Brave Woman

Adventures of a future nurse-midwife


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Posted by Lucille on June 4, 2011 at 12:45 PM Comments comments (0)

Snippets from a conversation with a nurse in inpatient.

"I want a husband who will promise never to take a second wife. And a lot of men say that, so I want one that I trust enough to believe him. I want one who will love me and take care of me." She started laughing. "One who can cook!"

I asked her when she wanted to marry. "Maybe in five years, when I'm 28. But of course you never have that much control over it. You just have to find a good man. And there are never enough of them, are there," she laughed, "You just have to find the right person." After a minute she added, "I wanted to marry last year."

"Oh? Why didn't you?" "I did not have my parents' permission. Because he was from a different tribe."

"You have to have permission?"

"Yes, don't you?"

"I mean, it's better if you have it," I laughed, "But no, in the end it's your decision."

"How old do you have to be to make these decisions?"

"They spread it out, but you can pretty much do anything but buy alcohol when you're 18."

Her face lit up. "What? So you could marry anyone, right now?"

I nodded, and she seemed to think that was the most amazing thing she'd ever heard. She called all her friends over so I could repeat it.

"So, if you have a daughter," I said, "And she wants to marry a Mandinka..."

"My daughter can marry whoever she wants!" she said, while her friends cheered their approval. "I mean, you long as he's nice."

After a while her friends went back to work. As we were packing up our breakfast to go join them, she laughed a little and said, "So, have a lot of guys been asking to marry you? There's a rumor that if you marry an American you can go to the United States."

Believe it or not I'd picked up on that.

America the ?

Posted by Lucille on June 4, 2011 at 12:40 PM Comments comments (0)

I've been asking people how they see America. Here are some of the things they've said.

"There is lots of food and lots of fat people."

"Lots of white people. Except Obama."

"I've seen movies. It is very dangerous. There are a lot of car chases and gun are very lucky you survived."

No more movies for him.

I also enjoy asking people about their plans for the future. Most women seem to want between 6 and 10 children and plan to marry in their early twenties (those that aren't married already. The average is 19). But there are also plenty of women who want to stay in school, become doctors, marry when they're thirty and have three kids. And there are women like the head of the maternity ward who are doing it. The strange thing to me is that these women coexist so seamlessly.

I saw a woman in a skimpy tank top eating lunch with a woman in a burka yesterday. I stopped to chat with them and asked them about it.

"She is a better Muslim than me," the one in the tank top laughed.

"Yes, but she is a better nurse than me."

"So we take care of each other and are best friends."

One of them asked how many kids I wanted.


"What? But isn't that dangerous?"


"Well, what if they die?"

I feel bad about it, but I laughed. Hey, these are my kids we're talking about, don't jinx it! It's actually pretty strange that I can almost safely assume my children will survive. We never think about it but compared to the rest of the world it's almost an anomaly.

I was talking about this with one of the doctors afterwards, and he nodded and said, "In America, you have a low birth rate and low death rate. Here, we have a high birth rate and high death rate. As long as everyone has a choice..."

The catch, of course, is making sure it's a real, informed choice, but he had a point.

You Understand?

Posted by Lucille on June 4, 2011 at 12:40 PM Comments comments (0)

I heard an interesting exchange that might give you an idea of the state of health education here.

"You have diabetes. It means too much sugar, so you need to diet. No big mangoes. Only small mangoes, see? And no more than one banana a day. Vegetables...cook the vegetables. And not so much rice. You understand? Good. Next!"

Say What?

Posted by Lucille on June 4, 2011 at 12:40 PM Comments comments (0)

When people here go to nursing school, they learn medical terms from books and teachers whose first language is not English, so almost everything is pronounced phonetically.

"This one has teh-TAH-noose."


"Teh-TAH-noose. You know, teh-TAH-noose!"

She had to mime stepping on a nail before I figured it out. It's a good thing they were so patient with us.


Posted by Lucille on June 4, 2011 at 12:40 PM Comments comments (0)

Stinks. A lot. As we were walking to the hospital, I remember thinking, "They need to burn this stuff soon, it's starting to smell," and when I walked back after spending the day in inpatient the trash-lined streets smelled like roses. I still had a good time there, though.

There are four wards: pediatric, female, male, and a fourth one called 'acute' that they said is for adolescents. There were enough newborns to fill up pediatric, though, so a lot of the kids in acute were barely crawling. I saw the first plastic sharps bins I've seen here (most of them are cardboard) and they used an antiseptic when they washed the floor.

Most people marry within their tribe, so recessive mutations are common. There was a guy with six fingers. I've seen a lot of people with a stump of a finger growing out of their pinky, but this guy had six fully formed fingers on each hand that reminded me of Princess Bride. I wanted to take a picture but I was pretty sure that'd be rude.

And I learned why the Cuban doctors always got to outpatient late. They start out doing rounds in inpatient. Cuba has this program where it exports doctors to developing countries for two years, which is why there are so many of them. I followed them for a while and it was really fun because they interacted with the patients and played with the babies while they examined them. I talked with the mothers as I went and a couple people tried to give their babies to me. At the end of the room there was a baby with a very young mother and her mom. "Your baby is adorable," I told her, "When I have children, I want a baby as sweet as this one."

The girl was beaming. "Yes. My baby, I love him!" I talked with them a few times today. The three of them clearly adore each other and are very friendly. I hope they're there tomorrow.

There were a LOT of patients with malaria. They have mosquito nets over all the beds, but only the patients with malaria use them. Most of the people at the lodge don't use theirs, either, because it's too hot, so people are used to getting malaria at least once a year. One nurse kept lying down between rounds and her friend pricked her finger and wiped it on a malaria test. She had it. I went with the nurse to outpatient to get her a prescription.

There was a boy in there that had tried the traditional medicine version of Viagra and had had an erection for 3 days. He was transferred to Banjul. I've seen a number of nurses get very angry in cases with traditional medicine. There was one in eye unit, too. "This woman has infection. She tried traditional medicine for the left eye, so that one is blind. But we may still be able to help the other one." Part of it is that the doctors only see cases where traditional medicine does nothing or makes things worse, but it's a very tense relationship.

I went back to inpatient, changed a bandage, ran a few malaria tests, and mostly played with babies. I could actually get used to this.


Posted by Lucille on June 4, 2011 at 12:35 PM Comments comments (0)

I hadn't thought twice about piling trash outside or letting children play in the road, but they make an interesting combination. We found a toddler eating a used tampon a minute ago.

Who Are You Calling Old?

Posted by Lucille on June 4, 2011 at 12:35 PM Comments comments (0)

Our group leader learned in maternity today that for any primip (first birth) over 25, they write 'elderly primip' across the top of their chart. She asked why.

"It's just a cultural difference."

"Oh, I know. I'm just wondering what that means to you. Does it tell you anything about the birth?"

"Well, yeah. It means she didn't get pregnant for a long time. So, you know, what's wrong?"

"Well how long ago did she get married?"

The nurse turned to a woman and asked her.

"Last year."

"Oh,” the nurse shrugged, “Well I guess you can cross that out, then."

Talk About Cultural Differences

Posted by Lucille on June 4, 2011 at 12:35 PM Comments comments (0)

I was walking back from the market today and some boys started calling to me.


"Hi, how are you?"

"Good. Can I have your email? Or Facebook, do you have Facebook?"

I kept walking.

"Hey, wait, come and talk with us. Hey! Hey, beautiful woman! Can I have your email?"

I never thought being white would make me exotic.

1000 Words

Posted by Lucille on June 4, 2011 at 12:35 PM Comments comments (0)

If I could capture the feel of Gambia in one image, it would be this one. Mangoes in the rain.

Also these honorable mentions.

Last Day in Outpatient

Posted by Lucille on June 4, 2011 at 12:25 PM Comments comments (0)

I got my pen back.

Most of the doctors weren't there yet when I arrived. A woman came in to drop off a box of medicine and asked my name.




The nurses that were chatting in the corner started laughing.

"No, you are Jainaba Fati!"


"Because that boy is nice and we like him to be happy."

Great, so now I'm outnumbered. It is still Tower, for all concerned.

While I was waiting for everyone else to arrive, a patient stuck her head in.

"The doctor isn't here yet," the nurse said.

"I want to see her," she said, pointing at me.

"She's a student."

"I want to see the tubab."

"The tubab doesn't know anything," the nurse said, "Go away and come back later."

It continues to astound me how many people assume I'm in charge because I'm white.

We saw a lot of five-year-old boys with genital infections, a couple guys that were injured at last night's soccer game, two hernias, and a couple UTIs. One guy came in howling, his eyes rolling and spit flying all over the place. They carried him toward the table where I was sitting, and I thought he had rabies and leapt to the other side of the room. Apparently the look on my face was a sight to see because the boy from Senegal started laughing. They diagnosed it as hysteria, which is pretty much their catch all for any odd behavior they can't pin down, but from what his friends were saying I'm pretty sure it was a drug overdose. He was thrashing so much he broke the table but he calmed down after a while. He started cussing out the nurse when she tried to give him a shot. A very kind, patient, and soft-spoken Cuban doctor stood up and said, "You come in here, you yell at my staff, you break my table, and now you don't want your shot? Me, I have had enough. You can sit quiet and take your shot or you can leave. The man accepted the shot and the Cuban doctor sat back down and resumed his usual content and jolly demeanor.

The police came in carrying a clipboard and an opaque plastic bag, and said there had been a baby dumping and they needed someone to write a report. No one seemed to know what they were talking about. "A dumping," he said, waving the plastic bag in the air, "You know, a baby dumping!"

"Is that a baby?" the student from Senegal said suddenly, pointing at the plastic bag.

"Yes, yes. The mother killed it and dumped it, and someone found it and brought it to the police."

I was staring in horror at the plastic bag. It didn't look baby shaped at all, and it kind of sloshed when they moved it.

"We need someone to write a report." They tried to hand it to me because I was the tubab. Hell no I'm not opening that. One of the Cuban doctors told them to take it to the head of the hospital.

The student from Senegal had been trying to take my hand throughout this, and finally said, "You smile and talk to me like you want to be friends, but you won't hold my hand. What is wrong?"

"It means something different in my culture," I said, "Here, I know everyone holds hands, but in the US people usually only hold hands when they're in a relationship with someone. I'm already in a relationship so I'm not comfortable with that."

"Oh, okay. Sorry. Je m'excuse."

He let me practice taking his blood pressure, then took mine. He stared at the dial for a minute. "Jainaba!" he said, "You need to eat more salt!"

Will do.

He then wanted to take my temperature.

"I know how a thermometer works," I said, but consented to holding it under my arm.

The Cuban doctor looked at it a minute later. "Normal."

"What?" the boy said, "Jainaba is not normal, she is hot. We must find a better thermometer."

The other Cuban doctor started laughing. "He tells me you are getting married in six years," he said.

"I said we'd talk about it!" I said, turning to the student, "There were no promises made!"

"I know, I know," he said, laughing, "By then I will be a doctor. Maybe I will have my own hospital in the United States."

"In six years you'll be 24, right Jainaba? How old will he be?" one of the doctors asked.

"He'll be an old man," I said, and even the student started laughing. Someone started playing music from their phone, which somehow evolved into an hour-long Cuban dance party. I'm moving to a new station tomorrow, but I'm definitely going to go back and visit.



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HIPAA Disclaimer

Sometimes I have the privilege of being a part of intimate, powerful moments in other people’s lives. I cannot and would not share these stories, because they are not mine to tell. However, they touch my life and become part of my own story. When I share these moments here, you can trust that I have not broken anyone’s confidentiality. The characters are invented. They are not real, but could be. I take creative license to communicate the essence of my experience while respecting the privacy of others.