From Computer Class:
In computer class today, we were learning about the internet. We were looking at allafrica.com, a good source for African news, and there was a link with a picture of Obama. It read “Ask President Obama about Africa.” Upon clicking the link, we discovered that allafrica.com was going to compile a list of questions for Obama from its readers’ submissions and then present the questions to him when he visits Ghana on July 10-11. Here is our question:
We are employees of the National Organisation for Welbody,a Sierra Leonean NGO. We run a clinic that focuses on giving free health care and education to the amputee community in Kono District, Sierra Leone.
As you may know, Sierra Leone suffered a terrible civil war for eleven years, during which amputation was used to intimidate and torture innocent people. These amputees continue to face great challenges in their daily lives and the climb out of poverty is even more difficult for them.
Africa is home to many different groups of marginalized people. Fortunately, there is now plenty of funding for the largest groups, for example HIV/AIDS victims. However, we want to know: how will you include smaller marginalized groups, like the amputee community, in your development plan for Sub-Saharan Africa?
We brainstormed together, and then wrote it together, and then after they typed it in (a process that took about twenty minutes) I edited it. To be honest, though, the issue for a group like the amputees is not just money. It’s opportunity and options as well. Like anyone else on the planet, amputees and their dependents need education and capital to get ahead, to make their ideas work. Handouts are not helpful, but sometimes foreign policies like cotton subsidies crush the economic possibilities of a West African farmer without him ever knowing it. It’s also important to remember that even the amputee communities are not free from corruption*; any aid needs to be monitored to make sure that it is being used in good faith. In the end, there is no single idea or perspective that will catapault areas like the Kono District from the fifteenth century to the twenty-first. It’s going to be a slow process, with many disappointments. With NOW, Katie and I have front row seats to (we’re even participating in) the struggle to eradicate poverty and provide all human beings with the opportunity to have a healthy and fulfilling life.
*I’m compiling a longer blog entry on corruption that I will post eventually. It’s a subject that requires care, and I want to give an accurate picture of both how corruption fits into the Sierra Leonean society and how Bailor and NOW interact with it. For now, suffice it to say that Bailor’s passionate desire to keep NOW a transparent and honest role model organization is effective and inspiring but not without challenges.
Wednesday, July 1, 2009
Malaria by Moonlight Part II
“It’s twelve.” Abu’s father woke us up three minutes before my alarm. Bori was instantly on his feet, and I followed suit, grabbing my headlamp. Actually, the strap of my headlamp is broken, so it’s just an oddly shaped flashlight now. Nonetheless, I’m glad we had it. It was dark; no moon yet.
First was Fanta. The medication schedules for each patient were written in pen on A4 paper. There were three ruled columns: time, medication, and signature. Fanta’s treatments were scheduled at 4, 8, 12, 4, and 8, alternating between quinine and glucose. This one was quinine. Abu’s treatments were at 4:25, 12:25, and 8:25, only quinine. Fatmata’s treatments were at 5, 1, and 9.
We moved the lantern on to the bed. If I hadn’t been there, that would have been the only light. Bori said, “Shine the light,” and motioned to the plastic bin containing the medications for Fanta. I complied.
A bug landed on my leg. Then, another bug. Another one. I looked at the lantern. There wer bugs everywhere. Big, stupid flies, dropping out of the darkness and flying straight into the light with sickening insectile crunches. Then they crawled around stupidly on the bed. And they were on the floor too. And not just big flies, but small, biting ones too, like large fleas.
Fanta stirred a bit while we changed her medication, but not too much. Bori kept passing me things to hold, and summoning my light around. Fanta’s mother watched silently. I checked Fanta’s pulse, and gave an encouraging murmur and nod to her mother. It was mostly so that she believed her daughter was in good hands.
We moved over to Abu. Bori wasn’t moving quickly, but the shadows from the lights gave the jars of medication a surreal cast. The needle on the end of the syringe was very difficult to see in the dim light, even though glints off of its metallic surface bounced around the room. I think the soft but distressed noises Abu was making also contributed to the tense atmosphere. Bori himself was quieter, concentrating very hard.
Bori gave Abu an injection while I held Abu’s shoulder. Through my hand I could feel Abu respond to the bizarre and painful feeling of having fluid injected. First his shoulder shuddered, and then it switched to rhythmic attempts to get free. But he didn’t cry out very loud.
“You’re very brave, Abu.” I think I was the only one in the room who knew what the word brave meant. But I hoped that my tone would communicate enough.
“Shine the light here.” Bori gave me a curt command. He was looking at the small chamber beneath the jar of medicine. I shone my light straight down into it, taking care not to flash Abu or his father in the eyes with the light. Bori and I looked at the droplets forming. I fumbled in my pocket for the watch; in France we always timed these; but Bori was already convinced it was okay. We headed back to our beds for a twenty minute nap.
We lay down. Abu was crying, louder. I thought about getting up to see if he was alright. Abu kept crying. I thought again about getting up. Then Bori got up, so I followed him.
We looked around for a moment with the flashlight. I stopped on the medication jar, which had been full of neon yellow fluid ten minutes ago. It was empty. Bori breathed in sharply. “It’s too fast, too fast.” I flicked the flashlight down the line. No leaks. So I guessed that the medication had drained into Abu too quickly, causing him pain. I can only imagine what the quinine feels like, coursing through his veins. A grown adult has only a few liters of blood; a thirty pound three year old has far fewer. There wasn’t a lot to dilute the quinine. I could feel it burning in my own veins, just thinking about it. I wiped his brow with my bandana.
Bori unhooked the line and Abu’s father gathered him up into his arms. We checked on Fanta’s drip. It wasn’t empty yet, but not much remained. Bori instructed Fanta’s mother in Krio, and she nodded. Then Bori strode back over to Fatmata.
“Why so hot? We faut open de windows so le’ cool some.” I agreed. It was a gorgeous cool night outside. The instant I pulled back the window, the sound of crickets filled the room. I noticed that the moon was climbing in the sky. “Dere a net?” Bori was referring to the screen, which was in place.
“Yes.”
“Shine the light.” Bori was peering at the medication instructions. The columns on this form were a little crooked, but the instructions were clear. Bori filled three syringes with the three different antibiotics. Fatmata’s mother secured her baby on her lap. Then Bori held out the capped tip of a syringe to me. I pulled the cap off. “No.” Oh, he wanted me to take the cap and the needle. I carefully replaced the cap and then twisted the cap and needle combination. It came off. Bori opened up the line and injected the antibiotic into Fatmata. We repeated this for two more syringes, and then I handed the caps back to Bori.
“One, two, three.” I dropped them in his hand in order. He replaced them all.
Cooler, drier air was filling the room now that the windows were open. The moon was bright enough now to cast shadows. Before returning to sleep, Bori and I hung the bag of glucose solution for Fanta, so that at 4am all we would have to do was turn on the drip. She was still asleep and rarely stirring. Bori and I lay back down on our worn out mattress. I set my cellphone alarm for 4am.
“You set de alarm?”
“Yeah. For 3:53am.”
Instead of counting sheep as I went to sleep, I counted Abu’s breathing rate. More than 30 breaths per minute. I was worried about him, but I knew his pulse was still normal. I didn’t know what I could do; so I drifted off to sleep.
When the alarm went at 4am, I experienced a vague moment of haughty dislike for the owner of that annoying cellphone ring. Then I realized it was mine, and that it was in my pocket.
“Do we get up now?” Bori asked. I thought, no, we’re done. A sleepy thought.
“Yeah, it’s 3:57.” Bori was on his feet, fumbling them into his flipflops. I followed with my light.
“Shine the light.” Bori motioned to the highest drip chamber on Fanta’s IV. We watched a few drops fall. “Okay.” I checked Fanta’s pulse. Abu’s breathing had lessened in intensity and decreased in speed. I carefully shone the light on Fatmata, and I could see her stomach rising and falling. Then we went back to sleep.
In the morning, Sasseko woke me up with his cleaning. The sun was coming up, and it was 6:36, according to the cellphone. I sat down and wrote most of this, before the new patients for today arrived.
By 7:30, Fanta was awake and laughing. Abu was awake and silently staring out at the world. His belly was still distended and round, with his belly button protruding. I spent a moment with Fanta because I was amazed at how fast she had gone from semi-conscious at 4pm the day before to laughing and alert at 7:30am.
“Good morning, Fanta. How de body?” I sat on the edge of Abu’s bed, facing Fanta. She was standing beside her bed.
“E’ done greet you now,” said Fanta’s mother, to Fanta. Fanta didn’t look scared, but she looked wary. I reached out and shook her hand with my thumb and two fingers.
“You de get welbody, Fanta. A proud.” You’re healthy, Fanta. I’m proud.
A few minutes later we gave Abu his final round of quinine. He whimpered a bit at first, when the quinine started coursing in his veins, but his dad whispered, “Abu, Abu, be man, Abu, hush...” and Abu was quiet.
On the other hand, Fanta was making up for her silence the day before. I carefully kept her legs in place, and her mother kept her shoulders and arms still, but nothing was stopping her impressive cries. I took that to be a very good sign; she was healthy enough to throw up such a spirited resistance.
Fatmata was also awake, and very suspicious of me. However, she too looked much better. Soon she went home with her family.
Fanta had another round of glucose solution maintenance for her hydration, so she stayed around until about 1pm. Abu’s father was 2000Le short on payment, so Yusuf refused to take out the IV line from Abu’s hand until the dad found the money. As both Bailor and Allan have told me, although there is plenty of poverty in the Kono District, there is also plenty of family support. If someone really needs 2000Le for health, they can almost always find the money somewhere in the family.
Soon the clinic was back to being hot and sweaty. When Abu said goodbye, he didn’t take my hand, he only looked intensely at me, as if he hadn’t noticed I was expecting him to greet me back. But I didn’t mind. It was much better to see the three pikin (Krio word for children) walking around than sweating from malaria under the moonlight.
First was Fanta. The medication schedules for each patient were written in pen on A4 paper. There were three ruled columns: time, medication, and signature. Fanta’s treatments were scheduled at 4, 8, 12, 4, and 8, alternating between quinine and glucose. This one was quinine. Abu’s treatments were at 4:25, 12:25, and 8:25, only quinine. Fatmata’s treatments were at 5, 1, and 9.
We moved the lantern on to the bed. If I hadn’t been there, that would have been the only light. Bori said, “Shine the light,” and motioned to the plastic bin containing the medications for Fanta. I complied.
A bug landed on my leg. Then, another bug. Another one. I looked at the lantern. There wer bugs everywhere. Big, stupid flies, dropping out of the darkness and flying straight into the light with sickening insectile crunches. Then they crawled around stupidly on the bed. And they were on the floor too. And not just big flies, but small, biting ones too, like large fleas.
Fanta stirred a bit while we changed her medication, but not too much. Bori kept passing me things to hold, and summoning my light around. Fanta’s mother watched silently. I checked Fanta’s pulse, and gave an encouraging murmur and nod to her mother. It was mostly so that she believed her daughter was in good hands.
We moved over to Abu. Bori wasn’t moving quickly, but the shadows from the lights gave the jars of medication a surreal cast. The needle on the end of the syringe was very difficult to see in the dim light, even though glints off of its metallic surface bounced around the room. I think the soft but distressed noises Abu was making also contributed to the tense atmosphere. Bori himself was quieter, concentrating very hard.
Bori gave Abu an injection while I held Abu’s shoulder. Through my hand I could feel Abu respond to the bizarre and painful feeling of having fluid injected. First his shoulder shuddered, and then it switched to rhythmic attempts to get free. But he didn’t cry out very loud.
“You’re very brave, Abu.” I think I was the only one in the room who knew what the word brave meant. But I hoped that my tone would communicate enough.
“Shine the light here.” Bori gave me a curt command. He was looking at the small chamber beneath the jar of medicine. I shone my light straight down into it, taking care not to flash Abu or his father in the eyes with the light. Bori and I looked at the droplets forming. I fumbled in my pocket for the watch; in France we always timed these; but Bori was already convinced it was okay. We headed back to our beds for a twenty minute nap.
We lay down. Abu was crying, louder. I thought about getting up to see if he was alright. Abu kept crying. I thought again about getting up. Then Bori got up, so I followed him.
We looked around for a moment with the flashlight. I stopped on the medication jar, which had been full of neon yellow fluid ten minutes ago. It was empty. Bori breathed in sharply. “It’s too fast, too fast.” I flicked the flashlight down the line. No leaks. So I guessed that the medication had drained into Abu too quickly, causing him pain. I can only imagine what the quinine feels like, coursing through his veins. A grown adult has only a few liters of blood; a thirty pound three year old has far fewer. There wasn’t a lot to dilute the quinine. I could feel it burning in my own veins, just thinking about it. I wiped his brow with my bandana.
Bori unhooked the line and Abu’s father gathered him up into his arms. We checked on Fanta’s drip. It wasn’t empty yet, but not much remained. Bori instructed Fanta’s mother in Krio, and she nodded. Then Bori strode back over to Fatmata.
“Why so hot? We faut open de windows so le’ cool some.” I agreed. It was a gorgeous cool night outside. The instant I pulled back the window, the sound of crickets filled the room. I noticed that the moon was climbing in the sky. “Dere a net?” Bori was referring to the screen, which was in place.
“Yes.”
“Shine the light.” Bori was peering at the medication instructions. The columns on this form were a little crooked, but the instructions were clear. Bori filled three syringes with the three different antibiotics. Fatmata’s mother secured her baby on her lap. Then Bori held out the capped tip of a syringe to me. I pulled the cap off. “No.” Oh, he wanted me to take the cap and the needle. I carefully replaced the cap and then twisted the cap and needle combination. It came off. Bori opened up the line and injected the antibiotic into Fatmata. We repeated this for two more syringes, and then I handed the caps back to Bori.
“One, two, three.” I dropped them in his hand in order. He replaced them all.
Cooler, drier air was filling the room now that the windows were open. The moon was bright enough now to cast shadows. Before returning to sleep, Bori and I hung the bag of glucose solution for Fanta, so that at 4am all we would have to do was turn on the drip. She was still asleep and rarely stirring. Bori and I lay back down on our worn out mattress. I set my cellphone alarm for 4am.
“You set de alarm?”
“Yeah. For 3:53am.”
Instead of counting sheep as I went to sleep, I counted Abu’s breathing rate. More than 30 breaths per minute. I was worried about him, but I knew his pulse was still normal. I didn’t know what I could do; so I drifted off to sleep.
When the alarm went at 4am, I experienced a vague moment of haughty dislike for the owner of that annoying cellphone ring. Then I realized it was mine, and that it was in my pocket.
“Do we get up now?” Bori asked. I thought, no, we’re done. A sleepy thought.
“Yeah, it’s 3:57.” Bori was on his feet, fumbling them into his flipflops. I followed with my light.
“Shine the light.” Bori motioned to the highest drip chamber on Fanta’s IV. We watched a few drops fall. “Okay.” I checked Fanta’s pulse. Abu’s breathing had lessened in intensity and decreased in speed. I carefully shone the light on Fatmata, and I could see her stomach rising and falling. Then we went back to sleep.
In the morning, Sasseko woke me up with his cleaning. The sun was coming up, and it was 6:36, according to the cellphone. I sat down and wrote most of this, before the new patients for today arrived.
By 7:30, Fanta was awake and laughing. Abu was awake and silently staring out at the world. His belly was still distended and round, with his belly button protruding. I spent a moment with Fanta because I was amazed at how fast she had gone from semi-conscious at 4pm the day before to laughing and alert at 7:30am.
“Good morning, Fanta. How de body?” I sat on the edge of Abu’s bed, facing Fanta. She was standing beside her bed.
“E’ done greet you now,” said Fanta’s mother, to Fanta. Fanta didn’t look scared, but she looked wary. I reached out and shook her hand with my thumb and two fingers.
“You de get welbody, Fanta. A proud.” You’re healthy, Fanta. I’m proud.
A few minutes later we gave Abu his final round of quinine. He whimpered a bit at first, when the quinine started coursing in his veins, but his dad whispered, “Abu, Abu, be man, Abu, hush...” and Abu was quiet.
On the other hand, Fanta was making up for her silence the day before. I carefully kept her legs in place, and her mother kept her shoulders and arms still, but nothing was stopping her impressive cries. I took that to be a very good sign; she was healthy enough to throw up such a spirited resistance.
Fatmata was also awake, and very suspicious of me. However, she too looked much better. Soon she went home with her family.
Fanta had another round of glucose solution maintenance for her hydration, so she stayed around until about 1pm. Abu’s father was 2000Le short on payment, so Yusuf refused to take out the IV line from Abu’s hand until the dad found the money. As both Bailor and Allan have told me, although there is plenty of poverty in the Kono District, there is also plenty of family support. If someone really needs 2000Le for health, they can almost always find the money somewhere in the family.
Soon the clinic was back to being hot and sweaty. When Abu said goodbye, he didn’t take my hand, he only looked intensely at me, as if he hadn’t noticed I was expecting him to greet me back. But I didn’t mind. It was much better to see the three pikin (Krio word for children) walking around than sweating from malaria under the moonlight.
Malaria by Moonlight Part I
I sat down on the edge of the bed and took hold of the little boy’s arm, firmly but gently. He was radiating heat, even in the hot African afternoon. He was sweating, and he was scared.
According to the medical form, Abu was three years old. (Out here in Kono, using only first names to identify people provides an unprecedented level of anonymity; there are more repeated names here than in A Hundred Years of Solitude.) His father had brought him to the clinic about 2pm that day, just as Katie and I slipped out for lunch. The chief complaint was his distended abdomen. As I quickly noticed, he also had an intense fever.
Almost every patient who comes to Yusuf, the nurse, gets a malaria test. It is common, dangerous, and the test is cheap. It’s especially dangerous for children who have nutritional problems. Abu’s malaria test came back ‘++’, which meant that he had between 10 and 20 malarial parasites per viewing field on the microscope. His hemoglobin concentration, however, was 7.0g/dL. That’s about half of the median recommended value.
Yusuf had prescribed him a course of quinine during an overnight stay, and now we were all gathered round the middle bed in the observation room, trying to put in the IV line. Yusuf, Bori, Confort, were all buzzing around the bed with jars, vials, and syringes. Abu’s father was quietly holding Abu’s legs with both hands. I was holding Abu’s arms.
At this point all I knew was that Abu had severe malaria. This confused me a bit, because while the malarial test result, fever, and hemoglobin concentration all matched, the distended abdomen didn’t fit. The next morning I learned that Abu had been given a large quantity of traditional herbs by someone, but Bori couldn’t tell me whom. I’m not sure if Bori knew but couldn’t say, or if Bori didn’t know but the father knew.
I’m no doctor, but usually the liver filters and otherwise deals with chemicals entering the blood, and when large quantities of strange chemicals come through, it can get temporarily damaged. When it’s damaged, it filters at a slower rate, which increases the blood pressure and causes water to be forced out of the blood into the spaces between cells, especially where the pressure is highest – right by the liver. Bori told me that it could take Abu weeks to recover from the damage from the herbs.
I could feel a slick layer of sweat forming between my hand and Abu’s forearm, which I was controlling. Confort handed me an alcohol pad to open and then hand to Yusuf. Yusuf carefully wiped the area above Abu’s wrist. Then he pulled a syringe device out of a package. It was a syringe with a rubber tube on the inside. All the adults braced, but Abu just kept crying at the same intensity. He didn’t know what was next. Yusuf had already tied off Abu’s arm with rubber just below the elbow, so I guess Yusuf could see where the vein lay. I couldn’t.
Yusuf stuck in the needle. Abu screamed more, and tried a bit harder to get free. When the needle was in, Yusuf slid the rubber tube through the needle into Abu’s vein. Then Yusuf removed the metal needle and attached a small plastic apparatus, kind of like a tap, to the end of the tube. A bit of blood came out of the apparatus before he could close it. “Gloves...” Yusuf shook his head. No one was wearing any. I actually hadn’t seen a pair since I arrived.
Confort and Bori, I think, were setting up the small jar of medicine. Confort was busily uncapping syringes, inserting them through rubber seals into small glass jars with long scientific names on them, withdrawing some small quantities, removing the syringes and capping the needles. Sometimes she diluted with water after drawing some chemical into the syringe. This involved holding the plastic water container at an angle, inserting the syringe through a small hole in the top, and pulling in water to the right amount. The largest glass jar was already hanging from the IV stand, and every now and then Confort would inject something right into this jar, through its rubber seal. The Krio all around was loud and argumentative, but it was mostly gibberish to my ears.
“Hold on. A de go for de get towel, a de soak towel an putam na de pikin.” I parroted a section of our malaria health module to Yusuf and the dad, and then motioned for the dad to hold Abu’s arm as well. Yusuf was in control of the arm with the IV.
I ducked outside and soaked my bandana in well water. I shook it off a bit, then came back in and wiped Abu’s brow a few times. It may have been coincidence, but he calmed down quite a bit. Amhidu was reclining on the third bed in the observation room, and he laughed. “You de soak towel, an’ putam na de pikinbody.” He quoted part of Katie and my health module on malaria.
After a while, the line was hooked up and the yellow medicine was dripping slowly down into Abu. Yusuf went back to the consulting room for one last patient, but Bori and Abu’s dad stayed. Abu’s dad and I kept him from flipping and twisting to prevent him from hurting the IV connection.
Abu actually wasn’t the only patient in the observation room. The first bed was occupied by Fanta, also three. I’d found all my computer class students while they were putting the IV into Fanta’s wrist. She also had ++ malaria, and she was very dehydrated. Later on that evening, her mother explained to me that Fanta had been in another hospital for two days, but she wasn’t getting better, so the mother pulled her out and brought her to our clinic. Putting in her IV had been much less eventful; she was very dehydrated and weak. I think there was something in the medicine that was making her sleep. Her treatment was a four-hour alternation between quinine for malaria and glucose solution for her dehydration. Every now and then I watched carefully to see if she was breathing, and took her pulse. It’s all I really know how to do, but it’s a good warning sign. If it’s too slow and weak, something is wrong. If it’s too fast, something is wrong. Otherwise, at least the heart is working alright. as Abu went to sleep, Fanta began to stir, so I moved over and made sure she didn’t damage her IV while flailing in her sleep. Her mother had gone home to get some things for staying the night.
“Wait. So Bori, you are going to stay with the patients tonight?”
“Yes.” Bori looked at me with his trademark wide-eyed excited look.
“Okay.” An idea was forming. Why couldn’t Katie and I stay too? We’d just need to duck back to Uncle Ben’s for a couple of things. That would only take two hours of walking, or twenty minutes of forbidden motorbiking.
“Hey Amhidu, could Katie and I stay here tonight, to stay and help Bori?” Amhidu laughed at me. I think he finds Katie and my enthusiasm a bit entertaining.
“Doctor Chris, you want to stay close to the patients?”
“Well, I’m just wondering if there will be enough places to sleep. I figure there’s the third observation bed, Allan’s room, the consulting room, and is there a mattress?”
“Hmm?”
“What do you guys do when there are more people than beds here?”
“There is a mattress that we use only when we have too many people.”
“Perfect.”
In a few minutes, I asked Bori.
“Hey Bori. Could Katie and I stay here tonight and help you take care of the patients?”
“Hmm. Ask Yusuf.” I was a bit surprised that Bori hadn’t immediately thought it was a good idea, but there was a good chance he just didn’t understand me, or that he didn’t want to overstep his authority.
When Yusuf finished his consultation, I asked him. “Yusuf, could Katie and I stay here tonight and help Bori take care of the patients?”
“You want to stay to help with the patients?” I nodded. “Till daybreak, all the way?” I nodded again. “Well, that is a great idea! Great, great. Bori!” Yusuf yelled for Bori, and told him what was happening. Bori was excited.
So Katie and I headed back. We picked up grilled meat and bread sandwiches on the way. We were back at the clinic by 7:45pm, just as the sun was vanishing. There were three tiny women bowing and praying on a rug on the porch of the clinic. Each one was wearing a different African pattern of yellow, green, and blue.
Inside, Fanta was still asleep, but now her mother was sitting beside her on the bed, cradling the arm with the IV. “How de body?” I asked.
“No’ bad.” She looked worried.
“How Fanta?”
“She sleep nomo.” She only sleeps. I nodded.
“I’ good. She de get welbody.” That’s good. She’ll get healthy. Fanta’s mother looked unconvinced.
Abu was asleep, but breathing noisily.
Abu’s father was out in the waiting room with a black plastic bag. I assumed he had some food inside. “You de sweat!” He said. I laughed.
“No, a been wass!” No, I washed! He seemed confused.
Out in the waiting room, I met the third patient, Fatmata. She was bouncing on her mother’s lap. Her mother was one of the women I had seen bowing outside, and she was slight and young. The other two girls were also her daughters, I think. Fatmata was a very chubby 10-month-old. I won’t lie, I don’t mind seeing chubby children in Kono. She seemed pretty unhappy, however. According to her chart, she had been brought to the hospital simply because of her fever. We gave her a mix of three antibiotics at 5pm, 1am, and 9am, so I inferred that she had some kind of bacterial infection. Her IV tube went in on the inside of her elbow, and she seemed much healthier than the other two.
Before we left to go back to Uncle Ben’s, Katie had been recruited to help with Fatmata’s IV placement. Unfortunately Katie was most unpopular with Fatmata, who may forever associate ‘white’ people with terrible pointy needles. In any case, Katie was trying really hard to comfort her.
Fanta never stirred, but Abu eventually woke up and walked around a bit. We disconnected his IV when he awoke. Katie and I worked a bit on OpenMRS, occasionally checking in on the patients, and Bori took advantage of the power to try the typing program Allan installed on the desktop. He loved it.
Eventually Bori pulled out a double-bed-sized mattress and tossed it on the ground at the door to the observation room. In the process he unplugged the generator power cord. I winced, because the desktop had been on. Oh well... Bori said to me, “You can sleep here.”
“Well, where will you sleep?” We had already decided Katie would sleep in Allan’s room.
“Don’t worry about me!” Bori clapped me on the shoulder.
“I can just sleep like this,” I lay down the wrong way on the mattress, so that my feet hung off the edge and there was an obvious space for another person. Bori liked that.
“Okay, good.”
We turned off the lights. I set up a small lantern in the observation room so that no one tripped over any cords, and then I lay down to sleep. I offered Katie her watch, but she let me keep it. I set the alarm for 11:57pm. There were a lot of bugs; it was the first time in Africa that I’ve been legitimately annoyed by bugs while going to sleep. I also thought about how glad I was that I took my Malarone (malaria prohpylaxis) – there were plenty of mosquitoes. The buzzing annoyed me to sleep.
According to the medical form, Abu was three years old. (Out here in Kono, using only first names to identify people provides an unprecedented level of anonymity; there are more repeated names here than in A Hundred Years of Solitude.) His father had brought him to the clinic about 2pm that day, just as Katie and I slipped out for lunch. The chief complaint was his distended abdomen. As I quickly noticed, he also had an intense fever.
Almost every patient who comes to Yusuf, the nurse, gets a malaria test. It is common, dangerous, and the test is cheap. It’s especially dangerous for children who have nutritional problems. Abu’s malaria test came back ‘++’, which meant that he had between 10 and 20 malarial parasites per viewing field on the microscope. His hemoglobin concentration, however, was 7.0g/dL. That’s about half of the median recommended value.
Yusuf had prescribed him a course of quinine during an overnight stay, and now we were all gathered round the middle bed in the observation room, trying to put in the IV line. Yusuf, Bori, Confort, were all buzzing around the bed with jars, vials, and syringes. Abu’s father was quietly holding Abu’s legs with both hands. I was holding Abu’s arms.
At this point all I knew was that Abu had severe malaria. This confused me a bit, because while the malarial test result, fever, and hemoglobin concentration all matched, the distended abdomen didn’t fit. The next morning I learned that Abu had been given a large quantity of traditional herbs by someone, but Bori couldn’t tell me whom. I’m not sure if Bori knew but couldn’t say, or if Bori didn’t know but the father knew.
I’m no doctor, but usually the liver filters and otherwise deals with chemicals entering the blood, and when large quantities of strange chemicals come through, it can get temporarily damaged. When it’s damaged, it filters at a slower rate, which increases the blood pressure and causes water to be forced out of the blood into the spaces between cells, especially where the pressure is highest – right by the liver. Bori told me that it could take Abu weeks to recover from the damage from the herbs.
I could feel a slick layer of sweat forming between my hand and Abu’s forearm, which I was controlling. Confort handed me an alcohol pad to open and then hand to Yusuf. Yusuf carefully wiped the area above Abu’s wrist. Then he pulled a syringe device out of a package. It was a syringe with a rubber tube on the inside. All the adults braced, but Abu just kept crying at the same intensity. He didn’t know what was next. Yusuf had already tied off Abu’s arm with rubber just below the elbow, so I guess Yusuf could see where the vein lay. I couldn’t.
Yusuf stuck in the needle. Abu screamed more, and tried a bit harder to get free. When the needle was in, Yusuf slid the rubber tube through the needle into Abu’s vein. Then Yusuf removed the metal needle and attached a small plastic apparatus, kind of like a tap, to the end of the tube. A bit of blood came out of the apparatus before he could close it. “Gloves...” Yusuf shook his head. No one was wearing any. I actually hadn’t seen a pair since I arrived.
Confort and Bori, I think, were setting up the small jar of medicine. Confort was busily uncapping syringes, inserting them through rubber seals into small glass jars with long scientific names on them, withdrawing some small quantities, removing the syringes and capping the needles. Sometimes she diluted with water after drawing some chemical into the syringe. This involved holding the plastic water container at an angle, inserting the syringe through a small hole in the top, and pulling in water to the right amount. The largest glass jar was already hanging from the IV stand, and every now and then Confort would inject something right into this jar, through its rubber seal. The Krio all around was loud and argumentative, but it was mostly gibberish to my ears.
“Hold on. A de go for de get towel, a de soak towel an putam na de pikin.” I parroted a section of our malaria health module to Yusuf and the dad, and then motioned for the dad to hold Abu’s arm as well. Yusuf was in control of the arm with the IV.
I ducked outside and soaked my bandana in well water. I shook it off a bit, then came back in and wiped Abu’s brow a few times. It may have been coincidence, but he calmed down quite a bit. Amhidu was reclining on the third bed in the observation room, and he laughed. “You de soak towel, an’ putam na de pikinbody.” He quoted part of Katie and my health module on malaria.
After a while, the line was hooked up and the yellow medicine was dripping slowly down into Abu. Yusuf went back to the consulting room for one last patient, but Bori and Abu’s dad stayed. Abu’s dad and I kept him from flipping and twisting to prevent him from hurting the IV connection.
Abu actually wasn’t the only patient in the observation room. The first bed was occupied by Fanta, also three. I’d found all my computer class students while they were putting the IV into Fanta’s wrist. She also had ++ malaria, and she was very dehydrated. Later on that evening, her mother explained to me that Fanta had been in another hospital for two days, but she wasn’t getting better, so the mother pulled her out and brought her to our clinic. Putting in her IV had been much less eventful; she was very dehydrated and weak. I think there was something in the medicine that was making her sleep. Her treatment was a four-hour alternation between quinine for malaria and glucose solution for her dehydration. Every now and then I watched carefully to see if she was breathing, and took her pulse. It’s all I really know how to do, but it’s a good warning sign. If it’s too slow and weak, something is wrong. If it’s too fast, something is wrong. Otherwise, at least the heart is working alright. as Abu went to sleep, Fanta began to stir, so I moved over and made sure she didn’t damage her IV while flailing in her sleep. Her mother had gone home to get some things for staying the night.
“Wait. So Bori, you are going to stay with the patients tonight?”
“Yes.” Bori looked at me with his trademark wide-eyed excited look.
“Okay.” An idea was forming. Why couldn’t Katie and I stay too? We’d just need to duck back to Uncle Ben’s for a couple of things. That would only take two hours of walking, or twenty minutes of forbidden motorbiking.
“Hey Amhidu, could Katie and I stay here tonight, to stay and help Bori?” Amhidu laughed at me. I think he finds Katie and my enthusiasm a bit entertaining.
“Doctor Chris, you want to stay close to the patients?”
“Well, I’m just wondering if there will be enough places to sleep. I figure there’s the third observation bed, Allan’s room, the consulting room, and is there a mattress?”
“Hmm?”
“What do you guys do when there are more people than beds here?”
“There is a mattress that we use only when we have too many people.”
“Perfect.”
In a few minutes, I asked Bori.
“Hey Bori. Could Katie and I stay here tonight and help you take care of the patients?”
“Hmm. Ask Yusuf.” I was a bit surprised that Bori hadn’t immediately thought it was a good idea, but there was a good chance he just didn’t understand me, or that he didn’t want to overstep his authority.
When Yusuf finished his consultation, I asked him. “Yusuf, could Katie and I stay here tonight and help Bori take care of the patients?”
“You want to stay to help with the patients?” I nodded. “Till daybreak, all the way?” I nodded again. “Well, that is a great idea! Great, great. Bori!” Yusuf yelled for Bori, and told him what was happening. Bori was excited.
So Katie and I headed back. We picked up grilled meat and bread sandwiches on the way. We were back at the clinic by 7:45pm, just as the sun was vanishing. There were three tiny women bowing and praying on a rug on the porch of the clinic. Each one was wearing a different African pattern of yellow, green, and blue.
Inside, Fanta was still asleep, but now her mother was sitting beside her on the bed, cradling the arm with the IV. “How de body?” I asked.
“No’ bad.” She looked worried.
“How Fanta?”
“She sleep nomo.” She only sleeps. I nodded.
“I’ good. She de get welbody.” That’s good. She’ll get healthy. Fanta’s mother looked unconvinced.
Abu was asleep, but breathing noisily.
Abu’s father was out in the waiting room with a black plastic bag. I assumed he had some food inside. “You de sweat!” He said. I laughed.
“No, a been wass!” No, I washed! He seemed confused.
Out in the waiting room, I met the third patient, Fatmata. She was bouncing on her mother’s lap. Her mother was one of the women I had seen bowing outside, and she was slight and young. The other two girls were also her daughters, I think. Fatmata was a very chubby 10-month-old. I won’t lie, I don’t mind seeing chubby children in Kono. She seemed pretty unhappy, however. According to her chart, she had been brought to the hospital simply because of her fever. We gave her a mix of three antibiotics at 5pm, 1am, and 9am, so I inferred that she had some kind of bacterial infection. Her IV tube went in on the inside of her elbow, and she seemed much healthier than the other two.
Before we left to go back to Uncle Ben’s, Katie had been recruited to help with Fatmata’s IV placement. Unfortunately Katie was most unpopular with Fatmata, who may forever associate ‘white’ people with terrible pointy needles. In any case, Katie was trying really hard to comfort her.
Fanta never stirred, but Abu eventually woke up and walked around a bit. We disconnected his IV when he awoke. Katie and I worked a bit on OpenMRS, occasionally checking in on the patients, and Bori took advantage of the power to try the typing program Allan installed on the desktop. He loved it.
Eventually Bori pulled out a double-bed-sized mattress and tossed it on the ground at the door to the observation room. In the process he unplugged the generator power cord. I winced, because the desktop had been on. Oh well... Bori said to me, “You can sleep here.”
“Well, where will you sleep?” We had already decided Katie would sleep in Allan’s room.
“Don’t worry about me!” Bori clapped me on the shoulder.
“I can just sleep like this,” I lay down the wrong way on the mattress, so that my feet hung off the edge and there was an obvious space for another person. Bori liked that.
“Okay, good.”
We turned off the lights. I set up a small lantern in the observation room so that no one tripped over any cords, and then I lay down to sleep. I offered Katie her watch, but she let me keep it. I set the alarm for 11:57pm. There were a lot of bugs; it was the first time in Africa that I’ve been legitimately annoyed by bugs while going to sleep. I also thought about how glad I was that I took my Malarone (malaria prohpylaxis) – there were plenty of mosquitoes. The buzzing annoyed me to sleep.
House and Machete
I was restless. It was dusk, and I was alone at Uncle Ben’s. Yann Martel’s Life of Pi was lying on the bed beside me, spent. So I went for a walk. That is, I went for a stroll, as Krio speakers are liable to look at you as if you are crazy if you tell them you are going for a walk, and if you instead mention the word stroll, they instantly understand.
Case in point: To begin my stroll, I left Uncle Ben’s and turned right instead of the usual left. I followed the road along a ridge around to the west of Uncle Ben’s, through a schoolyard with a red dusty field, past maybe fifty different steaming pots of rice and twenty unabashedly fascinated children. That landed me amidst a narrow grid of orange-red clay houses. The path was very narrow, and I walked through more than one front yard, and had to graciously decline a dinner invitation. Then I turned a corner and was face to face with three girls, about my age.
“Eh!” One of them made the peculiar high-pitched squeak that is ubiquitous in Sierra Leone. “Ousai you de go?” Where are you going? She looked affronted.
I shrugged. “Jus’ strolling.”
“Ohhhh.” All three nodded in agreement. It was a fine night for strolling. Nothing amiss here. I proceeded on, over a narrow path through a swamp, and then found my way back to Uncle Ben’s.
But I was still restless, so I left again. This time I walked down the main road out of town. Perhaps ten minutes southeast of Uncle Ben’s, the main road dips into a kilometer wide valley. The valley floor is a checkerboard of swamp, bush grasses and boulders, with rolling hills in the distance. Some are bald save the light green fuzz of freshly planted rice, and others have a smattering of palm trees. Tall old growth trees are rare, and from a distance it’s hard to tell whether the bush grasses at the feet of the palms and trees is two feet high or ten feet high.
The main road itself is typical of Koidu Town; somebody paved it once upon a time, but now the pavement bears more resemblance to the moon than the 401 and so all the vehicles drive with one wheel on pavement and the other wheel on the shoulder. This road isn’t as bad as some; on the Kainkordu Rd. in town, the pedestrians walk on the pavement in the middle of the road and the vehicles use the shoulder. It’s a strange inversion, as strange as the backwards development that has left Koidu Town with these roads. It was the diamonds, the locals will say. Before the war, they go on, with a clichéd widening of their eyes, Koidu was very big, with lots of money. Everyone was coming, and you could find diamonds just walking along the road after a rain. But the rebels took it all, they end. I’m never sure how much to believe the fairytale vision of Koidu. I believe the part about the rebels.
In the middle of the valley, off the road to the right, I noticed a shell of tiny house. It was made from orange-brown clay bricks, but all that remained was most of the exterior walls and window frames. One of the two corners closest to the road was smashed, and it looked uninhabited. That last point was a bit odd, because throughout Koidu there are similar ruins of houses brimming with people that clearly still live there. Amhidu confirmed my suspicion that by and large the inhabitants of such ruins are not the original owners.
The house was perched on a rocky promontory, above the valley, set back thirty paces from the road. At the end of the valley the sun was sneaking away into hazy obscurity instead of broadcasting a sunset across the sky. It seemed kind of fitting in the humidity. I thought about going to sit down on the edge of the promontory as I first passed the house, but didn’t.
A little further along I came to a bridge. I stopped, pulled out my cellphone and looked at it with purpose so that my fellow pedestrians wouldn’t think I was lost, and then turned around and walked back to the little house.
There was a path going past the house that was quite well-worn. The fork that headed towards the house, however, was very overgrown. I cut around to the left of the house, paused, and then sat down on the rock face.
First I considered the clouds. Some were puffy cumulonimbus clouds, filling out like anvils just as the textbooks say they do. But layered between those clouds were hazier white clouds, obscuring the sun. I don’t know the name for these clouds. Katie often points out how majestic the clouds are here, but I didn’t think they were very different from clouds anywhere else until I could think of a good reason for the difference – the humidity. Poor Katie, she’s very patient.
Those clouds weren’t majestic, though. They were calm. The hazy white clouds cast a fog over the hills, so that as they shrank into the distance they also vanished into the mist. For some reason palm trees stand out particularly well against hazy fog, so I could see many spiky palm trees silhouetted against the sky. For a few minutes, I was calm too.
All around me cricket chirps competed with car and motorbike engines. My mind kept wandering back to the idea that I was just far enough off the road, with my back to the path, the sun going down and no one else around, to be a great target for robbery. In general Koidu Town is safe, but the unspoken rule in Sierra Leone is that you don’t present an opportunity for crime, not if you’re wise.
I waited a minute longer. There’s some youthful pride in me that hates to let quasi-rational fears dictate my actions. At least right away. After thinking about it for a moment, and promoting the idea to fully-rational status, I stood up to leave.
Immediately I was face to face with a small boy, maybe eleven years old. He was staring at me intently, with a very serious face. In his hands was a giant machete. He was hugging it absentmindedly.
In retrospect, the machete wasn’t giant; he was small. At the time, though, my brain filled with images from A Long Way Gone, a book written by a former child soldier from Sierra Leone. And I heard the voice of Bailor, explaining about the amputations. “Foday Sankoh recruited the youths. And the small boys, they were too small for guns, but you can give them a knife, you can give them a machete, and then you give them some drugs, and then...” He says the word ‘machete’ with only two syllables. There’s no “eee” on the end – it sounds like “mash-et.”
“Good evening, sir.” I spoke deeply and firmly.
“Good evening,” he mumbled back, eyes still wide and fixated on me. We paused a moment. Then he set off down the well-worn path, and I walked back up to the road, restlessness gone.
Case in point: To begin my stroll, I left Uncle Ben’s and turned right instead of the usual left. I followed the road along a ridge around to the west of Uncle Ben’s, through a schoolyard with a red dusty field, past maybe fifty different steaming pots of rice and twenty unabashedly fascinated children. That landed me amidst a narrow grid of orange-red clay houses. The path was very narrow, and I walked through more than one front yard, and had to graciously decline a dinner invitation. Then I turned a corner and was face to face with three girls, about my age.
“Eh!” One of them made the peculiar high-pitched squeak that is ubiquitous in Sierra Leone. “Ousai you de go?” Where are you going? She looked affronted.
I shrugged. “Jus’ strolling.”
“Ohhhh.” All three nodded in agreement. It was a fine night for strolling. Nothing amiss here. I proceeded on, over a narrow path through a swamp, and then found my way back to Uncle Ben’s.
But I was still restless, so I left again. This time I walked down the main road out of town. Perhaps ten minutes southeast of Uncle Ben’s, the main road dips into a kilometer wide valley. The valley floor is a checkerboard of swamp, bush grasses and boulders, with rolling hills in the distance. Some are bald save the light green fuzz of freshly planted rice, and others have a smattering of palm trees. Tall old growth trees are rare, and from a distance it’s hard to tell whether the bush grasses at the feet of the palms and trees is two feet high or ten feet high.
The main road itself is typical of Koidu Town; somebody paved it once upon a time, but now the pavement bears more resemblance to the moon than the 401 and so all the vehicles drive with one wheel on pavement and the other wheel on the shoulder. This road isn’t as bad as some; on the Kainkordu Rd. in town, the pedestrians walk on the pavement in the middle of the road and the vehicles use the shoulder. It’s a strange inversion, as strange as the backwards development that has left Koidu Town with these roads. It was the diamonds, the locals will say. Before the war, they go on, with a clichéd widening of their eyes, Koidu was very big, with lots of money. Everyone was coming, and you could find diamonds just walking along the road after a rain. But the rebels took it all, they end. I’m never sure how much to believe the fairytale vision of Koidu. I believe the part about the rebels.
In the middle of the valley, off the road to the right, I noticed a shell of tiny house. It was made from orange-brown clay bricks, but all that remained was most of the exterior walls and window frames. One of the two corners closest to the road was smashed, and it looked uninhabited. That last point was a bit odd, because throughout Koidu there are similar ruins of houses brimming with people that clearly still live there. Amhidu confirmed my suspicion that by and large the inhabitants of such ruins are not the original owners.
The house was perched on a rocky promontory, above the valley, set back thirty paces from the road. At the end of the valley the sun was sneaking away into hazy obscurity instead of broadcasting a sunset across the sky. It seemed kind of fitting in the humidity. I thought about going to sit down on the edge of the promontory as I first passed the house, but didn’t.
A little further along I came to a bridge. I stopped, pulled out my cellphone and looked at it with purpose so that my fellow pedestrians wouldn’t think I was lost, and then turned around and walked back to the little house.
There was a path going past the house that was quite well-worn. The fork that headed towards the house, however, was very overgrown. I cut around to the left of the house, paused, and then sat down on the rock face.
First I considered the clouds. Some were puffy cumulonimbus clouds, filling out like anvils just as the textbooks say they do. But layered between those clouds were hazier white clouds, obscuring the sun. I don’t know the name for these clouds. Katie often points out how majestic the clouds are here, but I didn’t think they were very different from clouds anywhere else until I could think of a good reason for the difference – the humidity. Poor Katie, she’s very patient.
Those clouds weren’t majestic, though. They were calm. The hazy white clouds cast a fog over the hills, so that as they shrank into the distance they also vanished into the mist. For some reason palm trees stand out particularly well against hazy fog, so I could see many spiky palm trees silhouetted against the sky. For a few minutes, I was calm too.
All around me cricket chirps competed with car and motorbike engines. My mind kept wandering back to the idea that I was just far enough off the road, with my back to the path, the sun going down and no one else around, to be a great target for robbery. In general Koidu Town is safe, but the unspoken rule in Sierra Leone is that you don’t present an opportunity for crime, not if you’re wise.
I waited a minute longer. There’s some youthful pride in me that hates to let quasi-rational fears dictate my actions. At least right away. After thinking about it for a moment, and promoting the idea to fully-rational status, I stood up to leave.
Immediately I was face to face with a small boy, maybe eleven years old. He was staring at me intently, with a very serious face. In his hands was a giant machete. He was hugging it absentmindedly.
In retrospect, the machete wasn’t giant; he was small. At the time, though, my brain filled with images from A Long Way Gone, a book written by a former child soldier from Sierra Leone. And I heard the voice of Bailor, explaining about the amputations. “Foday Sankoh recruited the youths. And the small boys, they were too small for guns, but you can give them a knife, you can give them a machete, and then you give them some drugs, and then...” He says the word ‘machete’ with only two syllables. There’s no “eee” on the end – it sounds like “mash-et.”
“Good evening, sir.” I spoke deeply and firmly.
“Good evening,” he mumbled back, eyes still wide and fixated on me. We paused a moment. Then he set off down the well-worn path, and I walked back up to the road, restlessness gone.
Health Education Modules: Tricks we've learned
In presenting the health education modules in the amputee camps, Katie and I have learned a bunch of tricks. This post is going to be all the tricks that I’ve learned or that Katie told me she learned, or that I noticed Katie uses effectively. She probably knows a bunch more that I just haven’t noticed. I’ll have to ask after I finish the list!
1. It’s planting season, so it’s better for us to gather as many people together at one time as possible and then for all four of us (Jalloh, Amhidu, Katie, me) to present together. Initially we were going house-by-house, with the goal of keeping the audiences small. The audiences were non-existent, so we switched to the group method. Another asset of the group method is that the entire community can here the questions that other community members ask.
2. There are some questions that get asked every time, and so we now incorporate those right into our presentation. For example, “Can you get HIV from a mosquito?” – No, although that is a perfectly valid, even insightful question. I think the reason why is that the mosquito ‘needle’ is far too small to carry enough virus to infect another person. We explain that the mosquito doesn’t inject any blood, because it wants all the blood for itself, and that malaria is specially suited to living in mosquitoes’ mouths, and that’s why you can get malaria but not HIV from a mosquito. The scientist in me makes a face when we say that, but I’d rather not start a trend of uninformed amputee camp members thinking that small exposures to HIV are okay...
Another common question in our teenage pregnancy section goes as follows: “What do you do if, even though you try and try and try to watch your pikin (child), they still run off with boys and do business (have sex)?” The answer: It’s really tough, but you have to have patience and teach them how to use and where to get condoms and birth control. I don’t have any more experience with that situation than most other 22 year old Canadian guys, so it feels weird to answer such a question, but it’s important nonetheless.
3. Our translators sometimes extemporize and go into the next part of the presentation before we say it in English. We’ve learned that it’s not a big deal; it’s only when people are asking questions that we demand precise translations. Otherwise, Amhidu and Jalloh act as good cultural as well as linguistic translators.
4. English acronyms don’t work in Krio. I’ve given up trying to explain the ABCD prevention system for HIV/AIDS (Abstain, Be faithful, use a Condom, Don’t use unsterilized skin piercing instruments). Instead I just explain and number each point.
5. It helps to position ourselves in the obvious exit to the space we have been given for teaching. That makes it much more difficult for people to wander out when they get bored.
6. Similarly, learning a couple of names can go a long way. When a person whose name you know tries to slink away, we just call out nicely and they usually come right back.
7. The order of presentation needs to be flexible to the situation. For example, a fight nearby once attracted fifteen or twenty teens and preteens. We called them all over and immediately cut to the teen pregnancy section.
8. Make sure that all audience members are in the shade and will be in the shade throughout the presentation. Otherwise they will leave when the sun reaches them.
9. Learning and then using some of the Kono vocabulary for our modules always gets a big laugh and wakes up the audience. Katie does this very well. For example, she always uses ‘chima’, the Kono word for fever.
That’s all for now. Tomorrow morning Katie and I are presenting in the Motemas, the last two camps. We’re not sure whether that will take one or two days, but soon we will be changing over to the surveys that we will use to assess how much the amputee communities retained the information in our modules.
1. It’s planting season, so it’s better for us to gather as many people together at one time as possible and then for all four of us (Jalloh, Amhidu, Katie, me) to present together. Initially we were going house-by-house, with the goal of keeping the audiences small. The audiences were non-existent, so we switched to the group method. Another asset of the group method is that the entire community can here the questions that other community members ask.
2. There are some questions that get asked every time, and so we now incorporate those right into our presentation. For example, “Can you get HIV from a mosquito?” – No, although that is a perfectly valid, even insightful question. I think the reason why is that the mosquito ‘needle’ is far too small to carry enough virus to infect another person. We explain that the mosquito doesn’t inject any blood, because it wants all the blood for itself, and that malaria is specially suited to living in mosquitoes’ mouths, and that’s why you can get malaria but not HIV from a mosquito. The scientist in me makes a face when we say that, but I’d rather not start a trend of uninformed amputee camp members thinking that small exposures to HIV are okay...
Another common question in our teenage pregnancy section goes as follows: “What do you do if, even though you try and try and try to watch your pikin (child), they still run off with boys and do business (have sex)?” The answer: It’s really tough, but you have to have patience and teach them how to use and where to get condoms and birth control. I don’t have any more experience with that situation than most other 22 year old Canadian guys, so it feels weird to answer such a question, but it’s important nonetheless.
3. Our translators sometimes extemporize and go into the next part of the presentation before we say it in English. We’ve learned that it’s not a big deal; it’s only when people are asking questions that we demand precise translations. Otherwise, Amhidu and Jalloh act as good cultural as well as linguistic translators.
4. English acronyms don’t work in Krio. I’ve given up trying to explain the ABCD prevention system for HIV/AIDS (Abstain, Be faithful, use a Condom, Don’t use unsterilized skin piercing instruments). Instead I just explain and number each point.
5. It helps to position ourselves in the obvious exit to the space we have been given for teaching. That makes it much more difficult for people to wander out when they get bored.
6. Similarly, learning a couple of names can go a long way. When a person whose name you know tries to slink away, we just call out nicely and they usually come right back.
7. The order of presentation needs to be flexible to the situation. For example, a fight nearby once attracted fifteen or twenty teens and preteens. We called them all over and immediately cut to the teen pregnancy section.
8. Make sure that all audience members are in the shade and will be in the shade throughout the presentation. Otherwise they will leave when the sun reaches them.
9. Learning and then using some of the Kono vocabulary for our modules always gets a big laugh and wakes up the audience. Katie does this very well. For example, she always uses ‘chima’, the Kono word for fever.
That’s all for now. Tomorrow morning Katie and I are presenting in the Motemas, the last two camps. We’re not sure whether that will take one or two days, but soon we will be changing over to the surveys that we will use to assess how much the amputee communities retained the information in our modules.
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