An Unnamed Hospital

I usually make an effort to avoid going into detail about what upsets me about a health facility, but today was over the top.

Once again, we left Dakar to visit a hospital in one of the regions. Since I have yet to release my report, this hospital will have to remain unnamed. We interviewed several doctors, and it was the nurses who told us that patients here have to go to the pharmacies themselves and buy analgesics, and then bring them back to the hospital. At the Emergency Room, we spoke with the head nurse about problems with palliative care, and she began by saying, "in this unit, most of our patients come here alone, because it is an emergency situation and they do not have a family member with them." I was unsure of why she would mention that, since that's the issue for emergency rooms everywhere and doesn't seem like it would impact health care. But here, the problem is that the emergency room stocks NO analgesics--NO painkillers, not even the lowest grade, level I analgesics. Thus, when a patient is pain, they depend on a family member to leave the hospital, go to the pharmacy with a prescription that the nurses or doctors wrote up, buy it, and come back. If you come alone, there is no one to go to the pharmacy for you.

When she told me this, I thought perhaps I had misheard. "WHAT?" I exclaimed. "French is not my first language--let me clarify--did you just say that patients--presumably the ones you receive here are in extreme pain since it's emergencies--will have NO pain support until someone cares enough about them to go to the pharmacy and buy them pain medication?"

She confirmed that was the case.

"Well what do you do when someone has no money?? Or if someone has no relatives?" I asked.

"They suffer," she replied. "Well actually, if the patient really is in a lot of pain, the nurse or doctors might go buy them the medication with their own salaries."

The situation is same in the operatory bloc--there are analgesics to use during surgery, but nothing for post-operatory care--you need to go to a pharmacy to buy the analgesic and bring it back. Sadly, the hospital uses this system because it has no money--it cannot afford to keep analgesics, even level I painkillers, in stock and on hand. 

Last week in Dakar

Dakar is an assault of smells. In the morning I exit my hotel and walk towards the hospital. On the way, there is the aroma of onions grilled with meat, fresh bread, and sometimes, if the wind blows a certain way, the water. Unfortunately, there is also the smell of urine, body odors, and dust (yes, dust has a smell). Worst of all, I can never seem to escape the clouds of cigarette smoke. In a country in which the dominant forms of cancer in men are in the prostate, liver, and lungs, it seems that refraining from smoking is such an easy way to eliminate one of those three risks. It's such an expensive habit, makes you age faster, ruins your teeth, and exposes you to a variety of other illnesses! I'm changing hotel rooms tomorrow because I am next door to two repulsive men who spend their entire waking hours smoking. The smoke seeps into my room and despite opening all the windows, I can't get rid of it. One of them shaved his chest, and threw a handful of scraggly man hair into the hall way because for some reason the trash can was not a good enough destination--actually, I'm not even sure if it was from his chest, his chest happened to be bare, but maybe the hair was from elsewhere. How disgusting. I guess since they are French they have access to universal health care, so at least they won't have to pay as much for cancer treatment; maybe it's worth the risk to them.

I like Senegal, and have met many wonderful people here, but I'm not a huge fan of Dakar. Taiwan is a dirty city too, where everyone smokes, but I guess I put up with Taiwan because it's the home of my family. And, Taiwan has amazing food, awesome shopping, and it is very safe. I guess Dakar has great food and shopping too, but here I'm a foreigner, and have to make an effort to avoid ridiculously inflated prices every day. In Taiwan, no one can tell I'm a foreigner (if I keep my mouth shut), so I guess it's a lot easier to blend in. I was showing some of my photos from traveling to one of the girls at the cancer ward, and she said, "New York is beautiful. California is beautiful. Spain is beautiful. Amsterdam is beautiful. Everywhere is beautiful, except for Senegal."

"No, Senegal is beautiful too," I said hurriedly, but it took a while for me to think up of what is beautiful about Senegal. Indeed, parts of Senegal are beautiful--Cassamance, for example. There are also some impressive dunes to the North--and Ile Goree is splendid. Dakar also has some lovely beaches.

I'm really happy with how the work has been going here, but I'm ready to go home--to the USA, land where smoking is banned in all indoor establishments. 

Hospital Silence

For our last day in Zigunchor, we went to the Centre de Sante, also known as "Hopital Silence." That's an odd name for a hospital, we thought--Silence Hospital. It turns out that outside the Centre, they put up a sign requesting that passing cars and people refrain from making a lot of noise--it should have said, "Hopital, Silence," but because they omitted the comma, people thought it was the name of the Centre. As with some of the other Centres that we have seen, it is overrun with goats and cats. There are 3 doctors, 6-7 nurses, and probably 15 goats roaming the grounds.

Now I am back in Dakar. The receptionist at the hotel is from Cassamance, and he said that he would tell me the full story of the war there. According to him, the government claims it's just about independence, but it's far more complicated than that. When I told my interpreter this, he said, "that sounds like something one of the rebels would say."

One of the girls at the pediatrics ward gave me a necklace and a beaded key chain that she made.

Zigunchor, Cassamance

Zigunchor and Cassamance--two beautiful names. Dakar, Podor, and St. Louis don't have such a nice ring, but Zigunchor (pronounced zee-gun-shore) sounds like an exotic cocktail, and "Cassamance" sounds like a hidden kingdom. Some doctors warned me not to go to Cassamance because of the instability. However, there has been a ceasefire (there were several--one in 2001, then again in 2004, then sort of in 2010), and things seem fairly stable now. The people of Cassamance, predominantly the Diola, maintained a violent separatist movement for many years. Apparently the King there is honored with wrestling matches every week (my source is 4 years old, maybe that has changed now). Most people have said that Zigunchor is a good place to conduct field research because it is so different from the rest of Senegal. For one, it is predominantly Christian or Animist, while the rest of the country is Muslim. For another, its climate is lush, wet, and tropical--lots of great fruit.

As we left Dakar, I could see the white clay houses from above; they looked like crumbling tombstones. We flew along the coast, and as moved towards the Cassamance River, the land changed completely. Above the Gambia, the land stretches flat and dry, with parched looking plants (except on the islands). Southern Senegal is green and moist. From thousands of feet above ground, the rivers look like serpents undulating through patches of green. There are no structures--just these rivers and foliage.

At the hospital, everyone talks about "the war." I had thought the ceasefire solved things, but apparently not at all. Thought Zigunchor is fairly safe, outside there are still attacks. Since Zigunchor Regional Hospital is the only level III hospital in the entire region, the seriously wounded are often brought here. I asked if there are a lot of land mine victims coming to the hospital, and the person I was speaking with said, "not really, this year there has been only one."

Then I stupidly said, "Oh, that's not too bad."

Then he said, "well people usually die right away when they hit a land mine, so there is no need to take them to the hospital."

Apparently the last land mind explosion, which killed 4 people, occurred just 2 days ago, on December 3rd.

The conflict in Zigunchor has received very little international attention, given how long it has lasted (about 30 years). It has been classified as low conflict now, but it seems a lot of people are holding their breath. Given the recent election and change in government, things have been quiet because they are negotiating, but apparently they are always negotiating--then negotiations fall apart, and violence erupts again. Despite this being a conflict zone, there is no morphine (and never has been, except for some random donations) for pain management.

Dakar's Market and International Fair

It is the weekend, and once again I am happy!

It's nice to have time to relax, although it's already Sunday evening. Yesterday I went to the market and went on a shopping spree. I haven't bought clothes in quite some time, and I wanted to buy everything! Then I reminded myself that one Senegalese outfit was more than enough, since I would not be wearing it in the US. I love the clothes here! They are bright and shiny. We walked into a fabric store, and it was like entering a fairy land. Bolts of cloth twinkled with sequins and glitter, hundreds of shades all with some sort of shimmer to them. It was as if someone had put diamond dust in a...one of those machines that make fake snow (I forget what they are called) and went nuts with it. I was too overwhelmed with the selection, so I ended up just looking for something ready made. The ladies here however, pick their own fabric, and mix and match to design a custom made outfit. I found something suitable for a meeting with the ministry, and bought it for $12 because my Senegalese friend helped me bargain. They originally tried to charge me $50. I would have happily paid $20, but my friend said, "you don't talk with people about prices, let me do the talking." So I did, and was shocked (though not too shocked) at how far the price tumbled from the original offer.

I got ripped off by some Chinese people because I wanted to show my friend Chinese cuisine. They had one price on the menu, and when the bill came, they charged me another price. They claimed, "oh, so sorry, this is an old menu, and the prices have changed." It was a difference of 2 dollars, and I really didn't want my friend's first experience with Chinese food to be me screaming at the waiter over something so small--but I was pretty mad. Even though I get annoyed when people on the street charge me artificially high prices, I can understand their motive--their poor, and honestly, if I was in that situation and I knew a foreigner would be willing to pay twice as much for something, I would probably try to get away with it too. But I was really expecting the people in the restaurant to be a little nicer to me since there are not that many Chinese people in Senegal--and they own a nice (and expensive) restaurant and really don't need to resort to tactics like that to feed their families. If anyone visits Senegal, never eat Chinese food! They also served us "beef" that I'm not entirely sure was beef...I thought it looked kind of like pork (my friend is Muslim and cannot eat pork), but the owner said, "this is from the back of the cow, that's why it is different, very good texture." Before that, the owner kept pointing at my friend while addressing me in Chinese, saying, "black people like fish and things that are fried." I really hope it wasn't pork, for my friend's sake.

Later, we went to an international fair, in which people from all of West Africa set up stands and sold items from their country. I really, really wanted to buy this shirt with matching dress that had stingrays all over it (it looked a lot better than it sounds), but controlled myself. There were sandals from Pakistan with bells and fake gemstones on them, and of course, tons of fabric, beads, bangles, and headwear. Most outfits here come as a 3 piece set--shirt, bottoms (either a skirt of pants), and a head wrap. At the end, there was a concert featuring a famous Mbalax singer.

I had ice cream and chocolate, and slept for as long as I wanted. Also met with some peace corp volunteers in Dakar, who were very nice. I plan to go back to the fair later, since it lasts until the 12th of December.