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West Africa 2002
In to Africa
By Elizabeth McGhee  
 

08Jan02

The adventure begins Saturday 06Jan02 as I leave my home at 5:45 am to the Detroit Metro airport to fly to Kansas City .  I ended up going through airport security twice and they even had me remove my cowboy boots… checking for chemical residue (bombs).  They went through my carry on with a fine toothcomb.  I asked the security officer what she was looking for.  She replied it was folding scissors. I had forgotten they had been placed in a tiny pocket in my carry on pouch. UGH. Well, then she noticed my knitting needles and I made a comment about them being some for sleeves, some for fronts etc.  I ended up checking the whole bag as baggage!! Needless to say, I left all of that in Kansas City (KC).

Sun AM

Cathy (my sister) and I set up the” mission control” room, a Sunday school room for which her church will also be used for the Perspectives class.  We want to have international flags, three large tables, and a pit group of couches for small group discussions.  We have international cloths to cover the tables. 

We ate fruit from the deli at the store for breakfast, which was wise, as we did not eat again until very late that night.

The sermon was a missionary from China and about using your gifts and evangelizing.  I met John Harden the speaker for the first Perspectives class.  I was sorry I could not pick his brain about missions and some of the places he had been.  We were leaving and he was staying.

We had minor challenges in KC trying to get our luggage checked through to West Africa .  We had a 24-hour layover in Paris and they wanted us to get our bags at Charles de Gaulle ( Paris Airport ) and take them with us, then return the next day and recheck them in.  The downside was that the bags of medicine, we each had one, weighed 70lbs apiece, plus our personal bag and a carryon. Fortunately most were on wheels with pull handles.

We ended up taking them to our Paris hotel, dragging them around from shuttle to shuttle as there are more than one hotel with that name.  We were a sight circling that station lugging those on and off shuttles and carts.  It was a long day and night of flight to Paris . Our flight out of Cincinnati was delayed on the ground for 2 hours we waited for other connecting flights as many of the passengers were delayed due to weather and we waited for deicing of the wings.  It was an 8-hour flight turning into 11 hours.  It was an all nighter but I had plenty to read.  I stared with the first of three books by Jean Sasson “Princess: A True Story of Life Behind the Veil in Saudi Arabia ” It was a riveting look at a the women’s life a Muslim Royal.  Incredible reading and shocking. I could hardly put it down.

By the time we got to our hotel in Paris it was about 3 pm .  We decided to travel the Metro to Paris .  We bought a day pass, with unlimited rides for the day.  We were glad for that as we got on and off at the wrong stations many times.  The metro maps are easy to follow and a good way to travel in Paris , yessss they are in French.  We went first to the Institute of Pasteur .  Is currently a museum.  It was his home, laboratory and now his crypt.  The crypt is very ornate and is entirely a work of art.  The walls and ceilings are all mosaics each depicting a part of his work.  His wife is also buried there in the crypt.

I was amazed at the types of work he had done besides vaccines.  He was an excellent artist doing many portraits of family members.  There were 14-20 microscopes there that he had used and many of his chemical compounds and the equipment he used in his experiments with microbes and sterility.

I didn’t realize the work he did with silkworms and development of a disease resistant strain.  Hen cholera studies and how the vaccine was discovered after finding plates of cholera long forgotten in the incubator.  He also developed the vaccine for anthrax after many attempts due to the tenacity of the spores he had difficulty attenuating the vaccine.  But he did it and began trying it in sheep.  He also did much research on rabies and even though it was a virus and he never saw it, he was able to develop a treatment and a vaccine.  The first human he treated was a shepherd who had been bitten by rabid wolves.  Pasteur was not a physician and could not administer the vaccine but he developed it.  He also invented the pressure cooker (autoclave), which looks much the same today.  He also researched fermentation and the bacteria that affect wine and beer.

We whipped through the museum and rushed to the metro to the Arc du Triumph.  By now it was dark and the view of Paris was beautiful.  The temperature was 30-40 F and a bit nippy but we were walking fast.  As we came up out of the tunnel leading to the metro the Arc lurched up in all of its grandeur.  We were speechless.  The black night sky behind it while the Arc was illuminated majestically; I could almost hear the hoof beats and marching legions of men that had passed through, in their victories.  I felt like shouting hooray myself and waving a flag. We then flew to the metro again to the famous Eiffel tower.  It had been built only as a temporary structure for the World expo.  The Jambon du Paris (a sub sandwich of ham and cheese) was holding us well.  Three of the team members went up the Eiffel Tower to the tiptop and the other 3 decided (myself included in the latter) to hit a café for a croissant and espresso.  The waiter was surprised when I asked for a croissant as they only eat them for breakfast and it now was dinnertime.  He found one and brought it with a real cappuccino.  The croissant was so light and flaky it melted in my mouth.  The coffee is not like the cappuccino at the gas station in the US , which I think, is really just liquid candy bars.  It was strong with steamed milk and some espresso powder sprinkled on top. YUM!!  It was delicious. We strolled over to the River Seine while we waited and began to freeze, for our altitude seekers from the Eiffel Tower .  It too, was lit up and looked as if some one had taken strands of honey spun them into yarn and wove the Eiffel Tower .   What an architectural wonder.  Then we rushed again to the Metro and found Notre Dame.

West Africa

As we flew over Africa I glanced out of the window and was greeted by the Sahara desert.  The expanse of far reaching blanketing sands, hot, arid and a bit foreboding yet intriguing.  The sands looked as a sea of fire with ripples of gold and red with a taupe tide.  A long narrow ribbon of gray penciled a road through the desert.  It seemed endless this sea of sand.  How could anyone or anything ever survive?

The capital city of the Islamic Republic of Mauritania is Nouakchott , home to about 800,000 people, a crossbreed of various goats, some wool less sheep, and many burros.

West Africa is on the coast and in on the hump of Africa I refer to the backside of the brain if you looked at the continent as a profile of a person’s head.   The airport was small much like the one in Salina , Kansas , maybe not that big.  Most of the officials spoke French and were friendly to us.  Customs was relatively easy, as for me it was “ ok, Pass’.  If your paperwork for entrance into the country was not filled out properly (a disembarkment form) they questioned you.  The temp was about 78 F and the wind was light and cool.   We lugged our 12 bags, half of which were medicines and ourselves onto the truck and went to our apartment.  We are staying in a nice area, which stands out fantastically against the rest of the city.  There is a courtyard surrounded by a large 7-foot wall with an elegant marble entrance and walkway.  This is kept locked by the concierge, Omar, who sleeps on the floor in the garden shed. He maintains the garden of figs, bougainvillea, hibiscus, dates and various other plants in the courtyard.   Cathy and I roomed together on the second floor.  The room was like a suite with a parlor, kitchen with a gas stove, small refrigerator and sink and a bath with a shower, a bedroom with a queen and twin bed.  An armoire and dresser were the only other pieces of furniture in the room.  We had the luxury of hot water, shower, electricity, and a flush toilet, a stark contrast to the rest of the city’s accommodations. 

There is one main road that is paved in this capital city.  More cars than I expected race along the road or shoulder or yard or whatever happens to be the path of least resistance.  There are many pedestrians and several burro carts.  Most of the burros look very rough and bedraggled and seem to always be getting whacked or kicked to maintain their work pace as they pull carts, many of which are loaded with 55 gallon water barrels.  A story I was told about burros lot in life here, was that on occasion they are beaten by their owner for Allah’s sake, as a burro had distressed the prophet Mohammed at some point.  Oh dear, I saw one foraging on corn husks but most eat brown paper sacks given to them by their owners, while the local version of a dairy goat wandering around the streets eating trash and foraging what little vegetation they could find.  The only thing I noticed they did not eat was the Neem tree, which we know as tea tree oil. 

The women dressed in their brightly colored malafas look like radiant flowers in this parched land of sand.  The malafas are one piece of lightweight fabric wrapped around their body and head.  Everything is covered except the face, hands and feet.  There are other African people around wearing Pulas, which looks like a robe and a strip of cloth wrapped around and around her head.  The men wear bui buis a lofty robe with large sleeves.  Usually they are light blue or white and ornately stitched at the neck and chest area.  Only the wealthier men wear the ones with stitching.  Sandals are on most everyone except the children.  Those children absolutely love it when you take their picture and never asked for compensation.  The people are poor here and many I saw so far live in a shack like lean –to shanties or block houses with peeling paint and drab yards littered with trash and a few shrubs and wandering goats.  The goats forage in the garbage, eating scraps and paper. 

There is a type of caste system here of four levels.  The basic principle in determining where you were in this system was based on the color or rather the lack of color in your skin, the lighter you are the better and by the style of clothing worn.  The levels are White Moor, Black Moor, Black African, and Slave.  The white moors were lighter and looked mostly Arabic and men wore the bui-bui’s while women wore malafas.  The black moors wore the same as the white moors but they had black skin and looked more African.  The black African was very dark skinned and wore the pular style of dress, a head wrap and brightly colored robes and skirts that wrapped around them.  As for slaves, no one I saw admitted to being a slave or pointed one out to me, as the government says there are no slaves but everyone tells me they exist.

We met with the “Medicine Chef” or the doctor of the clinic, tonight to see the location where we would be working.  They have a clinic building we can use which is about 800 sq ft.  They recently built a maternity clinic but there is no one to work in it yet.  Come on midwives there is a place for you.  The hospital here is called National Hospital and I hear that if you go there it is so you can die.  It seems rather defunct according to the locals.  I hope we can visit it.  We plan to go to the “Kebe” the shanty trash town and set up a clinic there under a tent or a shack.  We want to reach the poorest people where the need for medical care is greatest.

We returned to our apartment and organized our meds by categories of pain relief, antibiotics, cough and cold meds, dermatologics, toothpaste and brushes, bandage supplies, and vitamins.  The sorting went fast as we worked quickly and as a team.  Our team leader Warren Johnson, a pediatrician, is a sweet gentle man who will be a great leader as he sees the needs of others before he sees his own.  Cathy Gordon, my sister, a family nurse practitioner is training Warren as a team leader.  She is the one with the vision and her infectious passion for the lost will spread through the medical teams to many.  She birthed Mercy and Truth Medical Missions (www.mercyandtruth.com) and has endured much travail in the labor and delivery of getting medical teams together to remote areas of the world.  Christy, a RN from Denver is a serious deep woman who fears the Lord and has a quiet strength that gives us a calm stability.  Patty, our supply coordinator extraordinaire.  She so adequately and expertly packed the pharmacy bags for the trip and eagerly has taken on the tedious job of dispensing pharmacy tomorrow in our first day of clinics.  Barbara, a mother of older children and an RN has been to Kenya but not as a Mercy and Truth medical mission.  She has a sweet personality of maturity and flexibility, which keeps us all flexible.

This afternoon a car with a speaker in the hassania dialect of Arabic announced the clinics would be open tomorrow.  We shall soon see how God chooses to use us in a land where they do not know, love and serve his very own son, Jesus.

Ah, as I lay down in my bed with the windows open a cool ocean breeze blowing in with a serenade by a burro, Warrens favorite West African tune! HEE HA  HEE HAAAA

Clinic Day

Wed 09Jan02

We met for devotions and breakfast as a 6-member team at 7:15am .  We ate fruit, juice, and corn flakes.  We had coffee at the office.  By 8am we were at the medical clinic, not the Kebe shantytown, to get set up.  People, mostly women and children, myriads of children were lining up ready to be seen.  The women were wearing brightly colored malafas and wraps and looking like beautiful spring flowers sprouting up in the dry barren sand.  The women seem to be the joy, the sparkle and definitely the splashes of vibrant flowing color of the people and land.  The babies are tied to the women’s backs with a bright colored cloth around the women’s breast in a wide band.  I saw many men, mostly for pain, coughing and anemia.  The anemia was mostly due to post cases of malaria.  We saw 127 patients today.  Most of the children had a cough, ear infections and worms.  Many say they have fever at night.  I have no idea what that would be unless it is just so very hot in the city or village cooped up in a little room or tent in the desert.  Most of the people were poor and dirty.  I can understand the dirty part with the way the dirt blows around here and the fact they sit and eat on the floor.  There is a lack of soap and maybe for some, a lack of available water for washing. 

The clinics ended, to my dismay, as the people (mostly the translators) take rests during that part of the day due to the heat.  So after a lunch of salad and sandwiches out of the cooler, we were off to the port.

THE PORT

The port in West Africa is off of rich fishing waters and fishing is the main income for the entire country.  The fishermen were coming in with boats teeming with fish of all sizes, starting at about 14” long.  I am not sure of the kind of fish, but they had scales and they were shaped like a carp.  I even saw a tuna fish, which was the king, at about 5 feet long!  Of course there was definite odor about the port that only a fish port would entertain, which made it very distinctive from the rest of the town.

The fishermen had boats about 40 feet long, wooden, and brightly painted.  As they unloaded the fish into a large crate, a man would place this crate on his head and run as fast as he could under the load to the selling booth and run back for another load.  They were an expert team in action as they worked as one, bringing the boat on to the shore.  They used logs to roll the boat up on to the sand beyond the reach of the tide.  Further on the beach I saw a lone fisherman using a line, sinker and hook, no pole.  He would cast with a wild, yet expert fling of his arm into the boiling soup of the sea.  He had 4-5 fish on the shore already at his feet.  I felt at that moment God was trying to tell me something as he did to Jeremiah the prophet at the potter’s house.  As I gazed at the lone fisherman and then the group of fisherman with the boat, my eyes moved to the fish and froze.  If only the church, the Kingdom church, not just one church and a pastor but Gods entire Kingdom church, would work as the expert precise team of fisherman, imagine the catch! Imagine huge bursting full boats with disciples running as fast as they could back and forth to the next level of Christianity, just as the fishermen did.  Rather so many times we are acting like the single fisherman casting a single line in his own strength for only a few. Of course it is better than none but the time is short.  We are fishers of men.

Because we had a dinner invitation from my translator Kertouma, we wanted to dress in proper West African attire, IE malafas.  We headed towards the peoples market in West Africa .  People crowded and swarmed us the instant they realized we wanted malafas.  Warren was with me and put his arms out and said,” tout lemonde de la, Je nes attend Pas!!” Which translates the whole world is here so I am buying nothing.  Well, we finally struck a deal after much bartering for 1500 ugewis (297 for each US dollar) I bought 4 by the time I got back to our apartment, for myself and to take to my daughters at home.

After much fussing with the malafa and more fidgeting with it to stay on, I was able to look somewhat respectable.  The Mauritanians loved it!  Such honor and favor we were given for showing deference.  Muslims like to see women covered.  Arms legs, and hair covered completely.  Very conservative Muslims veil their entire face and one-step more liberal is only the eyes showing.  Some Muslims wear the very conservative black robes called bui buis in Kenya , but in Mauritania the colorful soft flowing malafa were the norm.  The women looked as flowers in the desert and now we too were part of that bouquet, but with fair skin and an inability to maintain gracefulness swaddled in the malafa.

We met Kertouma’s three children.  A daughter, Hannan, and two sons Ali and Muhammad all very young and very cute.  After removing our shoes, we were ushered into a large majestic room filled with an atmosphere out a scene of “ Arabian nights”.  There were blue and gold cushioned couches along the walls without legs, setting on the floor.  The couches and pillows had elaborate fabric.  It seemed like an Arabic room for royalty with the multiple Persian rugs, chandeliers and extensive drapes along the walls. 

The first course was an array of juice and tea of which was set upon the floor.  Two decorative cloths had been placed over the Persian rugs and were to serve as our table.  We lounged on the floor causally sipping mango juice.  Women are allowed to reside on the floor on their stomachs or sides, never on their backs, as that is considered promiscuous.  Of course you can sit crossed legged or side ways providing your legs and feet are covered.  Well, if you could maneuver the malafa with out twisting it into a rope, no problem.  But I had great difficulty just keeping it on my head and out of my food and from tripping on it.

The next course was a large single plate heaping with dates, sweet and dried still clinging to their branch and a dish of sweetened sour cream.  We dipped each date, after snapping it off the branch into the cream and ate it.  The large long seed was to be tossed onto the table cloth (floor cloth), which by the end of the meal had accumulated many seeds and bones.  Most of the meal is to be eaten with your fingers, using only the right hand, never the left as it is used for wiping your bottom!!! Of course, we (the Americans) brought our own toilet paper and kept it on us, as many African restrooms did not have toilet paper much less any thing above a hole in the ground, rarely a flush toilet like we have here at home.

Before the meal, which is technically, at this point we get our hands washed in an unusual manner.  A servant brings a large silver or pewter pot setting upon four legs which has a swollen teapot that matches, nested on top.  As you hold your hands over the larger pot with legs, using soap, the servant rinses your hands using the teapot.  The next course was roasted lamb legs, ribs, shoulder with the scapula and a strange looking piece of meat resembling a corkscrew all basting in a green tasty liver sauce.  Upon inquiring the animal had been roasted outdoors over an open cooking pit, which is typical here in West Africa , due to the heat.  The meat was thoroughly cooked and the crunchy ends were a favorite of our hostess, Kertouma, who kept cutting me a piece and encouraging me to, "Eat. Eat.”  As I was eating and enjoying the lamb, a piece decided to revolt and become thoroughly lodged in my throat.  Well, this has happened in the past, except this time I could not dislodge it, nor could I even breath and worse, I could not even talk!  So, I quickly stood up motioning with my arm to my sister, Cathy, knowing she would discern the pleading in my eyes.  She immediately noticed me and asked if I could speak, my head shaking back and forth “No”, was all the confirmation she needed.  The Heimlich on a big person performed by a little person must have been the site for the entire day in West Africa !

However, it was effective, I swallowed the culprit and we went on to eating the rest of the meal.  The corkscrew meat was chewy but very tasty as I swallowed my second bite I was told it was intestine wrapped around another piece to give it the corkscrew appearance and thus easy to roast.  Yikes, oh well it was good and I will eat it again! 

The next course was Kous Kous a grain sort of like millet but finer in a large bed hosting more meat from the lamb including lung and stomach.  The vegetables were parsnips, carrots, and sweet peppers.  I did not adventure to the stomach and lungs but I did master the kous kous.  You must grasp a small handful in your palm with your right hand, and gently toss it around in your palm until it forms a small ball, which you can easily toss into your mouth.  It can be mixed with a bit of vegetable or meat. 

After the meal the same hand washing equipment was retrieved and after licking our fingers we washed them again.  Our hostess told me licking fingers was the norm.  Oh would my children love that!!  After the dish which held the food, which by the way we ALL ate from (there were no individual plates) were removed, the clean up was simple as rolling up the cloth.  The dinner had started at 8Pm and ended at 11PM .  No wonder so many had heartburn if this late night eating was the norm.

Our topics of conversation that night were wild and varied.  They went from the how to's of Mauritanian cooking, such as the meal we had in front of us to what kind of a wife Warren wanted.  Warren can only see children for they are his love, and the passion to help them seems to have overridden his search for a wife.  Other topics included schooling, which is not free in Mauritania, and college.  West Africa has a literacy rate of 38%.  Our translators both teach English in a high school.

I asked Kertouma about her wedding and courtship.  Unlike many in her culture she had known her husband before marriage even though the elders had made all of the arrangements for her.  She had not dated or even spent time socializing with him.  She was prepared for her wedding a few days in advance in some beautification treatments.  Of course, she had bathing for cleansing and had several women attend her.  Four working on her hair, one on each hand and each foot.  The ones at her head were braiding her hair and adding beads.  She said this was uncomfortable with all of the tugging and pulling of the hundreds of braids they put into her hair.  Each hand and foot was elaborately decorated with a henna stain.  Tape is applied to both surfaces of her hands and feet then a razor cuts and slices away pieces of the tape carving an intrinsic design with out cutting the woman.  Then a thick paste of crushed and powdered henna mixed with water are applied to the cut places in the tape which will stain the exposed skin a dark orange to brown.  This takes about 6 to 8 hours!!!!  The braiding takes an entire day.  Then a mixture of lemon juice and sugar are boiled together until it has the consistency of taffy.  It is then used to remove all body hair from the neck down!! Yes it is ripped off.  It sounds like waxing is for us in the US.  They do it every couple of months as purification, plus I think it is considered beautiful by them. 

Thursday 10Jan02

Today is rainy, overcast and about 60 degrees F, maybe less.  This is a surprise as we are in the desert and it is their summer.  It was very refreshing for us, freezing for them.  Breakfast of fruit and cereal at 7:15 AM and devotions.  Warren spoke on treasures of God and to ask BIG in prayer.  We went around the room with any testimony and prayer to be shared.  I shared the analogy of the fisherman and the church.  My translator Kertouma had told me the day before the price of sheep and goats is high during the dry season and during the holy days around Ramadan.  But after the rainy season they are abundant and cheaper because the rain allows more green plants and foliage, therefore more for the sheep and goats to eat.  The burros I saw are fed brown paper sacks.  With the rain I remembered the Bible said God allows rain so the earth could bring forth her fruit.  As sheep, the rain falling during the dry season it is time for fruit!  It seemed to parallel our efforts here in West Africa, the sheep getting more to eat so more could be added to the Kingdom.

By 8AM we were to the clinic.  The set up was the same.  We had 3 stations of providers Cathy, Warren, and myself.  We each had a translator.  We spoke English, (rather American) they spoke a dialect of Arabic and French.  There were 3 chairs; one for the provider, one for the translator and one for the patient.  Sometimes the patient was a family, which could be extended family such as a mother with children or an aunt with nieces and nephews.  I did not see any men come in with children.  After registering and getting a clinic card with name and age (each person needed a card to be seen) and the primary concern or the reason for the visit was also recorded on it.  After registration they see the provider.  After the exam and dialog, a diagnosis and a prescription are written on the card and a label is put on the card for the medication with directions for use.  Of course most could not read and English or even Arabic so we used a system of dashes and marks to indicated how often to take the medications and vitamins.  The patient takes the card and prescription label to the pharmacy. The pharmacy had 2 people working in it with a translator.  The translator, Zenabou, again would explain the instructions for the meds.  The pharmacy workers job includes counting pills, bagging them or maybe reconstituting powdered antibiotic to a liquid suspension and giving a demonstration on how to use it.  Besides pain relievers such as aspirin, Tylenol and Day Pro we have antibiotics like Biaxin, Zithromax, several brands of ceflasporins and erythromycin.  We also have cough and cold formulas like Tylenol cough and cold liquid and tablets and a small variety of dermatological treatments.  These contained maybe nystatin and meticlotrizole.  We did teaching on dental care giving toothbrushes and toothpaste and when we ran our to toothpaste we recommended salt.  Most people use a small stick cut from the Neem (Mkilifi or Mwarubaini) tree, which is a source of what we know as tea tree oil and they chew on the small branch and floss with the frayed ends.  I tried this and it is easy to fray the end a bit to floss in-between my teeth.  However it is bitter and tastes like turpentine or something like that.  We also had an ample supply of soap, which we dispensed with each dermatology case.  Until we ran out of soap any way. 

I saw most of the men again and most of them seemed to have back pain as they work very hard doing construction work most of which is manual.  One man had bleparitis, an inflammation of the eyelids and said he had difficulty seeing our of one eye.  Our equipment is limited to a stethoscope, a blood pressure cuff and an oto/opthalmoscope.  I looked in his blind eye to find he had a great case of cataracts.  I had to refer him to the ophthalmology clinic in the city, but it is very expensive and I doubt he could go much less afford it.  I was able to give him some antibiotic ointment for his blepahritis and instructions to wash his eyelids daily.  I doubt he washed daily.

Many patients were anemic probably due to malaria, malnutrition, parasites, or combination there of.  The basic prescription was a dose of pyrantel , a de-wormer, vitamins and nutritional education.  The World Health Organization at another center gives the malaria treatment free so we did not provide that.  Many people complained of constipation but it is most probably due to a lack of water consumption.  Many only drink ½ liter of water daily.  We encourage them to increase to 2 liters a day and to eat more fruits.

Several children had dermatitis mostly due to fungal infections.  We ran out of the favored derma cream and basically gave counsel to wash daily with soap and gave vitamins.  Many people noticed they had worms and asked us for the de-wormer which is a rather tasty liquid.  It tastes sort of like a banana candy mixed with those orange circus peanut candies.  I know because I drank it too, especially on the way home!!  One child who was not growing well and this was much concern to his mother had a ventricular septal defect; this is a heart defect, which involves a hole in the wall of the heart.  It is repaired surgically or by the hand of God.  Knowing this family could in no way afford the cost of the hospital much less the surgery began to overwhelm me.  The thought of this child probably not living a long life much less a strong one brought tears to my eyes and it was all I could do to not lay my head in my hands and weep uncontrollably for this child’s fate here in Nouakchott.  My translator, Kertouma saw this and all I could say to her was I have a mothers heart, as she understood this young dear child’s fate.  I had to turn away a bit and she said, “ This is Gods will, yes?”  Of course it was, but still my mothers heart was screaming for a child who was not long for this world.  What I did not know was the work God was doing in my Muslim companions who were helping us on the team as translators, and people directors.  They were the associates of the missionaries who lived there.  I had no idea how our team was affecting the hearts and minds of our Muslim friends.

Another child, with a painful arm whose mother wanted to know what was wrong.  The child was reluctant to move his arm and cried furiously when his mother removed his shirt, which was unfortunately too small.  His arm was not the problem, after careful examination it was determined that he probably had a shoulder fracture!  He would need an x ray to be sure and so again we had to refer him to another facility of which his parents would not have enough money to do so. I felt sad as his Mom began to put the shirt back on him, with his wailing cry, we advised her to not put his shirt on if it required his arm to be moved around as it hurt like wild.  One highlight of the day was the sheer joy of the children’s faces as we gave them toothbrushes and toothpaste. Getting one for their personal use and even in different colors was such a thrill to them.  What ever happened to such simple joy over something like a toothbrush here in the US?  They are viewed as drudgery here.  It was fun showing them how to use them and some children even wanted to keep the box the brush came in!  I suppose it would be a treat to them since they had to chew the Neem tree branch and its bitterness, even though I must say it should be effective as tea tree oil is a good antibacterial and anti-fungal.

After we were done in clinics for the day (too early for me) we went to the National Hospital for a tour of the pediatrics ward and the obstetrics ward.  The building was a very large and impressive structure yet very dirty and in disrepair.  There were no screens on the windows and very little if any privacy.  In the OB ward they did have private rooms if you could afford one.  One woman’s family had brought her sheets and a beautiful Persian rug, as none of that is provided.  The family of the patient is also responsible for all food consumed or needed by the patient, as there was no food service.

In the obstetrics department a taciturn Muslim lady doctor gave us the tour.  She told us that they deliver 10 to 20 babies a day!!! However 13 out of 100 die.  Yes 13% die.  Many are twins, some are premature.  There were three midwives who attend the woman in labor and the doctor does the catching.  We were also shown the surgical suite for cesareans.  It was a large sterile room with a cold steel ominous table in the center and at first I felt awkward entering a surgical suite for sterility reasons but when the roach ran into the corner I did not worry any more about my shoes.  The labor and delivery room had five stainless steel cold glaring tables with no curtain in-between.  There was one wall blocking and additional table but I did not know why.  The lady doctor lead us on through the delivery area even though a very young woman was still sprawled on the steel table after she had just miscarried.  I felt as if I was invading her privacy, which there was none of, and realized how blessed we are in our OB situations and I prayed a prayer for her wondering if she would go home to an angry husband for not producing a son?  Or was she even married and glad she did not have the child?  I do not know but many of the patients from the clinic remembered our Mercy and Truth team from the year before and were very glad to see us and talk to us, so maybe she will come to our clinic next time.  We must pray that the favor we have in West Africa will continue so we can continue to reach out to these people and help the missionaries.  Our tour continued through to the postpartum areas, which were large dark rooms with 5 to 6 beds.  No sheets or blankets were present even though the beds were occupied.  The women that did have a blanket had brought their own.  Some women and their extended family were sitting on the floor tending to one another.  The only nurses (I think they were nurses due to their clothes) were locking doors and patrolling the halls.  We greeted each new mother and congratulated her and asked to take a picture and they were very happy to honor us.  They seemed very proud of their babies.  One young woman did not seem to be any more than 14 years old.  Another young women indicated to us her baby had died and had been taken away, even though she was in the same room with these other moms and new babies!  I felt such grief for her and then remorse for making such a big deal over everyone else and not observing the fact that she did not have an infant in her arms.  All we could do was hold her hand and smile weakly.  Of course prayers went up for her as our mothers heart ached for her.

Our next stop was pediatrics.  A tall black man was the doctor in charge of this area, and was well suited for it.  His appearance was a bit surprising as he had the professional white doctors coat and dark pants and baby blue flip flops on this feet!  He walked us through the pediatrics area and rooms full of women and children with no privacy.  The children had IV’s and those that had a bed may or may not have sheets.  Most of the children were malnourished or dehydrated due to something like diarrhea.  As we walked through the halls a young mother dashed out to the tall doctor crying and pleading to him in Arabic holding her infant out to him.  The tiny bird of a child had a nasogastric tube and a feeding bottle with a milky formula substance attached to it.  We were all crying with this woman in our hearts, as she was so pitiful in her appeal.  The doctor gently took the baby and nestled him close and spoke gently to the mother with a clam low reassuring voice something none of us could understand.  He walked back into the room bursting with patients and settled her down and patted her hand and adjusted the baby. We could not see everything.  Our translator Isaac was horrified by this sad woman’s cries and I thought he was going to cry.  He asked ME what I thought and I said well I have no idea what she said but by the looks of her and the reaction of the doctor she may be a first time mom, they are worried about every little thing.  Actually, I was trying to help him feel better while I was making myself feel better.  After all, I told him I am a mom and have nine children. Neither one of us was really going to swallow my puny logic of the situation, and so eagerly we awaited the doctor to return and fill us in on the babe.  He came back in a few minutes and we where holding our breath awaiting an answer…He said calmly, with a look of wisdom,” First time mother.”  We laughed in relief!

We walked through the halls, which were partly outdoors and rarely indoors, much alike a motel with entrance to the rooms from the outside, to the pediatric ICU (intensive care unit).  A hand full of children was present with two nurses in attendance.  The first child we saw was lying in a bed with the bars to keep them from falling out.  His arms were hyper flexed and an IV was slowly dripping.  His head was the size of a watermelon and he seemed unresponsive, he looked about three years of age.  One of us asked what is his prognosis?  The tall doctor gently stroked the child’s arm and said solemnly, ”We are just waiting for him to die.”  We all felt great sadness but knowing these things happen.  The child had encephalitis and had hydrocephalic on top of it.  Another child in the bed next to this baby needed kidney dialysis and had an IV also.  This little one of maybe two, only looked at us with big sorrowful eyes and again I noticed the doctor gently caressed her head, while checking the IV lines.  In the same room were two abandoned babies, twins, looking good and resting at the moment.  The missionary has wanted to adopt these children and ones like them but the government feels a Mauritanian should adopt them.  We entered another room with large glass windows where three incubators where set up and there were two preemies asleep.   Beside the incubator was a bottle of IV fluids and another bottle for feeding.  I was impressed with the improvement these children had made in the last week considering the modest facilities.  Again the tall doctor reached into the incubators and stroked each child, it was if that was standard treatment for him to perform on every one of his patients.  The touch of a gentle hand has a lot of healing power in it.  The last and most difficult case was a small girl, may be six months old.  She was orange like an apricot and her abdomen was swollen to the point of bursting.   Her breathing was shallow and erratic.  Her nasal gastric tube had fluid coming out of it and fluid was coming out around it.  Her eyes stared out glassed over and seeming to see no one except may be afar off.  The tall doctor gently stroked her abdomen and explained how they were awaiting transport to another location for her surgery, which was scheduled for the next day.  It was obvious the child would not survive until tomorrow.  Realistically the child wasn’t going to last another two hours and we all knew it.  The child had an intusseption of the intestinal tract.  The intestine folds inside of itself causing it to twist and cut off circulation etc.  I was sickened and on the verge of tears as they could not do the surgery because they did not have the drugs and equipment.  Yet almost every veterinary clinic in the US has the equipment and expertise to do such a thing.  I have performed the very same surgery on puppies and they, a DOG, have survived.  A human being will die, yet here we save dogs.  I could hardly think, I had to focus on the gentle doctors hand stroking and gently loving the child to keep myself from screaming and crying at the same time.  We were almost done at that time and asked what supplies we could maybe help with.  The only thing I remember was IV lines and needles.  I got to the car and was numb, God was pulling the scales off of my eyes in a new way, newer than before and I was getting a new perspective of life and the world.

I had an opportunity to interview an amazing man.  This man was all of 3 and a half feet tall and obviously a dwarf.  He had complete control over the crowds of people that came to our clinic and he kept them in perfect order and calm.  No one pushed through the doors and every one stayed in line and maintained patience without any complaints.  I was very interested in this mans leadership abilities and got the translator to help me “ pick his brain”.   This very tall man in the eyes of everyone but small in stature had an unusual name. He is called Ngigli, which sounds like ingiglee.  He was born December 31 1941.  He came to the Kebey in 1973. The Kebey is divided into 4 sections and he is the leader of one of those sections.  I asked him to tell me his secrets about his leadership abilities.  He told me it was integrity.  People trusted him because he lives in the Kebey with them, he tells the truth at all times and because he is an elder.  His definition of elder had to do with age.  Even though he is divorced and has 2 children, he provides and cares for his dead sister’s 3 children.  He has been instrumental in organizing the people for Other NGO’s and World Health Organization projects to help poor people.  He also is an advocate to the local government for the Kebay people.  How simple but so very interesting to observe his firm ways and his command of authority without intimidation and manipulation.