Monday, May 17, 2010

True Crime

The Internet isn't always a place of wonder. I have enjoyed the rapid access to all things trivial, the real time information, and the great networking and net-reconnecting potential. I watch obscure movies and old tv shows online, read newspapers from around the world, and listen to vintage radio shows. I love the fact I can ameliorate some nagging need to remember or learn a character actor's name, the capital of Burkina Faso (Ouagadougou - actually I knew this, my favorite capital :), or whether or not Ernest Borgnine is still alive - he is! Despite this wonderful potential, I sometimes learn things I almost wish I hadn't. Such was the case when I was reminiscing about my high school days, and I remembered an old friend, Tim B., probably the most positive, upbeat guy I had ever met. After sorting through a dozen Tim B's on the Internet, I realized the one entry I did not want to read contained the only information available on his life via the Information Super Highway. Or more precisely, his death.
I knew thirty something years ago that Tim had a different heritage than I or most of us in our small town. He was dark-skinned and I knew he was adopted. His adoptive father was the Methodist pastor in town, and his siblings had been adopted as well. It wasn't an issue, and perhaps I am just now realizing his uniqueness. As I read the newspaper article, I learned he had rediscovered his Native American roots, moved to Washington State, and had taken a teaching job at Northwest Indian College. He was an athelete and a poet. By all accounts, he was very popular and was as gregarious and genuine as he had been in high school when I had known him.
At some point, Tim had fallen in love, and was living with his partner and their two young boys. Things had soured though, and he had even become frightened of his children's mother. He often slept in his office, and told his friends that he feared for his life. It would be revealed after his death, that she had attempted to poison him and even tired to rig his truck to explode. Ultimately, while two months pregnant, she strapped their two sons in the car, returned to the house and walked into his bedroom with her mother on the cell phone and a handgun. With maternal urging, she shot Tim in the head as he slept. When apprehended, she would claim domestic abuse as her defense.
Tim's partner and her mother are in prison. The abuse charges were absurd and eventually recanted. Piecing the story together through Internet sites, I was reminded of the plethora of television crime shows scattered throughout the 1200 channels I now peruse. The story was almost too bizarre to be true. Lost in all of that was Tim, and his amazing love of life. How ironic in this Internet age where there is too much out there on too many of us, there are those whose lives are distilled into one story, one tragic fact. I have lost many friends over the years (Robin, Greg, Simon, Larry, Virgil, Bill, Tim),and they are now evanescent ghosts, disappearing as fast as aging links expire. The Internet isn't always a place of wonder.

Thursday, May 13, 2010

Dialogue on Diarrhea

After my suturing adventure, I tried to limit my medical excursions. Despite my reluctance, I was occasionally called to help with something when there were no other resources. This was very ironic, as I barely knew what to do with simple medical cases. In the course of these "house calls" I learned far more than I wanted to about malaria, thyphoid, dysentery and female circumcision.
I had heard about female circumcision, but I considered it an antiquated practice. I would come to discover that there was a small sect of people in the camp that not only practiced it, but also infibulation (sewing the vagina nearly shut). It was very late one evening when one of my students came into my tent, obviously in distress. He looked about at his feet and stammered something in Afar. Eventually, we switched to a mixture of English and Arabic, and he let me know he wanted me to come with him, but we had to be very careful. We crept through the camp to a shack on the outskirts. He carefully surveyed the area, then whisked me through the cloth doorway. In the dimly lit room, I saw a young girl laying on a cot, moaning softly. There were a few other students in the room, and they were very frightened. They wanted me to help, and I knew something was wrong as it was very late, and there were no adults present. I sat down near the girl, and began to ask the other girls questions. I asked how long she had been sick, if she had seen a doctor, if she had a fever. She was covered with some thin material, and I knew I wouldn't be allowed to examine her too closely. I knew the problem was in her pelvic area, and I tried to get as close to her as I could without touching her. When I moved closer, I smelled the infection. I could also see some "projections" sticking up from her crotch, poking up into the cloth. She was incoherent, and I knew she was in dire trouble.
I told the students to stay with her, and I raced to the nearby village. A young female Sudani doctor had recently arrived in the village, and I thought this was a good time to make her acquaintance. I stopped and recruited a friend, a Sudani teacher, and we woke her up. At first she was reluctant (the refugees could never pay for medical service, and she would be looked down upon if she started to treat them). She finally agreed to come to the camp to see the girl. I was not allowed to go back into the room with the doctor, as a matter of fact, I was directed to go back to my shack. I was told the girl was taken to the regional hospital the next day, but she never returned. I am sure she died. Later, the translated story was that she had been sewn with some sort of thin grass, and that her family didn't want the officials to know. I was never allowed to know her name.
The first death I witnessed was that of a baby. I learned the child had died of dehydration. The camp had no running water (only salty wells), no electricity, and very few sources of fuel for fires and sterilization. Because of the heat, humidity, and poor hygienic conditions, the children were often sick. Malaria took its share, but more children suffered and died from dysentery and diarrhea. It is an eerie thing to push your finger into a child's belly, and not to see the skin spring back. After the first death, and the rumor of a second, I took a trip to a large town four hours to the north, and met with some Russian doctors I had met. They explained rehydration therapy to me, and gave me a copy of a newsletter, Dialogue on Diarrhea. I returned to the camp with a new mission - sanitation and education.
I met with the elders and told them I wanted to hold some classes for women in the new school. I showed them the tools I would use (liter cups, bottle caps, salt, and sugar). I bought enough sugar and salt to start the project, and an eager Yemeni shop keeper provided the bottle caps. Slowly, the mothers came forward and I, with the help of some of the early converts, showed them how to clean the water vessels and mix the rehydration solution in proper ratios. The students pitched in and made some posters with instructions written and drawn. And although I couldn't get them to boil all their water (there simply was not enough fuel), they did boil some communal water for mothers with young babies. It was a wonderful campaign.
Later, I turned my attention to the large garbage pits surrounding the camp. We found some large metal cans, and got most everyone to deposit hypodermics and other sharp metals into them. The older students patrolled the camp and picked up anything that was dangerous or unhealthy.
It wasn't that the refugees weren't aware of many of these issues, they were just so preoccupied with survival and day to day needs that they neglected them. Also, there was no designated person or official to monitor them. I was very pleased that once we started attending to the issues, the refugees (particularly the women and children) took charge. And I gained a new favorite literary source - the Russian doctors began to forward their bimonthly journal, Dialogue on Diarrhea to me. I was excited each time I got a copy.

Where there is No Doctor

When I got to Yemen to start my second Peace Corps tour, I found out that I once again had some freedom in choosing my assignment. Most of the volunteers were to serve as ESL teachers in the mountain villages. I too was to be a teacher, but I had input as to where. Two factors helped my decision: I wanted to be on the Red Sea (I had brought my snorkeling gear), and I discovered that there was a refugee camp in a small village on the coast. I lobbied hard for the refugee camp in Al Khawkha, a small fishing village on the coast. The coastal region of Yemen (named the Tihama)is very different from the rest of the country. It is at sea level, one of the hottest areas in the world, average temperature. It is also much less conservative, more easy going than the mountain regions.
When the Peace Corps officials forwarded my request to the Ministry of Education, it was denied with the following rationale - "The Tihama is too hot, too difficult for western workers, we will place them in large cities where they have access to electricity, but not in villages." I didn't give up though, especially as I learned another volunteer was working in the camp temporarily building a school. We went back to the ministry several times and finally wore them down. As we were leaving, the ministry official said something in colloquial Arabic that made my Yemeni Peace Corps official smile wryly. I pestered him for a few minutes, asking him what it meant. He looked at me and said "I believe the English expression is its his funeral." I laughed as only a 30 year-old fool can laugh.
When I arrived at the village a few months later, no one knew I was coming. It turned out that the ministry official didn't really believe I would move out to such an isolated, hostile place (hostile in the environmental sense). After a few days of confusion, I was given a timetable at the local school, and I went out to the refugee camp (for Eritreans) and met the volunteer. At the end of his allotted time on the school project, we had completed 2/3 of the school. He left the rest for me to finish. I then moved out into the shack in the camp that he had occupied. It had two rooms, one with a bed of sorts and a small table. It would be home.
I won't attempt to describe the heat and humidity of the Tihama, it is impossible to relate. Instead, I can share some reactions of folks who came to visit me. One volunteer, a tall, fit guy from the east coast showed up one evening and told me he planned to stay for a few days. He laid around for two days groaning, and insisted I get him to a phone (two hours away) so he could call the nurse to tell her he hadn't urinated for days. More typically, friends would show up in the evening (there was limited transport into the village) when it was 90 degrees and vow to stay for a few days. Inevitably, they would leave the next day before noon. You couldn't sleep at night, and you could barely breathe. It took me a month to acclimate.
I was living in the refugee camp for a few months before the residents grew to trust me. I worked with the orphan boys to finish the school, and I often entertained the children in my shack at night. When we did finish the school, some of the elders stopped by to congratulate me. One of them noticed one of the two books I had, Where there is No Doctor, a general first aid book given to all Peace Corps Volunteers. My life changed drastically shortly thereafter. There had been a doctor in the camp, but he had been recently arrested on some mysterious charge and was in the local jail. The Eritreans lived in the camp by the grace of the Yemeni. They had no rights per se, as they were not citizens. To this day, I don't know why the doctor was arrested, or what became of him. I do know that my first aid book had been noticed, and that I was to become the medical expert in his absence.
A few weeks after the discovery of my book, I was summoned to the the center of the camp by a group of frantic children. I had a base understanding of Arabic, and was just then learning some Afar, their language. They drug me by the arm to a shack with more than fifty people surrounding it. I was pushed inside where I saw a man laying on a small table in obvious agony. He had come into the village by motorcycle taxi, and had gotten his bare foot tangled in the chain and sprocket. It was mangled, cut to the bone. I was in a bit of shock, and I gradually realized I was being admonished for not bringing "the book." I rushed back to get it and also brought my meager first aid kit.
When I got back into the makeshift clinic, several of the adults were holding the injured man down on the table firmly. They pointed at his foot and told me to get to work. I got out some gauze and hydrogen peroxide and started to swab the cut. These were hard people, survivors of a 35 year civil war. They nodded and told me to clean the wound more rigorously. I reached in and scrubbed the wound feeling muscle and bone. I think I was closer to fainting than the patient. When I had cleaned it as well as possible, I reached in the first aid kit for some more gauze and wrap in order to tie up the wound. There was a buzz in the room that let me know this wasn't to be the course of action. Someone, I don't remember who, handed me a big needle and some fishing line. I was to stitch him up.
I hesitated for a moment (felt like a year) and became aware of hands pushing me towards his foot. I looked at the wound and tried to remember the suturing I had received on some of my own misadventures. If you can imagine how hard the pad of a foot is, particularly one that seldom wore shoes, you can also imagine what the next several minutes were like. I tried to push the needle through the skin and muscle and couldn't. He was screaming and I was pushing. It was a nightmare. Finally, a rusted pair of pliers was brought forward and two of us pushed the needle through. It made a sickening pop as it exited. We repeated this about ten times until we closed the wound. I used all of my hydrogen peroxide trying to keep everything clean. It was the most gruesome (at least at that time) thing I had witnessed, let alone participated in. Some days later, the elders in the camp were able to get permission for the man to leave the camp and go to a hospital three hours away. He recovered, with a limp, and his wife crocheted me a nice colorful cover for my bed.
Months later, at a Peace Corps gathering in the capital, I recounted the story to some of the Peace Corps nurses. They gave me proper suturing tools, but thankfully, I never needed to use them.
This was not my last medical experience in the camp, although I tried in vain to tell them I was not qualified for such things. They would remind me that any help was better than none, given that they had no access to proper treatment. I did buy more medical supplies, learned how to give injections, and worked very hard to get a Yemeni doctor to make visits to the camp. The worst however, was still yet to come.