Many tears

This blog may very well have reached its end.  Even the relatively rosy representations here scare those close to me into silence.  I wonder if people in comfy America really want to hear how it is here.  I wonder if I were truly honest instead optimistic if the people reading would get it or if they would still think I was "doing great work" or doing some noble learning exercise.  Would social studies teachers still use the blog to enhance their classes?  

This society is corrupt beyond comprehension.  Jonathan is working at a clinic on the highway, a horrible dirt road the government doesn't care enough to fix.  Just repairing that road would change Liberia forever.  It would improve the economy, the health care system, education, everything.  But I digress.  At Jonathan's clinic a 30 yo woman with six kids came in for a birth control implant.  Reasonable and responsible.  The midwife who is also the officer in charge at the clinic told the woman the implant is free but the procedure to put it in is not.  Total lie.  He found out she had $250 LD but that wasn't enough for him.  To get more he said the lidocaine at the clinic was expired so she had to pay for the gas for him to go get some.  She didn't have the money.  Jonathan took him outside and offered to pay the gas money.  Jonathan figured the man had to go to the next town so he prepared to continue to see patients while the guy was gone.  Five minutes later he returned.  Turns out he went 200 yards to his own home to retrieve lidocaine he had stolen from the clinic to resell to women who are just trying to keep from breeding like rabbits in a society in which men satisfying their sexual drive is a right but women trying to support a family in which many of the men don't work is a complete struggle.  So one could say what could the guy do?  His pay is not always delivered on time and when it is he gets only 180 USD per month.  All well and good until you do the math.  His housing cost is about 3% of his pay.  That's it.  The man has money relatively speaking.  So why the stealing, the conniving for more money?  This is just one such story.  There are many.

The chief's son was never brought in for medical help.  He will die of malnutrition.  He doesn't have a chance.  Maybe he has a wasting disease that can't be treated here, but he was never given a chance.  The chief's wife brought him to town on market day.  She brought me a chicken, but she didn't bother to bring him to the clinc or the hospital.  His bones looked like fish bones poking through his skin.  He had sores in his mouth.  He was listless.  He was almost two but didn't have the strength to stand.  His mother is pregnant agan.  Maybe he has HIV.  Maybe he has something else.  Apparently it is possible the family just doesn't feed him enough.  The rest of the family eats.  The boy will die.  Maybe he would die anyway but I am deeply saddened by the fact that no one in his family cares enough to give him a chance.  What kind of society does that?  

The PA at the hospital was seen ducking out the back door to avoid having to that a patient brought in by ambulance.  A child in severe respiratory distress was brought to the hospital and not treated until morning.  

There is one doctor in the county.  He is the only one who can do a C section.  He was called in the morning about a pregnant patient at the hospital who had been in labor for over 15 hours and the baby had not dropped at all.  One of our docs looked at her and thought probably the pregnancy was ok, certainly the fetus was alive with good heart tones, but she had a tiny pelvis.  The doctor was called again and he did not want the patient transferred or to leave.  He wanted to see her.  He never came.  A dead baby was delivered the next morning.  I was at the health center where he works while the patient was waiting at the hospital.  That doctor was in his air conditioned office all day.  

These are just a few of the stories.  There are many more.  These are not rumors but are witnessed accounts.   We all have stories like them, so to say we are doing good work?  No we aren't.  Maybe one or two patients will get more treatment than they otherwise would.  Maybe one or two won't die from pneumonia because Dr. Joe brought some antibiotics from home and gives them freely.  Maybe a solar panel bought by Chrissy will allow vaccines to be chilled in a clnic 2 1/2 hours away, but that will be the extent of it.  Everything else is just pissing in a cold, corrupt ocean.  There will be no sustainable change made.  None. 

Hail on the chief!

My walk to Jayproken kicked my butt, but it was an interesting day.  

Karnie, the CRNA from Fish Town, is one of our local ETU nurses.  He is an amazing person who has done a lot in his 27 years.  He has many opinions about his country.  Walking with him is fascinating and humbling.  He is half my age and, thus, walks way faster than I do.  He is kind enough to accommodate my speed.  We have the 3 1/2 hour walk down to a solid 2 1/2.  Turns out even I walk much faster than the average liberian.

Ebola triage where everyone gets screened even though ebola has never been seen here.

The dispenser in his dispensary.  Notice the empty spots on the shelves.

Kingston, the registrar.

Henry, the nurse.  He's been nursing for 40 some years!

James Quayee, PA, and me examining an OB patient in for her weekly check.  She should pop any minute.

On the right are the incinerators for trash burning and the cover on the ground on the left is for the placenta pit.  All birth products compost in there.

Dilapidated latrines.  These are squatty potties- pits with a hole you squat over.

After clinic Henry was kind enought to show us inside his house.  His is really nice compared to most.  

Karnie holding the welcome gift from Henry's mother in law.  They were delish!

This is a bed frame made of reeds (bamboo).  It is surprisingly springy.  They asked if I would buy them a mattress for it.  Not are how we'd get it there, but maybe a brave motorbikes would somehow load it on their bike and transport it.

Huge bamboo.  The men climb up in them and cut the reeds with machetes.

Termite nests are all over.  Thus no wooden buildings.

Jerry and me.  He was a patient today in the clinic.  I wowed him with my iPad then and he climbed up for more at the Chiefs house.  The chief is not a favorite of mine.  He has another grandson who is dying of malnutrition.  I saw that boy in the clinic as well this afternoon.  Hopefully the grandma will show up tomorrow in Fish Town to have more tests run and begin some sort of nutrition program.  We will see.  The chief had us over after out town tour and insisted on giving us a chicken.  Ironically they couldn't catch it.  The chief said he would send the chicken with is wife and the boy tomorrow.  Wish he'd keep his damned chicken and stew it up for the boy.  I may have to figure out what to do with a live chicken in a health center.  Stay tuned.......

Hospital?

Really?  That was a hospital?  Don't get me wrong the building was pretty nice for here and there were IV's hanging on a couple people, but that was about it.  They are so hurting for meds, equipment, and energy it was almost unbearable.  I was supposed to go to a far out clinic along the main road today, but I just couldn't stomach the ride.   It would have been 1 1/2 hours bumping along in a packed Land Rover type car, 3 hours of work and the same bumpy ride back.  So not worth it so I said no, and went to the hospital with Cher, a retired ER doc from Hennepin County.  She knows her stuff that's for sure.  We saw some interesting patient we could do nothing for.  One was an HIV positive 20 something with probable TB.  She'd had TB a few months ago and never finished her meds.  She was gurgling and hacking up a storm.  She was without a mask and in the women's ward with another HIV positive woman with typhoid who was 19 and looked 10.  When I heard the diagnosis I backed way away from the woman and made sure she coughed only into her piece of cloth she was holding.  First thing was to explain infection control to the workers and get her isolated.  From there we could talk treatment but in an environment in which there is little testing and few meds and one in which the clinics don't know what the hospital has or is doing and vice versa, there is little hope for this woman.  

The other patient worth mentioning was a man in his 20s or 30s who was referred to the hospital by one of our team who was working at another clinic.  The man had stolen a pack of cigarettes and as a vigilante punishment been heated on his head an back.  He was sitting on the ground when someon poured a bucket of "caustic water" on his upper back.  The chemical ran down his back into his pants and he sat in it.  He had third degree burns on his buttocks and upper thighs and second degree burns on his face, arms, legs, scrotum and penis.  He was a mess.  The ambulance ride was torturous over these roads.  We had Tylenol for pain and 10 mg of of diazepam.  Cher decided to de ride the scrotum and perineal burns while leaving the scarred buttock burns alone.  The man was understandably agitated so we decided to give him half of the available diazepam IV.  The hospital staff was laughing and chatting so the administration of the med was leisurely to the point Imalmost took over.  I did become somewhat drill sergeant like.  The IV was useless and by the time that was discovered they only had a tiny bit left.  Needless to say the man suffered all the way through.  Harper is a more affluent city south in Maryland county.  The man is from Maryland and has family there.  He should be getting his treatment there because family members can go buy supplies and bring them to the hospital if they are needed.  Turns out the man is a criminal wanted in Maryland County and is afraid to go back.  He is going to need months of care if he doesn't get septic and die.  He, like many others, is in a real pickle.

My day was exhausting and interesting.  Cher and I worked well together.  The glacial pace of the place and the lack of knowledge of what supplies they had drove me nuts.  There is a super complacent attitude born out of chronic deprivation that has almost completely killed creative thought. I get it.  I would probably have the same problem, but it is very frustrating and very, very sad.

Happy birthday, Dr. Joe

Today is the birthday of a very gracious and dedicated man.  Dr. Joe has made the very best of this ride.  Since he first set foot in the Fish Town Medical Clinic he has been the happiest, most fulfilled man imaginable.  He has met people and treated patients and had his world rocked not only by the poverty and resource shortage but also by the amazing people he has met.  One is Rose.  Rose is a certified midwife who runs the maternal health program at the clinic.  She's been there about 4 years and has delivered 1000 babies.  She is also the leader of the local Planned Parenthood and a person of authority at her church.  Like Dr. Joe, Rose takes life by the horns.  

Today four of us went down the hill to play frisbee.  We couldn't use the town soccer field as there was a game going on, so we took the disc to another open space and befor we had thrown it to each other even once there were 50 kids gathered trying to join.  It became an exercise in crowd control as the kids piled on top of each other for a chance to throw.  Then all 50 walked and ran back up the hill with us.  We organized them in a rough semblance of a line and had them wash their hands.  Why not?  We had to wash to get back in the gate and they wanted to wash as well.  Never too many hand washings.  We bid them good bye and disappeared in the gate.

Tomorrow we officially start going to the clinics.  Freelancing stops and we are now scheduled.  It should be interesting.  

Dr. Joe at Christmas.

Jayproken

This morning I made the walk with Karnie, a very talkative, outgoing, intelligent nurse anesthetist who was hired by ARC to be a nurse in the ETU.  We made it in 2 1/2 hours.  It is great having young legs pull me along.  We arrived at the clinic before the first patient was seem though after they had begun to gather.  We got another tour of the clinic which included a lot of detail of what they need.  Solar panel for the frig and other electricity, new covers for the incinerator, latrine upgrade, and a well.  All were real needs.  Then they showed us how inadequate their baby scale was.  They have the actual scale mechanism which is suspended from a wooden tripod.  The baby sits in a canvas seat like a kids swing.  I was with them on everything else but when I saw the scale situation I couldn't believe they would ask for that.  A new one could easily be contracted in a short time with almost no resources.  I should have taken a picture.  I will next visit.  It was a ludicrous request- such an easy fix for anyone there.  We may actually be able to get some of the other things done.  AND....the USAID said they have a portable bore hole digger they may bring here for our water.  Now my simple, hopeful and naive brain sees an incredible opportunity here.  The road to Jayproken is not passable for anything much bigger than a motorbike and certainly not for a well drilling machine, but there is a soccer field right next to the clinic that a helicopter could surely land on.  Why not drill two?  I know, I know....pipe dreams.  Still no one can say yes if the question isn't asked.  

The PA didn't show up until after 11, so, after the clinic was opened with a reading from Galatians and a prayer, Karnie and I began to see patients.  I am becoming a master at the rapid malaria test and the Depo shot.  The two big issues with providers here so far is the gross over use of amoxicillin and the gross underuse of physical examinations.  Those are my two educational goals for this clinic.  We go back Wednesday which is a busy day- tons of pregnant women.  I will be a master at measuring fundal height very soon.  One crazy frustrating thing today- a teacher at the school came in with headache.  His BP was 170/100.  This was a consistent reading with his past history.  In the past he had been given a short course of methldopa and followed up in a month.  No surprise that his BP was up at each visit.  Karnie and I agreed the man needed chronic meds but the only hypertension med the clinic ever has is hydrochlorathizide and they were all out.  We gave him Tylenol for the headache and aspirin for th blood thinning properties.  Such a cheap, simple treatment unavailable.  Sad.

I look forward to returning on Wednesday.  Tomorrow we head to a clinic on the road about 1 1/2 hours away.  I do not look forward to bumping up and down that road.  

Exercised AND useful

Today Mark, Jonathan and I walked to Jayproken again.  For those that forgot this is a clinc accessible by foot and motorbike.  Jonathan and I have been there two times before and last week promised to come again this week.  We finally did.  When we arrived I sat down with the OIC (officer in charge), a PA who has been there for 4 years.  4 years is forever in these clinics.  There is a lot of problem staffing the rural clinics so 2 years is about the longest you usually see.  I asked him point blank if our coming was a help or a hindrance.  His enthusiastic response made it clear that he would love our help.  Mark dispensed medication, Jonathan worked in a room with Henry, an RN who has been a nurse for 40 years and at this clinic for 20+.  I worked with James.  We saw all or almost all pregnant women from ages 19 to 41.  The 41 yo was on her 10th child.  I gave a lot of Depo shots to the rest of the patients. Here is the scary thing.  Wth just a little study I will be able to do the pregnancy checks on these woman with the same degree of efficacy as James.  Frightening.  The options and kills are so limited I May actually be able to teach them something in Jayproken.  Craziness.  

We came back and had a demonstration on how to put out a fire with an extinguisher.  The fire never went out.  That is until a bucket of water was brought out and doused it.  It was funnier than funny, but I will be keeping my wallet and passport on me just in case there I a fire 'cause this whole place is going up in flames is something ignites!

Here is my favorite wildlife to date.  Butterfly or two snakes?

Half way done.

My day began with water hauling.  Why not?  It has every morning for a long time.  We need water and I am willing to help.  We have a system to get it out of the river that works great- if everyone shows up.  

Today they did not.  Bright side?  I got good exercise.  Dark side?  I was very crabby at those who refuse to pitch in.  We are at a common point in communal living.  A few do the majority of the work.  We show up for meetings, we participate in fire drills.  In short, we carry the group.  My experience in this type of dynamic is that hard feelings now will even out and most of the non participants will end up contributing.  That is really hard to believe now, but usual history does not lie.  

Water crew.

After water Cher, Mark, and I walked an hour to Teajiliken, a little village an hour walk from here.  We knew there was no medical clinic but since some are assessing schools I volunteered to do that.

We met with the assistant principal of the school.  He declared right away that they needed a new building.  There are 127 students in nursery to sixth grade.  They have 5 teachers, all men.  They said they need a female teacher "to take care of the kids."  He admitted the men have tempers.  He claims they should have supplies though admitted he was not sure when the government would provide.  Here are pictures of the school.  My assessment?  They need a building!

School kitchen.  The kids get bulgar wheat at 1030 am.  They begin at 815 and are done by 1245 Monday through Friday.

After our walk we came back to afternoon electricity which was a real treat.

This evening I went down to Joes patio to talk with folks and catch up on our days.  The conversations were curt and snippy and snarky.  Again, we are at the midway point.  One conversation was about female circumcision.  One member of our team is older and from one of the tribes around Bong County.  He has a lot of pride in his heritage and culture.  He believes female circumcision is an important part of that heritage.  He particularly values the education that goes along with the surgery- education teaching women to be subservient to their men and holding very particular roles in society and the household.  Well you can imagine what was swirling around in the brains of the women gathered.  Everyone was determined to sway him which was not possible.  He is a strongly principled man and he has carefully sorted out his life in a way that makes sense to him.  It was a recipe for horrible and uncomfortable communication and was compounded by that fact that, yes, we are half way done.  I went back after everyone had left.  He explained that the women of Liberia don't know sexual pleasure anyway and the practice of female circumcision has kept teenage pregnancy almost nonexistent in his tribe.  He denies any knowledge of adverse side effects of the procedure in his tribe.  In his social structure women are respected and revered but should be educated in the traditional ways.  At the same time he values school education for women.  His daughters have advanced degrees and white collar jobs.  It is the new meeting the old and he values both and has decided for himself how to reconcile the two.  He also acknowledged the fact that I am not crazy.  He said most definitely the men I meet defer to any man which accompanies me.  It is part of the culture.  Wow.  I really really don't want to live here.  

This evening we had a meeting that was poorly attended and a fire drill that was not taken seriously.  Our leadership is weak and it really shows.  AND.......we are half way done. 

Good stuff

Nothing and lots has happened since my last post.  We have done little toward any health related stuff but we have talked a lot and gotten some parameters ironed out.  Keith, the country director has been in town.  He has talked and he has listened.  He is a mild mannered man on the surface at least and he speaks as one who knows the NGO world, Liberia, and world economics.  He has been able to put this mistimed ebola response in some perspective that those of us who want to can hear.  Some cannot hear it for their intense disappointment in this mission.  The biggest thing he did was make it clear that we can start really thinking of ways to reach into the community and design a project outside of ebola.  We are clinicians and not public health people or policy people and most of us will be gone in less than six weeks.  Add to that the inability to research anything on the Internet and the task becomes daunting.  Still we feel freed.  At least we can get some equipment to help those who want to work in the clinic and we can attempt to educate the health workers here.  Dr. Chessor was also helpful last night in illustrating some of the gaps in knowledge that exist here.  

The morning was again spend fetching water.  Many of the pumps have dried up or have owners that feel like they will dry up so we scouted the cleanest river farthest from garbage or homes and accessible and we have been dipping that water for showers and toilets.  The water is brown, but the WASH guys treat it and it doesn't even stink and they say it is safe.  We have an incredible system down which not only supplies water, but also money for the hired Liberian women and exercise for us.  Esther is the leader.  She makes $45 per week for her 4 hours of work per day including supervising the other women.  She is kick ass.  Her girls show up on time and work hard.  They are strong and happy and enthusiastic.  I have pics but no way to transmit them now.  Maybe in a later post.  

Yesterday we were sitting around discussing how to make the world better when a huge truck arrived at the gate.  It was either the bore hole digger or the second generator.  We were hoping for bore hole, but it was the generator.  Our disappointment was quickly turned to elation as we processed that we would have 24 hour electricity.  Sounds non essential, but the afternoon is the hottest and 24 hour power would mean afternoon fans.  EXCITING!!  As they unloaded the generator it was quickly noticed that the packing for transport had been shoddy enough that the engine had broken from the casing and was sitting akimbo.  Epic fail.  No generator.  No 24 hour electricity.  No afternoon fans.  Damn.

Today it was rumored the bore hole driller was at the ETU site.  As of this minute this is unconfirmed.  I will not believe it unless there is an eyewitness account.  If it is true and it doesn't break while drilling there maybe, just maybe we will have better water without all the hauling within a week.  There goes one source of exercise.  But like I say, nothing is assumed.  All must be confirmed by eyewitness to be believed.

Jonathan gave a lecture tonight on the origin of the phrase "I heard it through the grapevine."  It was the most entertaining part of the day!

Eyes forced open

Today I was assigned to work at the county health center.  I showed up at 8am and as is typical here there was no one to greet us for about a half hour.  Turns out they wanted me to take over one of the RNs office and see people all day.  The RNs here see patients order labs and prescribe meds.  If a PA is available the RN does more traditional nursing work but for today we were to take over their place entirely.  One of our staff is a PA from Monrovia so he and I worked together.  He did most of it because 1) he can understand what people are saying and 2) he is used to prescribing for the maladies here.  He had almost everyone tested for malaria.  All but one were negative.  I will have to read up on that.  Was he over testing or is the prevalence that high that testing most is reasonable?  Our RN who was working the pediatric room said almost all of his kids were positive.  All STD suspected patients get a rapid HIV.  Luckily the were all negative.  

The clinic is run like an urgent care- first come first served.  They show up with a paper chart without a cover that miraculously survives several years of use.  They state their complaint and a history is solicited.  No exam is done unless the case is "dire" which is not defined.  The only vital sign done is temperature.  Here is one blood pressure cuff in the clinic and it is not used for fear of transmitting disease.  These rules are the result of ebola and are limitations handed down from the ministry of health.  The labs possible are malaria, HIV, and hemoglobin if the case is "dire."  The panel of meds is limited as well.  One patient treated for gonnorhea could get the penicillin from the pharmacy but had to go to the hospital for the needle and syringe.  

One woman showed up with chest pain, back pain, and numb legs.  She was in her 50's which is no spring chicken around here.  There are no tests available anywhere, so we gave her an aspirin a day and some Tylenol.  It was the best she could get without going to Monrovia.  No exam was done.  Not sure we did no harm.  Another heart breaker was a 12 yo child with an enlarged liver and spleen.  He had been seen 2 weeks previous and referred to the doctor but was never taken.  According to the RN who saw him last he was deteriorating.  His spleen was massive.  We did examine him as the PA decided he was "dire."  He was referred again to the doctor, but who knows what the odds of him getting treatment is.  It was heart breaking.  

If I work there again I plan to disregard the crazy no touch rules and do more.  It just didn't make good sense.  What is clear, though, is that Americans are crazy lucky with the quality of our health care.  Now we need to take a page from Liberia and make it free and available to all.

Strong like a local.

This morning we went to the other end of town to pump water from the well of the HANDS NGO.  We had twenty 5 gallon jugs plus 3 fifty five gallon barrels to fill.  We did the jugs three times and the barrels twice.  We had some local liberian day workers with us who are hired for the task and we just go along to feel useful.  The leader of the Liberian troupe is Esther.  She has a mammoth smile, talks a mile a minute and readily makes jokes.  I can understand about 2/3 of what she says.  She is entertained by the Americans, but has Liberian pride.  I was honored today when she called me "strong like a Liberian" after I pumped 55 gallons without stopping.  Somewhere during the few hours we were working she went on a tirade about how the women in River Gee are so much stronger than the men.  What we have noticed in this land of incredible unemployment is that it is the women who show up at the gate each morning to see if there is any work.  None of the young men who come up to us daily wanting money to "get to America" show up to lift a finger.  We often see families coming in from the forest after cutting wood.  The woman will have a huge bundle of wood on her head and the men will have a machete balanced on theirs.  The gender roles here are crazy.  Men who I met first and have talked to most focus away from me and totally on the male I am with.  It is maddening.  In a country with a woman president and a workforce in which the women are so prominent it is amazing that they are still seemingly the second class citizens.  

I tried a machete today.  The security guard at HANDS was cutting the grass and I asked him if I could try it.  I was not very good at it.  It was amusing enough to the Liberians the ARC Liberians took pictures of me.  I am thinking mowing the "grass" at the cabin would be much more fun with a machete!

Fish town on a foggy humid morning.

Long walk

Today our great adventure to visit a remote village got messed up by a misunderstanding with the county health team, so Jonathan and I came up with a plan B.  We walked to a village we had visited before on motorbikes.  It is a sweet little village where we were welcomed by the singing ladies before- Jayproken.  We had a nice chat with the PA who runs the clinic and got a tour of the community by a couple of locals.  It is a community of much civic pride.  It is clean and neat beyond what we've seen before.  Everyone was friendly and the kids were fascinated by our white skin.  The walk is 3 hours each way so we made points by walking instead of driving.  We used our feet just as the locals do.  They walk the distance to the Fish Town market every Thursday.  There are no stores in Jayproken.  We found out there is a village a 5 hour walk past Jayproken.  That makes an 8 hour walk to the market for them.  

 On the way back we stopped for lunch of MREs left in our warehouse after the army's training of our staff..  I had cheese tortellini and Jonathan had chicken pesto with penne pasta.  We were living high off the hog tasting favors we have not had I quite a while.  Jonathan's MRE was complete with "patriotic sugar cookies" stamped with US on them.

We did see two snakes on the road.  On was killed before we got there.  And a smaller one was efficiently dispatched by a woman with a machete.

The spirit of Sunday

Today started for me with a man on the water tower listening to his radio.  Unfortunately it was only 343 am.  After two tries of asking he finally left.  Nevertheless I was awake.  I spent the next long while texting with my lovely partner.  As we were communicating I heard the first rooster crow of the morning.  Then at 500 sharp the Muslim prayer began.  They are probably the most punctual group in Liberia.  The women who haul water to fill the tanks arrived about 630 and the place just came alive from there.  Sleep over.

I dragged out at about 800 and immediately joined the water hauling crew.  We took three 55 gallon drums to HANDS, an NGO concerned with agriculture and women/child nutrition, where they were kind enough to let us harvest water from their well.  It took about 40 minutes to load the drums bucket by bucket.  We then loaded the water bucket by bucket into the tanks.  Between the women hired to haul water and those of us who just pitched in we hauled 1600 gallons of water.  Hopefully enough to last the day and night.  It is feared we have a plumbing leak, so we will see.  Word is we will have a bore hole dug next week so the hauling can stop.  

After hauling Dr. Joe and I went to the Lutheran church.  Andrew is the pastor and I met him when we took the bikes to Jayproken where he has another congregation.  He was fire and brimstone style without the hateful dialogue.  He preached self reflection and responsibility.  The singing was excellent. Lidya, one of our nurses from Monrovia played the sassa, the gourd with the beads tied around them, her face was beaming and her body was moving. If I have ever seen anyone lost in the grace of God she was it.  Gorgeous.  

Here is a picture of the inside of my room.  Notice the fine shelving courtesy of Dr. Joe, the furniture and creature comfort guru.

This picture is specifically for Jean.  This is Benedictus, the man who devised the garbage separation system- organics, cans, and trash.  Large plastic bottles are saved for reuse in town.  Cans are treated somehow to enhance rusting.  The rest is burned.  Anything we can do to decrease burning is excellent.

Walking with a native.

This afternoon Jonathan and I took a walk with John.  John is in his 60s and a nurse in Minnesota, but he grew up in Bong County, Liberia.  He knows a lot about the culture here.  We walked out the road through the jungle and came across a girl and her younger siblings.  They were there harvesting rice from their private plot of land.  John informed us that a man will have four or five wives all of whom (with their children) work on the man's large farm.  The women help there and if they are strong enough either lease or find their own small plot to grow a crop that will supplement the feeding of her children if there is not enough food or sell the crop to pay for school or books or clothing or just extra gifts for the kids.  It is an insurance policy of sorts.  They showed us how to harvest the rice and the boys explained how they process it beating it to take the husk off and then wash and dry it.  The fine rice particles and flour are made into cereal for kids and the rest is cooked for a meal.  

John was appalled at how hard the women worked filling our water.  They push full 5 gallon jugs up a quite steep hill from the closest pump three or four to a wheelbarrow.  They are strong.  He said in Bong County the woman would never be doing that.  The men have more pride.  They would be working while the women would be at home taking care of the house and kids.  Hmmm.  It did occur to me that the teenaged boys that keep accosting me on the streets wanting me to connect them up with a job could be up here at the gate offering to do day labor.  One of them today showed me his betting soccer betting cards.  "Winners" it is called and one can bet on almost any soccer game anyone cares about.  Not sure how that works.  Winners must have Internet.  

Here is sunset over tent city.

My final resting place

I think it has been almost a week living in the tent city now.

These are Army tents set up on cement slabs surrounded by a bamboo fence.  

There is another perimeter fence and a large metal gate separating us from the community.  As you can see we are on the top of a hill.  Too much symbolism if you let your mind go there.  The compound was designed to separate us because we would be in contact with ebola, but since we are not, probably, going to have any contact we should probably be in the guest houses in town.  That said the tent city is comfortable and affords us some privacy in a place where the white person is constantly approached for monetary help.  On a walk a couple days ago I was surrounded by four boys about 19 yo.  They walked about a mile with me touching my arms and purring their arms around my shoulders. This is just the physicality of the people here but it was uncomfortable.  I fairly rapidly put a stop to it but their proximity was still too much.  They talked the entire way about how I should take them to America and how I should give them my phone number so we could be friends.  About a half mile from my destination I stopped and told them I wanted them to leave.  It felt uncomfortable, but it is different here.  Engaging in conversation is risky and there is no subtlety.  I felt like carion plucked by buzzards when we parted.  

Water at our abode is supplied (until the bore hole digging truck arrives) by women who carry the water from different wells around town and fill our tanks.

The system is designed to be gravity feed or pressurized.  Without the bore hole we are having to conserve water as the human chain is not enough to supply more than the very basic water usage.  With the spotty water supply the toilet function is dicey as well.  There is a problem because there is no alternative for the toilets.  I am beginning to think a bank of outhouses may not have been the worst idea.  Maybe the well truck will come soon.  Even with dicey sanitation we have it better than most people in town.

Garbage is burned here.  There is no trash pick up, no recycling, and no organic disposal.  Imagine that, Minneapolis!  The incineration is done on the ground in any handy open space.  The smoke is nasty.  One of our workers has decided we should minimize burning so he is taking the liter size water bottles into town so they can be reused and has designated an organics waste bin that he will bury.  I thank him for minimizing burn.  His name is Benedictus.

Random people pic for you.

They just stopped my and asked me to take their picture.

First new post of 2015!

Here is my jungle walk this morning.  Now that we are in the tent city (more later) I can get through the population and have plenty of road ahead that is unpopulated.  The road leads to the Jayproken which is the village where the women danced for us.  The village is a 3 1/2 hour walk so the number of people on the road especially in the earlyish morning is few.  It is a walk through the jungle with small critters and a cacophony of birds.  If anyone can identify any of the plants, have at it!

Ants working hard.

Use with caution.  Motorbikes pick their boards wisely.

This afternoon we were officially welcomed by the County Health Team.  They did a ceremony in which the "cola" was shared between us and them.  

On the right is the county official presenting the cola, a walnut sized nut to Dr. Chessor, our medical director.  Because they were presenting to a woman they had to have a man receive as well so Dr. Joe stood up.  I was assured it would go vice versa as well.  This is a very gender oriented place.  

The chief spoke.  He was very animated and quite a showman.  Some of his speech was in the native tongue and interpreted.  He essentially welcomed us and sealed the partnership.

Found a new reddish banana today.  Very yummy and hardy.  I had a couple for dinner in order to take a break from Liberian food.  I almost lost my tongue and lips to chemical burn at brunch today.  Typically the food is pretty good, but there is little variety.  There is some common seasoning to pretty much everything and everything is hot.  Today's lunch was unpalatable in its peppery heat.  Loved my bananas tonight.

What an amazing day!

Having Cheryl here is excellent.  Not only is she supremely cool but this traipsing around doing investigation of the health system here is way fun.  We rented Isaac, Prince and Joseph and their bikes again and Jonathon, Cheryl and I hit the road north of town this time.  We visited a health center about a half an hour away and a health clinic on the way back.  The nurse at the health clinic was pretty straight forward.  He described the shortage of medication since the government took over supplying them about three months ago.  He said it is pretty frustrating trying to treat patients when they have nothing to treat them with.  Everyone else is pretty tight lipped about the shortage.  It is hard to get the straight scoop.

After the clinic we headed back to Fish Town and then to a village about twelve miles away down a road that was little more than a cow path.  I can't tell you how pretty it was back ther with the massive stands of bamboo and the clusters of some gorgeous yellow flower.

Prince and me on the bike.

When we finally got to our destination we found the clinic closed.  A Lutheran Pastor came by and an energetic woman who began yelling.  We thought she was crazy then realized she was dancing in excitement and calling the rest of the neighbors.  They gradually gathered and surrounded us.  First the women danced and sang.

Sorry I can't post the video of them.  Then the elders talked to us about their clinic and asked us our business there.  We were careful not to make any promises but let them know that we were medical and we are around thinking how we can contribute if we see no ebola patients.  After about a half hour we thanked them and they thanked us and we took off down the cow path back to Fish Town.  I wish you could hear the harmonies and see the discipline of the people as the elders talked and the respect they showed when we talked.  This village, a three and a half hour walk from Fish Town, is the population center for about 2500 people.  You can't even imagine the access problems with a road like we traveled.  Most cars couldn't navigate it.  

The Lutheran church has a large presence there.  The health clinic was built by the church.  The Lutheran church in Liberia has as a partner the Missouri Synod.  They built the clinic, but when the last war happened they pulled their funding so the government took over the clinic.  The church also built a school but the government built one of those too so the church is in the process of switching theirs to a vocational technical school.  There is a lot going on in what appeared to be a tiny village on a cow path.  

Tonight we went to a new place to eat.  It was the first time I liked plantains.  Not sure why theirs were good.  The beans were hot beyond belief so I had a couple of hotdogs.   It was good reminiscent of Cuttington.  Blech.