Sunday, April 6, 2008


A couple of weeks ago I traveled to Gile to start the TB project I'm working on there. It was a 6 hour drive over bumpy roads. We had the new gestor do dados for Gile and her two kids (surprise!) in tow, so it was a bit cramped in the back seat of the truck. After stopping in Mocuba a couple hours into the trip, I watched with misgivings as she poured a bottle of thick fruit juice in her toddler's mouth. Sure enough, the inevitable result of combining bumpy roads, toddlers, and lots of fruit juice occurred, necessitating a stop on the side of the road. The mom ran to some nearby huts to change clothes after wiping off the kid. She gave him to the other kid, a tiny girl, maybe 5, to hold. She looked likely to topple under his weight so I swung him up and addressed the damage with my water bottle and an old shirt.

We rolled up in Gile with Mt. Gile in the distance. It was a tiny bit cooler than low-lying Quelimane. Emilio is our physician there. He's Spanish impossibly energetic, and hugely friendly. He took me on rounds at the hospital. The different wards are in tiny round concrete buildings, shaped like traditional homes. The design idea behind this is mystifying because only three beds will fit in each building and none of the square furniture fits. The pediatric ward had patients with marasmus and kwashiokor. Lacking any capability for G-tubes, IVF, or other interventional feeding, they were doing frequent milk feedings in the hospital. We saw the TB ward. We saw a young woman who had initially come to the hospital to be dewormed, but was epileptic, had a seizure and fell into a fire. She was laying on her stomach under a net in a crudely built structure with stick walls. Her back was pale pink and covered in iodinated bandages. Emilio told that she was lucky and will do well because she really wanted to live. He had a cheerful word and pats or handshakes for everyone and it was clear the patients all like him. We visited the maternity ward where he told me that 2 women had died last week of uterine rupture. He introduced me to the on-duty nurse who came forward and vigorously shook my hand when he told her I was going into OB/GYN.

A walk before dinner led Emilio, Daniel (who works in community action for FGH), and I through the market where people sold cooking oil in little plastic baggies and goat meat on the freshly butchered skins and then down a dirt road littered with sparkling chunks of green quartz (or something) to the river. Emilio had his camera and took pictures of the little gangs of kids that gathered to watch us. When the flash went off they would scream, laugh, run off, and congregate further done the road to wait for us. A sly young man joined our walk and asked if we wanted to buy gems. The area around Gile is famous for gem mining, though little of the profit seems to be returned to the local community. However, the reputation makes it a good environment for hucksters looking for someone to cheat with a hunk of quartz. The river was full and fast from all the recent rain. It ran right by the imposing Mt. Gile in the distance. We could see storm clouds gathering around it. As the evening wore on, a lightning storm danced in the clouds in an impossibly huge sky.

We had dinner with Emilio, prepared for us by the amazing Sergio. Emilio, who has lived in Mozambique for 10 years, hired him away from another employer in Maputo and brought him to Gile to do the cooking and cleaning. He is a fantastic cook. I heard stories from Daniel about eating difficulties in Gile without a restaurant that could even make some beans and rice for you. He usually brought cans of tuna, but now that Emilio and Sergio were there, we were in luck. I had brought a bunch of fruit along the road as a host gift as it is hard to come by in Gile. The first night Sergio made some delicious rice and sauce. Next he brought out a large bowl filled with a bright green pudding substance. I took a taste. It was avocado, but mixed with lemon and sugar. Avocadoade. It was kind of ice creamy and actually really good once you got over the surprise. “Sergio,” I asked “What is this?” “Avocado.” “I know, but I mean, what is it called?” “Avocado.” “Does the dish have a name?” “Avocado.” He's a man of few words. After that he brought out REAL coffee. Now, we have been having a coffee shortage in Quelimane (more specifically a ground coffee shortage). Kevin and I had been sipping weak tea in the mornings for several weeks. No offense to the British, but it wasn't cutting it. Apparently Emilio has an Italian importer friend from whom he buys some really good stuff (cheese, coffee, pasta, etc.). Here I was in the middle of nowhere, enjoying better coffee and Parmesan than you can get in Quelimane.

A flash light would have been a good thing to remember on my way to a place without electricity or sell phone service. Emilio lives in a house powered by a generator for a few hours each night. Outside the rain fell into blackness. He let us borrow his head lamp for the walk back to the pensão. We could only see a few feet ahead of us at a time. Because of the storm there was no star or moonlight. It was truly black as pitch. We could hear voices of people laughing and talking in their homes as we passed. Some had candles or kerosene lanterns. Back at the pensão, Daniel waited with the flashlight while I lit the 1 candle provided by the pensão. He went to his room and I stood in the middle of mine, a bare candle in my hand listening to the rain and thunder. The rain was coming in the window screen. I decided to leave it open anyway, because I knew the heat would become insufferable with no air movement. There was no holder for the candle, so I dumped my cashews out of an old olive jar I brought and leaned the candle in there. Then I took my first bucket bath! I set the olive jar with my only light on the non-functional sink and surveyed the bath situation. There was a plastic bucket of cold water on the bathroom floor and a plastic dipping cup. I pulled my soap out of my back pack and started at my feet, figuring that would be easiest. I decided to leave my hair until the morning. Bedtime! I tried to maneuver the candle as close to the bed as possible without igniting the mosquito net. I moved too quickly and the flame wavered ominously. If it died now, I was in trouble because I wasn't sure where I had set the matches. I quickly arranged the box of matches in a corner with palpable landmarks and settled in to read a bit. I brought Crime and Punishment. I was not exactly feeling turn of the century, despondent working class Russia. Originally, Kevin and I thought we'd bring a lot of classic books to Mozambique, thinking we'd have time to appreciate and discuss. This turned out to be not as good an idea as I thought. Many of these books address serious social issues, failings of civilization, or universal questions about human nature. Sometimes these topics, while poignant, and can also be rather depressing. It was actually getting kind of difficult for me to see sick, starving, and dying children and adults all day in Mozambique and then also feel guilty about never having lived in a Hooverville like in The Grapes of Wrath or forced to march across the dessert like in What is the What. It's harder to see the redeeming and hopeful parts of these stories when you're surrounded by living examples of the misery described. Anyway, after a passage describing the main character's garret lit by a stub of candle began to seem strangely familiar, I worked up the nerve to shut the book and blow out the candle. Actually kind of hard to do through the mosquito net. Utter pitch dark blackness swallowed the room. “Don't be a baby, Lara,” I admonished myself. No reason to freak out. All the same, I stuck a hand out of the net and felt for the matches. Good. Easy to reach.

My sleep was interrupted by only one bedbug/rat nightmare. This seems to happen in every new bed I sleep in in Mozambique. It's pretty obvious what I have anxieties about. The next morning I addressed the hair issue. Getting my hair wet all the way through with the bucket was actually pretty difficult, especially since it has grown out some. Finally, I just dunked my whole head in the bucket and then soaped it up. Upending the rest of the bucket of cold water on myself definitely got my blood pumping.

On the last day, at the lab, Dr. Kizito came in to ask if we could do a gram stain on some “liquido cephalo-something” It was a new term for me, but I was pretty sure I knew what the combination of “liquido” and “cephalo” would entail. I asked the laboratorians if they had the reagents for a gram stain. “No” they replied unequivocally and Dr. K went away. Remembering to myself that Emilio had mentioned something about a gram stain, I instigated a search and found 4 dusty, filthy, browned bottles labeled “crystal violet,” “sarafina,” etc. They looked ancient. I searched for an expiration date on the bottle. June 2003. These went out of date before I entered medical school. Would they still work? How does a dye go out of date? I didn't think any of these were particularly volatile compounds. Did the lab guys know they were there? Hard to tell. I ran after Dr. K. and explained that we'd give it a try but I couldn't promise anything cause the reagents were ancient. He brought a syringe of crystal clear (Nice tap!) fluid. That boded better for the patient than cloudy fluid anyway. I put on a mask (no sense in being colonized with a meningitis bug) and put a few drops on a slide. There no instructions on the bottles. Should I leave the dye on a long time because of the age? I had no idea so I did a few minutes with the dyes and less with decolorizor. When it was all done, I took it over to the solar microscope. I had never seen one of these before. There is a mirror where the light source normally is and you direct sunlight onto the plate. Looking through the eyepieces, it was pretty dim. I couldn't see much on the slide. Either the dye hadn't stained, there weren't many bacteria to begin with, everything had washed off the slide, or I couldn't see anything because of the low light. I could hear the cries of a patient brought in the day before. A woman whom a homemade brick wall fell on. She was paralyzed from the waist down and terrified. Emilio had given her anti-inflammatories and put her in a brace in the hopes that the paralysis was due to swelling and inflammation around the spinal cord and not due to permanent damage. Without any way to image the spine or spinal cord, that was all that could be done.

Emilio popped into the lab where I was dealing with TB project training with the lab guys and told me the patient we heard about last night had arrived. Umbilical cord prolapse. She needed to come the night before but one of the ambulance drivers had gone with visiting Ministry of Health dignitaries to outlying areas and the other one no one could find, even after checking with all his friends. (There's no phone service, cell or otherwise, in Gile.) The nurses helped her out of the ambulance and into the treatment room. Poor woman was heavily pregnant and stumbling. On exam, the umbilical cord was visible and pulseless. One tiny hand was projecting into the birth canal. Emilio listened for fetal heart sounds and didn't find any. A craniotomy was briefly discussed, but finally it was decided it would be better to send her to Alto Molocue where there is sometimes a surgeon. The woman was already feeling warm so he gave her antibiotics and sent her another several hours down a bumpy dirt road.

We left by noon on our last day, aiming to squeeze in the return 5-6 hour drive back to Quelimane before dark.


Blogger Laine said...

Such an interesting unusual account. Seems like you are getting a life time of experiences in short order.
Thanks for sharing.
Take care

April 10, 2008 at 9:28 AM  
Blogger Alwin Co Daan said...

Great Article. Thank you for sharing! Really an awesome post for every one.
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