African EMS

A week after returning to OloOlogo I traveled to the next village to the East, Silbe, to aid with a health symposium. Planned by members of World Vision, a international NGO, and the Silbe AgroForestry PC Volunteer, it focused on women and children’s health and covered topics such as prenatal exams – importance and what to expect, malnutrition, vaccinations, and I gave a short demonstration on Oral Rehydration Solution (ORS) as a treatment for simple diarrhea, one of the leading causes of death to children in the developing world. I had expected to present in French but upon arrival I discovered that the presentations were supposed to be in Pulaar so I quickly condensed and simplified by presentation for easier translation. As far as I can tell the symposium went well and was well received although I personally believe some of the topics were too technical for the common African woman who is often uneducated beyond third grade. Attended also by 60 or so children under the age of 10 it was a “lively” event with numerous disruptions but nonetheless personally satisfying since it was my first official Peace Corps health event.
The night before the symposium, I was called to the health post to aid in a routine delivery – Little did I know when I left the house with nothing but my cell phone and water bottle that before sunrise I would travel to the hospital in Boghe and back. Actually, upon arriving at the health post I thought it was going to be a boring night since neither of the two women who arrived at the health post were in active labor, but for the 17 year old that quickly changed. After walking for 2 hours around the health post she was progressing rapidly but after lying down for a rest around 9:30 she suddenly started seizing. She was immediately carried inside where an IV was attempted and the local driver was called to bring the “prison van” for a trip to the Boghe hospital. I was asked to go along and immediately jumped at the chance to perform “African EMS.” For almost two hours, I traveled cross country from site to the hospital with the head nurse and 5 female family members of the patient, holding the patient on her left side on the floor of the van while also stabilizing myself on a seat that was not nailed to the ground. The patient continued to seize about 30 more times throughout transport. Eventually we arrived at the hospital where the patient was placed on the floor of the birthing chamber and I was sent with the head nurse to buy IV tubing and a urine catheter from the local pharmacy, even the regional hospital was not stocked with supplies taken for granted in the states. The patient was eventually taken by “ambulance” to the better hospital in Aleg (45 minutes to the North) where I later heard she delivered a healthy baby via C-section and was doing well.
The experience was extremely eye-opening especially as I compared elements to my EMS work in Richmond. Most notably that even the head nurse was unable to do anything for the patient but start a basic IV line and that everyone involved was untrained in caring for a seizing patient as they kept stuffing the patient’s mouth with fabric which restricted her breathing and causing her condition to worsen as she choked on her vomit. Additionally, the ambulance that I mentioned above was nothing but the shell with a cot – no supplies, no blankets, absolutely nothing but a large vehicle. Also, a lot of banging was heard from under the hood in order to start the engine and the family was forced to pay out of pocket for the gas to make the trip north. Although a nurse from the health post traveled with the patient so did all the family members suggesting little would be accomplished en route.
I returned home to OloOlogo around 4am - cold and starving – after an extremely bumpy ride en brusse during which I was unable to sleep and was scheduled to wake up at 6 to travel to the health symposium. Luckily the next few days were fairly uneventful and lounging is encouraged daily so I had plenty of time to rest and catch up on some much needed sleep.
My APCD (Mauritanian PC Director of Health), Daouda, was scheduled to visit me at site on the 16th but arrived a few days early. Fluent in Pulaar, French and English it was wonderful to have him in OloOlogo for a few days to aid with translation, eat exceptionally good food via Mauritanian standards, as well as to talk in English about global and PC news. During his visit we also talked to several village members and I was happy to receive a glowing report from several of them including the head nurse at the health post although Binta, my immediate counterpart, was not present for his visit. After many days of uncertainty it is always nice to hear you are appreciated even in I have yet to accomplish much in my own mind.
Binta, the midwife and nurse, has been at the hospital in Nouakchott for three weeks with her sick younger brother. Although her absence for an extended number of days has caused the number of patients to significantly decrease – no one wants the male nurse to help with prenatal exams – it has left me to do more work on a daily basis to aid her daughter and the head nurse who performed his first medical activity in my presence at vaccination day two Wednesdays ago!
An 8 month pregnant 12 year old was carried into the health post several days ago because of severe abdominal cramping. She refused to allow medical personnel to perform an exam and thus her mother was eventually called in to yell and slap her into cooperation. She further reinforced in my mind the fact that 12 year olds are not mentally, emotionally, not to mention physically prepared for motherhood. I was told a few days later that the same girl had arrived at another health post a day or two later and after a difficult labor finally delivered a baby that did not survive. It is hard for me to imagine undergoing such a commitment at the age of 12 when I was still playing with dolls but there I was presented with a married child who was unable to accept the consequences of her actions and thus encouraged to think once again about the numerous health issues facing this country – many of which surround the culture in general as well as the strong influence of Islam.
I am told the cold season is a busy time for the health post due to skin infections, colds and other general illnesses in addition to a large number of babies being born - based on the last week I can full heartedly agree with all three accounts. In three days I helped deliver 4 babies, two at odd hours of the night, since both nurses were gone leaving me to watch the health post with my 17 year old counterpart. In general, deliveries run fairly smoothly and I rarely wait more than 2 hours after the woman’s arrival for the baby to appear; however, the last two deliveries were complicated with the first needing an episiotomy and the second choosing to walk around the courtyard to aid the progression only to deliver the baby’s head while still standing outside in complete darkness. The first was an interesting case in that it further confirms the need in my mind to teach against female genital mutilation (FGM), a practice common in many African countries and cultures, and the second taught me to be weary of a patient who no one understands due to language constraints and never let a patient out of my sight! Both cases seem to have ended well with both women and babies returning home within 24 hours and as of yet no word of further complications, although they both made me slightly nervous at the time.
Several small children as well as adults have come to the health post seeking medical attention because of seemingly painful and wide-spread skin infections. Unsure if they are fungal or bacterial in origin at this point (most people are treated for both when they arrive) it makes me nervous since in the Hassaniya culture any cuts, skin problems, sprains or otherwise minor issue are often treated initially by rubbing fresh animal dung or recently slaughtered animal parts on the area frequently causing the problem to worsen before true medical attention is sought.
A pile of about 100 bricks sit outside waiting for the construction of my room to begin. I have been consulted several times regarding placement within the family compound and told that construction will begin soon but days continue to go by without any change. Additionally, the last few months I have had several more uninvited guests, most notably a pair of Hassaniya women who arrived one Saturday morning and sat right inside my door for about 15 minutes and watched me read. Due to language barriers I could do no more than the initial greetings and then allow them to sit and watch. Although they arrived during daylight hours I continue to find it odd and an unwelcome disturbance since it makes me feel like a goldfish in a glass bowl that has been placed on display for a child’s amusement.
Late one afternoon I was invited to visit the local women’s vegetable garden located on the far East edge of my village. We arrived right as the sky turned a magnificent rainbow of red, orange and yellow as the sun began to set and I was taken aback by the classic beauty of women working with their hands in lush, green garden plots while wearing traditional, bright colored clothing. I returned the next day to help with watering which entailed caring water from the river up the sloping embankment to the garden on my head and was forced to endure a number of obnoxious comments and bouts of laughter which did little to alleviate my recent irritation with the community.
Recently been also slightly nervous as I listen to the BBC regarding the world’s continued reaction to the current military government’s lack of action in regards to the demand to restore the president and restore democracy within the country within the last month. The most recent report I heard said that a new decision should be made before December 12 when another meeting is scheduled to discuss the issue and after a delegation has been sent to the country to meet with the leader of the current military junta.
On the animal front, I was awakened a few nights ago to a sheep or goat eating one of my books. He had wandered in the front door which was left open and decided that my papers looked like a delicious midnight snack. He quickly left once I awoke and began making noise but he showed his appreciation by leaving me a present on my floor as he was on his way out. I awoke again around 7 to one of the small children of my family compound entering my room and tripping on the animal droppings and proceeding to face-plant on my floor.