Cause of death

While Americans are busy marching for women's rights and holding out hope for their universal health care, small stories from the people between the lines are unfolding every day. Yesterday (ok, sometime last week, it's taken days to finish this post) I was riding to see a tailor on the other side of town (forever in search of a skilled and talented tailor...although at this point, I'll take capable.) Part of our drive passed through a section of town that I can only describe by saying I was reminded that some people are leading dismal lives. Dirt, poverty, frustration and anger. The sun shining doesn't bring light or happiness here - just plain heat.

In Abidjan it can be all too easy to forget that the difficulties are just as dire as in any developing country. There are plenty of highways, bridges and roundabouts connecting malls, shopping centers and restaurants. There are plenty of clean storefronts and bright neon advertising. Neighborhoods are spread out in such a way that you might never need to leave the confines of your area. Those that do leave residential cartiers are most likely on their way to commercial ones and so the poverty stricken neighborhoods end up being isolated and out of view. But they make the news often enough. And just because they aren't as visible, doesn't mean they don't exist, along with all of the problems that take root there.

While American women are marching, Ivorian women are having babies. There have been a lot of new babies since I've arrived. Aside from several neighbors, the nounou at my house had a baby and both the nounous who work for my friend gave birth.

The first was a younger woman, young enough that I think of her as a girl. She has her own family now, and was sequestered by her 'husband's' family during the birth, nothing too remarkable, both baby and mom healthy. The second woman, however, did not fare so well.

She already has a child and apparently the first birth was not easy. She appeared swollen about halfway through her pregnancy and we advised her to put her feet up, see her doctor and all sorts of other things pregnant women are always getting advice about.

Eventually it came to a point of increased concern. Her hands were so swollen she couldn't close them enough to pick anything up. We wanted to send her to the hospital right away. We tried to let her know how dangerous it could be. The problem was, the nurses weren't expressing the same message. One nurse told her she was going to bleed a lot, supposedly a warning that she should start saving money for medicines and treatment for a complicated birth. Her blood pressure was elevated, but the only council she received was to stay away from salt and oily foods.

I know that Abidjan has better care to offer, the problem is affordability. Many Ivorians have health insurance. But I think a whole lot more don't. And there was the doctor strike. She'd had plans to go to the village to have her baby, the ever elusive 'village'- home to family and traditional rememdies that cure all ills (being able to relax and have someone take care of you surely one of the most traditional of cures.)

However, one afternoon found her in an ambulance, touring the city in search of a hospital that would take her. She was turned away by several. She cites the strike or no room as reasons for this. We wonder if the severity of her condition and the light pocketbook weren't an influencing factor. Finally, she ended up in a clinic in Adjame. She had an emergency c-section and was still in pain when I talked to her a day later. She'd barely seen the baby but told me he was 'under covers'- the phrase for the care premature babies receive.

She'd racked up a hefty hospital bill and they weren't giving her any post natal care until she paid. During that first phone call, she told me they would keep the baby until the bill was settled. With Kinshasa flashbacks, I wondered how long the baby was expected to stay in the hospital. Preemies usually require more care, and I wasn't really sure how early he was.

News came later from her sister that the baby 'didn't stay'- their phrase meaning he'd passed away. She hadn't informed the mother yet. There is no way to know if it was because he simply came too early, or because, as rumored, the clinic didn't even treat him for the first 24hrs to see if he would, in fact, 'stay.' Or if it was a not having money for the required medicines.

I can't know the real answers, and I don't want to. It's bad enough to know that better pre-natal care might have saved him (or possibly not.) My thoughts were focused on the mom. She was clearly suffering, not only from her surgery but from the pre-eclampsia that'd gotten her there and the news of her baby's death. She needed money.

We scraped together what we could, my contribution much less than I felt good about, and she eventually received some medicines and was released in a day or two. But there remains that frustration of the 'holding the patient prisoner' model. There is the frustration of the patient needing to purchase the medicines (most often a relative must be there to get the prescription and then go to a pharmacy to purchase the medicine and bring it back.)

I couldn't, and still can't, have never been able to, wrap my mind around this. The hospital staff will work around this woman, watching her deteriorate and possibly pass away herself, because she can't purchase the required after birth medicine? It smells awfully close to murder. My memories invaded with images of another patient, languishing on a hospital bed, head split open, in and out of consciousness while hospital staff waited for the all important dollar. And even my own birth story, suffering malaria, pleading for a bag of glucose, anything to get the treatment started, while those around me negotiated the cost of my impending delivery.

Somewhere along the way, we humans decided money holds the most value, pieces of printed paper and imprinted coins worth more than our lives. It's better that I don't know the real cause of the baby's death. It's hard enough to sleep at night.

Another hospital story- for my nursing friends

There are two kinds of stories you can never tell enough of in Kinshasa. Because if you're not suffering some weird ailment, you're probably stuck in a traffic jam of one kind or another. My Western mind will never get used to seeing a car come barreling down the road with it's lights on and aiming right for me. In my lane. I'm ready; years of defensive driving courses have prepared me to respond to anything in the road but I'm never really expecting it. Something about a car in the wrong lane is always surprising.

Just as, while I am aware of the medical situation (or lack thereof) in Kinshasa, my Western mind remains stubbornly surprised at the way things work. A friend of mine recently made the trip across the river and back again to his hometown of Brazzaville. Apparently, the trip can be made at night, under cover of darkness, by way of pirogue. A canoe, basically. This version of the trip requires no documents but a $10 pay-off to the military on this side, again on the other side and maybe $10 to the canoe driver. One must also be prepared for battle. It's a rough trip.

He came back the roundabout way by Matadi to pick up a car and drive several hours to Kinshasa. That's where he ran into trouble. Thieves, bandits and military check points all along the way. Some guys mugged him (to use a New York term) and stole his watch and some clothes just after arriving at "port." Of course, he fought back a bit and somewhere in the scuffle managed to bang up his leg pretty good. He had a small cut there and paid little attention to it- more worried about the cold (after losing some of his clothes to the muggers) and getting the car back in one piece (the police confiscated the backseats in return for payment of some kind of "tax." We're still waiting to get the seats back. He has faith, I remain in doubt and have since suggested installing some wooden benches and making a taxi bus out of the whole thing.)

A few days later, the bruised up leg started turning red and swelling to unbelievable proportions. The pain was unbearable and the coloring terrifying. He went off to the hospital, only to be returned, only to search out another. I did some research online and came up with my own diagnosis. The hospital found a blood infection and began administering a variety of antibiotics. There wasn't much improvement.

After a few days, when talk of finding a traditional doctor began, I decided to speak to the doctor myself. I was quite relieved to hear her name the infection that I'd found on the web and have her answer most of my questions. I went home, did further research and found that healing often took time and the swelling might be a come and go thing. I was comforted by cold, hard facts but also slightly alarmed. Cellulitis has the potential to be dangerous- resulting in amputation or death. The doctor and I had spoken of signs to watch for that would signal a turn for the worse. I was mostly worried about amputation. Things always seem to happen too fast and too slow at the same time, resulting in grave situations that could likely have been avoided in a better equipped country.

But my friend, and his friend, and the patient in the next bed, and even one of the doctors all insisted that this was something you cure traditionally. I could do nothing but examine my own beliefs. I don't discount traditional medicine altogether. I do believe concentrated, bad energy can result in tragic consequences. I just wasn't sure someone had intentionally cursed him, although speculations about who it might have been began immediately.

When you arrive in Africa- well, the hot and humid countries- you can feel the heaviness in the air.  The first time I had an open cut I remember thinking 'Cover it up, things are living in the air.' You can practically feel them moving around. Personally, I think it was something in the dustiness of the port town, maybe coming off the river that got into his skin. And while the traditional wash may help the swelling and redness, I'm not convinced it can get into the blood and tackle the infection there.

So I was relieved when he was easily convinced to continue his rounds of antibiotics. At this intense stage, he requires several different kinds - one of which is an injection. Money issues- and personal comfort- required that he leave the hospital. Not to mention, the staff there weren't too pleased that he kept leaving and coming back. He wouldn't be able to continue the traditional course of medicine if he stayed in the hospital.

However, leaving means he needs someone to inject him. Not just a jab in the backside but into the vein. Yeah- that's not a skill I have. Last night we took the medicines and needles and went in search of a hospital with electricity (our first stop was too dark and he had a bit of fear that they wouldn't be able to see well enough by candlelight to inject him without too much rooting around and pain.) It wasn't too hard to find a clinic with lights and we went in, presented the items and he was given a shot. Very few questions asked. Which is when I really began to understand the differences in circumstance and even see some similarities.

I had found comfort in arming myself with facts, added to my basic knowledge of the workings of the human body. I even printed off some pages in French for my friend to read. While he doesn't have the background knowledge that Americans seem to gain through school and public service announcements ( and trips to the doctor where we ask endless questions and expect clear answers) he was able to get enough information to know what he needs and to self manage those needs. Out patient care. It could turn out to be quite efficient, allowing him to access medical care that he can afford. Apparently the traditional healer is not asking for payment (I'm sure they'll set up a barter system or some kind of gift giving) and the doctor charged a mere 1500FC for performing the injection. A system that has sprung up in the absence of a universal medical care program that ensures the sick will receive attention (money is always one of the first questions to come up before any kind of treatment is begun- no money, no treatment.) 

I'm still trying to merge the Western and traditional schools of thought, exploring how I really feel about each one and examining the different values, beliefs and skepticisms that spring up- part of  intercultural living I suppose - merging the best of both worlds. Maintaining one's own beliefs and understandings of the world while not discounting another perspective. I'm sure I'll have plenty of time to develop my thoughts when I next find myself stuck in one of those crazy traffic jams.