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July 5, 2011 / calebdresser

Circles

The days begin with prayer call at four-thirty in the morning. The local mosque is directly across the street, and its crackling loudspeaker can be heard even in the deepest corners of the hospital. In my room, I lie on my back in the pre-dawn darkness and listen to the night wind whistling past my window while the faithful trudge to their first set of prayers.

Afterward, if I’m tired enough – and I usually am – I drift back into sleep until the disembodied voice of my local cell phone cackles into my ear, repeating a single, disjointed phase: “It’s time… to get up. It’s time… to get up.” There doesn’t seem to be a way to switch my alarm clock to something more pleasant, and I’m beginning to feel a certain special loathing for the canned lady in my phone. At least it’s in English.

Breakfast is usually at about eight. There are corn flakes, powdered milk, tea, porridge, and my personal favourite – Somali pancakes. They remind me a bit of Ethiopian injera bread, with their soft, spongy texture and not-quite-sweet taste. I smother them in peanut butter and Nutella, stuff my cheeks like squirrel, and head downstairs for rounds.

Dr Said leads the medical rounds, which can last anywhere from twenty minutes to an hour and a half, depending on the number of patients and how many questions he decides to ask the gaggle of medical students that trail after him like baby geese. We see a variety of patients spanning a wide range of medical problems, though not the ones I was anticipating when I arrived. For some reason – probably something to do with the words “Africa” and “Somalia” – I was expecting to see trauma, malnutrition, and infectious disease. All three of these are present, as are a large number of GI cases. However, I’ve been surprised at the preponderance of diseases that we traditionally think of as affecting developed nations: diabetes, high blood pressure, and their complications. I think this may be partly to do with the diet, which is high in carbohydrates and fat, and partly due to the lack of health education and primary care for the general population. Whatever the reason, it is a twist of fact that has challenged some of the assumptions I brought with me on the plane fromDubai.

After rounds, I usually have a couple of hours of free time. On some days, I help with wound cleaning and bandaging for the burn and skin graft patients. On other days I shadow Dr Tanmay while he does his antenatal consults; he has begun teaching me the basics of ultrasound, and I’m fascinated by the planning that goes into successfully managing pregnancy. On some days, however, I’m too busy working on lectures and handouts for the students to spend any time downstairs.

Lunch usually appears at about 12:30, though people come and go as their schedule allows. Before lunch, I usually manage to sneak in a half hour of situps, pushups, chinups, and rather humorous cardio on an exercise bike that was donated to the hospital. It isn’t much, but unless I go on one of my rare walks in the surrounding neighbourhood, it’s the only exercise option available. Such is life on the compound.

The afternoons are sleepy and uneventful. If I’m tired, I nap or read on the roof. If not, I walk the wards and help the nursing students improve their patient presentation skills. At Edna’s suggestion, I’ve been spending at least an hour doing this almost every day since I arrived, and some of the students are getting much better at conveying vital information about their patients. Many, however, seem a bit confused by the whole exercise, and never seem to know how many patients are on their wards or what is wrong with them. They are still in their first few months of training, which begins after high school, and are still learning the basics of what they should be doing in the hospital. Nonetheless, Edna very appropriately wants to set high standards, and I have been doing my best to help the students learn how to meet them.

In the late afternoon, life creeps back into the streets and the wards and the courtyard. As the day cools toward evening, I usually find a quiet place on the roof to read. When dusk takes away the light, I spend time practicing English with local friends or working on pronunciation and grammar with medical students who are anxious about class presentations they have to give the next day.

The communal dinner comes later in the evening, between 7:30 and 8:00, and is generally a pleasant affair. We have a fine melting pot of nationalities, with nearly a dozen countries represented: Somaliland, Somalia, Ethiopia, Yemen, Oman, Sudan, India, Nepal, Australia,  the U.K.,  and America. The evening meal is at time for jokes and stories, including interesting titbits from Edna’s life.

After dinner, I usually work on my lectures and grade the week’s quizzes. I’m teaching a course on the basics of research to all three sections of the Pharmacy students, which totals about six hours of lectures every week. However, I spend at least twice as much time writing and photocopying lectures, handouts, and quizzes. I’m also spending two hours twice a week with a class of  B.Sc. students, trying to help them understand their research projects, so the teaching hours add up fast.

My days end with a half hour of TV on the couch outside my room. The television gets a package from Dubai, which means that other than Al-Jazeera, the BBC, and a channel that plays action movies, there isn’t a great deal to watch. The wind usually picks up as my bedtime approaches, so I fall asleep the way I wake up, listening to the wind pouring past the high white walls of the hospital.

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