Sunday, January 27, 2008


Here are several "mini-blogs" I've been writing that I haven't had time to post individually. Also, all our luggage finally arrived as you may have read along with all the medical supplies, thankfully. The pediatric BP cuffs are going to be a welcome part of the pediatric HIV treatment roll-out. I delivered the masks and gloves to some very grateful lab staff here. They will make their difficult jobs safer. The cute card from the United Methodist children is in our FGH office! Thanks to everyone for their generosity; these things will go a long way here.

Adventure in Namacurra: Last Thursday I went to Namacurra to check on the lab there. It was a somewhat slow day with few requests for lab tests and still fewer TB samples. After spending a few hours in the lab I realized I had neglected to bring water. I headed out to find our driver and get some water or Coke in town. We found a little stand and I had my Coke and we got some water to take to Dr. Paulo. We stopped in the market so I could buy some white sweet potatoes for Kev's and mine dinner that night. In Mozambican markets, you buy things by the “lugare” or place. They build little piles of produce on the ground and that's the unit of sale. I asked the vendor how much each lugare of potatoes was. He replied “10 contos.” That's about 20 cents. By this time, our driver had gotten out of the car and started berating the vendor. “Ten contos! You know it's 5! You're going to charge this Doctora 10?!” The vendor sheepishly agreed to 5 contos for each place. Our driver collected the 2 places I asked for and I gave the man 10 contos. Back in the car, the driver chided me, “This is why you shouldn't go to the market alone. These guys will try to cheat you!” I didn't have the heart to say that whether my huge bag of sweet potatoes cost 40 cents or 20 cents didn't make much of an impact on my financial life. I'm well aware that I get charged more in the market than anyone else (you'd have to be entirely stupid not to catch on to that.) But, I felt kind of bad for the guy who worked hard growing those potatoes in the field. Produce costs so ridiculously little (a pineapple right now is between 10 and 20 cents) and these farmers labor so hard to scratch out an existence that I don't really mind paying extra sometimes. Still, I appreciate the driver looking out for me.

On the way back, we saw FGH's Mozambican social assistant and 2 Peace Corps volunteers that are working with us, so they hopped in for a ride back to the hospital. I was in the front passenger seat, talking to our other passengers when one of them gave a gasp. I had just time to turn my head and close my eyes when I heard a loud pop and safety glass from the windshield burst all over me. The driver slammed on the brakes and I looked out the cracked windshield to see a small man stalking away and scowling at us ferociously over his shoulder. The large chunk of rock or metal he had thrown slowly slid off the hood of the car. My heart nearly stopped as I looked at his twisted expression; thinking this was my first experience with someone truly hating foreigners. But the social assistant said, “No, I recognize him. He's maluco.” He's the local mentally ill resident. Turns out he frequently throws rocks at women, children, cars, animals, whomever momentarily offends him for whatever obscure reason. We went to the local police building to make a report. They wrote out a description of the accident by hand and stamped it. They told our driver, “Yes, we are familiar with this man. He's crazy. We tell people to stay away from him.” Apparently that's all that can be done. There is no place for him where he can be kept from harming other people. (And a rock of that size thrown at a child's head could easily be lethal.) There is no treatment for mental illness, even severe mental illness and psychosis like this man may have. For most of Mozambique, the physically ill have trouble enough getting care, but the mentally ill are truly out of luck.

Patients: A young woman came in the Inhassunge lab with her sister and a small capulana wrapped bundle and handed me a slip for an HIV test. I introduced myself and told her to please sit in the chair by the testing materials. She sat the bundle on her lab and unwrapped it. Inside was a tiny, scrawny baby. He could not have weighed 6 pounds. On every limb, bones, joints, and ligaments stood out in a most unbabylike way. I've never seen a baby's patella before. I tried to think of the Portuguese words for “Was he born today?” but could only manage, “How many days old is he?” The mother replied, “He's one month old.” It's times like these that I'm grateful for the practice my medical training gave me in controlling my facial expressions. She was anxiously watching me as she said this. I nodded and picked up a tiny foot, no longer than my thumb. I cleaned it with alcohol and stuck the poor thing with the lancet. The baby let out a tiny mew and tried to kick. I gingerly kept a grip on the foot and ankle and squeezed a drop of blood into the little capillary tube and put it on the rapid antibody test strip with reagent. Thankfully, it was negative, one of the few that day. So what was the problem? Intrauterine growth retardation? Congenital metabolic disorder? Congenital malformation of the GI track? Allergy? Continual infections? Diarrhea? Abuse? Difficult to know here.

Colors: Mozambique is a jewel toned country, especially now during the rainy season. The sky is an electric sapphire that can't be relegated to the background of the landscape. It has a presence. You feel the brightness of this sky and the sunlight that pours out of like heavy gold. You can't ignore that either, especially if you're standing in it. It will fry your brains (that's a medical term). I had to wait sitting in the sun on the boat coming back from Inhassunge one day at about 1pm. I felt I better understood tales of people losing their minds from wandering around in the sun. When I got home I realized that my legs had gotten sunburned in splotchy places through my pants. The plants on the ground are vivid green from soaking up all the tropical rain and even the dirt is rich black or blood and rust red, never pale clay. There are tons of little birds I've never seen before, bright gold, ruby, and iridescent green that swoop through the bushes. Some have long sweeping tail feathers and some hide in little twig houses that hang from yellow-green tree branches. There are flowering trees so covered in vivid red-orange blossoms that from far away you would say they are on fire. While we were home over Christmas, lots of people commented on the bright colors worn by people in our pictures. I hadn't really noticed that before, I guess because the bright colors people wear seem to fit into the landscape somehow. They belong more than pastels would. Many clothes come from second hand markets. People at the market shop with a taste for the bright and flamboyant, with no knowledge of the designer's original intent for the garment. So occasionally you see a man sporting a woman's red satin button down or one of those crinkly shirts with lace trim. It's kind of refreshing really. The pointier the shoes; the orangier and more Hammer style the pants; the more covered in butterflies the shirt the better. They walk proudly in their finery, calling to mind the bold, brightly colored birds and butterflies native to this country. It's pretty clear Puritanism would not have gone over well here. Actually, it's hard to imagine Puritanism being popular anywhere but under a gray, cloudy sky isn't it?

Rain: The heat had slowly increased throughout the day in Inhassunge until it reached a truly suffocating level. The staff told me it meant the rain was coming, even though I could see no clouds in the sky. I was in the lab when the rain began to fall softly. It was the first time I'd seen rain there. It pattered pleasantly on the tin roof of the building. I smiled in relief at the sudden coolness and went to the screen door to watch. Suddenly, the pitter of the rain on the roof turned into a startling and deafening roar. It became hard to see people across the courtyard as sheets of water fell from the sky. The drainspouts started to gush and the water exiting them sprayed 1 or 2 feet before hitting the ground. Small rivulets in the sand turned into rushing gullies. This went on for about 20 minutes. It looked to me as if the whole hospital would be washed away. I began to look around at other people to see if anyone else was concerned. Everyone had stopped working since no one could hear and was watching the rain. Some were rushing to put out containers to catch the clean rainwater. But no one looked particularly worried. Then, as suddenly as it started, it stopped. You could see the last sheet of water hit the ground and then no more. The sun came back out and clouds of steam rose from the wet sandy ground.

That afternoon, as we headed the 18km back to the dock in the truck, we crossed the flat expanse of rice fields near the shore of the river. You can see for miles in this particular spot because there aren't many tall trees. There were billowing piles of angry storm clouds that towered into the blue sky, but that weren't very wide. Across the horizon you could see three or four cloud columns and the rain falling beneath them. In between the columns, it was sunny. This is an odd thing about rain here. The rain comes down like someone overturning a giant trough in the sky, complete with thunder and lightning, for 30 mins or an hour in a very contained space. Then it stops and moves on. Rarely is the whole sky covered with clouds. The one time this happened, I noted it because it was the first time I've felt all the muscles around my eyes relax when I was outside. Once in Namacurra I saw it rain across the street but not where I was standing.


Blogger Laine said...

How very interesting. I feel that I can SEE what you are writing.
Take care.

January 29, 2008 at 8:31 AM  
Anonymous Anonymous said...

I agree with your view on market prices but those vendors are not the farmers who grow the produce. They sometimes are relatives but mostly they are 'middle men' making a poor living on the difference between country & city prices.

February 11, 2008 at 11:38 AM  

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