different. Peacemaker’s has an actual living room. One of the big challenges for me has been balancing time spent with others with time I need alone to do my own things. Most people in Kabala don’t seem to have enough activities to occupy their time. People visit each other or hang out on their own porches. Constantly socializing. Theresa’s porch has a bench on it with people coming and going at all hours. Peacemaker has a yard with a table very much like this except there is also a living room with a light that centralizes activities and makes things at the house much less chaotic. They cook for me here as well. After 4 days of dysentery I’m eating more Western food than I had been – even though Merah’s, Peacemaker’s wife’s, food is good (if lacking in variety and nutrients). My only complaint is the rocks I find in every meal.