Assume the Position: Memoirs of an Obstetrician Gynecologist (3 page)

We had lined up a full day of cases.  Everyone miraculously was there hours ahead of time waiting patiently for surgery.  As I stood at the scrub sink with the resident for the first case of the day and went to turn on the water to begin my typical five -minute routine surgical scrub, there was no water that came out of the sink!  I looked at him and asked:  “What do we do now?”  The response was that this was common. We just put on our sterile gloves and performed the surgery.  Sterile scrubbing was out.

(A waterless scrub sink)

     He had chosen a laparoscopy as the first case and everyone was excited to see how the equipment worked.

(Preparing for our first laparoscopic procedure in the Gambia.)

  The operating room was windowless without air conditioning.  It was boiling hot and sweat dripped.  We wore heavy cloth gowns rather than the light disposable paper ones I was used to.  We managed to get the laparoscope into the abdomen with the fiber optics working, identified the pathology, and were ready to begin the rest of the procedure to correct the problem when the power went out and left us in the pitch black.  “What do we do now?” I asked again.  This was turning into as much of a learning experience for me as it was for him.  He said: “We wait, the generators will come on”.   Of course the anesthesia machine wouldn’t work either without electricity so the nurse anesthetist began to hand bag the patient.   I waited in the pitch-blackness, in the overwhelming heat, for what I considered to be an appropriate time for the electricity to come on, which it never did. When I inquired if there was an ICU and what happened to all those patients without electricity, the response was: “This is Africa, man!”

     All I could think of at this point was the first and most important dictum of medicine, which is “ To do no harm” to the patient.  In this case we couldn’t help her, but I certainly wasn’t about to harm her.  I took the opportunity to stress this point to the resident as we pulled the instruments out in total blackness.  The first case was over!  At least he had an equipment tutorial on a live patient.  The rest of the cases went better that first day; an abdominal hysterectomy with removal of tubes and ovaries for a large pelvic abscess; a vaginal hysterectomy; circumcision repairs; a fistula correction.  It was a full and satisfying day.

(Exhausted and exhilarated after the first successful day of surgery.)

     Upon arrival back to the clinic a phone call had come in from a local man for me.  When I called him back he identified himself as my landlord.  I had agreed to pay a certain amount of rent for the month I was there.  Rent and food were my own expense.  He asked if I was the gynecologist who had come to help the women of his country.  When I said I was, he told me no rent would be necessary! Mother Nature does indeed work in mysterious ways.  I felt as if someone were watching over me. Whatever fears I might have had quickly began to dissipate.

     BAFROW was all about empowering women to take control of their lives.

(Young women at the Bush clinic.)

Money from AJWS was used to build clinics in the bush country; set up ways for the women to have economic empowerment for themselves in the communities; learn how to bake and sell bread and vegetables;

(Economic empowerment)

end female genital mutilation; build clean, new outdoor toilets; bring in running water, dig wells and in general give women a sense of self worth, dignity, and joy in their lives. The fresh bread the women made and sold outside the clinic was spectacular. I gobbled it up and bought as much as I could carry with me back to the city.

(The bakers)

     Part of the arrangement with BAFROW included spending time at their clinics in the bush that required overnights in the villages.  My first overnight foray into the bush country was likewise an eye opener. We drove several long, hot hours from the city along the Gambia River far inland on dirt, pothole filled roads. It was actually easier driving over the death defying, high mountain rocky roads to Ouray in Colorado than along this road.   The kids in the villages had never seen a white man before.  They ran next to the van laughing, smiling, pointing and shouting ‘Toubab”, white man.  Upon first entering the village we had to stop at the village chief’s hut for a welcoming and blessing before being able to see the women of his village.

(The Village Women) 

I had been told to bring small gifts for the village chief as I did.  There were midwives to be met.  These women were the very same midwives who had performed the circumcisions and had now been converted by BAFROW not only to understand the harm being done but also to stop performing the procedure.

(Two former ‘midwives’ recently converted by BAFROW from doing female circumcisions)

Perhaps more than anything, this one act on the part of BAFROW made its very existence worthwhile.  It was a slow and difficult process, however, since it was never easy to make a cultural sea change like this.

     I paid visits to the local village school.