This Thursday I went out with the community health nurses to do a PMI visit there. It was pretty fascinating. Allow me to explain. PMI stands for Protection Maternale et Infantile. It is the community health arm of the hospital and has been run for almost 30 years by a nurse named Maman Sophie who is famous throughout the region for her efforts. The nurses have a clinic here on the hospital campus where they do immunizations and weigh children. Vaccination is free up until 1 year of age, provided by the Gabonese government. They actually just got the Penta vaccines here (DPT, Hepatitis B, and HiB make it up, I think). In any case, it's a great early childhood vaccine. They also still use BCG vaccine against TB. The Schweitzer PMI have achieved great vaccination coverage for this region, averaging around 85% of kids vaccinated. For Africa that is an impressive number.
As I was saying they vaccinate kids here at the hospital, but also on community visits every Wednesday and Thursday. They have 16 towns around Lambarene that they visit on a rotating basis. When they arrive, they weigh all the babies. This was quite the scene Thursday as there were about 50 moms and babies waiting for us. They all rushed forward to get a little harness for their kid, then they strip them nude, load them in the harness, and hang the kids up on hanging scales. For some reason all the babies hate this and so there was a crazy ruckus with all these naked kids screaming and hanging on scales.
Once they get weighed, the nurses go through the kids' health booklets to see what vaccines they need. Then they give them out. Another wild round of tears. While the three nurses were doing all the vaccines, Maman Sophie and I did “consulations” together. Basically this means doing a little clinic visit together. We are in the midst of an intense gastroenteritis (vomiting, diarrhea) epidemic, so that was the majority of cases. There was also an impressive case of a little one with months of scabies burrows that the mom had not taken care of. Those things can really get situated in your skin if you let them. After Maman Sophie and I saw the moms, I would take them over to this ancient chest of drawers that contained all the medicines and would try to get out all of the medicines that they needed. At the end, Maman Sophie gave a talk about safe sex, family planning, dehydration, and education. It was community public health at its best. I really enjoyed getting out a bit and seeing how things work outside of the hospital. Its neat to see how this system of vaccination and triage works in Gabon and to note its success.
Saturday, August 14, 2010
The local nourishment
A number of people have asked about this and so I figured it was time to discuss both the traditional foods of Gabon as well as the foods that I eat here. Obviously, the two do not overlap perfectly.
Gabon is an equitorial country and as such it is relatively warm here all year long. Also there are a uniform number of hours of sunlight every day. This makes for a strange and poor growing season. Two things grow naturally here. Bananas of a great sort and variety and manioc, which is a tuber similar to a potato. Bananas are eaten raw, but more often cooked like french fries, deep-fried in oil. Delicious and treacherous to the waistline. Manioc can be eaten both as the root itself, in which case you boil it, or you can eat the leaves, which look like spinach, sauteed. On its own manioc smells and tastes like vegetal sweaty gym socks. The leaves are very tasty though. I thought of them as a richer version of sauteed spinach. As far as other things that are grown here—and there aren't many things, Gabon imports almost all of its nourishment—there are mangoes, grapefruits, passion fruits, peanuts, and taro. Basically tropical fruits. Some places are also trying to get cocoa and coffee plantations underway.
As far as what I eat, this is deeply influenced by living at a hospital encampment controlled by a French administration. In short, I eat a nouveau Franco-gabonese style cuisine at the refectectoire, or cafeteria on campus. We have coffee and baguette for breakfast every morning. Always. That is the only thing I have eaten for breakfast here. I may die a carbohydrate induced death. For lunch and dinner, it is always a salad, a main dish, a side vegetable dish, and a desert. The salad is often shredded cabbage, cut tomatoes, or some lettuce. Then we have a meat entree, or grilled fish (which I prefer for obvious vegetarian reasons). The grilled fish is delicious and caught locally (in the Ogooue River). Some people eat the whole thing, head and all, but I have not worked up to that point yet. The side vegetable is usually aubergine, corn, or leek, usually swimming in a sea of delicious palm oil. Desert can either be fruit, or occasionally a small piece of cake or pie. In sum, we eat well. Like when I lived in India, I may very well gain weight in Gabon. At the supermarket, they also have a tremendous array of little cakes and biscuits as well as two fine local beers, Castel and Regab. In sum, Gabon is not my ideal gustatory zone but I am holding up pretty well all things considered.
Gabon is an equitorial country and as such it is relatively warm here all year long. Also there are a uniform number of hours of sunlight every day. This makes for a strange and poor growing season. Two things grow naturally here. Bananas of a great sort and variety and manioc, which is a tuber similar to a potato. Bananas are eaten raw, but more often cooked like french fries, deep-fried in oil. Delicious and treacherous to the waistline. Manioc can be eaten both as the root itself, in which case you boil it, or you can eat the leaves, which look like spinach, sauteed. On its own manioc smells and tastes like vegetal sweaty gym socks. The leaves are very tasty though. I thought of them as a richer version of sauteed spinach. As far as other things that are grown here—and there aren't many things, Gabon imports almost all of its nourishment—there are mangoes, grapefruits, passion fruits, peanuts, and taro. Basically tropical fruits. Some places are also trying to get cocoa and coffee plantations underway.
As far as what I eat, this is deeply influenced by living at a hospital encampment controlled by a French administration. In short, I eat a nouveau Franco-gabonese style cuisine at the refectectoire, or cafeteria on campus. We have coffee and baguette for breakfast every morning. Always. That is the only thing I have eaten for breakfast here. I may die a carbohydrate induced death. For lunch and dinner, it is always a salad, a main dish, a side vegetable dish, and a desert. The salad is often shredded cabbage, cut tomatoes, or some lettuce. Then we have a meat entree, or grilled fish (which I prefer for obvious vegetarian reasons). The grilled fish is delicious and caught locally (in the Ogooue River). Some people eat the whole thing, head and all, but I have not worked up to that point yet. The side vegetable is usually aubergine, corn, or leek, usually swimming in a sea of delicious palm oil. Desert can either be fruit, or occasionally a small piece of cake or pie. In sum, we eat well. Like when I lived in India, I may very well gain weight in Gabon. At the supermarket, they also have a tremendous array of little cakes and biscuits as well as two fine local beers, Castel and Regab. In sum, Gabon is not my ideal gustatory zone but I am holding up pretty well all things considered.
Wednesday, August 11, 2010
Adjustements
I am quickly adjusting to life in Gabon and at Hopital Schweitzer especially. I still feel a little tired and stomach achy, but it is going down. To me, this indicates that my immune system is adapting to all of the new antigens that are assaulting it. I have also been washing my hands like a crazy person which I think has avoided any giant gastro-intestinal problems thus far. Interestingly I had a lot of problems sleeping the first few nights because all the noises kept me up. Now I sleep like an old log at night and during my afternoon siesta. The sounds of animals, people, wind, water, insects no longer bother me. Speaking of insects, on Monday we had a migratory ant invasion. Apparently, a huge column of ants arrived at 7pm and invaded the house. According to my roommate (I was out at dinner) they covered the drapes and the floor. She fought valiantly against them with water and bug spray, and was able to get rid of them. By the time I got home they were much less numerous. Still you could sweep up giant piles of dead ants and the kitchen sink was full of drowned ants.
In terms of hospital work, there is a French medical student working with me in pediatrie and we are seeing patients all by ourselves all day long. We do the newborn visits in the morning, help with rounding, see patients in the late morning and develop the treatment plans together. We even admit our patients and follow them in the hospital now. Most of the cases we see are gastroenteritis and malaria, but even with the trickier things we are starting to head out on our own. It's a nice pace of work. Sometimes I worry that we are going to screw something up for a patient, but I remember that you can get antibiotics at the pharmacy here without seeing a doctor and that a lot of people use traditional healers still, so we cannot be doing more harm than those two avenues of health care. I do need to organize what I have learned and my work into more of a guide though. That way I will become more efficient and be able to help out even more. For example, today we saw 11 patients in total. I think within a few weeks I should be able to see even more.
In terms of hospital work, there is a French medical student working with me in pediatrie and we are seeing patients all by ourselves all day long. We do the newborn visits in the morning, help with rounding, see patients in the late morning and develop the treatment plans together. We even admit our patients and follow them in the hospital now. Most of the cases we see are gastroenteritis and malaria, but even with the trickier things we are starting to head out on our own. It's a nice pace of work. Sometimes I worry that we are going to screw something up for a patient, but I remember that you can get antibiotics at the pharmacy here without seeing a doctor and that a lot of people use traditional healers still, so we cannot be doing more harm than those two avenues of health care. I do need to organize what I have learned and my work into more of a guide though. That way I will become more efficient and be able to help out even more. For example, today we saw 11 patients in total. I think within a few weeks I should be able to see even more.
Tuesday, August 10, 2010
Monday, August 9, 2010
Not Crocodiles, Waterfalls
One instructive part about living in a semi-jungle is that plans change frequently and that you have to be flexible and go with the flow (toaist if you will). My roommate and I had hoped to go out crocodile viewing with a friend of a friend who studies crocodile biodiversity. He was going to take us this weekend, hunt some crocodiles in a nearby lake, catch them, tie their mouths shut and then take samples and pictures. But he ended up leaving at the earliest possible morning light, without us and our eager virgin crocodile eyes. So we had to retool our plans. I ended up going to a goodbye party for a Gabonese/German student who had been here the past months. This was a great success and interesting for its good mix of people from different parts of the world and different parts of the hospital and research center. Then on Sunday my partner in pediatrie who is a super French med student and I headed out to see the chutes de Fugamou, or les chutes de l'Imperatrice, named by a French explorer after Napoleon's wife, the empress Eugenie. It was a good day trip, both for the experience of traveling in Gabon itself, always by taxi and in a big group of people, and for seeing all these small villages along the side of the road. People here are accustomed to white people and unlike in India, no body begs. In fact, the only reason people approach you in general is to try and pick you up. Polygamy is relatively common here and a wedding ring is not even a mild deterrent. Anyway, Eve and I, the French girl, made it to the chutes in fine form. We even navigated the jungle-dense terrain on our own on the way home. A good weekend all in all. Just sans crocodiles unfortunately. A toute a l'heure mes amis.
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