Saturday, July 25, 2009
Akwaba
Tuesday, July 21, 2009
Malaria Sucks
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
Thursday, July 9, 2009
Back In Hot Water
Adieu, Daloa
Tuesday, July 7, 2009
Cold War, Détente
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.)


