So, let 39; s all disregard the loud silence which has filled the blog for much too long due to much working and much putting of the house on the market, about which, more later and finish up with So, let 39; s all disregard the loud silence which has filled the blog for much too long due to much working and much putting of the house on the market, about which, more later and finish up with Mali. When we left our heroine, she was about to set out from Kayes in a Land Cruiser for the three hour trip through the scrubby desert to the village of Aite AYEE-tay where Indielou has his house and his clinic. And now I will stop talking in the annoying third person and confess that the whole world-traveler thing which I 39; d been rocking from the start of the trip came to a screeching halt when I got car sick and had to beg the driver to stop so I could switch seats with the Ghanian doctor who 39; d been riding in the front. Car sick! I ask you! Clearly I belong in a donkey cart.
But once in the front of the Land Cruiser, I could concentrate on the red almost-desert blowing past the windows, with baobab and thorn trees and odd little scrub bushes the only vegetation. The road was a track which swerved through the scrub and dodged around boulders; occasionally it led through a little village, with mud-walled houses and compounds full of waving children. After three hours of this we saw a hill, and when we rounded its base, there was Aite, a huddle of compounds with two cement structures: a school and the clinic.
We did all the things one does: toured the clinic 5 inpatient beds; treatment room; pharmacy; consultation room; labor and delivery room; maternity” ward” with two beds and admired its immaculate cleanliness and the long lines of mothers and children waiting outside: met the chief and other village dignitaries, who each lived in a compound full of wives polygamous culture and children: took lots of digital photos and showed them to the subjects of the photos, who crowded around yelling and pulling at the camera kids, obviously and grinning hugely before running off chattering to each other with expressions which clearly said, ” Did you see how fine I looked and how bad her hair looked?” Then we ate a delicious meal of rice and stew prepared by Indielou 39; s wife Naima, and took a siesta.
I love siestas, mostly because I love lying down in the middle of the day, but also because the day is greatly improved, I find, by getting a chance to reflect on it as it 39; s happening. And there was so much to reflect on. The differences in medicine, for one, and I don 39; t just mean the fact that the ambulance is a donkey cart which takes, oh, two days to get to Kayes, and that epidurals are unknown and a toothache is dire and infant mortality is staggering. No, I mean the way practice changes when you strip it down. In my ER in the States-a mid-size, undramatic ER if ever there was one-I have access to Xray, CT, lab, ultrasound, all the drugs you 39; d care to name, and a bunch of specialists, from maxillofacial surgeons to psychiatrists. I can do an awful lot, in the sense that I can poke around pretty thoroughly to find out what 39; s wrong, and then take care of whatever 39; s wrong when I find it-or, more often, I can get the patient to the specialist who can take care of what 39; s wrong, within minutes to weeks, depending on the urgency of the situation. This amazing abundance of high-tech care leads to high expectations on both my part and the part of the patient, and can be problematic in, oh, let me count the ways, from dollars wasted to unneccessary pain caused.
Now you 39; re waiting for me to say, ” But it 39; s all different in Mali,” and yes, in a lot of ways I 39; m guessing it is I say” guessing” because I was there for ten days, so what the hell do I know. The pharmacy at Indielou 39; s clinic holds about twenty or thirty kinds of drugs-very well stocked, actually-and the clinic is set up for minor procedures but nothing more-i. e. they were doing a circumcision the day I got there. They do a lot of deliveries, but with no backup if something goes wrong: they don 39; t have C-section or neonatal recusitation capacity, for instance. The lab can do blood smears for malaria, and complete blood counts and urinalysis, but Xray? CT? Forget it. So yes, it 39; s very different from here in that what you see is what you get: to quote Madeleine, ” That 39; s all there is; there isn 39; t any more,” at least not without a 24 hour bus ride to Bamako.
So yes, medicine is, in a way, much simpler. As a primary practitioner, you don 39; t have to worry about whether to order anti-SSA anti-SSB antibodies on that patient with mysterious joint pain: you just give Tylenol and call it arthritis. You don 39; t have to worry about whether to run in some IV antibiotics and call the hand surgeon for that finger infection: there IS no hand surgeon, so you give Amoxil, because that 39; s what you have, and scrub it out and hope for the best. Oh, and Tylenol. Tylenol is always good.
I hope it 39; s obvious that I 39; m not making fun or being condescending here, I 39; m just ruminating. Simpler does not mean easier. Indielou lives in a mud-and-dung house beside the clinic and sees patients whenever they arrive with emergencies, and does it with no backup in 120 degree heat with no vacations and no reward other than an unimpressive salary and the boundless trust, love and respect of the tribe with whom he works. No, the medicine there seemed to sum up a lot of the other differences between my week in Mali and life in the States: here, it 39; s easy and complicated, there, simple and hard.
At the same time, I offer this: no matter where you go, there you are. Indielou and I worked each other up into gales of laughter describing the difficulties of running a clinic, because apparently patients are patients are patients. Everyone needs TLC and a listening ear, and every provider struggles with balancing giving that to one person with providing timely care to the other 45 people waiting impatiently outside the door. Patients present with pain all over in Mali just the way they do in the States, and they have a specific idea of what 39; s wrong with them, and if you, the provider, don 39; t do what they want, they 39; ll keep coming back until you do. Though Indielou does have one advantage, in that his patients think his stethescope is fantastic, and they make him listen over whatever part of them hurts. He says he listens to a lot of backs and hips.
Hi, it 39; s me, waving over here from off the track, where I have wandered in my undisciplined enthusiasm. Hi! I think we were having a siesta, no?
Yes. So, I contemplated away for a while, lying on the bed I shared with D., the other woman on the trip pastor from Iowa; interesting lady; deep thinker; fun to travel with; singer of songs in airports and at lots of other times and watching the dazzle of sun outside the window. Indielou 39; s house is pretty big, with concrete floors and five or six rooms and an outdoor kitchen and a roofless bathroom which offers a nice, small hole in the concrete for one set of activities, and a drain in the wall for the bathwater from your bucket bath. There 39; s also a courtyard where most of the household activity occurs, and a satellite dish for the TV electricity via generator, and a radio telephone.
Anyway, we got back up and went for a walk around the village in the sunset. Indielou has, over the years, gotten very good at squiring Americans around, and I had to laugh at the way he was able to whip us in and out of about five compounds during our round of dignitary visits in the morning-each visit could have taken all day, but he had us in and out, without even tea, in ten minutes every time. Clearly he 39; s used to accomodating fidgety visitors, and so is the village. Anyway, in the evening we just strolled, through the scrubby, dusty ground, and watched the boys herd the goats and cows home from the day 39; s” grazing,” though on what they graze I do not know. The smoke from cook-fires drifted in the air, which was perfectly balmy, and the wind tried hard to send my hat to Mauritius. You could hear cow-bells, and children calling to each other as they played soccer, and the blare of the odd radio, but under it all you could also hear the desert silence. The sunset was muted and delicious.
That night we sat around, because that 39; s what you do, and then took turns having bucket baths under the stars. Will it sound odd if I say that standing naked in the warm air, scooping warm water over myself, listening to the sounds of the village from behind the bathroom 39; s high walls and watching familiar Orion overhead, was the high point of the trip for me? Odd or not, it was.
Then I went to bed and got attacked by jet lag, and at two a. m. finally wandered into the courtyard to look at the stars, which of course are spectacular in the desert. In a few minutes The Dutch Dentist appeared-the other American on the trip-and sat down to star-watch too. Nice guy; we had a nice conversation. But at one point I looked over and realized that hey, this fifty-year-old guy is sitting out here in the courtyard in the middle of the night clad in his itsy-bitsies. Yes! A tank top and BLACK BIKINI BRIEFS apparently did it for this guy, and since he is about six foot five, this left a hell of a lot of white legs exposed. Great legs, I 39; ll grant him-he 39; s a runner-but hello? Dude? You 39; re visiting a Muslim culture here, and let 39; s just imagine for a moment that the lady of the house wanders out to check a crying child, or chicken, or whatever in the middle of the night, and hey now, there 39; s her guest and I mean all of him!
But I digress. Eventually the jet lag wore off and I crashed and got up the next day and went out to an even smaller village, Assoum, even farther from” civilization,” and the Land Cruiser got stuck in a sand hole, and Indielou sort of conjured up a bunch of villagers from nowhere and we all stuck neem tree branches under the wheels and pushed and yelled, and eventually the ridiculous behemoth got out of the sand trap. Meanwhile, several guys on camels rode by, boom boxes strapped to their saddles, and stood watching. Nobody had to say the obvious, which is that camels, while worse-smelling than Land Cruisers, are cheaper and do not get stuck unless they 39; re in a bad mood, in which case nobody can do anything anyway.
That was sort of the end of the trip, that visit to Assoum. Up until then we 39; d been traveling farther and farther from home, but from then on we turned around and kept getting closer and closer to the place we 39; d left. We had a few days in Bamako to rest and eat fruit and read, which was heavenly and a total vacation and I took naps every day we weren 39; t being total slobs: you have to plan a few extra days into the trip so you don 39; t get sabotaged by a canceled interior flight or something, but our trip went really smoothly, so we had the time at the end. We went shopping to price Land Cruisers for Indielou, because the man needs a vehicle and I plan to hit you all up for funds any day now, so beware. And I slept a lot and tried to scrub my feet back into recognizable shape.
And then we came home, and rode from Amsterdam to Minneapolis on a plane with a bunch of Americans out of a cartoon: overweight, in sweat suits, calling cheerfully to each other during the flight, sharing candy with each other and with us. When the plane landed in the States I heard the guy near me say, ” Home of the Free,” to himself. When we deplaned it was ten degrees and I had to exercise a certain amount of discipline not to get on the next plane back.
I was glad to see Da Boyz.
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