Both Sides Of The Coin

This blog post is all over the place, but it’s a running list I’ve been keeping of things I’ve come to appreciate here, and thing I’ve come to loathe here.  There’s no single theme; some are contemplative paragraphs, and some are fairly flippant.  Enjoy.

Things That Have Grown On Me Like Fungus On A Toenail

1.     Eating with the hands.  I don’t know when Western civilizations gave this up; the Middle Ages, perhaps, when the knife and the bread trencher became the flatware of choice?  While I understand the public health concerns involved in the direct insertion of grubby fingers into mouth (we did study the oral-fecal route of water-washed diseases at length during training), assuming indoor plumbing, available soap, and the standard of handwashing present in most American homes, I don’t see why there couldn’t be an anti-silverware revolution Stateside.  I find myself voluntarily disposing of a fork when I’m eating alone in my house, even for things like salads that don’t obviously advertise themselves as finger foods.  This either means that I can never go home again, or that I’m on to something here.  After a year of dribbling and splattering on myself like a baby left to his own devices with a jar of Gerber—much to the delight of my neighbors, who never stopped finding this entertaining—I have found that eating with the right hand really is only a question of technique and wrist control.  I defer here to the wisdom of the ancients, in this case Diogenes: “I have been a fool, burdened all these years by the weight of a bowl when a perfectly good vessel lay at the end of my wrist.”

2.     Communal eating and living.  I appreciate the way Northerners all eat out of a single plate.  True, this is hardly an egalitarian system, as men and women are never allowed to eat together; and also true, this too is a vector for disease transmission.  But those important concerns aside, I like the idea of everyone being so fully together.  I am one of those (potentially obnoxious) people who invite themselves to spear a piece of asparagus from someone else’s plate at a restaurant, assuming my dinner companions know they’re free to do the same with anything I’ve ordered; this is that mindset, taken to its complete conclusion.  We don’t share enough in America.  There is value in individualism; but as any socialist writer will tell you, there is equal, if not superior, value in collectivism.  I’ll steer clear of politics here, and stick to everyday examples: I cannot walk down the street in Mandama around noon without someone inviting me to come share what they’re eating.  True, I don’t always want to, because I don’t like what they’re offering or I’ve already eaten.  This is why I sometimes resent the aggressive, compulsive nature of hospitality and sharing that comes with Cameroonian Muslim culture.  But the open spirit of generosity—of never begrudging the opportunity to honor someone else with a gift—is, at its core, beautiful.

This has been one of the most difficult things for me to integrate into, as the American mindset towards property and ownership is so fundamentally different—think a rifle-toting Clint Eastwood growling, “Get off my lawn.”  When people let their goats into my yard, because I have so much long grass and no goats of my own to eat it; or when a boy named Salman asks me every other day for a cup of sugar—this is when I’m trained to think Robert Frost was right; good fences make good neighbors.  I am often a curmudgeon when put in these situations, reacting automatically in proprietary defense: this is my yard and if I want long grass just to look at I’ll grow long grass!  Get your own sugar, kid, and for the record you’re going to rot your teeth out!

But it’s also true that I am resourced beyond the imagination of most Mandamans.  What good does it ultimately do me to hold to what I own with a Scroogian fist?  Learn some humility and share the sugar; that is, after all, the definition of being neighborly.  There is no one in this village who would not give me anything they owned if I but asked; how can I, who have everything, bear the shame of being greedier than people who have nothing?

3.     Pit latrines.  There are times, particularly when I wake up in the middle of the night, when the thought of wrestling my steel door open and stumbling out to the latrine is the last thing I want to do, and in these times I fleetingly wish for a toilet, or even a chamber pot (although I used the latter during my three months of homestay, and let me assure you, that’s a piece of antiquity best left in the fifteenth century).  In general, though, latrines are vastly superior to poorly plumbed toilets in this country, and even some bathroom situations I’ve had at home (here’s looking at you, 7-person suite).  You know how many times I’ve cleaned my latrine?  If you don’t count weeding, zero, because that’s the beauty of it: you can’t clean a hole in the ground.  Unlike a bathroom left in its own fetid squalor, open-air latrines just don’t get that gross.  The rain keeps the slab of cement clean, and I have a lovely moringa tree inside the walls upon which to hang my towel and a roll of toilet paper.  Even those midnight runs are superior: here I am not doomed to contemplate dirty tile or the inevitable clod of roommate hair gently asphyxiating the bathtub drain.  Instead I squat and ruminate, gazing at the coruscating array of constellations flung across the firmament.  Absent light pollution, it’s an impressive sight indeed, and one worth waking up for.  Plus, you can throw anything down latrines.  One time some children showed up at my house playing with a used syringe and needle.  No sharps disposal container?  No problem.  Couldn’t do that with a toilet, now, could you?

Things I Still Detest, And Always Will

1.              Dried fish.  Many sauces that Mandamans eat are flavored with bits of meat, either pieces of beef or entire small fish, bones and all, which have been preserved  (like almost everything in the North) by drying them in the sun.  You might be wondering how it is that people get fish in the arid Sahel; this is a good point.  There is no water here, which is an important prerequisite for piscine propagation.  No, these fish have been shipped in raw, often from Chad, which means they had ample time in the back of a truck to get putrid before being set out in the sun to desiccate.  I am afraid it surpasses my descriptive powers to explain to you just how rank these dried fish smell.  To quote Shakespeare, they are “so rotten that the kites shriek in dismay rather than batten on so foul a carcass”.

Let me try to illustrate this anecdotally: one night this past week, on the way to my neighbor’s for dinner, I walked out of my house and into a miasma of thanatotic stench.  I assumed that this was another round of Scipio’s favorite game, Where’s The Dead Animal Part?, in which she squirrels away cow tails, intestines, and bone bits in and around the house, and I get to follow my nose to my next clean-up job.  Skip is unfortunately good at this game, which is rigged, anyway; whether I find it or not, I lose.  But a thorough search of the porch and yard revealed nothing, so scowling at the dog for good measure, I trooped over to El Hadji Moussa’s compound.  Howa was yelling over the back wall as I walked in, the senior wife, Mairamou, laughing.  I asked what was going on.  Howa wrinkled her nose.  “Salamatou”—the neighbor who lives behind the mosque between my compound and El Hadji Moussa’s—“got out her fish to make sauce.  Now she wants to trade for some of Mairamou’s tasbah sauce because her junior wife doesn’t want to eat the fish.”  This is not an uncommon arrangement; children, who carry out most menial labor here, are sent shuttling between households with small saucepots on their heads in diplomatic exchanges of one housewife’s sesame paste for another’s beef in peanut sauce.  “But Mairamou said no.  You smelled it a few minutes ago when she took it out of the bag, right?  Her junior wife has sense.  None of us want that.”  And so El Hadji’s wives and I join the kites, and shriek in dismay.

2.             Health Care.  Let me make it clear that I am in no way claiming America’s healthcare system is great; anything short of a single-payer system is missing the mark, in my book, but that’s another debate for another day.  What I will patriotically say now (Amuricah, hoo rah) is that at least we’re not as bad as Cameroon.  It’s not much, given where West and Central African countries tend to fall in rankings of this sort of thing, but it’s something.  Small victories, America!  You’ve beat the third world.

I recently took my neighbor Howa and her 18 month-old son, Abdul Karimou, to the regional hospital in Guider, where my friend Will works.  Abdul Karim had been sickly for months; he could not shake a persistent fever and cough and refused to eat, losing weight as a result.  His skin started to look loose, and I was getting more and more worried.  Howa has lost all of her children before they reach two years of age—Abdul Karim’s Dabare name, Touloublaye, translates roughly to “Shall I never give forth life from my womb?”  She took him to the health center in Mandama, where the nurse told her it was malaria; in fact, this is an unlikely diagnosis, but the one given automatically to anyone with a fever.  There are no rapid diagnostic tests in Mandama, and no lab in which to take blood smears and check for plasmodium parasites, so it’s seen as easier to just call it malaria and get on with the next patient.

I suspected tuberculosis, given the productive cough, and thought that at any rate Abdul Karim should be seen by a competent doctor with a laboratory at his disposal.  I had urged Howa several times to take her baby to Guider, but her husband refused to pay, a common attitude here.  He blamed Howa for not taking good enough care of her child, telling her that as he has twelve other children, he could not be bothered to take responsibility for this one.  Thus do polygamy and religion condone criminal male negligence.

So I undertook to bankroll Abdul Karim’s convalescence.  Thus it was that the three of us arrived, squashed onto a single moto, Monday morning.  We met Will, who guided us through the (to my villageoise eyes) bewilderingly complex hospital campus to the intake area.  At 9:00 in the morning, the rows of chairs set up in the sand outside the triage consultation room were already packed with patients.  The nurse, who knew both me and Will, eyed the waiting area nervously.  “You’re going to be here for several hours,” he began, then hesitated and lowered his voice. “Unless, of course, you wanted me to… speed things up?”

Normally I detest the culture of corruption, nepotism, and mutual backscratching that pervades every aspect of Cameroonian life, but as Will and I exchanged glances, I could see the same thought in his eyes: The line really was awful long.  “Play the white card?” I murmured, and he nodded discreetly to the nurse.  Howa and Abdul Karim were whisked back to the intake office, where his symptoms were recorded and we were sent to another building to wait to be seen by the director of the hospital. 

Here, not even my presence could get us special treatment, so I got my book out of my bag and we settled into our plastic chairs for a five-hour wait.  When we finally did see the doctor, Howa—trained to be deferential to men and particularly authority figures—was too cowed to even speak, so I asked if I could be part of the consultation, and explained Abdul Karim’s health problems.

The doctor began writing a two-page list, a battery of tests he wanted run—everything from a fecal sample to a blood smear to radiology—and an even longer list of drugs to buy.  I frowned, as seven medications taken simultaneously seemed above and beyond what could possibly be needed.  Howa, frightened and submissive, was ready to take the paper and bolt, but I stopped her, asking the doctor to explain to us both what he was prescribing and why. 

He sighed, impatient, and flew through the list with exaggerated rapidity.  “This is in case it’s tuberculosis.  This is for bronchitis.  This is an antibiotic.  These two are cough syrups--” (with, I might add, identical active ingredients; redundancy on top of excess) “—and this is an anti-malarial.  This is for the fever.  If none of those treat it and the tests aren’t conclusive, come back and see me.”

I asked if we shouldn’t wait to buy medications until we knew the results of the tests—if TB could be ruled out, for example, why begin a six-month regimen of antibiotics?  Why automatically treat malaria when rapid diagnostic tests are provided free by the Cameroonian government for children under 5?  He waved this away, however: he had too many patients already, and we had been seen.  We had our prescription; the consultation was over.

In typical Cameroonian fashion, we were unable to find any of the hospital staff that we needed to run the tests that afternoon; they had all gone home early, or were somewhere else, or had locked up and vanished.  I hesitated at the pharmacy, unwilling to subject Abdul Karim to a shotgun blast of medication (throw the whole pot of spaghetti at the wall and see what sticks!).  I am not a doctor, as I constantly have to tell people, and yet here I was, having to make an amateur diagnosis. 

I ended up buying the most general antibiotic, one of the cough syrups, and Paracetamol for the fever.  Howa was eager to return to Mandama, but promised to come back to Guider the next morning for the radiology and malaria test, which would guide any further pharmaceutical purchases. 

The next morning she never appeared.  I went back to Mandama that afternoon to find her and Abdul Karim in their compound.  “What happened?” I cried.  “Where were you two?”

She shook her head.  “You know how my husband is.  El Hadji Moussa would not give us permission to leave a second day in a row and go back to Garoua.  He said we saw the doctor and have all we need.  He will not accept that we go back for more tests.”

So there the matter came to an end.  It has been almost a week, and Abdul Karim’s fever is down.  He is still coughing, but it is a much drier cough; the phlegm and mucus have stopped, which is a good sign.  I can only hope that I made the right decisions.

Howa watches with trepidation as Abdul Karim wields baby's first hoe.