Tomorrow I shall cover myself with a fig leaf.

3/22/09, 10:20pm, a Sunday evening at the convent B&B in Leribe. Physically, I should be tired but, again, I’m wired before bed. There’s been such an immense amount of important newness these last four days that I can’t put myself to sleep. I feel like I did when I was a kid lying in bed listening to the adult party continue in the living room of the Seneca Street house, wanting to be part of whatever was happening. I guess I still have a hard time leaving parties, but we all knew that… But nobody else is up. Our young doctor roommate from Zimbabwe was asleep when we got home from the hospital and Kevin and Ethel have retired, appropriately exhausted after our weekend. And here I sit in the kitchen listening to crickets and the occasional Zimbabwean cough (it’s just a tickle, it seems), and sipping a “refreshingly crisp” Hansa Pilsener brewed from “The kiss of the Saaz hop” in Maluti, down the road a fur piece (sp?). So let me fill you in, people I love and from whom I feel oddly separated:

First let me say that my welcome here could not have been better. Maybe I’ve said that before, but Ethel and Kevin are the perfect people for the job. They’re funny, gentle, and enthusiastic, smart and confident with wonderful awe, and appreciate my bursts of both thrill and overwhelmedness. On Saturday we made our way from Maseru to Leribe (the town is also called Hlotse and is within Leribe province/county, but most seem to refer to the town itself as Leribe). Sara and Josh had rented a car to get themselves to Jo’Burg, so I got to ride just with Sara and have the one-on-one catch-up I’d been waiting for. The ride took maybe an hour and a half and was my first glimpse of the roads outside the capitol. The entire way they were teeming with people: shepherd boys in oversized beanies, blankets, and wellies riding donkeys and carrying sticks, tons of cute kids on the way from Saturday school, a massive soccer tournament on a field in the middle nowhere, road-side tin-sided food stands selling veggies, chicken, grilled corn, or cell phone minutes, and all sorts of other people. Many of them waved and we waved back, me silently practicing my “Dumela mé” or “Dumela mdaté” so I’d be ready to greet women and men in person (I think “oussie” is “girl” and “abooti” is “boy”).

We all went to the Shoprite across the street from the convent and got dinner stuff, then Sara and Josh and I picked up my big bags, sent the day before, from the public health interns’ house in “Little America” and they dropped me home and went on their way… so sad to have such a short visit with a great old friend. Tapiwa, the young doctor I mentioned above, met us at the door. He’ll be our roommate until his organization finds him a house, since he’ll be here for a while secondary to having a real doctoring job here, as many young Zim docs do, nowadays. He’s a cool guy. He bites off bottle caps, laughs with a little embarrassment at raunchy jokes especially when told by me or Ethel, and explained the tragic hilarity of the Zim dollar by telling us that a banana from a street vendor costs 50 billion Zim dollars after 12 zeros were subtracted from the currency last year. And we call ours a recession!

Kevin and Ethel took me to the local hotel restaurant for a chicken curry take-away dinner. Somehow in the hour it took them to prepare our food complete with three follow-up conversations about our order, they ended up adding a steak to our take-away bag. Funny, because nobody had ever mentioned a cow at all. The stars are ridiculous here, like blue-water sailboat under a new moon ridiculous. None of the street lights work, so light pollution is minimal. Of parental importance, the streets feel very safe even at night, with lots of friendly people about. During the day, everyone agrees that running the main roads is completely safe.

I fell asleep to the tachy rhythm of my oxygen-deprived heart (we’re high up) in my ear-plugged ears and tried to calm my thoughts and balance the need for air with my sleeping bag’s ability to keep away mosquitoes. I can’t believe that word has an “e” in it, spellcheck!

This morning Dr. Phil came over to trade in the borrowed Bourne Identity for All About My Mother and to take us on a sight-seeing and hiking adventure day. Phil is a family doctor from coastal Maine (just below Acadia) who recently retired and was hired by LeBoHA with his Nurse Practitioner wife to work at Motebang. Sandy, his wife, is out of town, so we snagged him for the day as our tour guide and (my) new friend. We drove first to Bokong, a park (indistinguishable from the surrounding landscape, except I guess there weren’t any huts on this part of the land) with a nice flat out-and-back hike to the top of a lovely waterfall. There was a bizarrely fancy “conference center” (“bizarrely” because nobody goes there; Phil had the last three entries in the guest book) with panoramic views of the mountains beyond mountains (to borrow a phrase borrowed by Kevin from Tracy Kidder) and stuffed local animals in decent condition. There were about 15 steps from the conference center, built into the stone wall, up to the trail and my quads were immediately flooded with lactic acid and I ceased being able to complete full sentences. I considered doing the old Daddy running trick of asking a thoughtful question on the uphills, but then things flattened out. The four of us walked in t-shirts on a quite nice path made of local stones to the top of the waterfall and sat there chatting for a nice half hour, basking in the warm sun and listening to the water fall. We three students in the group are still adjusting to getting awesome placements in the residency match, and Kevin and I, having hinted for months with our fingers crossed about both ending up together in Seattle, started planning our Pacific Northwest adventures inside and outside of medicine. I can’t wait to buy a good road bike, plant some edibles in a small garden, live near KP, Toby, Pete, and Soph, and explore the mountains and waters, not to mention the West Seattle Big Band and the 826 tutoring center for kids. ‘Cause I’ll have PLENTY of free time…

After returning to the truck we pressed on, often going 15 mph on the switch-backing, vertiginous, Canary-reminiscent hills (though, sadly lacking in snack stands, and much more lush) for another almost 2 hours until we reached a really impressive look-out populated by a cute gang of impossible relatives of the elephant, the Hyrex. There’s a picture in the last post and it looks like a guinea pig with a tapered nose.

A whole bunch of switch-backs and hundreds of road-side waving children later we reached the Katse dam from above. The gate was closed (though the guidebook had predicted a tour at 2:00) so we paused for peanut butter sandwiches and plums and drove to the base and walked in the last half mile to the base of the 185m engineering feat. We threw a bunch of rocks into the river (I thought about my recent rock-throwing fun with Nicholas in Aurora), many of which were embedded with shiny quartz, scrambled along the river bed, said “Dumela” to some fishermen, and then climbed willow trees to try to cut down a couple abandoned dangling birds’ nests for Phil’s porch decoration. By the time we were back in the car (and Kevin’s finger blood was staunched; ooh, I should clean my Leatherman) we were all on the verge of sleep (except Phil; he drove very well). I read a handful of poems aloud from Phil’s Garrison Kieller Poet’s Almanac and then we all gave up on verbal communication. Back at the convent we thanked Phil for the adventure and headed out to get dinner at the Pelican bar down the road and visit the hospital for a quick email check before bed.

Ethel, however, happened upon a crying mother holding an eerily lethargic and tiny one-year-old boy whose skin was retracting between his ribs and above his clavicles with the effort of breathing, and whose lungs sounded like serious crepital crap. The child had been ill for ten days and, due to some sort of money and transportation obstacles, had not been to the hospital yet. There were no doctors or nurses to be found so, after a quick exam in the computer office, we carried the baby up to the pediatrics wing while Kevin called in Christopher, the resident on call. Since I don’t know my way around the hospital workings yet, I manned the open office while Kevin and Ethel got the little boy oxygen and a bed in the ICU/trauma ward. It looks like the poor little guy won’t make it and, as he was severely volume depleted from diarrhea and vomiting, even as we left, nobody had been able to get IV access in arm, foot, or scalp to infuse replacement fluids. In the best hands available, we left the baby for the night. We’ll find out in the morning if he is pulled through.

There’s a remarkable calm that I felt, despite the flurry of action. When we walked into the pediatrics building it was immediately clear to me how different a game this is. There were many family members around the children there but no medical staff anywhere. Can we try intraosseous access? We don’t have IO needles here. What does the ICU have that the ward doesn’t? The nurses can give more attention to the baby. I imagine that some people reading this might expect me to feel frustrated or angry or desperate to try something. But all I felt was sad and calm and awake in a way I haven’t felt since ambulance work. I have more experience getting IV access than most of my classmates at home thanks to my paramedic years, but the resident here is better than I am, I’m sure, and Kevin and Ethel have been honing their skills for a solid month, so I had nothing to offer except a hand on the back of the weary and frightened mother. I couldn’t even explain anything to her, the fall-back student offering at home, as my Sesotho vocabulary includes only greetings and “thank you”.

Tomorrow I’m going to shadow Ethel in the male medical ward to start getting a feel for medicine here. Two of her patients died over the weekend so there are only five men under her care, one of whom has TB and one of whom is in the ICU; I’ll find out why tomorrow. I’ll bring in my donated goods, try to give out some stickers to kids, and start learning the limited formulary (drugs available) and treatment regimens. Ethel and Kevin have been super generous in sharing their medical experiences here with me, so I know I’m about to start seeing as normal the complications of AIDS and tuberculosis that I’ve only read about these last four years. Since I’m still up at 11:30 after a tiring past several days, I know I must be nervous. But mostly I just feel the preparations for becoming sponge-like for new knowledge, and for retraining myself for Basotho medicine. What will my role be? How can I figure out how to write prescriptions for new medicines for new diseases in this new (to me) depth of poverty in this new and beautiful country? What does this mean for my next 40 years of doctoring? How can this direct my next four years of training to be a family doctor? How will I learn to adjust my expectations and counsel myself through so much death and suffering? And how on earth will I put myself to bed when this sad and exciting party is going on ALL THE TIME just down the road? I guess I’d better start trying.