Medical Rounds on Moto

For the past three weeks, I have been a translator/nurse/assistant/photojournalist for a young Czech OB/GYN.The ultimate aim of her visit is to improve the health practices—which are believed to include many wrong or harmful ones—of the local hospital (which has no electricity or running water and closes at noon), the private Baptist clinic, traditional midwives or village health posts. Right now, she is the only doctor in a 100-kilometer radius. Things happen slowly here however, and so the doctor spends every free minute treating as many patients as she can, anywhere.

To get everything done, the two of us have been shuttling between Ba’Aka villages and health clinics on a moto taxi.

We make quite the sight.

Some of the quick tests the doctor uses.

She goes through dozens of malaria tests every day, and most are positive. I got to perform a few malaria tests, which was fun (including on myself!). The second test I did, which was also the first I did on a child, was under unusually stressful circumstances: we were outside our house when an elephant was dangerously close and trumpeting rather loudly. I was trying to focus on getting the blood sample from the squirming child while readying my body’s flight response, in case it was needed.

A kid so feisty that he squirmed out of his mother’s grip and yanked out the syringe the doctor had inserted into his leg, hence the five adults holding him down in the photo above.

The newborn baby whose birth we missed by a few minutes. 

Being an interpreter is much more difficult than I expected. The literal translation itself is not an issue at all. The difficulties arise when the equation includes medical terminology, a whole other language—Sangho—which is too simple to include words like “contractions” or “fever”, a Czech’s not-so-great English and Central African French. Add cultural misunderstandings, low levels of education in the general population (including health staff) and the fact that the vast majority of our patients are too young to speak for themselves: now there is a real headache-inducing problem.

One of the hundred photos I have of the doctor making small children cry. 

The most hated person in the village. 

Here is a typical conversation between myself and the patient’s relative (I am skipping the steps where I translate from the doctor’s English into French, and where the nurse/assistant translates into Sangho or Ba’Aka):

Me: “How long has he had a fever?” (Note that people use the term “chauffer”, or “to heat”, to mean to have a fever. Also: when people don’t have an appetite, the local health workers call it “anorexia”. It is quite strange to be told that a little baby has anorexia.).

Relative : “Oh… since!” (In the CAR, “depuis”, meaning “since”, is an acceptable answer by itself. It means that it has lasted. For an indefinite amount of time. No further details are ever given.)

Me: “Since when??”

Relative: “Oh.. It’s been a while!”

Me: “So a year? A month? A week?”

Relative: “Oh… maybe 2 weeks.”

Me: “Does he have any other problems?’

Relative: “No.”

Me: “No other symptoms at all?”

Relative: “No.”

Me: “Does he have a cough?”

Relative: “Yes.”

Me: “… Diarrhea?”

Relative: “Yes.”

Me: “Have you given him medicine?”

Relative: “Pas encore.”

(Another peculiarity of the local variety of French: “pas encore”, which actually means “not yet”, is synonymous with simply “no”. It is a subtle but important difference, particularly when speak with hospital staff: one can never deduce whether the staff planned on giving a medicine, or was never going to in the first place. Furthermore, Sangho borrows heavily from French while often distorting the original definitions. For example, “jamais”, which means “never”, is most often used as an emphatic “no”. As you can imagine, this makes for confusing exchanges: “Does he have a fever? “Never!”)

In Mossapoula, a mixed Ba’Aka and Bilo (Bantu) village. 

Then, the health worker usually repeats everything three or more times, just to ensure we know they are knowledgeable and informed. This means that it takes about 10 minutes to extract information that in more efficient circumstances could have been exchanged in a few seconds. Meanwhile, the Czech doctor just looks perplexed and tries to interject with more questions and comments while I’m still teasing out a proper response. It is exhausting.

A baby who is being weighed, and who is very unhappy about it. 

One of the funniest moments yet was when the head of the hospital’s maternity ward grabbed the wooden penis model sitting on her desk to point out her daughter, then without skipping a beat used it to break open an injection vial against the side of her desk.

Another kid who was more than willing to fight back. 

A few days ago at the Baptist clinic, there was the case of the daughter of a WWF tracker, an 18-year-old Ba’Aka girl, who claimed to have been in labor for three days. This was her third pregnancy; the previous two babies had died before they reached their first month. She was clearly very nervous. We checked her several times over the course of two days. With no cell reception at our house, and no reliable cell reception in general, it is rather difficult for us to keep in contact with the staff of any health facility, who were instructed to call us for any emergency. After a long day of work yesterday, we checked on her once again at around 9 pm. It was impossible to communicate with her and she did not seem to understand anything we asked, and we were afraid that she might be in need of a medical evacuation to a larger hospital 100 km away.  The doctor decided that we’d come back at 1 am. It might not sound that late but here, most people including myself wake up at approximately 6 am. Not feeling well to begin with (not surprisingly considering the number of sick people I have been exposed to), it was quite unpleasant to wake up and hop on a moto in the middle of the night.

At the local public hospital. 

I sat there, half awake, fully miserable and completely aware that my misery was pathetic compared to what this poor girl was facing. The awareness that my self-pity was completely ridiculous makes me even more miserable. I couldn’t quite believe that I was waiting outside an electricity-less clinic, in the middle of a night, for a woman to give birth while my moto driver played Justin Bieber’s “Never Say Never” on his phone’s crackly speakers. At least the stars, as usual, were beautiful. When the doctor and midwife concluded, as had been concluded several times before, that the woman was not ready for labor, I decided that I was not committed enough to spend the night here (especially not on a hospital bed that is merely wiped down in between patients) and went back with the moto driver.

The doctor doing all the work during a delivery in which the woman gave up on pushing. I used to feel awkward standing in the corner relaying questions and answers back and forth while she conducted  vaginal examinations, but you get used to it. 

The resulting baby!

We were near the house when the moto driver suddenly stopped. “Elephant!”, he pointed out. It took me a little while to make out the elephant in the monochromic scene revealed by the dim headlights. Holy shit, it was a massive elephant with giant tusks standing in the open, right on our path! As the elephant slowly retreated away from us, the moto driver seemed to think we could continue on the same path. He was not our usual, trustworthy driver and his reckless speeding moments before did not make me confident in his risk assessment abilities. Finally, we took a long roundabout way to the house, hoping we would not cross paths with the elephant.  The adrenaline and stress of the night made me unable to sleep the rest of the night.

The hospital at night.

I found out this morning that the woman did indeed give birth, without any complications. Despite the facts that the Czech doctor and local midwife had slept the night at the clinic precisely for her case, and that they had gone to a clinic out of fear of any birth complications, the three older women who had accompanied the Ba’Aka girl declined to wake any one up for the delivery, and chose instead to have her deliver the baby outside, behind the clinic, on the ground. By the time the doctor was woken and arrived at the scene, the baby and the placenta were already lying on the bare sand.

Nocturnal medical care was primarily lit by my headlamp, as were many post-delivery vaginal suture jobs.

We’ve had three deliveries (not including a delivery we missed during our lunch break), a death (a small child who was brought to the hospital too late), a stroke and countless malaria and pneumonia cases. We’ve had to fight against hospital staff, who automatically prescribe antibiotics no matter the diagnosis. The health chief of the hospital wanted to give dozens of antibiotic pills to a young, healthy and strong man who had gotten beaten up, but who had no open wounds. His reasoning was that we did not know whether the stick he was beaten with was smooth, or rough, and hence we could not know whether it transferred microbes through his pores. Another hospital staff member brought us his child who was not recovering from his flu “despite” the month of antibiotics he gave him; he had no idea antibiotics could not kill viruses. The head of the maternity ward was adamant that long-term contraceptive use sometimes caused sterility, which is disconcerting considering the fact that here, a woman giving birth a dozen times is not out of the ordinary. The lab tech, who is de facto the doctor of the hospital (but who has no training beyond lab work), gives antibiotics to breastfeeding mothers in order to ward infection off in otherwise healthy infants.

The scene in Yandoumbe, a Ba’Aka village, illuminated by my flash.

The roots of the problems—educational, socio-economic and political—run so deep that I have no idea where anyone is supposed to start. But we must start somewhere, and so this week we will be holding basic sanitation and health workshops for the local communities and health workers. There are so many easy preventive steps that could be taken so I’m quite excited! As a lover of public health, I absolutely abhor the ubiquitous practice of shaking hands. Everyone shakes everyone’s hands. All the time. Gross. Virtually everyone has worms, because no one washes their hands. This is not helped by the fact that the Ba’Aka do not use latrine facilities, and instead do their business everywhere. (As hunter-gatherers who have only recently become more sedentary, they’ve never had the need to care about sanitation before.) I’ve also tried to teach everyone I’ve seen coughing that they should cough into their elbows, instead of into their hands or well, everyone else’s faces. Wish us luck!

What the scene actually looked like. As tired as I was, I couldn’t deny that the night sky was beautiful. I’ve never seen more stars than I have here in the CAR, which according to National Geographic has the least light pollution in the world. Not very hard to believe. 

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