Saturday, February 11, 2012

Pebbles in a well

The stoic TFG forces warmed considerably as the hot dry day progressed. Initially flat, icy black eyes and motionless faces met my smiles and greetings. I felt a need to connect to thank these men for the protection they were giving. If anything happened, they would be the ones to put themselves between the danger and my sweating pink face. Hours passed and eventually they were smiling, shaking hands and looking for eye contact. These hardened militia fighters are still people after all. As we part ways at the Kenyan/Somalian border, I watch and smile as ten skinny fierce warriors clutched their AK-47s between their knees or in a free hand and were waving goodbye from their cramped perches on the back of their small pickup. Mostly broad smiles but a few remain sullen. I wish I would have had time to learn more about individuals, their families, beliefs and opinions about what they were doing and why they were doing it. Do they see a future for their Somalia? 

Clinic in Dhobley was good, it is organized, and like I mentioned previously, held in a building that was finished only a few weeks ago. My interpreter today was very skilled and that makes a huge difference when taking a history and explaining to a patient how to get better. Days that I have a beginner interpreter can be frustrating as I am trying to communicate with only a few hundred words, often only a handful of those words anatomical or medical. I was able to offer some instruction to clinic staff which was hopefully helpful. While helping individuals is important, teaching the existing staff is paramount. 

Sadly, today there were five rape victims. Training for medical staff on PEP (HIV prevention) for rape victims is to be arranged.

Dhobley is still not secure. It is on the border between Kenya and Somalia and sees a tremendous traffic of internally displaced persons (refugees) moving in either direction or staying. Al Shabaab is still active with local sympathizers. I noticed halfway through my clinic that the metal shutters were perforated and the indoor wall behind my patients was cratered with bullet holes. Many of the buildings in town are pock marked from rifle fire, collapsed or burnt. There are intermittent gunshots to be heard, mostly celebratory. While we are there, the TFG forces secure the entire area around the clinic, clearing the streets and redirecting traffic. Patients are searched and held distant to the clinic prior to admission to be seen. It is an interesting environment to see patients in. There is no concept of medical confidentiality, several patients lined up on a bench, able to hear each others issues plainly. Abruptly before clinic ended today, we were told it was no longer an option to remain in Dhobley and left quickly without incident.

In Kokar, a bundle of miraa is passed into the cab. Miraa (Qat) is the stimulant plant used by so many here. Curious to taste it, I choose a small leaf and chew it. It tastes like lawn, not bad but not particularly special or yummy. I chew it for a few minutes. If I was experienced with miraa, I would spit. I am not experienced and I was in an enclosed vehicle so spitting was not an option. Eventually, I notice my gums, tongue and lips tingling a little bit. The chewed wad of miraa leaf is provided an exit out of the landcruiser window.

We continue to drive back to our compound at Dadaab, bouncing out of the bush and returning to my temporary home. I am jostling in the back seat, sweaty and pressed against my team of the last weeks. A dry tree with hand sized umber flowers zips by the window; absurd in its beauty. Herdsmen slow our return as a sea of white goats flow down the soft sand trail we call a road. They evaporate by scattering, tails raised, into the brush. Camels sway by and look down aloofly, imagining what it would be like to spit on us. Around a long neck, an unobtainable wooden camel bell is fastened,  clacking unheard as we cruise by. My mind wanders to the stew of humanity I've been treating in Africa: bright eyes, swollen livers, honest smiles, coarse wet lungs, snake bite punctures, untreatable fractures, bones worn from unendurable work, amazing infectious laughter and humor in spite of the heat, the dust and the suffering. The suffering and the happiness. Seeing both married here makes me believe suffering and happiness are not mutually exclusive and perhaps, like a good marriage, give meaning to the other. The laughter erupting in the midst of poverty and famine and indignity is the most magical and true laughter. The cup of chai offered after prepared on a dirt floor and sipped from a cracked mug is the sweetest. Holding hands with a brother is a deeper love than my heart is accustomed to. These genuine gestures startle  my heart like dropping a stone into a deep well- a pause and a splash and maybe, just maybe, ripples that shimmer on the dark sweet waters. I watch the lazy white clouds crowd and boil in the impossibly blue unforgiving African sky and I am filled completely with gratitude and blessing for the opportunity to share my skills as a physician with my fellow humans (my brothers and sister as spoken here). I shift my sweaty leg and sweaty arm against my seat-mate and am reminded I am not alone in this service and look from face to face of our team. Some eyes closed, some smiling, some focused in their own self. Together we alleviated some suffering, perhaps saved a life or more and offered a small but real step for Somalia. As my heart and mind is filled with these things, I grin and am teetering between tears and laughter. 

I do chortle to myself when the cynical voice in my head says the miraa is speaking. It's not though (I didn't taste enough for effect). 

Gradually the road widens and the antennas of the UN compound come to view. We are almost back from our last day in the field.  We share heartfelt goodbyes and a goat dinner.  As I type this, a small toad is ambushing ants from under my chair. The day is trading heat for mosquitoes. Tomorrow we drive (hours and hours) back to Nairobi for debriefing then soon back to home where my family waits.

Thank you Africa - I feel you gave me more than I could ever give to you.

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