Senegal Clinic

The second thing I noticed was the sigh. It had a dramatic quality, as though a mother were empowered to cast off the cumulative burden of heat and disease and despair…all in one expansive breath. After noting the sigh, my eyes were then fixed upon what had first caught my attention, her daughter and our patient, 5 year old Maria.

This is Senegal, Africa. It is Thursday, February 7. I am sitting in a classroom, fashioned into a temporary clinic for this and the subsequent 2 days. We are in a remote piece of land, located near an even more remote village called Diourbel. We have traveled the 100 miles from the capital city of Dakar by Land Rover to meet with the local church and operate this clinic, at the cusp of the Great Sahara Desert.

My associate is a refugee from the Chad named Gundar. He is a medical student trained in Senegal and is a doctoral thesis away from being credentialed to practice medicine. 

Gundar is a very capable physician, and derives great amusement from exposing my vast pool of ignorance in tropical medicine.

Gundar leaned back in his chair, gestured to Maria and asked; “What are you going to do for this young girl?”

In many respects, Maria was like many we had seen in clinic that day. She was feverish, lethargic and had a bulging stomach and swollen feet, giving evidence of protein deficiency. A swollen spleen testified to malaria that had not been treated. No doubt she had parasites competing for what little protein she had eaten. But this is not what made Maria different.

Maria’s body was covered with lesions. Encrustations that, over time had eroded her eyelids and several fingers. The devastation was so complete that it looked as though she had been burned all over her body, and then afflicted with leprosy. The result was a grotesque disfigurement that was at once, abhorrent to look upon, yet utterly fascinating.

After Maria’s mother had settled into her chair, she reached into her bosom and retrieved an oversized zip-lock plastic bag. From the bag she carefully extracted small documents, some note cards and sheets of paper. She unfolded each as though it was a sacred relic, she placed them on the table before us. The documents told a story of numerous visits to other clinics and healers of every stripe. It was evident that this mother had spent all of her means to find someone, anyone who could bring healing to her little girl.

Gundar cleared his throat, and managed a faint smile as if to prompt a response to his question. My gaze moved from Maria to Gundar, but I found nothing to say. Presently, he found a scrap of paper and scrawled out in French a word I later found to mean Icthyosis, a rare genetic skin condition that derives its name from the scaling of fish.

Gundar spoke to Maria’s mother in Woloff, the language common to both of them. He told her that we could not cure her daughter. We would give her something to ease her pain, and some emollients and topical ointment for the localized infections. But that was all we could do. He was very sorry.

Gundar began writing instructions for the pharmacy on a prescription pad. “Maria, is very fortunate,” he said in precise English. “Such cases do not usually survive past the third year in this part of the world. Maria has a very good mother.”

“Fortunate?” In a world where any feature outside of normal is regarded with suspicion, ‘fortunate’ is not a word that I would have applied here. And yet, as the mother was carefully replacing the hallowed documents into the zip-lock container, she held out the overstuffed bag to her daughter to tamp them inside with a mutilated hand, in what appeared to be an established ritual between the two.

“She really is a good mother” I thought, witnessing once again that dignity is not dependent upon circumstances, and compassion is a quality of character without borders.

Our medical team left Portland on February 13^th, 2010 to conduct a primary care clinic in Gbangbatok, Sierra Leone. Our team consisted of one physician, seven nurses, two medical technologists, one EMT and four lay persons. I will summarize the trip based on the mission objectives outlined in my correspondence to you prior to leaving for Sierra Leone.

Primary Care Clinic

We set up the clinic in Tuesday morning after having arrived in Freetown on Sunday and driving back country on Monday. The main road to Sierra Leone has improved significantly since our last visit in June; however, the back roads to Gbangbatok were very pitted and rutted.

When we began clinic Tuesday morning, our first patient had a deep left shoulder wound. His assailant thought our patient was an “evil spirit” walking in the night and attacked him with a machete. We also saw several patients in this area who had been marked with body piercings related to the “secret arts” which we commonly refer to as Voodoo. We saw more than the usual amount of epilepsy in this community. One patient in particular was brought to the clinic and experienced a grand mal seizure while in the waiting area outside. Her attendants allowed her to spasm in the dirt. Upon inspection it appeared she had fallen multiple times and had many wound on contact points from hitting the ground, many of which were freshly opened. We saw many patients with severe dehydration and dispensed a lot of oral hydration solution to kids. We saw much active malaria and severe dehydration. We did a couple of infusions for dehydration and also incision and drainage of several abscesses. Our physician repaired a hand that had been cut quite badly from moving a bed.

I had opportunity to visit with the Paramount Chief for Gbangbatok area. He was very appreciative of our coming and told us that this was the first Western style clinic that had come to this village since its inception 120yrs ago.  

We typically had between three and four hundred patients waiting for us each day beginning the first afternoon. There had not been much publicity for the clinic but much of it had occurred word of mouth. We were told patients came as far away as 20 miles; in one case by boat from a nearby island.

As our custom, we visited the local school and nurses triaged each of the students to select those that we needed to see in the clinic. The students were treated for worm infestations and as needed for low grade infections of the eye. Many patients who came to the clinic did not have any particular infectious process but wanted to receive medication for pain. I had the privilege of standing outside in the waiting area with the Paramount Chief dispensing Tylenol to patients who met this description in an effort to relieve the congestion for those waiting to be seen in the clinic.

 We dispensed over 1000 glasses, including reading glasses, prescription lenses and sunglasses from a donation we received from the  Lion’s Club.

We had one unusual patient who came into the clinic as a litter case. She had an unrelenting seizure of clonic tonic type and did not appear to be able to make eye contact and did not appear to be fully conscious. Her vital signs were normal except that she had a very high fever greater than 104°. We placed her in our treatment room and our physician went through the process of ruling out several different causes. He determined that the seizure was not related to the fever and that the seizure continued even after the fever had abated. Dr. David subsequently ruled out encephalopathy,  psychosis and drug induced seizures. After treating her with several medications, we left her in the attendance of her family and went off for lunch. We presumed that after being gone for an hour the symptoms would subside. However, when we returned the symptoms appeared to be as forceful as ever. Dr. David noted that the seizure activity was “volitional” and that her extremities could be moved at will, apparently against no resistance. He observed that the amount of energy that the patient was expending to sustain the seizure activity would be exhausting if it were strictly emotionally induced.

Dr. David observed “I don’t know that I’ve ever seen demon possession before, but if I did see it I don’t know that it would look a lot different than this.” At that, we summoned our team intercessor, Francis, to come in and pray with the patient. I was particularly curious to see how this approach would work given that we had exhausted the available medicines that we had brought with us. Francis was very confident with is approach and prayed with the patient for about twenty minutes in a very low tone of voice. At one point I heard him mocking the sprit that he perceived controlling the woman.

At times the woman would use her hands to shield her eyes from looking at Francis. She would persist in this behavior despite Francis’s repeated attempts to set her hands aside. Presently, after about 20 minutes, the woman sat up in the bed. The seizure activity was gone; she remained very drowsy from the 50mg of Benadryl that we had given to her, then she walked out of the clinic. This particular case drew a lot of speculation among the team members about what had actually brought about the change in the woman. Some thought the entire episode was precipitated by hysteria. This would not have been the first such case where this appeared to be true. What was unusual was in this case was the amount of energy the woman expended for a sustained period of time.

Others suggested that the change was manifested from the medicines that we had administered to the woman in the morning. Most of us believe empirically that the most substantive of the change/clinical presentation of the woman was brought about at the ministry of Francis’s prayers. We leave the readers to decide for themselves.

Gideon Testaments

Francis dispensed at least 350 testaments while in-country. They were enormously appreciated by the locals; most of whom are Muslim in faith.

Young Life Event

We conducted a Young Life type of event with the youth in the community. At the end of the clinic, I believe on Thursday, four of the clinic staff went to the local church and conducted a Young Life event. It was particularly challenging in that the group wanted to

select games that would appeal to an African audience and not waste food which is typically an occurrence in an American style games. They ended up putting nylon stockings on their heads and swirling tennis balls above their heads in a competitive game. They also shaved balloons and did the mannequin game.

All of this was hilariously received by the African kids. The event concluded with a presentation of the Gospel by John.

Serabu Hospital

We visited the hospital and the Sierra Rutile Mine. In our June trip, we had explored with the Rutile Mine the interest of developing a managed care relationship between the Mine and the Serabu hospital, as had been the case prior to the war. In the interim, the general manager for the mine was replaced. In addition, many of the employees in the mine had been contracted out to vendors such as for security and meal hospitality. Consequently the 800 employees that were original members of the mine had been cut roughly in half.

In our conversation with Mr. Wonday, the General Manager,  he expressed enthusiastic support of the initiative as had been previously been discussed. He had been made aware of it by his predecessor. We are committed to providing a proposal to Mr. Wonday by March 30^th. To complete this proposal it will be necessary to obtain financial data from Serabu Hospital as well as employment data from Sierra Rutile Mine. Chad has been working to accumulate these numbers since our departure on the 24^th.

Rice Initiative

We had occasion to stop by Taiama on our way back from clinic. The rice has been harvested from the 20 acre field that was planted last spring. It sits in storage awaiting drying and hulling. We had opportunity to witness the process of hulling the rice; several of our team members also participated. We also expect that once hulling has completed we will have a yield of about 50 bushels.

We also visited the tractor. It’s in storage in Bo under lock and key. It appears that most of the components are there. We made a list of some of the parts that we will need to ship with the next container. The tractor is fully operational and Howard Ropp, our team member with agricultural experience, was able to give us some sound wisdom about where we should farm next and what components we should add to the tractor to make the rice growing initiative more successful.

Waterloo

We visited the Dam at Waterloo. The superintendant’s building that had been constructed by a team last January remains intact. The grounds were in good repair and there were several gardens growing in the area. I was informed that there were six officials or Ministries that needed to sign the lease allowing us to make continued reparations to the facility. Thus far the agreement has been signed by five persons. One signature remains with the Ministry of Lands. Since  returning home, I have forwarded three letters to various ministries to encourage their signature from the Ministry of Lands.

About the Team

This was an unusual team in that ten of the fifteen persons who went on the team had never been before. Four of the nurses who were seeing patients had to become familiar with the protocols in fairly short order. You will recall that when we first opened the clinic Dr. David was engaged in repair of a shoulder wound right off the bat. The nurses responded superbly. We were able to see 100 patients in the first afternoon. Each of the patients was administered to with the greatest of compassion and accuracy to the protocol. Moreover, the admitting area ran flawlessly. Rivers was able to keep patients coming through the clinic at a rapid pace and there was not a backlog of people waiting to be seen for any lengthy period of time.

The pharmacy was dispensing medications efficiently. We were working in a relatively confined space so I was concerned about congestion of people at different choke points in the clinic but this did not occur at any time. Folks were treated efficiently and with great dispatch.

One evening Pastor Ben was able to give us a little insight into not only the community but how we were being perceived by the community. One of the observations made by our patients was that “Americans work very fast.” They were enormously pleased by the reception that they received; a welcome smile, a handshake, a kind greeting was extended to each person coming into the clinic without regard to faith or tribal affiliation. We were, up to that point, unaware that there were twelve different tribes represented in the community and much factionalism is evident during political times because of tribal loyalties. In addition, the Muslims were very open and receptive. They were a little concerned how they would be received; some of them altered their dress before coming to the clinic so as not to be treated with prejudice. However, after coming to the clinic the Imams reported to their people that the medicine we brought in was “blessed” and that they were welcome to receive it. Moreover, the Imams who came to clinic asked Pastor Ben for us to pray for the Muslims. Pastor Ben responded that he would be happy to do that.

 Submitted by Jerry McIntosh, President Willamette Medical Teams