May 25, 2010 -- El Transito, Nicaragua

Hello from Nicaragua!

Leaving the Airport in Houston

I’ve actually been here a week already, but the internet is spotty, and I’ve been using all my opportunities to check my email. I’m currently in El Transito, Nicaragua, a small fishing town about an hour outside Managua (the capital) on the Pacific coast.

El Transito, Nicaragua

El Transito is not exactly as I expected. For one, the town is much less poor than Bwiam, where I spent last summer. Additionally, the food is not only near-plentiful, but delicious. Even the chickens than run around the area are fatter, and there are more dogs – from which breeds are almost distinguishable. I’m developing a theory that you can rank per-capita GDP of a region by how different the average dog looks from the nondescript brown shorthaired mutt so common in the developing world.

There are cows, pigs, and horses wandering around, too. The horses use this property, Rancho Fifo, as a byway to move from one street to the other, as it has big open gates at either end.

I’m here as a sort-of emissary from Rice doing construction work and teaching English. Beth started organizing this trip independently in the Fall, but worked extensively with Mac and secured a grant to send us here. The whole operation is orchestrated by Julie Edwards, who was driving through Central America 3 years ago looking to build a beach house. Mesmerized by the sunset over the Pacific, she found herself stranded, a woman alone in a rental car at night. One of the local families let her stay with them, and she decided that instead of building a beach house, she would instead dedicate her resources to building a community center in El Transito.

Sunset over the Pacific, El Transito, Nicaragua

So that’s what we’re working on. The community center was pretty much finished last week, but we’re still moving dirt to fill in holes and carting wood around. There’s a beautiful little classroom in the center, as well as a room that will be converted into a sort of dorm for volunteers. It’s all cement, still unpainted, but (the beautiful part is) the cement keeps everything cool inside, and there are fans on the ceiling. And lights. And outlets with standard American plugs from which to charge, for example, Beth’s laptop. We work under the direction of Oscar, a man in his mid-twenties (?) who serves as the project’s site manager. He’s great. His new wife, Belkis, cooks us fantastic lunches.

We’re also, as I mentioned, teaching English classes. We teach one class at around 10AM (meaning we teach at 10 Nicaragua time, which usual translated to 10:30 or later) and split up to teach 2 more at 4; one for los jovenes (teenagers, mostly ages 13-15) and ninos, ranging from 6-13.

Beth and Manivel teach los jovenes, and we concentrate on whatever topic they ask us to address, but usually end up wandering around the point. The overarching idea, though, is to improve pronunciation by engaging in conversation with native English speakers. Our conversations, though, have been pretty limited… it’s hard when everyone is at a different level.

Kathleen and Lisa teach los ninos at the primary school at the top of the hill, and the classes usually follow the same pattern as a Montessori kindergarten or first grade. Lisa is Beth’s sister, and doesn’t go to Rice – she’s studying to be an elementary school teacher, so even though her Spanish is extremely limited, she’s in her element. We’ve been concentrating on basic vocabulary and conversational questions, so naturally, everyone’s favorite activity is (following a round of “Head, Shoulders, Knees, and Toes”) dancing the Hokey Pokey. Pronouncing the word “shoulders,” though, seems a nigh-impossible task.

Kathleen and Lisa teaching at the Primary School

Some of the students are really exceptional. I’ve befriended a girl named Roxana, who is pretty good, and a boy named Julio adopted Kate and Beth last year and is still hanging around. Of the adults, one woman, Gina, is very good – she spent a while in the states when she was in high school, and understands English quite well, though she likes to practice speaking with us. She’s amazing. We’re all in love with a nine-year old named Amilcar. Amilcar doesn’t come to our classes – he’s a troublemaker with a bad family situation – but we all feel for him and want his situation to improve. If I could adopt Amilcar, I would.

Roxana

We haven’t done a lot outside of our official capacity. We have, though, taken advantage of the hotel’s natural saltwater pool. I’ve also used our long walks between the hotel and the town (it’s about 1 km, or 20 minutes on the hot, soft basaltic sand) to collect tons of shells and sand dollars that wash up in the tide. The waves are too fierce and the currents too strong for swimming, but they’re incredible… the waves often exceed 10 feet, and crash over basalt breakers that resemble small mountains. Over the weekend, during which I read 2 books and played Hearts and BS for hours, over 2 feet of sand (we estimate) were eroded from the beach in storms, revealing the weathered sandstone bedrock below.

Manivel, in awe of my Prowess at Cards

We’ve also befriended the cook/housekeeper/yoga instructor at the hotel, Lindsay. She left Santa Cruz, CA, four years ago after she graduated from high school, and has been traveling around the world ever since. She’s spending a few weeks working in Nicaragua with her husband, Ben (they met in Australia) before traveling around Central America for a while longer and going home (finally) in July.

Hotel Grounds

Sunset from the Hut, Looking North

I’m learning useful vocab, too. For example, muñeca = puppy, garrapata = tick, pinca = tweezers, and navaja = Swiss Army knife, or rather, any of those multi-tools with lots of different implements that fold together. And that’s in the last 10 minutes. Oscar has a new muñeca named Fox, and he is really, really adorable. The hotel, too, has a kitten named Zanita, or little carrot. She’s hilarious.

Zanita

Fox, with Beth

I fly to DC on Sunday (it’s Tuesday) but hopefully I’ll be able to post again before I leave!

Monday, July 20 -- SJGH

I don't really feel like writing a novel like I have been, so this is going to be a lot shorter.

It's funny being here -- half the people we meet could have walked directly out of a brilliant novel. The other have are geniuses, hiding here in the middle of nowhere. Here's a short rundown.

Mr. Badjie -- the CEO of the hospital. He studied in England, and was asked by the President to head the hospital. He would have gone back to the UK anyways, but his friend from Tanzania told him that if he left, he would be "just one more drop in the ocean," so he stayed. A tiny man, he is very well-respected and well-known throughout the country. However, he could literally have stepped out of a novel: every morning, a man (who has, I think, no other job; the hospital employs a large portion of the town to do very little) cleans Mr. Badjie's glittering Nissan SUV (complete with leopard-print seat covers). Then, Mr. Badjie gets in a drives the 200 meters to the administrative building, where he works. He'll walk back to his house, which is directly across from our quarters, for lunch, and then drives home in the evening, to start the process over.

President Jammeh -- called "His Excellency," the President's face is everywhere. The cell phone companies "congratulate" him on "building the foundation of the Gambia" in big billboards, and banners celebrate his birthday. Cloth is sold in the markets emblazoned with his face, to be made into full outfits work by most of the ladies -- especially approaching July 22, the anniversary of the coup in which the President took power in 1994. But that's not the best part. His Excellency President Jammeh travels in a huge glittering motorcade that looks surprisingly like an American one, only with fewer limos, and from his window he throws cookies. Bags and rolls of oat cookies and coconut cookies and lemon cookies -- and they're all for the little kids -- the soldiers with machine guns will glare at you if you go for them. A dozen or so kids die from it every year, running out into the road for cookies (they really are that good, by the way) and then getting smacked by the next car in the caravan.

Mr. Sarr -- the 3rd in command at the hospital, Mr. Sarr would be the antihero of a dystopian novel. He is never in his office, and is always feigning urgent work. Reeally, he goes to a department and sits to talk. If you are looking for him (it usually takes about half an hour, especially if you bother to check his office at all) and find him somewhere, he will claim another errand, and move his lack-of-operations somewhere else. It will then take a further 45 minutes to actually do anything. And forget about setting up a meeting -- you'll have to get Mr. Beyai (2nd in command) to call his cell phone, because there's no way he'll actually show up. Of course, I'm also feeling a bit more uncharitable towards him than usual, as working for him until 1 in the morning made me miss the cataract surgeries that I'd been looking forward to for 3 weeks. Of course, why were there cataract surgeries at midnight? Because this place is insane and the opthalmic surgeon was 13 hours late.

Dr. Ulrich Jones -- the general surgon from Sierra Leone. He trained in Edinburgh, worked as an orthopedic surgeon in Liverpool, then came back to Sierra Leone and headed the surgical unit at the major hospitals. He took a fellowship to learn neurosurgery (and become fluent in Japanese) in Tokyo for a year when the field was first emerging, and was eventually sent to The gambia by the WHO. He is known all over West Africa, and has travelled to the states several times. Furthermore, he's brilliant and well-versed in literature. In short, the greatest biography that has yet to be written is about him.

Dr. Wilfredo -- the head of the Cuban Doctors here, he's the one who is really committed to working in Africa (or elsewhere in the 3rd world). I described him in an earlier post; ylu may remember the haircut description.

Robert DiFlavio -- A local Gambian man, Robert takes the name of whoever he feels like being for a while -- the real Robert diFlavio was an Italian-American who worked at the hospital several months ago. When Chuck, the local Peace Corps, met him, he introduced himself as "Chief Justice." He's a pot dealer, though he doesn't smoke it himself, and his biggest dream is that his birth parents will get back together.

Touba -- one of the medical students here learning from the Cuban Doctors, Touba is a very bright but very quiet man who studies until 4 in the morning and then works at the hospital all day. It's a tragic story here, though -- Touba's father is no longer in the picture, and there is the possibility he may have to drop out to support his mother and three younger sisters instead of pursuing his dream of becoming a doctor.

Lamin Ceesay -- at 29, Lamin is the brightest person I've met at the hospital. The holder of an RN degree and the head of the medical department (at 29!) he doesn't actually want to be a nurse -- he wants to study biochemistry and pharmacology, and do drug development for Big Pharma. He could do it, too. He wears glasses with purple lenses and is a fantastic nurse, so if anyone has an extra biochem book, I know someone who would love it.

Mariama -- Mariama works in the eye unit, and since my Gambian name is also Mariama, we say we are named after one another. She is the opthlmic nurse -- no accredited -- but she loved it so much that she apprenticed the opthamologist so that she can diagnose pretty much anyone as soon as they walk in. She's also tiny -- smaller than me, and I think shorter than Nicole (I KNOW, CRAZY) and gorgeous, with three beautiful children, the oldest of which just graduated as Head Girl (class president) of nursery school (kindergarten).

Lamin Fatajo -- the 2nd in command in the Lab, Fatajo also does not hold a degree. He came to work in the lab directly after finishing high school, and is very good at it, and is very, very bright. However, he doesn't want to study medicine or be a doctor -- he wants to be (no joke) an entomologist. He wants to study insects. He says he learned about bees in high school and was absolutely fascinated, and will study anything about insects that he finds. However, a career in entomology isn't really an option here in The Gambia -- but if you have extra literature about bugs (and I know some of you reading this do), then I known someone whho would devour it.

Lilu -- the Peace Corps guy here, Chuck, adopted a dog. A rascist dog. Since the dogs here are usually wild, most Gambians will beat them or throw rocks. As a perfectly logical but highly amusing result, Lilu only likes white people. It's actually hilarious.

Hassan -- the head of OPD (outpatient), Hassan is the nicest guy I've met here. You know when you meet people who are just flat-out good people? Hassan is one of them.

Katherine Cunningham -- Katherine is the girl you find when you look for this hospital on the web -- she raised $350,000 in 3 years to put this hospital on solar power. When she started, she was my age -- 20 years old, and had just finished her second year of college -- and now she's just completed her first year of UPenn medical school. She's visiting for a moneth along with her 17-yr-old cousin Lucy, her husband Mike, and her mom Carol, who actually flew back home on Sunday. We hit it off right away, and I'm sure I'll be talking to her a lot more soon (she's currently in Banjul for a few days).

Mohammed -- Mohammed owns the shop across the road from the hospital, and we see him almost every day. he is our hook-up for (somewhat) cold sodas -- Pineapple Fanta, anyone? -- from glass bottles (soda always tastes better in glass bottles) and sandwiches for lunch. He's also tiny, and fluent in five languages -- and when he sees us or says goodbye, he sings it in a bizarre falsetto. Salam aleikum! Yes, Helloooo! Okaaaay!.

Bintou Camara and her younger brother, Bob (ModouLamin Bojang) -- they come to the hospital every day, and do this every summer. As a result, their english is excellent. They know all the crossroaders, and love to play cards. Bintou is 12, and is obviously becoming a sassy teenager -- however, she looks about 9. Right now, her hair is plaited in dozens of tiny braids that look like tiny dreadlocks, so her nickname is Baby Rasta. Her little brother Bob is 7, and just graduated as Head Boy from nursery school (kindergarten). He NEVER wears shoes and his pants almost always have a highly indecent rip, that may or may not be intentional. His head is enormous, and last week, he tripped over his (unshod) feet and got a giantic lump on it, bigger than a golf ball. He's also always really dirty, as he will roll around in the dirt and then refuse to bathe. He's also got the worst poker face on the planet, and cheats (poorly) at cards.

That's all the bios I'm going to do -- this was still really long. Short update on what I've been doing: 2 baby-naming ceremonies in 2 days this weekend, I fell off a bench after falling asleep and scraped my knee in possibly the dumbest injury known to man (it was funny, though), in the medical ward, I administered meds through IVs (I suck at it) and cough syrup to little kids (I suck at it even more), I saw a woman dying of meningitis that had progressed to psychosis, and I stood in on surgery for over 6 hours, and saw a Schwannoma (a tumor in a myelinated nerve cell) and caught it on video. It was gross -- the size of a racquetball, it blurped what looked like orange marmalade. Mmm.

20 days til home! When we get off the plane in Atlanta, Molly and I are going to find the really good parfait place and we're going to have a PARFAIT with blueberries and granola and raspberries. Then, when I get home, I'm going to eat cereal -- Cheerios! And Cinnamon Toast Crunch! And I'm going to eat salty things, which are nonexistat here -- Sun Chips. And I'm going to have a frappachino from Starbucks and it will be delicious, and I'll go out for Mexican and have a green chile enchelada, and go to Chipotle and have tons of guac, and I'll go to Olive Garden and get a SALAD (no greens here) and I'll eat chicken and finish it off with tiramisu and a chocolate mint that has never melted. any my dad will grill pork loin with lemon pepper marinade and maybe we'll make the curry chicken skewers with cucumber sauce. And I'll go to Graeters and get a double scoop of Black Raspberry Chip Ice cream. And then my system will go into shock and I'll be kind of miserable, but it will be worth it. I MISS real food.

(I am eating, of course, but it's easy to get tired of rice and pasta. There's a lot of starch and little of anything else -- except out egg (pre-boiled) sandwiches for lunch!).

Tuesday, July 14th -- SJGH, Bwiam

Hello again, and sorry again for the delay. The guy in the records room -- "Eddie," allegedly -- didn't pay the bill for the dial-up, so we were sadly Internet-less. It was actually kind of nice, in retrospect, because we were forced to be a lot more disconnected with the world we know.

I've noticed myself saying things like that a lot lately. For example, yesterday, I was explaining different cardiac conditions to some new medical staff. One was "disrhythmia," and so I said that it would be treated by the insertion of a pacemaker. Their reaction: "what?" They almost never do surgery. So I launched into one of my most common sentences; "In America..."

Speaking of surgery, we watched 4 surgeries on Saturday. Actually, I watched three, and then I scrubbed in and HELPED. I didn't cut the guy open, but I did hold it open while the surgeon poked around inside. But I'm not telling that story yet.

I mentioned in my last post that I was going to Bakau (which I misspelled miserably), and we did. It was FANTASTIC. First we went to Janbanjelly, the village that my group leader, Alison, stayed in when she came to the The Gambia in 2007 with Crossroads to build a library. They had arranged a grand festival to commemorate the birth of the Prophet Mohammed, for which they arranged for a great marabout (kind of a spiritual healer) to come to the town. Everyone was decked out in their fanciest, most colorful finery, crowding around the compound where the marabout was sitting.

Only the girls went to Janbanjelly; the guys had stayed behind to be in surgery and to meet back up with us in Bakau. As a result, our group was whisked off to the rest of the women, who were cooking in the back. A little lost, we were immediately handed something to do: peeling a basket of onions. When I say a basket of onions, don't think it was a little basket the size of a basketball. Oh no. It was a giant basket, maybe two and a half feet across, and at least six onions deep. The really strong purple ones. And we peeled them with our fingernails. Once we finished -- and the little girls we recruited to help us do it were way better at it -- we were each given a blossom of garlic (you know, all the cloves together) and were instructed to peel all the cloves out. With our fingernails. Do you have any idea how difficult it is to get all the little white peel bits off of a clove of garlic with only pathetic stubbly fingernails that already have onion jammed under them? Really hard. We smelled AWFUL.

But, stench included, we were taken to see the marabout. We went right past the throngs of jealous (who were writhing with jealousy), through what was obviously the nicest compound in the village, and into the back courtyard, where the marabout was seated in fine, sky-blue robes next to the head religious figure of the village, dressed in the beautiful forest green of Islam. Around them were four boys fanning the great marabout, and over him stood a member of the Gambian Military Police, whose companions were guarding the entry and exit. We kneeled on the prayer mat, and the marabout prayed for us. He asked us for what we wanted -- we all said "success in our endeavours here" and "that our work here will not be in vain" and stuff like that -- and he said another prayer and then announced that it would come true. Some enterprising mother had managed to slip her baby boy in there (aged maybe 6 months) and he stared around looking like young kids do, clearly astonished at the fact he was in this incredible arrangement of toubabs and great religious figures. It was odd enough, but with the little kid, the experience was surreal.

We spent the night in Bakau, and, as a result of some hotel confusion and a lucky encounter between Tammy, Ling Ling, and an American woman who owns a club, we moved into a REALLY nice hotel. The Sae View Garden Hotel in Senegambia, next to DreamPark (a run-down and somewhat creepy amusement park that looks like bad horror movies would be shot there at night -- you know the ones I'm talking about, with machines that run themselves and scary clowns) has a full restaurant, a bar overlooking their POOL, TV, HOT WATER,FLUSHING TOILETS, and rooms that usually run about 2000D/night (~$80) However, we were there for 600D/night/room, and with 2 people/room, I only paid $12. In fact, I didn't even pay it, because it came out of group money. AWESOME. Getting into that pool was the best thing ever. It was the feeling of killing all the germs that you know have been crawling all over you for days. And then I took a shower under hot water... with water pressure.

The beach in that area is kind of sketchy, but we did go to the strip of restaurants, and ate pizza. I also found a little street stand that sold pineapple smoothies. By American standards, they were pretty crappy, but by Gambian standards... look! ICE! IN A CUP!. We went to the craft market, too, and I got some things. I exchanged travellers checks, which was nice, because I finally had money. We went to Kairaba, which is a GROCERY STORE. This was all so amazing that I think that when I get back home, and then to Houston, my brain might explode. Ice in a fridge? Toilets everywhere that all can handle toilet paper and flush and don't smell? COFFEE? Yeah, culture shock on the way back is going to be ridiculous.

The next week, I was in the outpatient department (OPD), which was great. This wasn't the case because of the patients we saw, which were, in fact, often cool. It was because of the doctors who work there.

In outpatient, everything is happening at once. At around 9:30, when the doctors get in, things start happening. Picture a room, maybe 10x12 (this is generous for the bigger room). Put in a filing cabinet, a standing movable curtain, two tall cabinets, and an examination bed at the side. Put an average computer desk in the middle, and cover it (bizarrely) in fabric with a large pattern of howling timber wolves (for real. it's great). In the middle of the long side, put me, opposite two doctors. On the short sides, put a patient, and behind the patient, standing, whoever they came with. Leaning over my shoulders, put two Gambian medical students or nurses, who are acting as translators. Now have everyone except me start talking. If you're feeling cruel -- or if it's before 10AM, when the power comes on -- turn off the fan.

In comes the parade of patient, following the doctor's call of "Duena!" Next! Conjunctivitis. Endless high blood pressure patients. Diabetes. One suspected meningitis (negative). One schizophrenic 16-yr-old girl. Boils. Scabies. Skin rashes. Skull fracture. A previous week, a broken femur. Horrible burns. Asthma. Pneumonia. Kidney failure with severe edema. Heart failure. All of it (except those maternity-bound and those with rotting teeth or obvious cataracts) come into one of the two small outpatient rooms, and into the hands of the Cuban Doctors.

The Cuban Doctors are two men and four women on a two-year volunteer program from -- you guessed it -- Cuba. Their leader is Dr. Willy (Wilfredo, but the Gambians can't say that), exactly the kind of person The Gambia needs. Long story short, he is heartbroken by the people he sees and who he is often unable to help, but he loves to work here, and still shows a great deal of compassion for all the patients. side note: he has the ugliest haircut I have ever seen in my entire life. No joke. I'll briefly describe it: imagine a receding hairline. You know how it carves out two lines, which are occasionally (and disastrously) attempted to be covered by a comb over? Follow those lines to abut two inches before where a bald spot would start. Now make a square: forehead, two lines, and then boundary before the bald spot. Cut all the hair in that area to about half an inch long. Let all the other hair grow to about three inches long, and let it wave down behind the ears and down the neck (trim it a little shorter over the neck). That's the mental reconstruction of the the modern art masterpiece that is Dr. Willy's bizarre hairstyle.

I'm especially glad Dr. Willy is here because Matt and I had a particularly hard time with one of the patients. One year old, and coming to SJGH right when the tide of patients was going out, she had fallen into the fire where her mother was cooking. About 25% of her body was covered in horrible peeling burns, massive blisters that peeled away in giant curls of charred blackness and revealing pinkness the color of a flushed Caucasian underneath. She was crying continuously, and in the way that means real pain -- not bawling, and not crying because she wanted something, but the unending crying of a little kid in a lot of pain who can't even verbalize it, but nothing you can do can fix it.

She was immediately whisked to the back of OPD, and treated by Hassan, the RN in charge of the unit (I'll probably talk about Hassan again -- he's another one of my favorite people here). She was rubbed with a yellow solution -- iodine for antiseptic -- and then a mysterious cream -- silver sulfanimide. You know when America used silver sulfanamide as an antibiotic? 1930.

Matt and I watched for a little while, and then talked to Dr. Willy. He sees these patients, he says, all the time. And it's horrible. With so many kids, running around while the mothers cook on open fires, it's bound to happen. So what to the doctors do? They want to treat with cyclosporin, but all they have is silver sulfanamide. They want to give a DV5 IV, but all they have is normal saline and some dextrose, neither of which provide potassium. They want to give the child morphine, but instead, they give out what every patient gets, Paracetamol (PCM), more commonly known in the US as acetaminophen. Tylenol.

It's more than enough to harden the hearts of the foreign visitors here. You can see it in the eyes and hear it in the voices of a couple of the Cuban Doctors. But not Dr. Willy, and not really Eliana, and not as much Mayena.

And it convinced me -- I do not want to be a doctor. I don't. I didn't really, before -- I considered it, but I never really wanted to. And now I know I don't want to.

Another thing that sucked about last week was that we were all sick. Me especially: I probably had at least three infections. Four of us (inclusive) vomited spectacularly over the veranda (which is interesting because there's a long delay between throwing up and hearing it hit the ground; sorry to be disgusting, but it's true). Matt was horribly sick, and finally managed to keep down a Cipro and about two inches of bread after a day and a half. I had some mysterious and disgusting bacterial(?) infection on my lips. You know the boundary on the inside of your lips where the skin you see on the outside meets the mucosal membrane that covers the inside of your mouth? For me, that boundary was entirely covered in white oral ulcers. Imagine for me, please, the difficulty you would have eating something if all that is served comes on crusty bread and if you touch the bread with your lips, they bleed. Yeah, it was unpleasant.

Also, someone came into our rooms and stole all of our (Molly, LingLing, Tammy and I) dalasi. Remember how I just said I was able to exchange my travellers checks for the first time, and finally had money, seeing as I exchanged as much as I could because I didn't know what my next chance would be? I lost all my extra American cash, too, and even the clean bills I had saved in a little pocket of my wallet as keepsakes. I had divided it all into four separate stashes, too. One -- of 600D -- was untouched. the rest were gone. In total, I lost about $150 USD. Molly lost all her American cash, too, so she lost more. All told, we are missing about $500USD of cash. Nothing else, though -- it was the epitome of petty crime, and really just served to make us really untrustworthy and rather depresssed.

But I'm getting better. I found my knifeand flash drives, which I thought had vanished with the cash. I showed the Cuban Doctors and they diagnosed it in about two seconds -- of course, I can't read their handwriting, so I'm trying to find it online -- and they wrote my a script for some antibiotic. I only have one blister on my lip now, and the ones all over my soft palate (they moved) are going away. (Still gross, right? Sorry). And on Saturday, I went to surgery. I told you I would get to this point, and it only took me 58 minutes of typing.

Alison and Tammy went back to Serakunda with our passports to get them re-stamped (stamps are only good for 30 days), but the rest of us met Dr. Jones, a highly respected surgeon from Banjul. And I say it right here and now: Dr. Jones is an incredible person. Born in Freetown, Sierra Leone, he is fluent in English, French, and Japanese in addition to his local language. He trained originally in Britain for general and then orthopedic surgery, then came back to Sierra Leone and was the only resident in the major hospital, serving four surgeons at once. He was immediately promoted after residency to head the surgical ward of the largest hospital in Sierra Leone, in which he was personally responsible -- by himself -- for 125 beds. He later travelled around, working at other hospitals in West Africa, before he applied for -- and won -- a fellowship to learn the burgeoning field of Neurosurgery. In Tokyo. For which he had to learn Japanese, and he was there for a year. One of the most respected people in the whole of West Africa, Dr. Jones currently works in Banjul, and travels to other regional hospitals to perform surgeries where needed. At 68 years old, he celebrated his 48th wedding anniversary last week.

And not only did he let us watch surgery -- all 7 (Ling Ling was too sick to come) watch at once, he let us scrub in and ASSIST. CUTTING PEOPLE OPEN. I didn't cut anyone open, as I said, but I did get to touch someone's femoral artery.

The first surgery was disappointingly boring. A 10-month old baby girl had a prolapsed rectum -- imagine pooping so hard that part of your rectum comes out, like those toys that have jelly inside an elongated donut-shaped bag of plastic that squirt out of your hands. (If you're my brother, it squirts out of your hands and bursts on the wall of the living room, staining it blue and glittery. Remember doing that, Mitch? You were grounded). We thought the surgeon was going to resection the colon -- chop a section out -- but he just inserted a ring of nylon that followed the sphincter muscle. Hopefully, that will make the anus small enough that the rectum can't come out any more, and will reattach to the mesentary in the next 6 months before the stitch is removed.

Also, I forgot to mention: these patients are under local anaesthetic only. Lidocaine, like the dental surgery. Which becomes an issue when I talk about surgery patient #4.

The next two patients were hernia patients, which is by far the most common surgery in West Africa. It's a tear in the faschia, so, for example, when the patient coughs, the membrane underneath (which has been stretched by wear) inflates like a balloon. It would actually be really cool -- a fun party trick -- if it didn't hurt. The solution is to cut into the body, through the faschia, and find the membrane. Cut open the excess (it looks like a bag), suture the excess away. Then close it back up.

I assisted on the second patient, a man with an indirect femoral hernia. I got the good spot to stand in -- I could look into it the cut really easily. I got to poke and prod, and held back the skin when he sutured the cut back closed -- and then I cut the suture to finish.

It was the fourth surgery, though, that was really cool -- a hydrocoel of the scrotum. This is not particularly interesting in and of itself -- it's a localized fluid buildup caused when the lymphatic system doesn't remove liquid from an area. What you do is cut into the area, drain the excess fluid, turn the tube (which has expanded, balloon-wise) inside-out (so fluid contacts a new cellular surface, which will; absorb it), and close it back up. This guy had a good amount of excess fluid -- it was larger than a grapefruit.

Matt and John scrubbed in, local aneasthetic -- that's right, just local, not general -- was applied, and Dr. Jones made a neat, 2-inch lateral incision. he reached his fingers in a pulled the faschia apart. Underneath was the hydrocoel -- dark purple under a cloudy white membrane. Dr. Jones explained how they were treated, and then offered to pull it completely out of the incision, so we could see the entire coel, and started pulling, Matt leaned forward to help hold the forceps, and the hydrocoel burst. All over Matt.

Clearish, yellowish liquid, thin like water and odorless, splashed about eight inches into the air and at least two feet sideways, soaking Matt's scrubs from about his collarbone to his knees. It was disgusting.

It was also hilarious. Even for Matt.

The matching hydrocoel on the other side was reduced by suction without removing it from the incision, unfortunately, because it would've been awesome to get John, too. The surgeon also apologized -- and grinned -- because he didn't burst it on purpose. He says.

I really didn't do this story justice at all, and I promise to tell it better in person. Right now, though, I'm really tired and the crazy raging thunderstorm subsided, so I'm going to bed.

Next post: the Medical Ward. Preview: say hello to reconstituted penicillin!

PS Elizabeth: 3 hrs and 1o minutes til HP6. I'll see it with you on August 10th!

Thursday, July 2 -- Sulayman Junkung General Hospital, Bwiam, The Gambia

Wow, guys, I'm really sorry I've completely abandoned this. If it makes you feel any better, I only just caught up in my for-real paper journal that isn't even my real journal on Wednesday. And by that, I mean that I got a nice journal to record my journey in, but I got really behind, and so I record notes about everything that happened in a day in this little notebook. Then this little notebook, which I also use for scrap paper, gets passed around among little kids and mango-slimed and dropped in the dirt, and the pages are all affected by the humidity so half the time my pen won't write on it. All in all, my record-keeping... well... sucks.

Almost exactly two weeks ago, we arrived here in Bwiam in the middle of the night. It was very dramatic. By that, I mean that there were BEDS. SERIOUSLY. And TOILETS. And (and this is incredible) one time, the toilet flushed.

We were tossed around in a lot of confusion for about the next five days. We tried to settle in at the hospital quickly by getting an orientation, but here in Gambia, that's not really how you treat time. When it happens -- if it happens -- it happens, whatever "it" may be.

Highlights:

Monday: we were invited to a baby-naming ceremony in the village. In this culture, a baby lives with it's mother in the maternal grandmother's compound (house and yard) for a week before it is officially named. When this happens, the maternal grandparents host a huge party for all the family friends. The men and the women (and most of the children) eat in three separate groups, and we ate A LOT of AWESOME food. We had goat. Later, we had the best chicken we've ever tasted, which we think they killed just for us. We also had a traditional celebratory drink, chakiri, which tastes like sour banana yogurt mixed with cous. I didn't like it and tried to give it to a little kid, but she didn't like it either so I had to drink/chew it all myself. We all had babies dropped in our laps (it's good luck if a traveler -- especially a white person -- holds a new baby) and at the end, we were pulled into the group to dance with the villagers. They laughed at us, because, as most of us are white, we can't dance.

Wednesday: we finally had our hospital orientation. we met with Mr. Badjie, the CEO, first. He's a small man, well-educated in the UK, and we all like him a lot. He's the Steve Jobs of this hospital -- it grew out of and because of him, and if he were to leave, it would collapse. He's also very well spoken. We went on a tour of the departments, too -- the hospital is both better and worse than I thought it would be. It is NOT what you think of when you see the word "hospital." There are goats and chickens and dogs wandering around, and at around 5 in the morning, there are some donkeys that sound quite clearly like they are making more donkeys. LOUDLY. We all hate the roosters. You think, from movies, that roosters crow at dawn and then shut up. THIS IS A LIE. IT IS A FILTHY, DIRTY LIE. ROOSTERS WILL NOT, EVER, SHUT UP. They even crow at NIGHT. We hate them all. However, they are very kang-kang (tasty).

Thursday: we all took an assignment to different departments, and I was placed in Eye/Dental. Which sounded a little boring and potentially very disgusting, but I actually really enjoy it. Here's the rundown of the units:
Dental: there are two dental chairs, one with a modern dental light. Since this doesn't work until the electricity comes on (which is usually does) at 10AM (or around there), the nurses usually sit around talking until then. There's Kaddy, the stylish youngest nurse, who is also in charge, and Fatou, who is older and very nice, and much bigger. She has 7-month-old twin sons, Hussein and Hassan, whom I have not yet met, but I have met Soma's five-month-old. Soma works in eye/dental, but she mostly just goes from one department to the other and talks to the others. She's not an RN -- only Kaddy is, and so she is more of an assistant than a nurse. When we do accept a patient, they file in, we record their name in the ledger, and then we pull out the tooth. Always. Rich or poor, young or old, abscess or cavity or residual roots, all roads end in extraction (sometimes preceded by a 5-day course of antibiotics in the case of a bad abscess). It's intense, too. There's a big curved chisel that they use to work the tooth loose, and then big pliers to rip it out. The pliers look a lot like wider, tong-like wire cutters, but they're actually specific in size and shape for each tooth. Before the extraction, the nurse applies a nerve blocker (painkiller) of 1.8 mL of 2% Lidocaine, injected from one-time-use vials and one-time-use needles into the jaw. As a result, most patients don't feel their teeth coming out. If they have an abscess, though, they feel it, and you can tell, because it looks like it hurts. A lot. (Two people -- one girl who refused an extraction, and one guy who came in for a routine cleaning, which almost never happens, got fillings. However, there are no dental drills to really remove all cavity-causing bacteria, so they will probably need extractions later anyways). Grossest case: a woman wanted dentures because she thought her teeth were ugly, so she asked to have all of them pulled. They hospital will only pull one side at a time, so she had almost all the teeth on her left side pulled out, one right after the other, until there was a little pile of ten yanked-out teeth.

I thought the eye unit would be way grosser, but it's actually just much more interesting. Mariama, the main nurse (who is actually not an RN either, but apprenticed the ophthalmic nurse because she loved it), it reall great. A tiny woman, smaller than I am, she diagnoses cases almost as soon as they come in. She assesses vision with an E chart (all E's, pointed different directions, rather than the different letters we use) and the patients, many of whom can't read the alphabet, use their four fingers extended to indicate the direction of the letter. There are a lot of cataract patients, and an eye surgeon comes from Brikama ("sometimes" to operate them for 500 dalasis (~$20). There are also a lot of cases of "allergic conjunctivitis" (basically pinkeye) and "vernal conjunctivitis" (not entirely sure, appearance is dark brown patches on the sclera). There are also patients with these nasty boils on their eyelids, and people who get dirt or soot in their eyes. I haven't seen a glaucoma patient yet, but I want to, because there's this cool little weighted device (which is apparently used in the states, too) that you put ON SOMEONE'S EYEBALL to measure they pressure. You put a painkiller on first, though, so you can't feel it, even though there's a scale resting on your eye. The hospital doesn't do glasses, though, they refer to another clinic for that. Mariama was very impressed by the power of my glasses. Grossest case so far: a young woman (late 20's) had continuously scratched her eye, which was itchy from vernal conjunctivitis, until she developed a pea-sized corneal scar. She's blind in her right eye, and there's nothing anyone can do about it.

On the weekend, we did a wonderful, wonderful thing. We went to the beach at Sanyang, and it was GORGEOUS. We stayed in this little (extremely cheap) beach house, which was 200D/person/night ($8) that was RIGHT on the ocean. There was also a shower, and I got the room with the fan that worked, so I was having a great time. We swam in the Atlantic Ocean and we picked up shells and tortured some crabs with flashlights and ate fantastic food (bennechin, a sort of spicy/sour sauce with rice and fish that had no bones in it!!!! FISH WITH NO BONES?!? CRAZY!!!) It's also about 20 degrees F cooler in Sanyang than Bwiam, so that was also a pleasant change. The only drawback? Rastas. It's a beach, and they were everywhere. In The Gambia, it's common during the holiday season (which is, not now) to see an old white woman with a young Gambian man. It's gross, but it happens all the time. There's a whole class of people (of Rastas) called "bumpsters" who are all ripped and smoke pot and hit on white women, because they all want green cards to get out and on to better places. They're also jerks, but they are all talk, and they'll leave if you tell them to.

There are two main drawbacks to being here, both of which we're feeling very acutely right now, as the initial luster of the trip has mainly worn off. The first is being white ("toubab, pronounced two-bob). The second is being a woman. Neither of which I can help.

Everywhere we go, people stare at us. All the time. White people are exotic here; we're the spectacles, the new things, and the rich ones. Everyone knows we're here, and everyone knows we're Americans. They point and they call us toubabs, kids (strangers!) swarm around us at the internet cafe (email? email? I can have? And then they ones you receive -- I tell them mine's broken, sorry, but others have given them spam addresses -- are all "I met you once and I think we can be great friends. Maybe you can write me and one day I will visit you in America?) and they walk with you, clutching your hands at the markets, pointing at things they want. I need a football! bag for school? Look! Shoes! Even here in the village, one little girl told Alex (one of my group members) that her father beat her, and then smiled hopefully, looking for a handout.

This has hit one of our group members, Heedoek, particularly hard. He wants to be a pediatrician, and kids follow him around in droves. He hates the idea that parents will hit a misbehaving child, and that they will physically fight one another to settle scores. It's even worse for him to have small gifts to give but one enough for everyone, and to know that a lot of these kids are just using him. It's really hard.

The other hard part is being a woman. Women in The Gambia are treated like crap. Part of it is lifestyle -- like in most developing countries, it is the woman's job to bear and raise the children, keep the house, fetch and carry clean water, tend the fires,cook the food, and do the laundry, and since most women have at least 4 kids, these tasks can commonly take 20 out of every 24 hours. Furthermore, having plural wives is not uncommon for a Gambian man. Most have two, since it's hard to support that many kids, but the limit is four. This limit is imposed by their brand of Sufism, a branch of Islam that allows for the incorporation of traditional animist beliefs, and is common throughout Africa. I mean this next statement in no offense whatsoever to any Muslims that I know -- you know me, guys -- Islam helps to treat the women badly, too. Women have a lower religious standing, and I don't think they're even allowed in the mosques at all. Most women have their hair constantly covered, and if a woman's knees are uncovered, she's stared at. Women are commonly beaten for breaking these codes, and domestic rape is common, but very rarely reported.

Worst of all is the high prevalence of FGM (female genital mutilation). Look it up if you don't know what I'm talking about; I don't really feel like getting into it. Many men don't want a woman who hasn't undergone the procedure since she's "unclean." This is the issue that's really hurting our group member Tammy, who is a nursing student in New Orleans. She's in the maternity unit this week, and she says it's absolutely horrible. I'm really excited to be in the maternity unit -- they let use catch the babies when they pop out -- but I'm also really dreading that particular part of it.

Our group, being toubabs, are not treated like that. The girls are, however, treated far worse than the boys. Meeting a man's eyes is a sign of being a loose woman, so since we naturally look at people when we're talking to them, we either get a lot of unwanted attention, or we have to stare at the ground. Men hiss at us to get our attention -- I threatened under my breath, once, to cut the man's face off, and Tammy offered to help, we can't stand being treated like animals in that way -- and we are patronized. If our knees are showing, they come over and stare at us -- inappropriately. When we shake hands in greeting, as customary, they hold on FAR too long and their eyes wander. They try to talk to us one-on-one and keep us from having conversations with others, and they fight over who gets to vie for our, attention, too. They compliment us in ways that aren't really compliments, they insinuate, and they will go further, too. One guy in Jambanjelly tried to make out with Alex (who has a boyfriend), and she slapped him. One man stripped for Ling Ling. Those two get the most attention -- Alex because she's the whitest and wears makeup, Ling Ling because she's Asian and even more exotic than us white people. Tammy gets a lot of attention, too, because of her dreadlocks. "Come here, Rasta Lady! Share the love with us!!!" And all of us: "Come here! Now! I want to talk to you! Why do you walk away from me?" Because you're an asshole. Excuse my language.

Worst of all, you know they only do this for two reasons: first off, to sleep with a white woman, and second, to get a green card. That's all they want. Even married men have asked us to join their "nice nice compounds!" insisting that their other wives "won't mind if I have an American wife." One of Alison's (our group leader) friends married a Gambian man, a really good guy named Modou (but we call him Ras). He's fantastic. However, she says that he's the only guy in the country she actually would trust with her life. She's lived here for a year, and she only completely trusts one man. that's horrible.

Anyways, that's really long, and I left all the depressing bits to the end, where I thought only the really dedicated people would read anyways. I'll leave off with three happier things:

1. This weekend, we're all going back to Jambanjelly for a celebration of the Birth of the Prophet Mohammed. Then, we're going to Brikau, the really nice resort area, and we're staying at a hotel on the beach that has AIR CONDITIONING. It's the white-people area, so we won't be stared at, and people don't bother the toubabs on hotel property. We're going to buy ice cream and be very American all weekend in celebration of the 4th.

2. I think I'm assigned to OPD -- outpatient -- for next week, which is the most interesting department. All the cases come through there, and it's very busy. the doctors are very nice, and are from Cuba. I'm excited.

3. My group that I'm with, and I've said this before, is fantastic. We even have a guy, John, who is the comic relief, and another Russel, who is there as eye candy. Molly is my roommate, and we get along really well. We work well as a group, and since we all have similar interests -- seven of us are pre-med, Alison is getting her Master's in Social Work, Russel is doing international relations and I'm doing international development -- we get long intellectually, too. We're reading books and then trading them around, so we expand our libraries, and since the food all affects us the same way (badly) we have a Diarrhea Club, occasionally nicknamed the Poop Troop, composed of whoever is feeling badly on that particular day. This afternoon, we sat on the veranda (yesterday was dreadfully hotm I was feeling really sick, and then at night there was a storm that was literally as strong as a hurricane -- my only comparable experience was Ike, so today was cooler) and played Mafia and charades all afternoon and read books. I'm reading Rushdie's Midnight's Children, which is fantastic. Whenever we have a particularly intense experience, we all share it, and it makes this whole trip both more fun and a lot easier.

Maybe I'll be better about updating this from now on. No promises. Congratulations if you read this much, I salute you for it. Particularly if you're not related to me.

Saturday, June 21st -- Brinkama, The Gambia

I'm in Africa!

We flew into Dakar, Senegal, on Friday morning, on South African Airlines-- which happens to be a really, really nice airline. Of course, then we had to drive to Bwiam, and most specifically, drive through Dakar and along the coast of Senegal.

Senegal is not pretty and it is not nice. The people try to con you, and there are dunes of trash everywhere. However, the farther away from Dakar you get, the more quickly things improve. The border, not so much. you have to check out of Senegal, then drive 50 feet and check in to The Gambia. The Senegal border, though, is a mess. There are people everywhere, mostly kids, that walk up to the windows. Their job is to ask us toubabs -- tourists -- to give them stuff. I was writing in my journal -- "pen for school?"-- and one girl just kept pointing to different things -- my bracelet, my watch, my sunglasses -- "can I have that?". When I told one little boy that he couldn have my silver bracelet, he screwed up his face to cry, decided it wasn worth it, and walked away.

The Gambia, though, is very different. Here, "It's nice to be nice," and everyone is. On the street, you greet everyone you come across, and with at least 2 exchanges of greetings.

The hospital we're staying at is very nice. We have beds and usually electricity and occasionally flushing toilets.

The worst part so far, for me, is the malaria medication. It makes me feel really sick, and this morning, I threw up on the packed bush taxi, which was really disgusting. On the bright side, I now have a new african skirt, and it's very pretty.

Also, I've been using my French! Incredible, I know, but it worked.

Next time I'll write more, but you pay for time to spend on the internet and I'm out.

Wednesday, June 17th -- New York

We finished up orientation today, and we're heading off to Africa in the morning. Today, we mostly did our medical briefing, and then talked in groups, and took a train to Target.

From now on, my blog posts are going to be different. I'm not going to be posting every day, and I'll decline, probably from writing lists of what I did. To be honest, the only reason I was really doing that before is so that I can remember what all of my pictures are of.

And speaking of pictures, photo uploading on Gambian dial-up could give me an aneurysm, so there will be fewer of those.

But I'm really excited! I like my group a lot, and we leave in 6 hours. Earliest possible contact will be on Saturday -- it'll take us about 2 days to get to Banjul and settled there.

Notes:
Banjul: (bahn-JOOL) capital city
Bwiam: (bwee-AHM) where I'll be, at Sulayman Junkung General Hospital.

I am flying New York to Dulles to Dakar, Senegal.

Tuesday, June 16th -- Adelphi University, Long Island, New York

Today was my first day of orientation!!! I can't wait to go to Africa.

I got up at 5:50 AM. I was supposed to get up earlier, but I was so tired from walking around everywhere and packing, etc., that I slept through the alarm the first time it went off. As a result, I missed the 6:04 N train to Atlantic-Pacific, which was actually two trains earlier than I needed, but the next one was late and I missed the layover at Atlantic-Pacific/ Flatbush Avenue (LIRR) for the train to Hempstead, NY that I needed.

Of course, this was all for the better anyways. There was coffee upstairs. Delicious, delicious coffee that I put on a giftcard, so it was like free coffee, which is even tastier.

The train to Nassau Blvd (Adelphi University) was actually pretty nice. It was very similar to the long distance-style trains in Europe, but with smaller overhead areas and not THAT nice. Padded seats, though. I started writing in my journal (I'm keeping a journal, too, for when I don't have Internet access or anything. I always keep a journal when I travel) , and I quickly discovered what was NOT nice about the LIRR (Long Island Rail Road), which is that it swings boisterously back and forth while speeding along the track. And since I was facing backwards with nothing but coffee in me, I was feeling a little gross.

All in all, I got to Nassau Blvd at 8:25, where miracle of miracles, there was an Adelphi shuttle waiting! For random Adelphi people! And my backpack, so I didn't have to lug it however many blocks there were! It was a beautiful thing.

I checked in at New Residence Hall and dumped my stuff in my room. It's nice. It's a triple, smaller than my triple at Rice, but still big -- two beds long, and the width of two beds plus a desk. There are two big windows, and then a little entryway. One one side there's a bathroom with a sink, counter, shower and toilet, and then across from that, there's an alcove with drawers and closet space. The lighting is pretty good too. I mean, Rice rooms are nicer, but this is really good.

I went downstairs and a group of us walked to a little on-campus cafe spot to get food, and I met some of the first people in my group! More about them later. I also met another girl from Rice named Kristen (Brown College '09). She was Larissa's roommate. We're the only Rice people, and have no idea each other were going, and we're going to different places.

Then, orientation began. The first part was a panel discussion with previous crossroaders, who talked about their experiences, good and bad moments, and embarrassing moments. My group leader, Alison, is great. She's big and loud and exuberant, and loves the area we're going to and has infectious energy. Her bad moment -- when digging out a septic tank, she was throwing big rocks out of the pit, and accidentally cracked a fellow crossroader's head with the rock when he bent down unexpectedly (he was fine).

We also did a teambuilding exercise, building the tallest tower possible out of a stack of notecards. The five group leaders (there are only 5 groups [2 to Gambia, 2 to Ghana and 1 to Kenya] of 10 people, this program is WAY smaller than I thought) performed skits about things that might come up. We talked about culture shock and how hard it will be to come home, as well as icebreakers and don't-judge-by-appearances types of activities. At some point, we broke for lunch and ordered Chinese, which was delicious.

Afterwards, we met with our group and talked about pet peeves and such, as well as general rules and such for the trip. We'll get much more in depth tomorrow, which is also when the medical officer is coming to talk about health risks and such, and we'll register our plans with the Embassy.

After that, though most of our group walked down to the Strip, which is Adelphi's tiny little street of shops and restaurants and stuff. The group was me, Alex, Molly, Ling Ling (all girls) and Matt, Heedoek, and John (all guys). The only people missing were Alison, Tammy and Russell. Everyone but me got Chinese, and I got pizza that looked way more delicious than anything they ate. No offense, guys, but my pizza was awesome.

I had a really good time, and I really like my group. Everyone seems really nice, and I think we'll get along well. Plus, everyone has such interesting stories and comes from different backgrounds and has varying interests, so we won't run out of things to talk about forever.

We went on a mission after that -- a mission for ice cream. And it failed horribly. Even though it was still light out, we had talked until 8PM, and everything had closed. We had to settle for donut holes and frozen coffee at Dunkin' Donuts -- we're trying to cram in as much American junk food as we can before we cook roots on a camp stove for 2 months.

All in all, I can't wait to go to Africa. My group is great, my group leader is great, the place we're going sounds fantastic, and I'm ready for my adventure to start!

Less than 36 hours til departure!