After the fast-moving, life-saving activities of the last week, today I have been feeling stuck in a political quagmire, slowly sinking into a swamp of local intrigue, complex connections, suspicions and general shadiness.
After the big welcoming smiles, this is the other side of Africa. And perhaps, the other side of most of the world – mirrored in the part of ourselves where we do not trust anyone, where we are suspicious of others’ motives, where we fear, but we don’t know what.
On arrival at the Dispensary yesterday, I was told by a very regretful Mariam and Islam that my activities there had caught the eye of the district inspectors who were passing through Lamu, and I would have to avoid being seen in the downstairs medical clinic for a couple of weeks. Because I am a volunteer and not a licensed doctor in Kenya, the inspectors need to be given the impression that I am just in the upstairs alternative clinic doing some remedial massage on a few villagers, and not playing any active part in their medical management.
In a way, it’s a relief because the responsibility of prescribing medicines, diagnosing multi-systemic disease and responding to emergencies was rather taxing on my brain and body. On the other hand, it leaves just Mariam and Islam with those jobs (although they don’t respond to emergencies as they don’t live in Shela but in Lamu town). Even as just a 3rd year medical student, I know so much more about disease processes than they do, and I try to teach them everything I can.
The sort of secret compromise we have come to over the last two days is that Mariam and Islam send complex cases upstairs to see me for examination and a thorough history taking, and then I go downstairs and tell Mariam what medicines and tests are required so she can write out the prescriptions and referrals. If I have the right medicines available upstairs, I give them to the villagers who cannot afford to go to the chemist’s, or who are too sick to make the journey to Lamu town.
Once Sister May returns in a few weeks’ time, I will hopefully be allowed to venture into the downstairs clinic again more regularly, as she will be “supervising” me. Mariam cannot do that as she is only a healthcare assistant, but the district inspectors still find it fully justifiable to leave her in charge of the Dispensary in Sister May’s absence… Curious!
And then there’s the hustling…
Every single time I walk to Lamu town, I am met with a barrage of sea-front hustlers calling out “Brother, brother, how are you?” and they want me to see their goods, give them money, ride their donkey, sail in their boat, or sometimes the sneaky ones want to “borrow” money (for urgent medication for their daughter who fell off a donkey, or some-such) that they will pay back later when they come to the DIspensary in Shela next time.
Another sneaky approach is to “give” me a present, like a small wooden carving, because they know I am a medical volunteer and I am helping the villagers, but then, after 15-30 minutes where they follow me around for no obvious reason, comes the inevitable request for a “small payment” for the gift. I got so fed up with this that I give the “gift” back to them, and if they won’t take it, I put it down on the roadside and tell them to take it back or leave it there. It can get a bit cringeworthy with them begging dramatically for money, but I have to set my boundaries very clearly. I know that if I start handing out money to one of them, everyone will be on my case for the rest of my stay here, and it’s not very pleasant. Tough love.
The first week, I was smiling back at them, listening to their stories and politely telling them No. Now, I find myself putting on a sort of solid-steel defence all around my energy field before I get too close to Lamu, I keep my eyes firmly fixed on the ground a few metres in front of me, and I don’t respond to any of the calling. Then of course they get insulted that I ignore them, and start calling out other types of things, which I will spare you here, and the whole thing is pretty exhausting.
I think it touches the “self-righteous” nerve in me where I get a bit outraged at being here, working free, giving my own time, money for medicines and sleep at night to help them, and some still try to take advantage. When I first arrived, Crispus (Wendy’s local manager in Shela) told the villagers that I was not to be treated like a regular tourist (ie. no hustling!), but because he is away for a month, I seem to have become fair game again.
I don’t like the bitterness it brings up in me, so I try to accept it as part of this place, and many other places on this planet where a white person may be seen as a source of cash for the local non-white population. I know they are just trying to get by, however they can. And the many wonderful aspects of Lamu do balance out the hustling… like, for example, the children!
We had a virus outbreak here over the weekend, where a lot of children were getting fevers, throat infections and starting to cough a lot. I think I saw 12 children with those symptoms who were brought in by their mothers on Monday and Tuesday.
Some of the young children have never seem a white person before, and others have been in contact with a few, but have never been so close to one as to me when I am trying to examine them! It results in some quite funny situations…
As I don’t have any children’s toys with me, and there are none at the Dispensary, I offer them my stethoscope to play with, as it is quite shiny and not too scary looking. Then we have to do a sort of game that may involve both another sibling and mummy too, where I take their temperature first so the young child knows it’s not too dangerous or painful, and the same with shining a light down their throats to check their tonsils. One little girl of around 5 told her mum in a sweet and concerned way, when she saw the tongue depressor (looks like a large version of the wooden part you have left after eating an ice lolly), that please could I not stick the whole thing down her throat? I showed her I was only going to use a few centimetres, and she was happy with that.
Other children are completely convinced that anything in my hand is a needle and syringe, and they will get a sharp injection as soon as I come near them! This takes a while to carefully negotiate with them… And most of them, when asked to take deep breaths when I listen to their chest with my regained stethoscope, simply stare at me with big brown eyes, and do nothing, while their mummy is hyperventilating in the background trying to show them what to do!
So I am quickly learning that examining a child is a whole other level of difficulty even to examining an adult whose language I do not speak. It takes creativity, patience and lots of humour. And sometimes I know that I won’t be able to perform a specific test without the child getting very distressed, so I just rely on what their mother tells me, and prescribe cough syrup or paracetamol accordingly.
Paediatricians, I have a whole newly gained respect for you!
Then, when the consultation is over, the child will more often than not turn their head round as they walk or get carried out the door, and they give me a smile, a wave… or a very loud “BYE BYE”… and I think to myself that not a hundred hustlers or weeks of strange local politics could put me off helping out this village.
