thanks to all of you who commented. today, after one week on tuberculosis treatment, he has defervesced. this morning, he struggled to a shaky stand. i will report more as the week passes and I get a chance to read your comments. i have only infrequent and poor access to the internet, so have only been able to read a few. two have mentioned stevens-johnson syndrome
which is a great thought. he did have ulcers before he came in, but i am not sure what treatments he may have received prior to presentation. it is common to find empty bottles of penicillin in patient’s pockets. i will let you know.
i have just more than two weeks left to go here. i finished my
end of mission evaluation with my field co the other day. we talked about how i arrived to be so tired. part of it, i explained, was that i never really feel like i leave work, that a corrider stretches from the hospital to my tukul. i suspect that is why i often write about life away from it, when i can find it.
so, to life outside of the hosptial. it keeps apace. the garden is
planted. carrots and lettuce. it will grow after i am gone. i will leave the facile metaphor buried with the seeds. we are in the midst of a deluge, so i wonder if any will remain where they were planted, or if they will be carried away on the hard clay.
abyei’s fields are flooded. the people in akur are now stranded on their island. we tried once last week to reach them, but had to turn back. yesterday, after days without rain, we finally made it. with this latest torrent, it might be weeks.
i went for a walk yesterday, through the market, and took the long way back. there is nothing much to buy there, no local fabrics, no aromatic Sudanese spice, no exotic fruits. but it is the centre of life for the people here. shop after repeating shop selling batteries and soap, stools clustered around tea pots and hukkas, someone repairing bicycles, parts scattered around him like bones. i would show it to you, but we only take pictures in the compound and the hospital. there are too many soldiers, and abyei is too sensitive, to be wandering around wearing ones camera and a foolish grin.
i passed tukuls along the way. inside many of them sat families
talking. i wondered about their conversations. what do they talk about? at home, I talk about music, current events, music, films, books, music. and them? music too?
“hot today.”
“yes. hot. it’s always hot.”
“true.”
“soooo… how was the wedding last week? did they serve the goat i sold them?”
“no they didn’t. everyone was waiting for it, but they just served beans. can you believe it? we all saw it sitting right there, plain as day. i mean, how many times do you get married? three or four times, tops. if you’re not going to serve goat at your wedding, then when?”
“ridiculous.”
“definitely. everyone is talking about it.”
“… … ….”
“… … …”
“my little one was sick the other day. diarrhea. i took him to the hospital. he’s better now.”
“did you see the kywyja?”
“yeah, briefly.”
“was he wearing a different pair of sunglasses?”
“yes. black ones.”
“I’ve already sold him three pairs. what is with that?”
“i have no idea.”
on my walk, i was peppered with “kywyja! kywaja! my friend!”. i ignored most of them, pretended not to hear. people are used to Europeans driving by in fast landcruisers with tinted windows, not walking like everyone else. they want to get my attention, to interact.
we all respond differently to “kywyja” like mzungu in other parts of africa, it means white person, or rich person. it irks me. i hear it, and instantly, despite myself, i am irked. i can’t help; it. i am not sure if it is because i am from a culture that teaches ethnic generalizations can only be pejorative, or if i have a point, that i am not like the kywyja that just drive past. nor the english colonizers. i am different. the name’s james.
after five months, i want to be anonymous. i want to be scenery,
not seen. i am not sure if that is typical of us as individuals, or just of of me. i walk through the market, and through the hospital, and somehow imagine that i don’t stick out, that i fit in just like everyone else.
but i don’t. when i run past in the morning, people stop brushing their teeth and stare. some children in the hospital cry when they see me. others work up the courage to touch the hairs on my arm.
i talked to my translator it. he said that when he was small, he
was the same. he wanted to follow us, to watch what we ate, to see how we slept, to see what made us different. i told him that, for me, the i couldn’t avoid thinking of kywyja as an epithet. he was startled.
kywyja, it is not informed by the terrible history that the western world shares, of slavery and conquest, where people with visible differences were only either commodities or obstacles, not quite human. for many people here, and in other places, their knowledge of us is from dropping food from planes, or traveling from place to place spending money without having a job. we seem irreconcilably different. much more different from them than we are the same.
no matter how it makees me feel, of course kywyja is not an epithet. nor is it a term of affection. it is a measure of distance. the distance is approximately 50 cm, the clearance of a landcruiser from the ground.
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Thank you for sharing your experience so vividly, and the hope in humanity you provide to a newly graduated MD & fellow Canadian. Beleive it or not, I came across the link for the blog on Facebook (!!!) and I have not been able to stop reading for the last 2-3hrs. I think I understand what you said about being called a white person. I was referred to as such even though I’m not even ‘white’ when I lived in a Botswana village! I hope you find the time you need for yourself during this last stretch of the marathon that I am sure have encouraged and inspired many others.
Hi James,
Great, tough, terrible young case. Given he’s defervesed on TB Rx:
1) Papulonecrotic TB is one possibility – basically spread of the TB bacilli from a focal TB source in a patient with good cell mediated immunity (this is from the AMREF derm book). Do the ulcers begin with papules that then necrotize into ulcers?
2) We used in Burundi the “Keith Edwards” score for treating children with suspected TB. I agree with you this kiddo definitely meets criteria to be treated.
3) HIV coinfection. Are you sure the child may not be infected? Could he be so immunocompromized the test is false-negative? What kind of HIV test are you using? What does the package insert say about false-negatives? How about just repeating the HIV test….
4) Pellegra? D-D-D. Dermatitis, dementia, and diarrhea – sounds like he’s had at least 2. There is probably niacin (vit B3) in the refeeding you are giving him. Any Casal’s necklace around the sternal area? There is also often a dark dermatitis in the face area like SLE. Emedicine says for pellegra’s rash are sites are the dorsal surfaces of the hands, face, neck, arms, and feet (sun-exposed) and is made worse by isoniazid and pyridoxine.
5) herpetic lesions? Brought on by malnutrition – could he have repeated bouts of HSV1 affecting the mouth and anus?
6) EM or Stevens-Johnson – it did not sound like he had EM rash – but be careful James not to put him on sulphonimides (bactrim or thiazide diuretics) as they are the leading cause of SJ as you know.
Warm wishes and take care ‘eh. Can’t wait to have you back in Canada but great job out there.
Raghu
Did I miss something? I thought you had 3 more months to go. I’m sorry I won’t be reading your writing every day any more, but it sounds like you need a break. I have very much enjoyed your sensitive, poetic and sometimes humorous reflections on life in abyei.
Peace be with you.
Sincerely Dawn from Vancouver
Two more weeks!!! How am i going to continue to get my James fix…. you have been a constant (and often a teary part) in my daily routine for 5 months!!
Patricia
hi james:)
sounds like you’re leaving behind a lot more than just carrot seeds. i’m looking forward to having my mentor back in town! safe return ok?
dawn