Senegal Clinic - Story from Jerry McIntosh

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.