Harmattan

Friday, March 10, 2006

The town and countryside have been searing in a haze of tan dust for more than 5 days. The annual harmattan wind brings fine sand particles from the Sahara, hundreds of miles away and suspends them in the atmosphere, turning the sky a featureless dun in which the sun hangs, an anemic disc. The eyes turn gritty and everything coats with dust. Shadows lose their definition and the muezzin’s voices sound hoarse as they call the faithful to prayer.

Mid-day in Banjul. Dust from the harmattan obscures the sun.

People with lung disease have problems when this sort of weather hangs about. They pile into A&E coughing and wheezing. Those with marginal respiratory function are sometimes tipped over the edge and our resources are slim.

Today on the street, returning from the Albert Market and man called to me from across Independence Drive. I didn’t recognize him. He ran across to me. He is ebony-skinned, with high cheekbones and fine, chiseled features. As we shake hands I touch a shoulder hard as granite. “Remember, you took care of my father in the A&E?” he asks. Then I do remember. The father was a tall, dignified, calm man of 84, in a caftan and fez, struggling for breath. He had been left on a gurney in the waiting room for quite some time. No one had thought to triage him in to the doctors. No one thought he might need oxygen. So, he was simply put with all the non-emergent cases. Eventually, a family member came in and asked me to see him. He was in obvious distress. It took a bit of goading but I had him moved into what passes for a procedure room. No oxygen. It took some time to locate an oxygen cylinder, tubing, and a mask. (In the used car business the mask and tubing would have been referred to as “pre-owned”.) Two men carried the big H-tank, tall as a man, into the room. Then it took a while to get him hooked up on a cardiac monitor. An IV was started. A nebulizer treatment. I asked if a 12-lead electrocardiogram (ECG) could be done. Tomorrow, I was told. No, I say. We need one now. Arterial blood gasses? No such thing here. Pulse oxygenation meter? Same. How soon can we get lab results? Tomorrow.
Eventually, someone finds an ECG machine. Eventually they discover the electrodes. Is there conductant gel? A withered tube of gel is found. We get the patient hooked up to the machine. I read the ECG. He is having a heart attack.
Did I cause it by ordering the nebulizer treatment before the ECG? I won’t ever know. I really had no choice. His breathing improves somewhat and we ship him to a medical ward. The next day I look for him but can’t find him. There is no central admitting here where you can locate a patient.
Today, the son thanks me for taking care of his father and tells me the old man passed away. With a sense of futility I try not to show, I shake his hand and tell him it was my honor to take care of his father; that he was a lovely man. I don’t mention my misgivings about the (in-)adequacy of my treatment.
I have devolved (evolved?) into working permanently in A&E. Dr. Azmi, one of the Egyptian surgeons told me they needed help there and would I come work. I don’t feel competent to do emergency medicine but they do need the help.

The big news this morning is that someone in the hospital “misplaced” 41,000 Euros donated by a Rotary Club in Holland for the psychiatric unit. An investigation is in progress.

Tonight, I took my laptop to Essa’s compound and showed the family the photos Essa and I have taken around the compound, in the streets, and on our trip to Fort Bullen. The show was a great hit. Ebraima brought out a Boyz II Men CD he hadn’t played yet and we put that on for awhile. Then we played some Ali Farka Toure, Afro-Cuban All-Stars, Supremes, Coasters, and The Rail Band, from Mali. Lasers in the jungle. What a priviledge! To sit on ramshackle chairs by the light of a single candle, under the rusty, corrugated metal shade, and share music from places imaginable and unimaginable on a machine that cost three times what the average Gambian makes in a year, with people whose richness of culture and family beggar the sterility of our technology. The grandmothers exude such a pure, unaffected, joyous love and warmth. And they thank ME! How strange.
Today, being Friday, I wore my caftan in the afternoon. Friday is the Muslim Sabbath and most people dress up in their go-to-meetin’ duds; the men in caftan and “alhaji” hats, the women in their brightest finery. Even the children all duded up, scampering about. I am accosted by men who want to know if I am “alhaji” (converted to Islam) or just wearing the clothes. The clothes seem to some Africans to indicate being Muslim but others tell me it is simply African. A few of the accosters are quite persistent that I must look into converting. Despite the insistence that there are no fundamentalists there are certainly some very, very evangelical Muslims about.
Essa and I had a long talk today about his statement (a repetition of a national advertising slogan) that there is “Zero Crime” in The Gambia. The discussion began when we left the hospital by the A&E entrance to see a body, tightly wrapped in faded, patterned cloth, being loaded into the back of an ambulance. Essa said it was a young man who had been stabbed in the chest by another young man. I asked him how he could make the statement that there was no crime in The Gambia. He explained that No Crime meant “compared to other places”. I pointed out that Zero means Zero and that one loses one’s credibility if one makes such statements and they prove to be untrue. That even if crime is very low it still exists. He answered that they didn’t consider it crime when it is just a bunch of no-good young men who get drunk and smoke cannabis and hurt each other. It is only crime when it involves “other people”.