On the Road Again

As of 5pm local time (11AM CST) I am sitting in a guest house in Accra (Ach-RAA) waiting for dinner. I leave at 6:30 for the airport. The plane leaves for Amsterdam at 10PM. I get there at about 7AM and get to sit and stew until about 4 PM when I get the flight to ATL and on to MGM, arriving there about 10 PM on Tuesday 5 January.

I have several posts in the works that I haven't beaten into shape, as yet. These will surface when I can, so please check back. In the meantime, I spent most of today writing the next book and walking a mile in one direction for lunch and two miles in the other direction for a cup of coffee and some banana bread. Breakfast is served only if you sign up in time (I didn't know this). Lunch is not served.

I arrived yesterday via a flight from Tamale (TAM-a-lay). The hamarttan has relented for the time being and planes are flying again.

T'was the Night in Nalerigu

T’was the night before Christmas, I was beginning to crash,

When two boys from the village got into a stash,

Of their grandmother’s cassava. She was saving it special,

And had it back of the house, there, under a kettle.

But, it, they had found, slicing it up for a snack,

(The stuff kills if not washed up and cooked right)

And they gave that a try, by the time that I saw them,

Retching and puking themselves on beds in Men’s Ward. Then,

Under the lights that are kept on all night,

To make the rats bashful or put up much fight,

Over food that is lying about in the ward,

Or get over-bold and gnaw charts, I wrote orders.
                                             

The boys got their IVs and charcoal, as well.

And, this time it worked. God has mercy for fools.

So I walked back to Six, through the silvered moonlight,

That you get when the hamarttan’s blowing just right,

In time to change, get some tea and a biscuit,

And go off to rounds on the fevers, and boils,

Malaria, the typhoid, the burns, the kwashiokor,

TB and ulcers of skin, gut and soul,

Which characterize, in part, the Fall of us all.

The kid in bed two is a pitiful sight, skin taut over bone,

Sighing gasps show his gauntness.

We have tried all we have. All to do we have done.

Yet, every few days, he’s a fever, despite us.

Then there is the girl with the compounded fracture,

Which the local healers set, two weeks ago Tuesday,

Her arm, she can’t feel, not a finger she moves,

It looks like raw meat; it stinks and it oozes.

By five PM, all we doctors are gathered,

In the front of the clinic, with bushels, we’ve come,

With oranges and good will, we go to the bedsides,

We’ve left just before, with frowns and concerns.

We’ve come back, now, with spouses and children,

And in one case a puppy, ‘though he stayed outside,

To sing to our patients, of Jesus first Coming,

To sing alleluia, to staff nurses and aides,

To sing of a Virgin, alone in a stable,

To sing of a Miracle, expected by none,

To sing to the people in pain and in danger

To sing of saving from care and from sin.

T’was the night before Christmas, I’m too tired to eat.

But among Jesus’ people I sing and I greet,

Such a great Christmas, the best I remember.

Merry Christmas to all, this dry warm December.

(NB: It has been a practice since the early days of the Baptist Medical Centre, for the doctors and their families to carol through the wards.on Christmas eve and present small gifts, usually oranges, to each of the patients, their people, and the staff.)

Night Noises

Over the years, I have spent not a few nights outside. Becoming a connoisseur of the sounds that the darkness may hold, I looked forward to coming to Ghana, in small part, to listen to the night. The last time I was here, in the middle of the dry season, about the only sounds I heard was the one per second, creaky-door noise of the local fruit bat. While evocative and all, it does easily slip into the background and let you sleep the night away.

I arrived this time about six weeks earlier in the season and Nalerigu is a far different place than what I experienced before. The night is full of sounds. It has become difficult to sleep. Not that it is ever easy.

Thursday was a big night for funerals. I could locate two, one with major detonations of some explosive. I could hear a shaman/land priest/local healer/witch doctor screaming imprecations for about a half-hour before the drums started up again. It was a school night and the whole thing was over by nine.

I start going to bed about 9:30. It takes some time and it starts getting light at 5:30, so that is when I get up anyway. Besides the usual stateside ablutions, brushing up and in and over, I have to make my bed. This is complicated. One has to be sure the mosquito netting, a cone suspended from the ceiling, does not interfere with the ceiling fan, to dire consequences. The netting must be tucked in all around so that it won’t drape over exposed skin, defeating its protective purpose. The aforementioned ceiling fan must be ginned up so that a little breeze gets through the netting and it is not so claustrophobic. Too much, of course, and if I can get to sleep with the noise, I have dreams of being a slice of papaya on a dehydrator sheet. Truth.

Finally, I to bed, comfy enough if under-generous and limited by the enclosing net. I read until I can doze off using a headlamp I bought for an Alaska trip. Practically like new. Summer trip. I never used it.

It is then that the night noises intrude: wolf-whistles, frog creakings, laughter that I swear comes from a Three Stooges schtick of the forties. Just when I think I have gotten all the acoustic signatures lined up, a battle breaks out in the “screaming bloody murder” genre, setting my teeth on edge. The combatants gradually subside with snarky comments back and forth before settling in. There is the slight shift of the wind, and an owl outside my window asks unanswerable questions. In short, it sounds like a Foley table from a cartoon with unlikely “whoops,” braying calls (some from the musical donkeys about), yakking laughs, clanks, knocks, dribbles, and the creak of a nightjar when all seems to have quieted.

I was called out on Thursday, my first full day back at work after a run in with a gastrointestinal grippe of no small proportion but no lasting significance. The man was lying unconscious in bed, covered in dried blood from tip to foot, with a swathe of gauze wrapped around his head, stiff and dark with more of the same. His buddies gave me the story: while riding on his motorbike he hit another motorbike. The other fellow was not so badly hurt and he went away, but their friend was knocked unconscious for the two hours it took them to get him to a district center and then on to the “big hospital” a Nalerigu. My patient was in his early twenties and a well-built worker-type, his hands telling me what he could not. During my exam he woke up and was cooperative. He was oriented and had no localizing signs. His retinas showed no hemorrhages. There was a certain ethanolic scent about him. Examining the wound was a process: soak the stiff bandages with saline, peel away a few square inches of gauze, repeat. When we finally got down to cases, my young friend’s wound was singular: a deep curvilinear gash on the top of his head, deeper in back and shallowing in front, about six inches long and down to the bone. I asked, “What happened?” He said “They attacked me.” “And you were running away.” He nodded.

By the next morning when we got down to putting it back together, the assailants had miraculously become a bridge abutment. When we asked how it came to be on the top of his head, it became a bridge girder. It closed with 3-0 nylon. He should have a nice scar.

During the dry season, the local constabulary close some of the roads east of here toward Nakpanduri because of tribal tensions. At the end, a few bodies might be discovered. Think Hatfield-McCoy, if you want to go that route.

As I walked back from seeing my head wound patient about 2 AM, through the shadows now thick with dried leaves, rustling in the wind, I looked up at Orion, too big by half than what we see at home and lying on his back, as he does this far south, I pause. It is all there, just like my father pointed out to me as a child. The three stars of the belt, the red shoulder star, the sword with its fuzzy central gem, the lion skin skein of stars facing off against the Bull, his one eye, red with anger. The night hides and reveals. It is a privilege to be here.

The Hamarttan

Hamarttan

The Hamarttan started blowing a week ago. It starts subtly, barely noticeable in the rattle of falling leaves. The ridges in the distance are just a bit imprecise, an impressionist painting rather than a photograph. During the day, it is no cooler, the mid-nineties, but at night the temperature falls after midnight to a bone-chilling 64⁰F. I am not kidding. The Ghanaians are chilled to the bone. Living in concrete or rammed-earth constructions, heat insulation is a foreign concept. Fires are for cooking and not heating. No other fabric is available other than the gaudy, imaginatively printed batik-decorated cotton.

The hamarttan is a wind that blows from the Sahara to the Gulf of Guinea during the dry season. The Sahara, super-heats during the day, creating a fixed high pressure zone, while the Gulf of Guinea, off the coast of Ghana has now cooled down. The wind picks up the finest particles. It is dry, and reflects the sun back, cooling the night. I have never been to the desert but I know its taste. Fine as talc, the dust gets into everything. Surfaces whipped clean at noon have a fine coating by dinner. The air becomes hazed with the dust, noticeable from ten feet off and enclosing us seemingly in a great globe of dust a few hundred yards wide. This is just the beginning. Ghanaians say that the wind, when it is bad, rattles windows and causes scorpion bites and skin rashes. (More scorpion sightings this last week …remember to turn out shoes left at the door overnight). It does give me a sore throat and a cough.

The leaves are dropping, leaving the branches bare except for the ‘frangi-pangi” tree with each branch adorned with a single place yellow blossom at the very tip … and its lovely scent.

Received a 1.1kg (2# 6 oz.) baby last week. In the states, at delivery, the infant would have been immediately placed under a warmer and, except for a few rude intervals to get weighed, would never be far from a carefully warmed and protected environment. This little girl delivered at a health center. The mother was told to bring the infant to maternity at BMC, just down the street. She walked. By that time (60 minutes) the infant no longer had a measureable body temperature. The infant was transferred to Paediatics because we have the functional incubator. At 90 minutes I became aware of her and popped her into the incubator after only about 15 minutes of filling out forms (I sometimes think all of British rule was a ploy to infiltrate an entire continent with self-sustaining bureaucrats). Over the next three hours, every time I went to find the baby, she had been removed from the one effective treatment option I had: to place an IV, to feed, to be bathed (bathed!). At 4 hours, after never having gained a measureable temperature she became apneic and was again removed. When I found her she had the cold grey-blue color, the clammy cool skin and the absence of a heart rate of the newly dead. I spent some time showing people how to effectively use a bag-mask to breathe for small infants. The death forms are very bureaucratic … and familiar.

Cause of death: respiratory failure due or in consequence to hypothermia due or in consequence to prematurity.

Bureaucrats never give you enough space.

On a brighter note, malaria is on a bit of a holiday, we only admitted about six overnight. No new cerebral malarias. Enteric fever (probably Salmonellosis or Shigellosis if we could get the labs) is in a resurgence. We several docs watch the fever curves assiduously, looking at each peak and its aftermath, rather like overanxious grandmothers.

My burn patient is doing well so far. He suffered blisters to most of his back after “pulling the soup off the fire.”

“How is it that the burn is on his back and not his front?”

“We do not know.”

The dry season is the season of burials. That is not as grim as you might imagine. Generally, roads are better during the dry than the wet, and easier for travel. The malaria season is just too busy for anyone. People who die at other times of the year are buried rather rapidly. Then the family prepares for the funeral, this might take two years more. Afternoons and evenings are filled with the sounds of the big drums, beating an incessant rhythm, well past midnight. The area has three main faiths: Animism (over 65%, Islam 20% and Christian (Assembly of God, Baptist, Jehovah Witness and Catholic).

Animism (here since the earliest records) is administered by land priests, “shamans,” witch doctors, or however you wish to name them. Children I see frequently have ritual scarification around their navels (to reduce the almost universal umbilical hernias, and since they go away anyway, appear to work). The scarification is quite skilled, slicing through thin infant skin only partway, deep enough to scar but not deep enough to create a gaping wound. Some people I see have hundreds of them, collected over years of successfully treated (or non-fatal) illnesses. Many children wear medicine bags, filled with Who Knows What, and carefully sewn into a tidy amulet.

Islam came in with the Mamprugu Empire in the 13^th century and its attendant Saharan slave trade. Slaves for Gold (Ghana was the Gold Coast). Many tribes, including the Malaprusi and the Dagomba, have origin stories of escape from the Nile Valley to escape Muslim slaving operations. Nevertheless, the Malaprusi have a veneer of Islam being for the court of the Niyiri (paramount chief), if not a state religion, at least an ornament. A Muslim must hold the throne for the Niyiri on his assent. Muslims are viewed as wealthier and they allow a good deal of syncretism with Animism. To become a Christian means a concrete break with the past. Old relationships end. Killings for converting from Islam, fortunately, have never been a large part in this country. To become a Christian is to put off the old things of a person’s life and to accept a new one, one with no reassuring icons, totems or amulets. It is tough. People’s joyful exuberance in the celebration of worship is understandable.

It is the Christmas season … and one can barely tell. If it were not for the (artificial) Christmas trees (a pagan holdover from Yule, the holiday at the winter solstice) I would not know it was. Nine more shopping days to Christmas.

The Hunt

This would not end well for one of us. She had already tasted my blood, and I was now out for hers. I should have been warned. All evening, that busy, crowded evening, I had caught just the suggestion of her high pitched cry. I had stopped each time, trying to localize it, track it, in the world of noise: native drums, cries, a ceiling fan, clunking and slashing its way to its inevitable destruction, and the myriad of night birds’ calls, I had lost her cry each time.

I had known, of course, her power to wound and kill. The long, warm wards lined with pale, fevered faces, the fetid smells blowing in from the choo, the empty beds that greeted me each morning were proof enough of that. She is capable of so much damage. I have seen her take even small children, days from the womb, eyes staring in horror, or closed in resignation as they die. She works with other beasts, of course, but you know she is there, out there, all the time.

After a long day and a troubled evening, I retreated to the safety of my protected haven, feeling my anxiety melt from the taut attention I had not known I had devoted to her. She would come closer in the night, circling my place, but I was safe, within. Almost immediately my eyes were closed. Perhaps I slept. The nights are so warm, and the rushing air of the fans cools only by imagination. I wager she came through the window, past the zamu, the guard. She could have been there all the time, hiding in a corner, waiting for me to come and lock us in together, so she could feed.

I was awake enough to rouse as she started. She was wise enough to leave her meal as I roused.

Now, despite my internal armor, I am at her mercy. She always leaves a little of herself behind. Even so, I will find her, and we will do battle.

I turn on the small light and look inside the cone of my mosquito netting that covers my bed. She is there somewhere, waiting for me to fall asleep again, so she can feed again. I see her in a faint crease and launch an attack. She flies off. I bring out the big guns and the next time she lands, my pillow comes away with a large smear of blood, my blood. I have been avenged. I sleep.

At BMC Nalerigu, Malaprusi District, everyone is presumed to have malaria, to have just been over it, or to be just about to get it. Safe money. The female Ades egypti mosquito is the final vector. Malaria complicates all disease, weakening the patient and opening the door to other diseases in those she does not kill outright. I should have looked for her before I turned out the light. 

Trip to the Wall

Having a half-day free on Saturday, I decided to walk to the Nalerigu Wall, about two miles distant. The wall is old and its history is complicated. People do not frequently slow down enough in their rush to the future to post a sign about what they are doing, Facebook notwithstanding.

However, in this case, the Nalerigu Wall is well documented to be from the 17^th century, built by order of a Na Atabia (1688-1742), the king of the Mamprugu Empire (begun about 1350 by the “the red hunter,” whose army took most of NE Ghana, southern Burkina Faso, and northern Toga) from the indigenous farmers who had been there already for centuries. The grandson, Na Gbewa, held the empire together but his sons would not. They split it (amicably) into four kingdoms, each with its paramount chief. The Malaprusi chief is the Niyiri and is much honored and venerated by Malaprusis as well as the three other “gates” of the former empire. In turn, Malapruli princes have spawned other kingdoms further west. The Nyiri’s real powers, however, have been limited to judicial decisions since the coming of the republic in 1957. It is not really an inherited post, yet there has been no sanguinary conflicts to gain the paramount chiefdomship. Candidates must have a paramount chief as a father (not a unique distinction, he has 12 wives) but then must have gone through a rigorous tutelage of being a sub-chief of one flavor or another inside the larger kingdom, before he might claim the “lion skin” upon which rests his throne in his palace in Nalerigu. One requirement is that the candidate must be able to recite his lineage back seventeen generations to Na Atabia and the “red hunter.”

At any rate, Na Atabia was anxious to encourage trade (Slaves mostly sold for gold by Muslim traders) from Toga to Gambaga (just down the road a bit). Predation upon caravans was getting irksome and the fortification was erected to house warriors and, not surprisingly, tax collectors. The ruins remain.

I start at 2:30, when the town is beginning to stir after avoiding the hottest time of the day from 11AM on (98 degrees by 10 AM, actual measurement). The sounds heard while walking through town are an experience: a cover of Bob Marley’s “Buffalo Soldiers” sung in Arabic, harpsicord music, Ghanaian patriotic songs, family arguments and “Frosty the Snowman.” Children and younger men and women try out their limited English (the official language, Ghana has a couple dozen languages but no one understands them all) on the funny white man.

If anyone passes close it is important to acknowledge them with a greeting. The response to any greeting is “N-aaah” which mostly means “I acknowledge your greeting.” Dodging leaky and, at times, truculent goats, the odd pig, chickens, motorcycles and motorcycle-energized two-wheel carts takes a certain dedication of purpose. I pass three mosques and three churches. The smells of the town waft back and forth: grilling meat, wood smoke, fetid aromas, dust, humanity, and gasoline. Most of the commerce is motorcycle carts selling 50 gallon drums of water as well as the ubiquitous plastic water packets containing about 8 oz. of filtered water. The discarded packets for Bisvel Water are everywhere. I am able to get up to the Via Gambaga within 25 minutes and know to turn west on the road to get to the reservoir. This affair is probably 20 acres and about 6-10 feet deep. You do not drink from it. Potable water is Bisvel Water or wells, some dug by my friend Tommy (see a Day with Tommy in this blog).

Once I get within range of the reservoir, I find a way to cross the small outflow downstream from the earthen dam without confronting some pigs, hock deep in the mud and looking proprietary about it. I have no idea where “The Wall” it is except “near the reservoir.” I start to circle the lake, about a three mile circuit. Luckily within about a half mile I find the best preserved specimen (pictured). The highest segments are only about 7 feet high but the plan is massive.

The wall is made of an odd concrete-like adobe made in a huge circle. It was constructed using slave labor to safeguard the slave trade. At the time of its construction, Queen Ann was ruler of America. America was three generations from its conception. Ghana was old even then, old and civilized and it had been for a millennium.

I came back through town on a parallel road, passed the Niyiri’s digs, very impressive in a concrete and steel sort of way and stopped near the (Bus) Station because my purpose-bought phone would not recognize the sim card I bought for it just last week. The Vodaphone shop was nearly empty this late in the day (5:30 PM) and the young proprietor motioned me forward almost immediately. I showed him the “no SIM card” warning and he opened up the back, turned the card over and gave me a long hard look before he closed things up again. All fixed. He refused to take any money. I wish he had  not.

Happy Thanksgiving from Nalerigu

Wishing all of you a very warm and happy Thanksgiving. Guys! Volunteer to clean up! The look of astonishment and disbelief, by itself, is worth the price of admission.
In Ghana, this is the fat of the year. The maize harvest is in, of course, and the rice is coming in now. I can see men on bicycles with huge sheaves binging it in to be threashed. The trees are just beginning to lose their leaves. By the end of the dry season, all the green will have become gold. The trees will be barren and the nice patches of shade as I walk to and fro will be but a lacework of shadows. Then things will get tough.

Still, the malaria season, falling as it does immediately after the Wet, is trying for all, children
most especially. Their nutrition, never the best, is knocked off the fence by each bout of malaria and then comes the lean times of the dry season.
About half of my patients in the ward (some fifty or so) are here for malnutrition. I am measuring swollen bellies all day, for reference sake. While I was rounding this morning a child was brought in from Emergency in the last stages of starvation. It was the first time he had been seen by a doctor. It was the last as well.
Happy Thanksgiving. Please give thanks to the Maker and Sustainer of this world for the bounty we Americans enjoy, the health that lifts us all up and peace.
Dr. W

Back at Nalerigu

I spent the night at the Accra Baptist Guest House on the 20th Nov, had an interesting conversation with a couple from Oklahoma going home from a teaching mission in Kumasi. Dinner was hamburgers which were good. Any American travelling abroad knows how remarkable that statement actually is.
I got my American cash exchanged in Ceti. Surprisingly, this term is a hold over from the origins of trade along the Gold Coast, what Ghana went by in my youth. A ceti originally meant a "stick" of two hundred cowrie shells, presumably after the snails who inhabited them had been asked to leave. The New Ceti was worth fifty old ceti or 10000 cowrie shells. It is now worth about $0.26 and is one of the stabler West African currencies. It is divided into 100 peshewari which is a name derived from the colonial days, meaning the smallest coin available and made of gold.
I had to get up at 4:15 to make the plane to Tamale after a night disturbed by the cries of black kites, guinea fowl and extremely low flying jets. The Cantonments are just south of the airport.
The three hour trip from Tamale to Nalerigu was an experience. The rains had rutted the roads into a maze best navigated free-style. It has been three weeks since the last rain, which is the last rain for about four months. The dust right now is minimal, nothing like the several feet of flour-fine redness that will cover the roads in drifts by season's end. The short paved bits were taken at 70 mph, goats included.
Baptist Medical Center is very much as I remembered it. There are new buildings, partially finished and vacant, still crowded wards and solemn zamu guards that open the screen doors for you before you know they are there. I am staying at the same guesthouse as before, although the only resident at the moment. My room is has a single bed, a ceiling fan and a naked light bulb. Bowa, the house cook, my cook, has a two-week menu posted for the residents but not for reference, it appears. “TIA- eat what you get.”

I worshiped this morning, and early afternoon, at First Baptist Church of Nalerigu. It is much as I remembered it: noisy, hard benches, nursing mothers, passing babies from mother to auntie to auntie as needed, the long prayers and the longer bi-lingual sermons. By far the most animated and joyful part was the “parade” (my word) offering. Each row files up to the offering box amid glad cries, singing, out-stretched arms and small offerings.

I am always uplifted by worship when I am abroad. The small golden things of the spirit can be found more easily, perhaps, when one compares it to the mounds of discarded shells which the world values more highly. 

Making Sausage

20^th November

Accra Baptist Guesthouse

The Cantonments, Accra, Ghana

Johnny Osusuwi was there waiting for me as I came out of the terminal building. Reporters lifted their hairy microphones, signs expressing welcome, affection and loyalty were raised from an adoring crowd … and then lowered in that embarrassed fashion that one uses when discovering that it was just some old guy and not “the band!”  Moments later the real band members (for a group I don’t know) emerged and were engulfed by their adoring fans. Traffic was worse than usual.

The trip was “nominal,” I presume because someone named it “long and boring” and it lived up to the advertising. I have observed before that air travel is like sausage-making. One starts at one end and moves through metal tubes of various sizes to be deposited at the other end, transformed and most likely unrecognizable. Some of the tubes jiggle and in those attendants bring you food and drink at intervals. Other tubes do not vibrate but you have to fetch your food yourself. Like sausage and lawmaking, the actual process should, perhaps, not be described in polite society.

The longest leg of the trip, of course, was from New York’s JFK to Accra, the capital of Ghana and its largest city. My time on board was shared with a young lady who eventually slept with her feet in my lap, ate my lemon drops and tried, unsuccessfully, to steal my cookies. Avery is eighteen months old and travelling with her mother back to Ghana to see her family for the first time.

Stepping down from the plane mid-morning, I encountered the smell of Accra: distant wood smoke, humidity like a warm comforter on a warmer evening and the faint fetid smell of the Gulf of Guinea. The night before I managed to get about three hours’ sleep, packing an entire bag filled with mardi gras beads, kool-ade, stuffed toys, soccer balls, EKG machine, transcutaneous oximeters, various books and a single can of strawberries. Anyone going up country becomes the default omnibus carrier for all the missionaries there. I am extremely lucky to have a friend in Linnie Dickson who helped me wrestle this beast into his car and dropped me off at 5AM on Thursday morning the 19^th in order to start the sausage-making.

All that said, I had over a hundredweight of impedimenta for Johnny Osusuwi to wrestle into the elderly Datsun before we braved traffic on the two lane highway that ground away from the airport. Sometimes, if a stretch of road is not being used convincingly by the oncoming traffic, entire lines of automobiles, trucks, matatus (not a really correct name as it is Swahili and I am in west Africa), motorcycles and bikes postulate one or two additional lanes of travel, double yellow line notwithstanding. Auto accidents are frequent and mortal.

After changing my money into Ceti and getting a local sim card for my phone, I was deposited at the Accra Baptist guest house by 1030. My room was ready: small, walls entirely of window, ceiling fan set to “sweat copiously despite use” and a large hard bed. I perspire and doze until mid-afternoon, repack my bag for tomorrow and go to dinner. I leave at 4 AM to get a flight for Tamale (TAM eh lay). The real trip begins.

On the road. Thank you for your prayers.

Dr. Walt

Getting Ready to do it Again

After so long, it seems odd to re-activate this blog. Since leaving Ghana I have been on a number of mission trips. Much has happened at Baptist Medical Center in Nalerigu, as well. Dr Faile, of course, has retired and my good friends Cindy and Paul Shumpert, have been working tirelessly (well, continuously) to find materiel and personnel to continue BMC's mission. Most of you may be aware that the original sponsor for BMC, the Southern Baptist Convention, has been withdrawing support for medical programs for decades. BMC is on its own.
I accepted an assignment here over the holidays to help in a usually thin part of the schedule. As a physician, all holidays are "moveable," of course, none being guaranteed to occur on time or in that idyllic non-time of celebration when the larger world agrees to be held at bay.
This time, however, I will at least be leaving healthy. I hope to stay that way and not become a burden on the resources like I managed to do last time.
The weather I expect will be very similar to what I experienced last time, the dry season. It will be earlier in the season, so I hope that the malnutrition, malaria, and fevers will be less mortal to my marginalized population. Last time, malnutrition clinic, an outdoor affair among the mothers and babies who collect around a government feeding station, was a three times a week intervention of mine to find the kids who were sick enough to be admitted.
I am collecting stuff. Once people know you are going out, you get the emails to take along "a few things" for someone already in the field. My porch has been committed to the collection of piles of books, medical equipment and "stuff." I will need a second bag.
I just published my first novel the end of October, Outland Exile (some of you will get it). You can actually go buy the thing now! If you want a signed copy at substantial discount ($12.95 +S&H) you will need to wait until I return in January, however. http://oldmenandinfidels.com is another blog on writing and the books that I will keep up in the usual dulsatory fashion. I hope to finish book two while I am gone.
Lastly, I covet your prayers for guidance, strength and health. My next entry should be from Ghana.