How to climb a really, really tall tree with a piece of vine

I am currently back in Hong Kong relaxing and spending time with my family, and I will be returning to the C.A.R. on February 7th. Everything is looking relatively good, with the peace agreements signed, a new prime minister appointed and the cabinet dissolved. From now on the only hold-ups I anticipate are silly delays, like when government officials were late to the negotiations in Gabon while the rebels were on time.

In an unrelated matter, Ugandan soldiers together with US Special Forces have killed Kony’s chief bodyguard in the eastern jungles of the CAR (I’m in the west, phew). I think this is good news!

A few months ago, there was a period of time when the radio in our camp was broken. Being our sole form of communication to the outside world, it is rather vital that it remain up and working. After several fruitless attempts to fix it, someone came up with a decidedly novel solution: have the best Ba’Aka tree climbers mount antennae at the tops of very high trees. Didou and a couple other trackers were enlisted due to their elite tree climbing skills and were driven in for this specific purpose.

The Ba’Aka are known for their amazing tree climbing skills, which they need to access the most prized treat of all: wild honey. Check out the mind-blowing segment above from the BBC’s Human Planet, in which a Ba’Aka man climbs to head-dizzying heights and braves a hive of bees in order to impress his wife with some fresh, all-natural honey. (Human Planet is similar to their more famous series Planet Earth but about people and yes, narrated by David Attenborough!) Seriously, watch it. CRAZY. This was actually filmed in Yandoumbe, a village very close to where I am.

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I’m not sure if this picture does justice to the height of this tree, but I guesstimate it to be about 130 feet high. If it helps at all the tiny oval at the base of the tree is a toilet seat; I have no idea why that is there, because we most certainly do not have any toilets.

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This is Didou looking rather smug with himself at the top of the tree. It was pretty terrifying to watch him as I was half-convinced that I was going to witness him plunge to the ground that day. Using no equipment except for a piece of vine with its ends tied together to form a hoop around the tree, Didou shimmied his way up  (watch the BBC video above to see how he did it). I couldn’t tear myself away to grab my camera as he was going up, but scroll down a little to see the video of him coming down.

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Here, Didou is performing some careful maneuvers trying to get a giant pole up the tree. I’m not entirely clear on the thought process behind this entire plan, so don’t ask me why he was doing this.

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A couple of other men climbed up other trees to attach yet more antennae. This guy here uses a different technique than Didou, chopping small footholds into the bark for a surer grip.

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As you can see, there is a very precarious split second during each upwards shimmy.

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The same guy up another tree.

And finally, here’s the video of Didou descending. I couldn’t zoom out to give you a full view of the tree but the length of time it takes for him to get to the ground should give you an idea.

Party in the C.A.R.

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Party in the C.A.R.

A month ago, in honor of a Czech researcher’s departure, we had a matanga (party) at Bai Hokou. To host a matanga, you carry out the following steps: you order beer in advance for the occasion (for even bigger matangas you also order palm wine for the trackers, but we only wanted a mild matanga), pull all of the chairs into the middle of camp and wait for the trackers to bring out their instruments.

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At the beginning, it was slightly less awkward than a middle school dance as we sat quietly eating in a large circle.

But soon, they start playing their instruments (real or improvised) and the alcohol starts to flow…

And people start to dance! Check out the recording and be prepared to be surprised at how you might want to start shaking your own booty to the sound of clanging empty beer bottles.

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It seems like the thing to do at matangas is to dance in a circle, slowly shuffling round and round. It’s quite fun. I might bring it back to the dance floors of Hong Kong.

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Then things start to get really heated up. Mobo, shown here in the red shorts, adorned himself with leaves and starting energetically rolling around the floor to the rhythm, making quite the sight.

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Meanwhile, Ngombo (first on the left above) decided that a straw tutu would be his costume of choice, and started challenging everyone else one by one to a dance off. He won every single time… according to him, at least.

The festivities ended at around midnight, but more wild matangas often last until the wee hours of morning. It made for a great first weekend in Bai Hokou, and I’m excited for all the matangas to come!

Hygiene, Condoms & a Preventable Death

Last month, as the doctor’s time here came to its end, we finally got to what I had been very much looking forward to: the workshops. On the schedule were two community workshops in Ba’aka villages, and a workshop for health personnel from nearby clinics and health centers.

It is a universal law of nature that the back of a classroom always fills first, as demonstrated by these attendees in Yandoumbe. Also, you might be able to tell from the hysterical laughter in the room that at the time the subject of the lesson was yes, sex (and the various diseases one can get during it).

One grizzled woman was adamant that a condom, if used near a woman’s period, or if broken inside a woman, would cause her death. Amazingly, a workshop attendee had a condom on him and so the doctor got a volunteer to help demonstrate that condoms are actually quite strong and can even fit around a water bottle.

Here are the kids demonstrating how one should cough or sneeze: into one’s elbow! This also applies to all of you reading this. I’m serious. As you can see this workshop, held at Mossapoula, consisted primarily of children. This is because only a handful of people showed up despite many notifications in advance and the village chief going from hut to hut to ask people to come. After a few hours of waiting around, I commandeered a nearby classroom where kids were attending regular school and took over for an hour.

Some of you may already know how I’m obsessed with proper hand-washing technique, and that was a vital part of my curriculum. A few weeks later one of the gorilla trackers, who apparently attended one of my workshops during his time off, showed me how I taught him to wash his hands. That alone validated my whole month with the doctor (click here if you missed that post).

I thought our time spent treating individual patients was over, but the day before our last workshop and my departure for Bai Hokou, there was an emergency case regarding a tracker’s daughter. She was pregnant with her first child, but had been in painful labor for days. Her strong-willed mother—over a head shorter than me, with no toes on her left foot but terrifying nonetheless, and not least because of her bulging muscles— refused to let her seek medical care as she did not trust Western medicine.

We tracked the woman down and after a yelling match between other community members, her husband and her mother, we finally got her mother to agree to let her go.

 The woman’s husband and his first wife, who was to accompany her to the private Baptist clinic, helped her onto the moto.

The motorcycle ambulance convoy. She’s not visible in this picture, but the doctor is between the driver and I. 

After we arrived at the clinic, the doctor soon discovered that the fetus was dead, but for how long she could not say. Her husband (who as I mentioned earlier, has two wives) had untreated syphilis, which may have been the cause of the baby’s death. Though it was too late to save the baby, the mother’s life was still at stake as there was a severe infection inside of her. The only option was to evacuate the woman to the nearest actual hospital in Nola, 100 km away. The woman’s mother refused again, but was eventually convinced.

The doctor and I then had to frantically jump through several bureaucratic hoops; time was of the essence if this woman were to be saved. One was a visit to the woman who was in charge of the local public health center during the night shift. Her husband happens to be the local “sub-prefect”, who went on a long (drunken) rant about how the local government should not help a private clinic to evacuate a patient despite the fact that it was the official protocol that all evacuations must be authorized by the head of the health center. He continued to say that the couple in charge of the private clinic were unqualified and uneducated, unlike the staff at the public health center. It was very, very difficult to hold my tongue. The two individuals who run the clinic are in fact lovely, caring and competent health workers while just a few days ago, one of his government health staff—the only one present at the center at the time—had been completely drunk and acted completely inappropriately while a woman was in labor. He asked for bribes, offered to get her stung by a scorpion he claimed would hasten the delivery and sexually assaulted her. And there I was, nodding my head as the sous-prefet went on and on about how incompetent the private clinic staff were compared to his staff.

At one point, I had to rush to the WWF office to get some paperwork copied and some cocky eco-guard (armed guards whose job it is to protect the park) stopped me and refused to let me through because I was being “impolite”. No matter that a woman was dying. I am so incredibly sick of African men on power trips—they are arguably the single most significant hindrance to development on this continent.

Here, some of the woman’s relatives are packing food for the journey to Nola. 

Sadly, we found out the following morning that she died soon after her arrival at the hospital. Though the doctor felt like she failed, the woman would have had a much better chance if she had sought proper medical care days earlier. That can be traced back to the lack of education, the lack of access and the discrimination against the Ba’Aka—all problems that obviously started way before the doctor came here.

A picture we used during the presentation. 

The following morning, we had our last workshop. The aim was to teach health personnel how they can improve based on what the doctor and I witnessed over the past few weeks. The major problems in the local health system are the overprescription of antibiotics and the misuse of drugs. Antibiotics are prescribed for every single ailment—whether it’s a cold, malaria or a bruise. One example of drug used carelessly is  dexamethasone, which is prescribed highly frequently for a host of complaints ranging from fatigue to comas. According to the doctor, in reality it should only be used in cases of severe allergic reactions or pulmonary crises when the patient is unable to breathe, such as during an asthma attack. A very potent drug, it should not be used lightly and can even cause death if improperly taken.

The local health center’s lab tech, who had been the most stubborn and frustrating person to work with those few weeks, declared during the workshop that “there was no discussion” regarding the way they use their drugs: he said he could only explain to us why they were forced to use such drugs because he insisted, as he had many times before, that the Czech doctor simply could not understand the circumstances and diseases the local population had to deal with. I personally believe that he just did not want to listen to two young foreign women. There is no quick solution to all of the issues leading to poor healthcare in this area. But a new doctor has just arrived a few days ago, and we are hoping that some leadership and proper medical expertise will do this place some good.

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. 

A Ba’Aka Party Under The Full Moon

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A Ba’Aka Party (click “play” to hear a recording!)

On the last full moon, we went to Yandoumbe—Louis Sarno’s village—for the dance they were having in honor of several deaths that had occurred. It made me realize how it’s a rare privilege to experience such a “cultural event” (for lack of a better term) that would have happened irrespective of our presence, in its natural state. We were still a bunch of awkward foreigners standing to the side as they danced and sang, but we were guests and they didn’t seem to care about our attendance.

I didn’t want to disturb them, so I didn’t take any photos with flash (and ok, because I forgot to bring my flash). In the middle you can make out a figure that looks vaguely like Cousin It: that is the forest spirit, or Jengi, who comes out on special occasions in the form of man wearing a costume made of straw.

In the photo below, I took a long exposure of the clearing but it was too long to capture any of the people. The audio should be enough to give you an idea of how energetic and lively it was! I highly recommend that you get your hands on some of Louis Sarno’s recordings of their music. I can bring some back to you, but you’d have wait a year or so.