Assume the Position: Memoirs of an Obstetrician Gynecologist (4 page)

(English instruction)

The kids were absolutely wonderful, delightful and respectful, full of life and laughter as all kids are.

Some of the kids were mothers themselves. 

(Children having children in the Gambia.)

They were being taught ABC’s so I was able to have minimal English conversation but meaningful for them.   I gave everyone the opportunity to pose questions to me through interpreters.  George W Bush had just paid a visit to neighboring Senegal and promised millions in aid to Africa to fight HIV.  They all wanted to know when the money was coming, as if the Brinks truck would show up tomorrow. They also asked incredibly detailed questions about how genital warts were acquired and what could be done to prevent them.  This, of course, immediately told me what a major gynecologic problem it was for the villagers.

     The clinics for the women were most interesting.  Invariably the first patient in line was the village chief himself.  All that mattered to him was that there was a doctor in his village.   He needed to be seen first despite the fact it was a woman’s clinic. He had massive bunions and undiagnosed Parkinson’s disease, neither one of which I could do much about other than education and a referral to the Banjul medical and surgical clinic.

  During my first clinic day four of us were wedged into one tiny overheated room; my interpreter, the patient, the largest hairy spider I had ever seen in my life resting quietly on the ceiling, and me.

I kept my eye on it, but as the day wore on and I became involved with patient after patient I realized that it had disappeared when I took my eye off it.  It was a bit unnerving since I had no idea where it went and the room wasn’t very big.

     I fully understood after being at the clinics in the Bush why obstetrical infant and maternal mortality was amongst the highest in the world.  Women would labor for days often unattended or attended by untrained ‘midwives’, in small windowless unsterile conditions and overwhelming heat to the point of fetal death, exhaustion, dehydration, and sepsis.  They were miles and hours from help.   Those that were luckiest would be put on a small boat and sent down the Gambia River into Banjul, often with a dead baby inside of them for days, hemorrhaging and septic.  By the time they would get to the hospital many of the women were dead or close to it.  The hospital had ample antibiotics but almost no narcotic pain medication for surgical or obstetrical patients.  These women often suffered alone in large wards in silence.

(Our postoperative ward patients covered with antibiotics but without pain medicine.)

The look of despair and death was etched in their faces.  It was just a way of life. The challenges of having a healthy baby in the bush country were astounding.

     I had travelled as deep into Gambia as time would allow, and it was time to turn back, to the city and eventually to home.   Imagine my surprise and wonderment on my last day in the bush when at dusk I went for a stroll on the banks of the gently flowing Gambia River. It was a beautiful site despite the overwhelming heat and humidity, the amber moonlight glistening off the river, the clouds a beautiful pink and mauve, the birds chirping away endlessly discussing their day.  I glanced one last time skyward to take in the moonlight again before turning back. Flying alone high in the sky was a stork, a most unusual delivery system as yet to be explored in depth by me.   I had never seen one before, nor since, but it was truly a spiritual and serendipitous message for me – I took it to be a thank you from the heavens for the brief time I was allowed to spend in this beautiful country in the service of their women.

     Far away from Western civilization, even far away from Banjul, the capital, these were inspiring and wonderful accomplishments in the villages as a result of the aid of BAFROW, supported by AJWS funds. I was proud to be a small part of it all and proud to be bringing health care to these women.   I enjoyed the opportunity to lecture to the nursing students on various topics and to the British Medical Research Council.

(Lecturing in the Gambia.)

I was able to establish a reliable Pap smear system in the country and more importantly I trained the practitioners in cryosurgery, a safe, cheap and simple way to deal with abnormal precancerous conditions of the cervix and venereal warts.

      I found the average Gambian outside of the hospital to be happy, smiling, and exceptionally friendly, more so than the average American.  By our standards they had little money and few material possessions.  Yet they smiled spontaneously, broke into song and dance for no apparent reason, and extended big open hands of greeting when passing on the street.  It was a remarkably simplistic and easy way of life to get used to.  I learned as much from them as they likely did from my presence.

     I was asked on my return what I was most afraid of when in the Gambia.  There were really only two things -mosquitoes and dogs.  When in the Bush, mosquitos were rampant at sunset.  They would come out at night so sleeping under a mosquito net was critical for me as it was for everyone, though most people could not afford the few dollars that a net cost.  The first night I crawled into my net and found I had company inside the net – mosquitoes.  So not too much I could do about that.  I placed my trust in Lariam, but it didn’t make sleeping any easier.  When in Banjul during the daytime I noticed packs of wild, flea-bitten and abscessed dogs roaming the streets.