Saturday, July 25, 2009

Akwaba

This morning, after more than 17 total hours in transit, I said Akwaba (welcome) to myself in the JFK airport.  It is strange and yet wonderful to be home--I think it is going to be a bit of a process to re-adjust.  Aicha, that little bandite=literally bandit, affectionate term for a troublemaker, is adventuring on for another month, so please join me in wishing her luck and safe traveling.

Thanks to everyone who followed, commented on, or otherwise participated in AfricaNurse... because I ended up making $0.02 total from all the ad sales!!!

Hopefully this is just a "see you later"; I've begun anew the search for gainful employment, and you never know where this AfricaNurse might find herself next...

Tuesday, July 21, 2009

Malaria Sucks

Doxyclycline, I spit on you. I got malaria anyway, and spent Sunday through today in a hospital in Abidjan, which I have to tell you was pristine and sterile as any other (gloves aplenty), and where I received excellent medical care and especially excellent nursing care. I'm ok now. If you read the rest of this post, you forfeit your right to fret, worry, or otherwise be concerned about my health, because really--I'm ok now. But after having spent a few days on the other side of the patient-provider line, suffering such indignities as The Assisted Shower and being the recipient of the health care I was sent here to help improve, I do have a few tips to offer my fellow practitioners or students of nursing or medicine.

1. If while palpating an abdomen, you come across a belly button ring, do not let out a little yelp and ask, "My Lord, what is that?!?" (It's jewelry.) "Girls in my village don't do that!" A belly button ring is perfectly normal, at least in my village.

2. Look under the sweater. Out of fear of getting stuck a second time, I hid a blown IV from my nurses for about 6 hours, until concern for the loss of feeling in my hand outweighed the fear of being IV'd anew. This is not "best practice." So look under the sweater.

3. If you have to have to re-start an IV that was in the left hand, choose a site, any site, other than the right hand. If you take out an IV from a left hand and bandage it up, and put a new IV in a right hand, then the patient has no hands. Which is awkward.

4. Don't criticize your patient's French, which is quite excellent when she doesn't have a bloodstream full of parasites, thankyouverymuch.

These tips can apply even if you never see a patient with malaria. I am grateful, actually, that that the malady erupted here, rather than after I returned home (quite possible, as the incubation period can be as long as 3 weeks). I can only imagine the residents crowded in my hospital room, the Grand Rounds, the vampire-ish battery of tests, the case presentations... No, I'm lucky that this occured where palu=nickname for malaria (from paludisme) is commonplace and the clinical competency is high. I'm also lucky that I had Aicha to help me do literally everything--in fact it was she (and not the QBC rapid test) that delivered the earliest diagnosis. But if you really want to know what malaria feels like, take a cold shower and stand out in the Montreal winter, have someone kick you in the stomach a few times, and turn up your internal thermostat to 103. I'm going back to bed.

p.s. I am COMPLETELY better. Stop worrying... you know who you are!

Friday, July 17, 2009

Move Over HDI, And Make Way For The PDI

At the turn of the century, before I became AfricaNurse, I was a student of International Development at McGill University in the Nation of Quebec.  International Development was a catch-all major for diplomacy and development geeks (most of whom were unknowingly destined for the Peace Corps), with one too many economics classes for the likes of me. I did, however, learn some useful things that helped me to ultimately become a better AfricaNurse.

One of the things We the International Development Majors learned about first (after the school had provided us with unlimited quantities of a certain product of one of their better-known financial contributors, Molson), was the Human Development Index (HDI). The HDI, if I remember correctly, is a system for ranking the relative development of countries according to the following parameters: education, as measured by literacy rate (2/3 weighting) and educational attainment of its citizens (1/3 weighting); population health, as measured by average life expectancy; and standard of living, as measured by the logarithm of the gross domestic product per capita.

Almost 5 years after singing "we don't need no education" to my economics professors, I'm returning to my developmental roots.  I would like to propose, for the consideration of the International Development community, a new-and-improved development index for Africa: The Peugot Developmental Index (PDI).

I explain.  A Peugot is a make of French car, and the Peugot 7 passenger model is a popular choice for a shared taxi (a seat for one passenger in the front, 3 in the middle, and 3 in the way back... kind of like your soccer mom's van, except with only one window roller-downer that has to be passed around the car).  Aicha took a little side trip to check out Senegal this week, and one of the first things she said when she returned was that she had seen a taxi, a Peugot 7 passenger taxi, with... wait for it... SEVEN passengers inside.  This made me think, automatically, wow... that Senegal is really ahead of its time.  Here in Cote d'Ivoire, a Peugot "7 passenger" taxi would normally have 2 customers crammed in the front passenger seat, 3 in the back with at least 2 children on laps, and at least 3 guys in the back.  How to quantify my astonishment?  Let children = 0.5 persons, and every additional passenger in the front over 1 person=1.2 persons (because of the relative danger of this practice), for an average passenger burden of 9.2. Already you see that Senegal is more developed than Cote d'Ivoire.

Compare this with Aicha's previous experience in Guinea, where a "7 passenger" Peugot would have no less than 3 adults sharing the front seat, 4 in the back plus 2 children on laps, and 4 in the way back: 1+2(1.2)+4+2(0.5)+4=12.4.  Guinea is in the earlier stages of development.

Now we transform the raw variable into a unit-free index from 0 (least developed) to 1 (most developed), using the formula:

x-index= 1 -  [  ( x - min (x) / (max (x) - min (x) )  ]

where min (x) and  max (x) are the lowest and highest values the variable x can attain, respectively.   I choose 1 as the lowest possible value (for what is a taxi without at least one passenger?), and 13.5 as the highest possible value (3 in front with 3 kids on laps, 3 in the back with kids on laps, and 3 in the way back with kids on laps. Remember - a kid is 0.5 people).

Thus Senegal receives a 0.48, where Cote d'Ivoire receives a 0.344. Guinea receives a 0.088. Not so hot.  Interestingly, the relative rankings correspond with the actual rankings given by that old dinosaur, the Human Development Index (which is sooo last year). Ok, I'm supposed to be writing my final report, so I should probably stop procrastinating.

p.s. I don't care if this math doesn't check out.  Don't email me about it.

Sunday, July 12, 2009

Ivoire At Last

It just keeps getting better.  Saturday, after 4 hours in a bush taxi (2 hours of which were spent waiting for the taxi to actually leave), we found ourselves in Assini, whose sandy beaches are the first ivory I have seen since arriving in Cote d'Ivoire.

This is for all of you who asked me to send post cards (I haven't actually found any of those yet).

Wait, I skipped a few things.  First of all, Abidjan is entirely too chic for me.  Look how our friend, A., shows up for a day at the beach.  (That's his suitcase.)

After finally arriving in the town of Assini, we had to hire a pirogue=small, flat-bottomed dugout type of boat that is either poled or paddled by a local after a lot of haggling across the lagoon to get to an island in the middle, where the beach was.

Look how I helped.
Two different forms of rice power: some of the other pirogues had sails (like this one made of rice bags) rather than paddlers.

Once on the island, we were obliged to patronize the bar to earn the right to stay there.  In that bar, as sometimes happens, I was challenged to a reggae dance-off.  It would have be culturally unacceptable, of course, to refuse.  Aicha wasn't quite ready with the camera to catch the actual competition, but I'm going to post here her take on the delivery of the results, because I keep watching this video and I think the reactions of both winner and loser get funnier every time.

video
SUBTITLES: The self-appointed judge says to my rival: out of 20, you get... 12.  Then he turns to me and says: out of 60... 22.  I don't know which makes less sense: the scoring scheme, or the fact that I lost.

After my humiliating defeat, we got back in the pirogue to paddle down the lagoon toward the Atlantic Ocean.

These are the docks on the other side of the lagoon, near the Ghanaian border.  They call this part "Air France"... I guess because it is the jumping-off point for so many people headed into Ghana.  Coke float, Pepsi float.  Look how nicely the competitors are getting along.
After so long above all that glistening water and beneath all that gleaming sun, nothing could have seemed more inviting than a dip in the pacific waters of the Atlantic.  So when we got through the mouth of the lagoon, where the brackish water met the ocean, I just jumped off the boat... just like that.

It was at that moment that I recalled a passage from the Lonely Planet guidebook, under the heading "Dangers and Annoyances", just below street riots, security checkpoints, and the need for rebel paperwork when traveling in the north.  I quote,

"Finally, take care at the beach.  The Atlantic has fierce currents and a ripping undertow and people drown every year; often strong, overly confident swimmers."  [Overly confident swimmer pictured below.]  

Oops.  The beach seemed so close and there were no waves at all, but swimming with all my might, it was all I could do was try to hold my position, and not get sucked out to sea.  The astonished piroguer swung back around and motioned to me to try to crawl back into the boat, which I did, "like a crab."  Hey, it couldn't have been all that serious... Aicha was snapping photos.  Note the lack of other swimmers, though.
Unrelated image from Yamoussoukro:

Thursday, July 9, 2009

Back In Hot Water

We arrived safely in Abidjan a few hours ago.  Let me just say that a hot shower after a month of not having one is just about the greatest thing ever!  I'm on my way to go take another one, but first I wanted to post this picture that I snapped from the road on the way here, because I thought you might want to see what an agouti (see 6/30) looks like up close.  ça se mange=people eat that.  

Besides edible rodents, we also saw the largest and tallest place of worship in Africa, and one of the largest in the world--La Basilique de Yamoussoukro, modeled after St. Peter's in Rome.  

At over $300 million, some (including my cab driver in Washington, DC--see 6/2), criticize Cote d'Ivoire's first president for this hefty expenditure.  However, I can say that Ivoriens are proud of their Basilica... and besides, it's a popular tourist attraction.   Here I am fighting my way through the throngs.

I know, I know, my wrap doesn't match my shirt.  The guards made me put it on because they found my halter top indecent.

On that subject, I have to admit that my favorite part of the tour was overhearing another guide giving a tour, in broken English, to some Pakistani UN soldiers. In front of a stained glass window depicting Jesus riding a donkey, the guide said, "And here is Jesus on his ass."

Not your neighbor's nativity scene.  This one's carved from cashew wood by a sculptor from Yamoussoukro:

Aicha bargains for everything.  No, everything.  I'm actually complicit in her bargaining scheme sometimes--I look sympathetically at the poor sap at the market (usually, her target is selling shoes), and I shrug, asking, "What can I say?  My sister even bargains at the supermarket." After a few short minutes of Aicha's merciless austerity, he considers himself defeated, and she walks off having practically stolen another pair of shoes.  All this to say that today, at the Basilica, Cote d'Ivoire's national treasure, Aicha bargained down our entry fee.  There was a price for residents, and a price for foreigners (four times as high).  Aicha got us the student/resident price, even though we didn't have any student ID cards to show.  She put up her hands and asked, "Would I lie in a House of God?"  Voilà, student rate.

Adieu, Daloa

Today we are bidding adieu to all our friends in Daloa, Bouafle, Issia, and Bonon, and heading back to the "Paris of West Africa."  Paris (Abidjan) is a 4 to 5 hour drive from here.  Luckily, we are not taking mass transit:

Tuesday, July 7, 2009

Cold War, Détente

It happened suddenly, unexpectedly…

One night, across the maquis (see 7/2), we spotted a group of blancs=white people (the level to which this is derogatory is uncertain)--the first we had seen since arriving in Cote d’Ivoire.  The group eyed us, and we them… but no words were exchanged, and we took our separate tables.  Overcome with curiosity, we trained our ears on the table across the way, straining, aching for a clue as to the origins of these rare creatures... and finally concluded from snippets of verbiage that floated our way that The Others were probably Russian.  Glances were exchanged, but distance maintained.  Aicha and I amused ourselves with inventing explanations (what could four Russians possibly be doing in Daloa—our Daloa?).  United Nations we immediately ruled out based on their reluctance to unite even our tables.  Healthcare?  Impossible; their rate of cigarette consumption was appaling.  Footballers, we decided; the only possible occupation this scruffy crew could have.  We left after dinner, self-satisfied in our espionnage and powers of deduction, but still ungreeted by our rivals—I began to think of it as our own little Cold War.

Jump ahead two nights, and curiosity gets the better of The Others.  They gesture to us to join them in their sphere of influence, and we gesture-reply in full American-ness, no… if you want to do business, you have come here.  They oblige, and the two superpowers sat together at last at the table of détente.  The Russians, it turns out, speak neither English nor French (except for “big beer”, which they happen to be able to order in both languages), and I quickly learn how very little 4 semesters (!!!) of Russian earned me.  

The “conversation” of the night consists mostly of comic gestures.  For example, their leader would submit, “Barack Obama?...”; to which we replied with thumbs up--handshakes all around.  “George Bush?..." thumbs down--handshakes again.  “Michael Jackson!…” (followed by gagging sounds and mock collapse).  Yes, we all agreed. Michael Jackson is totally dead; and so on.  Being an expat is not nearly as cool as Hemingway and those guys made it out to be.  I'm still not sure who those people were, or what they are doing here in Daloa.  I think, judging by an unscientific sampling of their iPhone photos, they might have been helicopter mechanics, but as even a well-functioning car is a rare sight in Daloa, it seems unlikely.

In the end, it turns out that you can have a good laugh without being able to speak the language of your compatriots, which is probably exactly what everyone was thinking when John F. Kennedy (thumbs up) declared, during his own cold war, Ich ben ein Berliner (I am a jelly doughnut).

Glastnost, From left: Their Leader, Aicha, The Quiet One, Alpha Blondy.

Failing in my conversational skills, I tried to redeem myself by showing each one how I could write their names in Cyrillic.  Be impressed.  (Also pictured: big beers.)