Friday, March 26, 2010

Visions of an Eye Clinic

Highlights Kedougou Eye Clinic 2010

drop it like it's hot!
-One ANCIENT lady sounded very distinctly like a gremlin but we loved each other. She kept hugging me and saying in her smoker-gremlin voice, "You're my baaaby!" Haha! Hilarious!
-I tried to get the pre-op room to sing along with "Mmmbop" at one point, but they weren't very good at it
-holding several small flashlights inches over the surgery space when the power went out

I know, big scary needle and no qualifications. But this is the post-op steroid shot that they can't feel... and I'm a fast learner!
-Fumbling with a man's crotch when he said he had to pee: We were all shouting and running around. We brought his wife in to help him, but she refused to step even towards the table. I went in for it and the nurse shouted that wait!- I should have gloves. Come to find out the man was able to hold it in the end anyway (unlike last year when the pee was thrown multiple times at me and Michele)
-witnessing the rapid descent of hygienic standards: The medical team started out appalled, alcoholing everything until we kept running out of alcohol. A fly entered the room and they freaked out. It eluded murder efforts and buzzed around the Sterile Area. I was able to secretly chuckle behind my mask. I tried to help them feel better about it all, but it was hard for me to summon the correct mindset. I'm about as far as I could get from it. I picked up cataracts from eye goop and blood puddles on the floor. At lunch one day, I licked sardine juice from my fingers and tasted the iodine I'd rubbed on patients' eyes. Had I washed my hands? Ooops!

the sterile blessedly air-conditioned OR and Dr. Judith and Nurse Christine (I love them!)
-Even at my personal low on the hygiene front (clearly pretty freaking low), I could tick off the things wrong when the Senegalese team swept in to borrow the OR for C-sections (of which I saw 3). They know they don't want to track in dirt... so they take off their shoes. However, their feet are still filthy as mine, cracked open, and tromping around those blood puddles I just mentioned. C-sections bring a LOT of blood. Two people had booties at least.
We brought this up to a very nice assistant. He said, "Yeah, but the blood is over there--" he pointed 1.5 feet from his own feet. What about stepping on needles? "They're over there too." We pointed to one that was literally 5 inches from his big toe. He picked it up and laughed the way you would laugh if someone hit a good shot on your side of the ping pong table. "Oui, c'est pas bon.."
-Otherwise, the c-sections were pretty awesome. Bodies are much more pliant than I thought. To suddenly suck up a grey alien-like person from a slice of rubbery skin flaps and wet organs seems quite unnatural. They spank it and it cries. Or, if it doesn't, they suck stuff from its mouth, do CPR, and continuously smack it around so it makes enough noises to placate the mother. The mothers can't see any of this as their upper halves are blocked off by a cloth. Most of them were younger than 17.

planet cataract
cataract removed, hook going into cut above eye
in the eye, dialing in the replacement lens
-On the last day, an emergency c-section (baby dead, but arm and leg already emerged) kicked us out of the OR. Three of the four medical teamsters were ready to pack it in. They were at the end of their two weeks and clearly over Senegal. They waxed poetic about their beds at home and moaned about the dogs barking at night and the AC shutting off. We tried to be sympathetic. Anyway, they were done. Dr. Judith, however, refused to cancel the last cases and decided to do them in a non-OR instead (the "pre-op room" as it was). Dr. Donald McDonald III (I did not make that up) refused to work outside of the AC so we helped Judith mop the floors and walls so she could set down to it herself. She is AWESOME. But it was so far from sterile: windows open, pollen blowing in.... Oh well, it worked!

This is what senegalese feet look like and why I will need the first pedicure of my life when I get back. Thankfully mine aren't quite this bad yet.
The hospital also functions as a dump, goat feeding-ground, and all-over outdoor bathroom...

-My older sister who doesn't live with us had a near death experience during the clinic. She only lived because an ambulance was able to go all the way to her village and bring her to Kedougou where they took out the baby that died inside her and gave her blood transfusions from three people who came with her. Anyway, this is why I saw my baaba and neene there! It was very strange... I was running around self-importantly with scrubs on and couldn't even get the whole story from the family without having to rush off in between. My mother slept on the filthy hospital floor that week (as per usual when family members are kept there. It's up to family to bring food and water). I saw them throughout the day and felt guilty not sitting with them more. When I put pre-op preparatory drops in the patients' eyes I could even see my dad sitting outside the window. But when I got back to the village and was talking to my baaba about how I'd like to go into medicine, he laughed and grinned and said, "You are! I saw you myself in Kedougou! You're a real doctor!" He looked as proud as a biological father would.

It's great to see.

Sunday, March 21, 2010

FĂȘte Fecale

As a companion to all the new latrines in our village, we had an educational causerie. I wanted to explain that we don't just have them to look more patrone (adj: wealthy, rich, ritzy, balla). In the US, the word "diarrhea" sends kids into peals of laughter. Here, kids die from it. So my poo party, or fete fecale, if you will, intended to explain how we get it, how kids are more susceptible, why latrines cut down on it (beforehand, everyone just went in the bush), and what to do if you/ your kids have it.
I certainly understand better than ever how important it is to relay all this information. But the American in me still felt ridiculous presenting this in front of all the important and respected village elders who come to all my meetings (bless them). I insisted some women and kids come since some of the lesson was specific to them. It became further awkward, however, when I realized none of the women or children could enter the meeting space. It was a holy spot just for devout men. When men need to pray but can't make it all the way to the mosque, they enter this fenced in rectangle of gravel. They take a huge liberty in allowing me to enter, but seeing all the women outside, I did not exactly feel flattered. So I stood awkwardly on some stumps of the fence, literally and metaphorically straddling the barrier.
We played some games with sequence pictures, that amused me because I painted them in watercolor. They depicted things like people pooing in the woods, so it was pretty funny when people asked if they could keep them and hang them in their huts. In the end I quizzed everyone and gave out prizes to the people who knew the answers. These prizes consisted of all the knick-knacks you all have generously sent throughout my time here, that I didn't want to give away as random cadeaux. So the very end became a lesson about yo-yo's, paint-by-numbers, pot-holder making, and best of all, BUBBLES. Most of you should already know how I feel about bubbles, but here, they hover at the very peak of excitement. Blowing bubbles for a group of kids who have never seen them before is in all honesty the Very Best Thing in the world.
So fete fecale seemed a success.... Then again, the very next day I helped build a mud hut. To do this, you need water, dirt, and... POO! (Animal manure; fret not.) It was quite gross. We mix it all up with our hands and then slather it all over the walls (previously made the same way) with our hands. I tried not to think about how people are committed in my country for this sort of thing. The smell was quite bad, but I especially disliked all the maggots, worms, and other bugs in the poo now crawling on my hand until I spread them on the wall. I had a sour expression on my face for the first ten minutes that made everyone laugh. Three hours later, I was a pro. One lady accidentally smeared her entire full hand of poo mixture all over my butt, but I just calmly let someone else rinse it off like I was a baby and continued working.
A real baby came in a pooed herself (no pampers here!) quite appropriately in the giant mound of animal excrement. They sort of cleaned it and soon after brought in a bowl of food which they set just on the edge of this mound. Some people squatted in it. "See, this is what I was talking about! Fecal matter getting in your food makes you sick!" I said, exasperated. I'd spent a chunk of my lesson plan illustrating how it could get into food from things like flies and chickens without us knowing. But I forgot to take into account that people don't even mind eating literally in a pile of feces....
"Haha, yeah, yeah, you're right! Come eat!" At least it was the porridge eaten with ladles since everything else is eaten with hands. Remember, ours are covered in poo. I still said I wasn't hungry, thanks.
Just pooped out.