TheAfricaNurse

Akwaba

2009-07-25T09:55:00.000-07:00

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...

Malaria Sucks

2009-07-21T14:26:00.000-07:00

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!

Move Over HDI, And Make Way For The PDI

2009-07-17T06:45:00.000-07:00

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.

Ivoire At Last

2009-07-12T13:40:00.000-07:00

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.

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:

Back In Hot Water

2009-07-09T12:34:00.000-07:00

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

2009-07-09T01:22:00.001-07:00

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:

Cold War, Détente

2009-07-07T01:16:00.000-07:00

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.)

Don't Judge Me

2009-07-06T09:26:00.000-07:00

I ate this.

...and then I ate this.

(photos from about.com; blogs.fayobserver.com, respectively)

Ratmadan

2009-07-02T07:39:00.000-07:00

I love our new site--CSU de Bonon--the smallest hospital we have visited so far. Paradoxically, it is this itty-bitty hospital, with just one doctor to its name, that seems to be functioning the best--at least in terms of HIV-exposed infant care. Perhaps this is because all of the services (prenatal care, vaccinations, HIV testing, and HIV treatment) are all located within the same small compound; the "rice-powered" data-sharing system involves just walking from one room to the next. After running into some resistance at our last site, it is encouraging to be among people who genuinely welcome our work.

There's only one little problem, which rears its ugly (furry, grey) head at lunchtime. The maquis=small, family-run restaurant that generally cooks and serves one pot of food at each meal, serves only agouti (see 6/30). I call it the ratstaurant. After three days of choking down those furry fiends (while chickens run free in the yard...?!?!?), I declared myself to be on an agouti fast. Whenever a local person has trouble understanding why I don't want anymore agoutis, I explain that I'm just not used to it--that, for example, raw fish is an expensive, chic, and popular food where I come from... how would you feel about eating that if you came to visit me? It translates.

In other news, the market near our place is filled with wonders: check out my hair, post cow-placenta, bone marrow, and cannabis oil treatments... does it look different?

Aicha has befriended the guards that sit on the other side of our walled-in office. Here they are having afternoon tea (a delicious minty, thick concoction that is so caffeinated that it gives you superpowers):

And finally, some late-breaking news: the strike has been suspended for two weeks! Let's hope the respite transitions into a lasting solution.

(Exotic hair tx photo courtesy of Aicha Scott)

The New York Rongeurs

2009-06-30T04:38:00.000-07:00

I ate this.

French word of the day: Rongeur=rodent, such as the agouti (pictured above).

Curious about the difference between the agouti and its more petite friend, the rat, Aicha posed the question. Just the size, it turns out, they have the same taste. (Which, by the way, isn't bad.)

(photo from tsgcs.co.uk)

Midterm Evaluation

2009-06-29T01:42:00.000-07:00

In celebration of the halfway point of my adventure, today I'm going to cover my three favorite things: music, dance, and clothes.

First, the nearest and dearest to my heart, music:

I GOT A MIX CD!!!!! As everyone who knows me is fully aware, this is far and away my most preferred gift item. I must have been complaining a lot about my lack of radio here (it's possible that I even said at one point that "I need music like Africans need rice"), because a friend in Abidjan just sent me a mix CD to Daloa via express mail, and even arranged for someone to go to the station, intercept the package, and bring it to my apartment. If you will permit me a generalization, I would have to say that this culture is all about giving (see discussion of tchep djen 6/14). Among my favorites on the CD are morceaux=literally "bits", or songs from Youssou N'Dour (Senegal), Salif Keita and Richard Bona (Mali and Cameroon, respectively), Magic System (Cote d'Ivoire), and Les Garagistes (also Cote D'Ivoire). I'm afraid that if I play it one more time, it might wear out.

Moving right along to my next greatest passion, dance:

We spent the whole weekend hosting, C., a friend from Bouafle, at our apartment. C. is the authority on all the current dance moves, which afforded me the opportunity to spend an entire afternoon learning them before debuting them in front of the nightclub mirror (see 6/14) on Saturday night. Among the steps I picked up were le climatiseur (the air conditioner), le ventilateur (the fan... see a pattern forming?), la grippe aviare (bird flu--where you stick your arms out and flap them, obviously), and my personal favorite... wait for it... le Barack Obama. Anticipating your disbelief, I've recorded (with permission), a demonstration of the Barack Obama. Listen closely, and you can make out the matching song lyrics (which may or may not have been ripped off of the Alex Walker song of the same theme):

The ubiquitous dance mirror setup I've been telling you about:

Le Ravin. The sign boasts "air-conditioned bar."

And how 'bout that electric orange palm tree? Raise your hand if you think S.O.B's in Ossining needs one of these.

Team Daloa:

And now, for the clothes. I submit, for your consideration, my newest panya:

That's it for today... stay tuned for my next post, "Rodents I've Eaten."

(Ravin sign, palm tree, and panya photos courtesy of Aicha Scott)

Still Stricken

2009-06-27T04:00:00.000-07:00

It has been two weeks since the national doctors' strike began, and the effects weigh heavier than ever. With their minimum demands still not met (they still make less than policemen; after 8+ years of schooling, their salary is less than $1000/yr), the doctors have stopped providing even minimum services and are no longer responding to emergencies.

The implications for HIV care are vast. Yesterday at the hospital, women came as usual from villages over 50km away refill their ARV prescriptions (medicine essential to AIDS treatment). When they arrived, some after spending the last of their borrowed money to share a taxi, some after walking long distances without food, they found that it was all for naught. Although nurses, who practice in a much more advanced capacity than in the US, are able to provide some consultation and treatment, their hands are tied when it comes to medication (the public pharmacists, too, are on strike). Cessation of services will continue at least until July 3, and one can only imagine the implications for drug resistance, to say nothing of the overall health and well-being of the patients.

On the more positive side, the ladies were able to attend my project's second support group, to discuss their experiences, gain social support, and have their questions answered. An interesting subject that I had never really considered arose yesterday--the question of fasting for Ramadan vs. the need to take ARVs with food (believe me, the consequences of taking them on an empty stomach are grave). The leader of the group concluded that God would forgive, but I'm sure it must be difficult in the face of stigmatization and hidden HIV status to explain the need to break an important religious rule.

In the interest of not depressing my readership completely, let's turn to happier things that I've learned recently, such as the important distinction between two classes of chicken. Poulet bicyclette, pictured below, is literally "bicycle chicken", sold, as you can see, from its namesake. These chickens are what you might think of as "free-range"; African, natural, hormone-free, bicycle-ridin' and tough as hell--consume only with spicy sauce. They are distinguished from their farm-raised fatty friends, who (at a higher price) can be found fried or rotisseried, and who travel more stylishly.

(P.S. these guys are alive)

Kids, this is where chocolate comes from. This unassuming yellowish pod is cracked opened to reveal a soft white (yes, white!!!) pulpy bean, that yields a deliciously sweet flavor when sucked on. When cracked open, the seed reveals its purplish, bitter contents, which must be processed and sweetened to make cocoa or chocolate. Ironically, the powder has to be shipped off to France to be processed there, and then is sold back to the Ivoriens as chocolate at an astronomical price. Even the money with which the Ivoriens buy their chocolate back is made in France, it turns out. Colonialism, it seems, lives on in subtle ways.

Doctors In Africa (Or, Big Problems)

2009-06-19T10:20:00.000-07:00

Today is my last day at the CHR de Bouafle. After 2 weeks of interviewing staff and mothers, observing treatment, and digging through patient charts (made out of actual paper!), I have enough information to make my recommendations on how to improve care for HIV-exposed infants. However, I almost didn’t get it done.

Today, when I arrived at the hospital, I discovered that the power was out. Sitting in in the dark, breathing in the stagnant, fan-free air, I laughed aloud thinking about the number of times I had tossed around the words "resource-poor settings" in my public health classes. When my laptop’s trusty battery finally bit the dust, I was left with little to do. I confided my frustration at the power outage (on top of the doctors' strike, the fierce rainstorm that prevented most patients from coming in today, and other hassles) to Dr. B., a plump and lovable Ob-Gyn whose favorite (and perhaps only) English phrase is “Doctors in Africa—big problems.” Below, I translate his response:

Oh, the electricity goes out all the time. Sometimes when I’m operating.

Really??? What do you do when that happens?

Oh, you know… I send someone out to get my flashlight.

Your flashlight???

Yeah, but one time I didn’t have it, so everyone stood around me with their cell phones so I could see what I was doing.

Doctors in Africa—big problems, indeed.

While I floundered about in the dark, Aicha (who, by the way is not only a nurse, but a midwife-in-training), literally had the experience of a lifetime. She witnessed a breech birth (that means feet first) of twins, delivered vaginally (that means not by c-section), by midwives (that means not by doctors). A breech birth is something you and I almost certainly will never see, and I am happy to report that two healthy baby boys ensued. How appropriate that the French word for midwife is sage-femme: literally, a wise woman.

Today I also said au revoir to my two closest compatriots at the CHR, the data manager and the HIV counselor (pictured below), with whom I spent most of my days. The counselor has done 108 HIV tests so far this month, 26 of which were positive, all with—you guessed it—the same pair of gloves.

Here pictured is Dr. B generously using his strike-time to help me review records:

Me with my leading ladies:

Hospital beds, IV poles:

Organizing a support group for HIV+ moms:

Monday I depart for Issia, a smaller hospital, to do the same assessment. P.S.: What do you think of my new complet=outfit made from panyas I found in the market (see 6/14)?

("Leading ladies" photo courtesy of Aicha Scott.)

Note on video posted 6/15: The mystery has been solved: it turns out that the jogging choir is actually none other than the Ivorien military in training. Onward, singing soldiers!

Caption This Video

2009-06-15T01:24:00.000-07:00

This is what I saw this morning at 7:30 on the road. Sports team in training? Striking workers? Church choir? I have no idea what it was about, but I liked it!

Retrospective

2009-06-14T04:47:00.000-07:00

Things I’ve done over the past few days:

1) Learned the art of the “bucket bath.”

In spite of the comforts of our apartment building, which ironically includes a large and inviting swimming pool, we continue to suffer from a lack of running water. There are taps and showers—don’t get me wrong—but most of the time, when they are turned on, they yield little but the mocking sound of dry air. Running water does come for a few precious minutes a day, but it is impossible to predict when that will occur, and the chances of it coinciding with your desire to shower, brush your teeth, or flush the toilet are small.

This is where the garbage can full of water and spoonful of bleach, judging from the scent of it, comes in. When I confronted the building manager about the water issue, he assured me that it’s not just our building—that the situation is the same all over town. That’s why you have that reserve of water in your room, he said. Oh, you mean the poubelle (trash can)?, I asked. He laughed uncomfortably, but let’s face it buddy—that’s what it is. Yep, he said, that’s what we use. So I began to practice the ancient art of the bucket bath, using a plastic tupperware as a scoop and being careful to go “clean to clean and dirty to dirty”, as Aicha advised, so as not to contaminate my precious reserve of water. I learn something new every day.

2) Got famous.

Last night, as nostalgic for our friends as for the running water in Abidjan, we decided to suck it up and check out “King Discotheque” next door. It did not disappoint. The music was just as good as it was en ville, and the setup was exactly the same. The culture of going out dancing here has nothing much to do with pairing up—quite the opposite, actually. With my sample size of two dance clubs, I can now conclude that what you’re supposed to do is get dressed to the nines and then go dance by yourself in front of the full-length mirror that will inevitably cover one of the walls, staring at yourself. All night.

Also, the the music will inevitably be interrupted every few minutes by a DJ shouting something or other. Last night's interruption-shouting theme was “Aaaaaaaaicha!”, and some form of my name, alternately, “Maaaaara!”, “Maaaaaria!”, “Maaaaaariam!” or “Maaaaariama!” It’s the most famous I’ve ever felt.

3) Found the AIDS medicine in the market.

Yesterday we explored the market, a vast labyrinth of stalls and vendors, a veritable tower of Babel with local and foreign languages rising in a chorus of salesmanship. More than one person offered a bowl of dead frogs, sweating under the hot sun and covered in flies. More appealing to us were the cloth sellers, offering panyas, unfinished rolls of brightly printed cloth for tailoring. I bought two sets (enough fabric to fashion a top, a long skirt, and an extra piece for a matching baby carrier, headwrap, or bag, for the price of about $14. I've already met up with the tailor, who will deliver me a my new African costumes on Wednesday.

We also noticed a woman selling medicines--it was hard to miss her, actually, because she had one of the loudest salespitches going. We approached, and she showed us her dried leaves, berries, and re-used water bottles full of a muddy-looking liquid. This is for stomach ache, this is for fever... and so on and so on. What about AIDS?, Aicha interjected. Do you have anything for that?

Of course, she replied in a lowered voice.

Really?, Aicha asked. Do you know what that is?

It's a sickness, the seller supplied. You lose weight, and lose weight, and lose weight. I have this medicine, she said, waving vaguely toward a pile of plants, and progressed to an explanation of which ones were used for abortions.

4) Asked for and received.

I think I've mentioned before the breakfast bar that we go to every morning--$1 for rich bitter coffee or hot chocolate, and fresh bread and butter for the two of us. When I learned that the owner of the little shack was Senagalese, I had to ask about tchep djen, my favorite local dish to date (see 6/4/09). In typical African hosptality, he not only had his brother's wife make some the next night, but he served it to us in his breakfast bar at the time of our choosing, for free.

5) Made friends.

There is a bar behind our apartment, always empty except for the owners, with Ivorien reggae always blasting. We ventured over early this week to check it out, and made fast friends with the boss, a middle-aged lady with a husky voice and a steamy love affair with alcohol. Plainspoken and boisterous, Lili--as she is called--has taken us under her wing, and welcomes us as we come to visit for a few minutes each day. One night, she inquired which ONG (NGO) we worked for. I was surprised at the question, and even more surprised that she was familiar with ICAP. I asked her what she knew about HIV, and she launched into a scientific explanation, complemented by stories of her relatives and friends who had the disease. She knows her status. She knows that it's important to get tested, because the medicine works well and you can live fairly normally, as well as prevent infection to your baby if you are pregnant. Finally, she recommends a campaign to educate villagers en brousse, who are both the most affected and least informed. What could I say besides... great idea.

Aicha has dubbed Lili's place "the mosquito bar", due to its outdoor setup and the relentless feeding frenzy that occurs at sundown. Thank goodness for malaria prophylaxis!

6) Got two new names (as if I needed them).

Actually, an African name offer is something I’ve been coveting for a while. If someone gives you a name, in my opinion, it means two things: that your name is unpronounceable in the giver’s language, and that they care about you enough to want to fix that. My first new name, Adjua (meaning born on Monday, which I was not), was given to me by the pediatric nurses at the hospital. Aicha’s name rolls off the tongue (although it almost always invites the half-joke, Are you a Muslim or something?), but mine seems to get stuck in the back of the throat somewhere. So, sensing frustration, I put the idea forward that they find something else to call me. They jumped at the chance, and Adjua, a Baolé name, was offered and stuck.

My second name came about more naturally. Tantie Lili (Auntie Lili), the rough-and-tumble owner of the mosquito bar, looked over her glass of whiskey at my face one night and said flat out, “You look African to me.” Actually, before you laugh, this is not the first time that assessment has been made—the rasta man who owned the coffee farm I stayed on in Jamaica said exactly the same thing. Anyway, Tantie Lili continued on to say, “Yes, you are African. You are Bété. I will call you Yao.” I am guessing at the spelling of my name, because when she said it, it sounded approximately like Yaaaaaaaaooooooooooo, which is probably Yao with a whiskey accent.

French word of the day: Sensibilisation=No real equivalent in English, but encompasses education, sensitizing, and introducing an idea, as in Tantie Lili's idea to go out and discuss HIV in the villages.

Bananamobile:

No peeing: Fine $4.

En Brousse

2009-06-11T01:18:00.000-07:00

Today I'll get straight to the French Word of the Day, of the month even: en brousse=in the bush (meaning, out in the middle of nowhere, and everything that comes with it). We're up in Daloa, working in the smaller nearby towns of Bouafle, Issia, and Bonon, and though we're not really en brousse, after Abidjan's comsopolitan comforts, it feels that way a little. It's great though, because I always regretted not doing Peace Corps, and now I feel like I'm getting a chance to experience the living conditions (as well as the service aspect).

We went into the hospitals for the first time. I don't think anything could have prepared me for what I would see there.

I'll just give the one example that has stayed in the forefront of my mind for the past few days. HIV counselors routinely wash and re-use gloves, and when the gloves run out, they do HIV tests without gloves at all (which is always a risk, but it is seems especially salient after looking at the records, which reveal that maybe 1/3 of the results are positive). I report this situation not to criticize or embarrass anyone. On the contrary, the counselors' dedication is astounding: "We know the risk. But when someone comes to be tested, we don't want to miss the opportunity, so we do what we have to do, and put our trust in God that we won't get infected." I reflected on how many pairs of gloves I throw away in the course of a 12-hr shift... it must be several dozen.

The lack of basic protection for those on the front lines is echoed by the lack of basic comforts for patients. For some reason, I feel that it's a bit of a betrayal to describe them in detail, so I won't. Suffice it to say that it's about the farthest thing imaginable from the hospital settings that I am familiar with. Some of the health centers here are without electricity or running water, even.

The silver lining to the situation is the dedication and competency of the workers, which is really something special to see. Nurses and doctors work tirelessly to empty overflowing waiting rooms at a pace that can only be described as American. And the education for both professions is thorough, to say the least. Nurses do 3 years after bac (which is an extra year after high school) plus a thesis for their degrees. Doctors, I learned, go to med school for a minimum of 8 years after the bac for general practice, plus specialty (obstetrics is 4 extra years). They are paid by the state, and not paid well, according to the gynecologist I spent the day with yesterday. Which is why there is going to be a nationwide strike, starting Monday. No doctors (except for emergencies) in the entire country. I hope that next time I'm able to report that it has been resolved quickly and with good outcomes.

This is Aicha posing with the snakeskin that adorns our apartment lobby. The proprietor assures me it was not caught and killed in the building.

Live From Abidjan, It's Saturday Night

2009-06-07T05:01:00.000-07:00

I wouldn't keep you waiting... here are my photos from the boite, where, as if to prove the cosmopolitan claims of Abidjan, I danced salsa with a Rwandan.

They told us West Africa was conservative; they told us to cover our knees. They forgot to tell our waitress.

To continue our hard work, we went to the beach in Bassam today. The waves were definitely too big and the current too strong for actual swimming, but it was pleasant nonetheless.

Aicha and C.:

Sea horses:

Peanut sellers:

Basket seller on his bike (Alec, this could be just the business for you):

Rabbit seller on the road:

The personality cult knows no borders:

It wasn't all fun and games. We were stopped by the police on the way home, for reasons that are unclear to me. At first, the policeman didn't like the fact that the door of the woro woro (a shared taxi that stops along the side of the road and stuffs in an improbable number of people for a very low price) was broken and tied together with string. Then our passports were demanded. Of course, we hadn't carried them to the beach. I had a color copy of mine, but that wasn't cutting it. I was in the back of the woro woro on the far side, and couldn't really hear or understand what was being said up front. I was getting pretty nervous as voices started to rise. While I was sweating, Aicha played it cool; to my amazement, she at one point bought an ice cream through the window of the woro woro from a passing kid, even as the police drama continued. Finally, our friend handed over 1000 CFA (~2 USD), and we were allowed to pass. All that for two bucks. Amazing.

Anyway, in case anyone was waiting with bated breath... yesssss, Les Elephants DID beat Guinea in the football match today. Actually, football (soccer) is serious business here. Earlier this year, 19 people were killed trying to get into the stadium in Abidjan.

Starting tomorrow, my posts will probably be coming much less frequently. We are leaving Abidjan for Daloa, up towards the center of the country, to start our work in the hospitals around there. I doubt I'll be enjoying the easy access to internet that I've gotten so used to here in the city, so bear with me. Besides, I'll be working.

French word of the day: marchander=to bargain (as in, I was pretty impressed watching Aicha bargain in Pular [that's a language] today)

Sun Day On Saturday

2009-06-06T09:06:00.001-07:00

Today, for the first time, I saw the sun (and also, the Son). Check out Abidjan's Cathedral St-Paul:

Jesus with the elephants:

Equal time for another of Cote d'Ivoire's faiths:

We also went to the largest market in the city: Le Marche de Treichville. I have to say I wasn't prepared for the mayhem, and was feeling pretty claustrophobic and pestered by the end. They sell everything here from Chanel mascara to those snail kabobs you were wanting so badly:

With so many delicious snails, it's hard to choose:

What's that? No snail kabobs for you? How about some bin bin, then.

Beader at work:

The market's cutest rice vendor:

I also learned that people don't really like to have their picture taken, but some will submit for the price of 500 CFA (~1 USD). Here pictured is the exception to the rule, the dishcloth seller who chased me down and begged me to take her photo (500 CFA not required). So here is Africa's Next Top Model... Doesn't she look proud?

French word of the day: Une boite de nuit (Literally, a nightbox=disco/nightclub. As in, do I take my passport to the nightclub, in case we get stopped by the gendarmes on the way home?)

Picture This

2009-06-04T10:51:00.000-07:00

I haven't had time yet to take many pictures of the landscape... (plus I've realized that "rainy season" actually does mean that it rains ALL day), but I did manage to get a few important things on "film":

"Choose abstinence: It's the best move for avoiding AIDS." True enough, if your life situation permits it.

For those unable or unwilling to obey the poster above, I submit "French Feelings" as a prophylactic alternative.

Pictured here is one dollar's worth of tchep djen, a Senegalese dish served widely throughout West Africa. The deliciousness is comprised of rice, fish or chicken, bitter eggplant, squash, cassava, and a bitter collard-like vegetable yet to be identified by me. Mostly just rice, though.

African Red Bull! The captions read "the end of the office nap" and "snore prevention."

Hard at work in the office on pre-hospital-departure stuff. Could have used some of above snore prevention.

Oumou, office teddy bear.

Franc, the cleaning guy, sporting his "Inter-Net" uniform. In lieu of French Word of the Day, I will explain why this is a hilarious pun. (Nettoyage=Cleaning... Inter-Net... Get it?)

I like this poster. "Do the HIV test with your wife! It's the only way to protect your baby."

Aicha, my lovely RN partner in this adventure, modeling our surprisingly luxurious accomodations in Abidjan.

More to follow, if I can ever get outside. Should have brought one of those underwater cameras...

First Day At The Office

2009-06-04T04:21:00.000-07:00

Today, after a restful night's sleep, we were met at 10am by the driver for my first trip to the Abidjan office. From the back seat of the car, I got my first daylight glimpse of the landscape. In the pouring rain stood stall after stall of vendors, mostly women in brightly-colored dresses, crouched with their infants in the dirt, flashing smiles to the passing cars and offering their wares. Bananas, corn roasting over a fire, cloth, avocados, and finally, a stall with a crude, hand-painted sign: "Vente de cle USB, 1 Giga" (USB ports for sale: 1 Gigabyte). You're not in Madagascar anymore, Toto, I thought.

The office is busy; there are more than 20 people working here non-stop. I completed the tour and round of introductions and am now settling down to review some PMTCT (prevention of mother-to-child-transmission of HIV) tools, to the soothing sounds of the rainy season.

French word of the day: fardeau=burden (as in, the effect of prolonged breastfeeding on the burden of HIV in Cote d'Ivoire)

Arrival, At Last

2009-06-03T14:31:00.000-07:00

Good Mooooooorning, Abidjan!

In contrast to the first departure attempt, the second one went off without a hitch. I'll check in later--it's time to unpack and go in search of rice & sauce.

French word of the day: Invitation=Local polite thing to say when eating; invites others to share

AfricaNurse Blogs From Exotic Washington, DC

2009-06-02T15:08:00.000-07:00

Welcome to TheAfricaNurse, a nickname affectionately given to me by Marina (impossible Polish last name here), fellow nursing alum. I'll use this blog to update interested people on my adventures (and hopefully get your comments, as well!).

Unfortunately, I must disclose at this point that I am not actually in Africa.

It's already started, and I haven't even left yet. In typical African-traveling fashion, I arrived at JFK last night, all backpacked and ready to go... only to discover that there was un gros probleme with my visa to enter Cote d'Ivoire. So, an unexpected trip to the Ambassade in Washington DC, a trial-by-fire of my cobwebbed French, a new visa (rendered in under 4 minutes by the apologetic staff... incroyable!), and so on.

The cab driver who took me from the station to the embassy and back, and who I correctly guessed to be West African (from Cameroon, to be exact), insisted that this had happened for a reason. As proof, he gave me his contact number in Cameroon (being a taxi driver, he is something of a "big man" in his district, I guess), and invited me to call it in case of emergency.

This, after a cascade of brilliant advice. To the best of my translation abilities: 1) Don't buy the malaria pills in the open-air market. They are made from cassava. I know a guy who does this. He has a machine, from Pakistan. You put it on the cassava and press down, and poof! It looks exactly like the real thing. 2) You will be happier in Africa. There, nobody has anything to do, so they are nice. I used to think I was better than my twin brother, because I live in America and he is still in Cameroon. But you know what? He has two wives and thirteen kids. I live alone; I cook my own food because I have no wife. He has no rent problems, no problems paying the phone bill. Every time I open the mailbox, my heart drops, because I know there will be bills inside. My brother doesn't even have a mailbox.

I think there is a lesson there... and I'm definitely looking forward to not having a mailbox. Plus, now I know not to buy the cassava pills--so maybe this did all happen for a reason.

So, planes, trains, and automobiles, and plenty of American $ later... I am now officially ready to go-- for real this time. Maybe I'll treat myself to a nice gin and tonic on the plane (for anti-malarial purposes, of course). Laissez les bon temps rouler!

French word of the day: à compter de = starting from (as in, your visa is only valid starting from the first of July)