23 October 2007
This is another day that didn’t go according to plan. We knew the electricity was to be turned off for 1 hour. By 10 am the power went off as scheduled for maintenance. Unfortunately, it never came back on consistently. Over the next few hours it went on and off for 5-15 minutes at a time. They won’t start cases in those circumstances, so our day was done after just 3 of 9 cases. Hopefully a few more will get done this week. The others may wait in the hospital until next Tuesday.

I’ve had some interesting conversations with some of the other doctors, especially during these unscheduled down times. One of the doctors is from Congo. He described to me what he saw happen to his country’s government and economy. The prior corrupt Congolese government was supported by the US and other western countries by giving cash that was supposed to be used to for specified projects but often instead was used for the personal benefit of the government officials. Western governments chose to ignore this in order to keep the governments in these countries on their side in world politics. A few years ago the government decided that the Congolese and not foreigners, should own all businesses and resources. They simply gave ownership to the people who had worked in the area. He saw a lot of businesses fail because the new owners did not having any training or support. He was glad the western government involvement was largely gone because it seemed to do more harm than good. I asked about the new Chinese presence. He said the Chinese were after the same things, natural resources and political influence, but went at it more openly. The Chinese come in and tell the Congo government exactly what they are going to do, i.e. build a road or a bridge, and then do it. They bring in the majority of the workers from China rather than give the jobs to the local people. In exchange, they expect access to the natural resources. He was less uncomfortable with the way the Chinese operate because it appears open and he feels the outcome will be to add infrastructure rather than just build the wealth of a few people in government. He felt that this helped the Congo but with the acknowledged loss of their natural resources. I have read about this problem in several countries in Africa and his description was very similar to what I have read. The countries with the largest oil reserves and other resources have been developed and access committed, leaving the Chinese to look to the next tier when trying to gain access to the resources they need to supply their large and growing needs.

There are so many problems for which government seems to be totally ineffective in designing solutions. I don’t think that is different in Africa or the western countries but the types of problem and the scale are very different. The corrupt politicians and the bureaucratic barriers are everywhere but the consequences here seem so much greater than at home. Maybe it’s partly my location in one of the poorest areas that makes it seem so profound. I have met many wonderful people who are so poor they can’t see anything different for their future. Their priorities are to have enough to eat most days and keep some type of shelter for their families. What they seem willing to accept as having accomplished this is very hard for me to accept. Seeing the children going to school dressed in their nice uniforms coming out of some of the most awful housing and hearing the people express their commitment to their education, tells me that they see this as the way forward. Of course there are others who have given up and survive by stealing. Not all of the children succeed and finish school. As a whole, the problems I see here are not so unfamiliar to me as is the scale.

It’s easy for me to get focused on what problems I see here although most of my experience has been meeting wonderful people and being surrounded by beautiful mountain landscapes contrasted with almost desert like areas. I have a comfortable but very simple house to live in. It has been good to see how simply we can live and be quite content. We make do with what we have. Megan and I have had more fun trying to bake cookies as we laugh about how hard it is to mix by hand, chop our own chocolate (no chocolate chips here!), trying to get them baked and not burned in this challenging oven and appreciating them so much more because of it.

24 October 2007
Today started with our normal morning report. This was followed by teaching ward rounds. Dr Mdaka and I had lunch in the cafeteria. I was disappointed because they ran out of samp and beans. This is one of the local staples. It is a corn and bean dish. It is fairly bland. Another local favorite is fat cakes which they serve in the cafeteria several days a week. They look like a large roll or small loaf of bread but it is fried like a doughnut. I had been told they were fried in fish oil which surprised me since it sure doesn’t taste like fish oil. I have since learned that years ago the only oil available was cod liver oil and it was used for anything that was fried. Now that there are other options, it is rarely used but people still refer to oil for frying as fish oil although it is generally vegetable oil of some type. To me fat cakes are something like a large doughnut without the hole. They really are called fat cakes. The third food they tell me I should consider a local staple is a sour milk drink that they often serve for breakfast. I’m told they serve it to patients every morning here at the Bedford Hospital. I admit I haven’t sought out an opportunity to sample this one.

Dr Mdaka and I spoke about how fast this month is going and what we both thought about it. I think they could get a lot more out of the volunteers if they had an organized plan for what they wanted from us and spent a little more time getting us oriented. A specific role for us would make it much easier to feel like something was being accomplished. He seemed to feel that I did help more than I appreciated and asked if I would be willing to come back. I was totally surprised. He would really like to be able to do laparoscopy and I agree that would be a great step forward for them. If he is able to get the equipment, they should have help to start this up and it would be a great role for one of us. I wish that we could have done more with colposcopy while I was here too. We’re going to try again tomorrow. I already have my bottle of vinegar at the hospital so I am hopeful. If they can get colposcopy established and add LEEP they would be able to benefit a lot of women. Currently, any woman with dysplasia that requires treatment is admitted for a cone biopsy (usually without having had colposcopy). This admission is usually for several days in order to hold their bed so they can have the surgery and then many of them stay in the hospital while waiting for results. I’ve been seeing 8-10 day hospitalizations for a cone biopsy. It’s situations like this that could easily change and open up beds for those that are waiting for hospitalization and really need it.

We had another nice dinner at the McConnachies tonight. Caroline made a very rich chocolate cake for dessert that was a big hit.