At 6:30am, just as the sun was peaking over the horizon, we set off. Phil, a nutrition specialist from ACF, our driver, Darius, and I were embarking on a journey to assess four extremely remote clinics in Nimba County. We wanted to determine if each was equipped to add and facilitate supplementary and nutritional feeding centers. Our goal was to visit all sites and return by the early evening.
For the first 45 minutes we drove quickly down a relatively flat dirt road, but when we veered left for the trail to our first clinic, I knew we were in for a long day. The path was just wide enough for one vehicle and was filled with watery pits large enough to swallow a Volkswagen Bug.
On a few occasions we were presented with a fork in the road. Two times we chose incorrectly. Minutes after selecting the wrong direction we were driving in a residential area filled with mud huts and people cooking on open flames. The residents were not upset that we had just driven into their backyard; they just laughed and point us in the right direction.
For three hours we trudged on, often spinning the tires as we narrowly escaped another muddy abyss. Finally, around 11am we pulled up to the clinic of New Yourpea. It was a small concrete structure with holes for window, no electricity or running water, and in obvious need of some TLC.
In the reception, we were happily greeted by the staff, and then for 30 minutes, we talked about the nutrition program. As we were preparing to leave, the Officer in Charge (OIC) asked if I could consult on a patient that presented last night.
As I walked into the dark “short stay room”, four sets of eyes anxiously peered up at me. They were all concerned about their child/sister who was my new patient. She was a 14 year-old who developed fever, vomiting and headache yesterday. On exam, she was writhing in the pain and moaning. Her left eye was deviated to the right (something new since this morning), her neck was stiff as a board and she screamed when I shined a flashlight into her eyes. It was immediately obvious that she had a serious neurologic infection.
I asked what antibiotics they had and the response was “we are well stocked in amoxicillin, gentamicin, chloramphenicol and quinine”.
I quickly said, “OK, let’s give them all!”
The team looked at me like I was from Mars. One nurse aide said, “you want to give all of them? Isn’t that too much?”
I just smiled. They jumped into action.
After we secured the IV, I uttered nearly unspeakable words. I said “I’m sorry but I must go to the next clinic. Please watch her heart rate and blood pressure closely.”
I felt like a horrible, negligent physician, but I walked out of the clinic and joined my team in the idling truck.
We then drove one hour to Gblarlay and visited another similar clinic. Again after a warm reception, we sat down and talked nutrition. As we were winding down, the OIC asked me to consult on a “very sick patient”.
When I walked into the room, I immediately thought “oh, no!” There was a woman screaming in pain and clutching her protuberant abdomen. I quickly examined her and felt two distinct fetuses in her uterus. She had no fever or vaginal bleeding, but had a history of pain for 4 days!
I was very frank with them and said the only thing that will save her life is transport to a hospital. I do not have the materials or skill to help her. We ran out to the truck, borrowed Phil’s satellite phone and called for an urgent transfer.
Moments later, we boarded the truck and headed onward. After many hours more, we arrived in Buutuo, a small town on the border of the Ivory Coast. The first sight to catch my eye was an enormous helicopter surrounded by throngs of people. As the propeller blades began to turn, someone whispered in my ear that the Special Representative to Ban Ki-moon had just visited the refugees. As they lifted into the air, gusts of wind sent people running for hundreds of feet.
When the dust settled, we visited the clinic. This time there were no patients needing consultation and we finished quickly. Afterwards, Darius, Phil and I huddled together and debated our plan. It was already late in the day and the next clinic was many hours away. We decided to hunker down and try to find a place to stay.
We pulled away from the clinic and drove just a few feet up the road. As we reached the crest of a small hill, I was taken aback by the sight. Thousands of refugees from the Ivory Coast were gathered around a WFP distribution truck or were walking down the road with their goods stacked on their heads. I had seen similar scenes on TV from Sudan, Sierra Leone, Somalia or Rwanda, but I had never seen it in person. I was entranced.
We drove slowly and the crowd calmly parted to let us pass.
We quickly found the only “motel” in town. It was a run-down residence with a few rooms and couple of mattresses. We each paid a woman five dollars and steeled in.
I walked out back to find some water to wash my face. Just feet away, 5 or so refugee women with all of their young children were pumping water from a well. I grabbed a bucket and stood in line. After 10 minutes, when it was my turn, I placed the bucket under the spigot and walked around to the pump lever. With a rhythmic up and down motion, I got the water flowing…..and the children laughing hysterically. Apparently, white people don’t usually live with the refugees or pump their own water.
After washing up, I walked to the front of the house and was surprisingly greeted by the chief of the town. She was a short, stout, 30 year-old woman, with beautiful round, dark eyes and flawless charcoal skin. She wore an immaculate yellow dress covered in white woven designs.
She stuck out her hand, smiled and said “Welcome to my town. Now tell me what you are doing here”. Over the next 20 minutes, we explained our mission and she listed her needs. She then abruptly stood up, said “You are welcome here. Thank you for coming”, and hurried out of the door.
Soon after, darkness fell and we each went to our room. I was sweltering hot so I opened the window. Unfortunately, that had little effect, so I stripped off all of my clothes and positioned myself supine, like da Vinci’s Vitruvian Man. I was hoping for some of the dampness to dry up. Eventually it did and I fell quietly asleep.
I am not sure how long it had been, but I was startled awake by a woman. She said “You should not leave this window open.” She stuck her head in the room and shined a flashlight in my direction. There was a brief pause and the she repeated “oh, oh, oh, oh!” I had not had time to wake up fully and cover my naked body. I have no idea who she was, but she got an unexpected sight.
After a brief moment of embarrassment, I fell back asleep and did not wake up until morning.
We departed at 7am. My back was sore from the day before so I laid down in the back of the truck. At 8:30, I was suddenly thrown in the air and, as I landed, I heard an enormous thud. The driver then softly said “this is not good”.
We exited and discovered the left front wheel had slipped off the bridge we were crossing and the truck was tilted, resting on the undercarriage. It looked bad, to say the least.
Seconds later, men began swarming in from the surrounding dense forest. We tried to jack the car up; futile. We tried rocking it; no luck. We tried spinning the tires; nope.
Then, after we had enough bodies around, we all just pushed and lifted as the driver pressed on the gas. Miraculously, the car jolted off the bridge and onto land. We tipped our rescuers a few dollars and were on our way.
Six very long hours later, we arrived in Zodru, the most remote clinic. They staff was lounging on the porch and seemed very happy to see us. They had an extremely busy week with the refugees and were taking their first rest.
After talking about the nutrition program, we sat around for 30 minutes. We did a little teaching and they did some story telling. They had all been positioned at the clinic for a long time and have been away from their families. During the tales, they described how they formed a new family in Zodru and took care of each other.
It was then time to head back to my home in Nimba, Saclapea. I was excited to end the jostling and get back to my bed. Five hours later, I arrived, grabbed a Coke and began writing this.
I am tired and going to bed. Good night!