African Exclusive

There are some experiences that almost solely happen in Africa. People think about wildlife, poverty, malaria, safaris, clicking languages, polygamy, etc. There are other experiences that are just so outside the imagination, it’s hard to even predict.

With all the Coronavirus talk, the government officials came to the hospital for an impromptu “sensitization” lecture. Of course, they came at 4:30 right as everyone is supposed to be going home. Then it takes 30 minutes to set up and is just a bunch of people reading directly from slides. Regardless of how boring it is, I’m a bit nervous. Things aren’t finalized with all our paperwork, government officials always pick out the white people, and all the staff is also at the meeting. It’s a packed house. In the middle of all this, Ami comes over and starts tapping me on the shoulder quite insistently.

Before I go on, let me describe her a little bit. Ami has a fiery personality and with her things are either great or terrible. She’s either dancing or sulking. She speaks such deep Krio that even after 6 months here, I still can’t understand her most of the time. She insists on speaking to me in Temne, even though it’s clear I have no idea what either she or I am saying. Here’s a picture of Ami with Rachel last Sabbath. I’ve never seen her wear such a great hat.

 

So Ami is insistently tapping my shoulder. I try to brush her off, but she won’t be deterred. She whispers something into my ear, that I have no idea what she’s saying. Then she shoves something into my hands. At this point, whatever is going on with Ami seems super important. I turn towards her and open what is in my hands.

It’s my underwear.

Ami is our laundry lady and it was laundry day. She must have found them and she decided that an all staff meeting with all the government officials was the best time to bring back my lost unmentionables. That evening I walked home with a conspicuous bulge in my pants pocket while trying to imagine any situation on any other continent, where a woman would hand me my underwear in the most important meeting of the week. I decided that I’ve had a once in a lifetime experience.

Strange Encounters

Things that would be strange in the US are totally normal here. I notice it daily, but thought I would jot down a few instances.

I'm walking through the hospital and a nurse pulls me over, "I need you to meet someone." I think it's a patient's family or one of her friends. Instead, she leads me to a white person (a rarity). She says, "Hello I'm Paula. I'm a cardiologist from Italy." She asks if I mind if she gives some recommendations about one of our admitted patients: a 50 year old woman who came in with blood pressure of 240/120 who had been on IV antihypertensives combined with triple oral antihypertensive therapy for 3 days without any effect. What a perfect consult for a roaming cardiologist!
"I hear a mitral valve regurgitation murmur, have you considered lasix?" Firstly, I have no idea how she heard that with the nurse's stethoscope. Secondly, in this country I'm always happy to have a second opinion from any non-witchdoctor. Because I frequently want to have a cardiologist around, I ask "How long are you in Waterloo for?" She casually replies, "Oh, probably another 4 hours." I wonder if she could see the disappointment on my face. Unfortunately I didn't have another consult for her within 4 hours, but I certainly did within 12. Either way, both me and the patient were blessed by the roaming cardiologist.



A few weeks ago, right as the coronavirus fears were really picking up, we had a Chinese man walk into our hospital. He asked how many masks he would be allowed to buy. Now normally we don't sell medical supplies. But we have thousands of masks that it'll take us years to use and since we struggle to make payroll, for the right price you can have almost anything. After he made the purchase and left, Dr. Kabba noted, "I hope he doesn't know a coronavirus patient."
The next day he came back, wanting several hundred more masks. Then rumors started flying around the hospital. Is he hiding a coronavirus patient from the government? Is he trying to protect himself and his compound without telling anyone? Well, we're desperate for money so we sold him the masks. But when he arrived back on the 3rd day in a row, enough was enough.

Dr. Kabba notified the Ministry of Health, who called Immigration, who requested backup from local police. Soon the hospital was swarming with uniforms. Any man in a uniform is instantly interested by an Apoto (white person), and it's not always for good reasons. So Dr. Kabba recommended that Rachel and I make ourselves scarce. In the end, they discovered that he was just a shrewd businessman making a pretty profit in China. There was no risk of exposure. But with all the police around, they needed something to do. So they accused the hospital of selling government supplies. Dr. Kabba, Mr. Fobbie the business manager, Augustine the clinical supervisor, and Danquah the chaplain all got hauled to the police station. For several hours they were held and asked multiple times about exactly which staff member did the selling and where the masks came from. Once they learned it wasn't government cheese being sold, they still wanted to arrest a staff member. Dr. Kabba said, "If you want to arrest someone for alerting the Ministry of Health for the good of the country, you can arrest me. I was the one who gave the ok to sell the masks. I'm sure the news will find this story interesting." Needless to say, nobody was arrested. But I saw a lot fewer patients visiting the hospital that afternoon. I'm starting to believe the local version of "No good deed goes unpunished" is actually translated: "No one who calls the police in Africa goes un-harassed."

Hello!

Every day as we walk to the hospital, there is a 4 y/o boy who lives across the street. He loves to yell “Hello!” to see our reactions. Usually I wave; if he persists I use two hands; if he perseverates I even try to wave with my feet and hands simultaneously. It doesn’t matter the circumstances: rain, sun, big trucks, weekends, he always greets us.

Last week the mother called me over and told me that he was sick. I walked across the street and they pulled up a chair for me. I sat in their front ‘yard’ (really more dirt) while they tried to find him. I looked him over and he wasn’t dying. So I didn’t commit to free consultations or medications like they wanted, but they also didn’t ask outright. I noticed a deep dimple on his tongue at the same place I’d expect his frenulum to attach from underneath. I asked about it and it’s been there since birth. I asked if he talks ok and the mother gave him a firm nudge (that in the US would be ‘hitting’) and commanded him: “Talk!” Under those circumstances, nobody would have anything to say. So I squatted down, shushed his mother, and said “What’s your name?” He responded, “Ishmael.” Sounded good to me, so time to have a little fun. “What’s my name?” I asked with a smirk. I honestly didn’t expect any response at all. He smiled back at me, waved his hand, and said “Hello!”

The small crowd that had been gathering laughed, as it was obvious I’d been out played by a 4 year old.

Spiritual Battles

The longer we stay in Sierra Leone, the easier it is to see the spiritual warfare.

Every time that someone moves into a new office in our hospital, the staff gather for a prayer of dedication. It didn’t seem unusual to me, until the office prayer was delayed for several days due to busy schedules. The staff member refused to move into the new office until the prayer. I asked around and learned that it is often dangerous to be promoted. Jobs are so rare, everything is seen as a zero-sum game. So, if someone is promoted they become a target: threats, poison, curses, etc.  Spiritual attacks are so common the phrase, “I’m going to Waterloo for you” means that you’re headed to Waterloo to find one of the many witchdoctors to order a curse on someone. One of the reasons people are so happy to work at a Christian institution is they feel some safety from these attacks. Prayer is protection.

I had another case where a young Muslim man (maybe in his 20s) came in unconscious. Nobody from his family could provide any conclusive history. On physical exam, it was clear that he wasn’t completely unconscious. I would lift his leg and after letting go, it would slowly return to the bed. I told the CHOs, “I don’t know what this is, but you need to be thinking beyond just physical. In the States, this would be a psychiatric issue.” I ordered a bunch of labs, all normal. I ran some IV fluids and just waited.

Oh, I did have to tell the family I didn’t want them rubbing raw garlic all over his body. Who knows what else they did at home.

After several hours the nurse came to me and told me that the family wanted discharge. “What‽ Do they want to take him home unconscious?” The nurse responded like I should somehow know without being told, “No, he woke up and feels fine.” I pulled the patient into Mr. Abu’s office, because I didn’t trust my Krio enough to dive into psychosocial issues alone. Without the family present, I delved into all the sensitive issues: Sex, HIV, Drugs, Anxiety, Abuse, Depression. All negative. As I dug into psychosis, I got an unexpected answer: “Does your mind ever play tricks on you? Do you see and hear things other people don’t see or hear?” “Well, no. But 7 nights ago a Devil came to me in my bedroom.”

He told me that more than a week ago, he went to the ocean. He was swimming while wearing a hat, and he lost his hat into the waves. With fear in his eyes, he described how he was unable to retrieve the cap. (Demons and beliefs relating to water are very common here). Then after a few nights he was asleep and a Devil woke him up and presented him with two identical caps. “One of these caps is yours, one is mine. Pick the correct one or you will be sorry.” The man grabbed the one on the left. “Wrong!” the Demon shouted, as he started to cackle and dance around the room. Then he vanished.

For several nights, the Demon visited to ‘torment’ the man: ‘You’re going to die’ ‘I still have your cap’. Then the next few nights he slept well. Later he was in town, walking down the road and the Demon appeared. “Give me my cap right now! I need it!!” The man pleaded, “I don’t have it! I’ll go home and get it right now.” “Too late” screamed the Demon and the man went unconscious.

It was at this point that I realized my mouth was hanging open a bit. I asked him, ‘Have you told your family about this?’ He hadn’t. I asked him if he would benefit from a Christian prayer and he declined. Mr. Abu and I encouraged him to tell his family so they could provide ‘Muslim Prayers.’ He left and I never saw him again.

In the States, Demons and spiritual battles are the last thing anyone thinks about. Here, even rashes can be attributed to spiritual curses. I’m learning more and more that the truth lies somewhere in the middle. I need to keep an eye on the Great Controversy, while also leaving room for a contact dermatitis of unknown origin.