Tuesday, July 28, 2020



PPE FOR BDDH:  As the SARS CoVid 19 pandemic erupts around the world and surges in the US the Sandy Christman Foundation looked to our friends and colleagues at the Biharamulo Designated District Hospital (BDDH) in Tanzania.  We inquired about PPE for the hospital and we were told there was none. This was going to be a problem. I was unsure about what Covid-19 would do in Africa but I had been through some near misses with epidemics in the past so we thought we should act in a preventive manner. During   the  Ebola crises, first in east Africa and then in Kivu, DRC, I saw how fear preceded the arrival of Ebola. Even though it never came to Biharamulo, the Kivu district in the DRC is less then 200 miles from Biharamulo and border checkpoints are porous. Even in rural, impoverished west Tanzania everyone knew about Ebola and its deadly effects. One day in 2016 a Public Health official from Dar es Salaam came to BDDH to give hospital staff instructions on donning and doffing a hazmat suit in the event that Ebola could appear. A serious discussion turned into comedy as he stumbled and tripped his way into the suit. He finally needed help from a few of us. In the end the suit didn’t fit and as he left I wondered if this was his first try on.   Then in typical East African logic he left with the suit leaving the hospital and probably all of west Tanzania with no hazmat suits. Where we would get one, perhaps on short notice, was a question no one asked. Ebola remains active in the DRC (last outbreak reported June 2020). Luckily, to this day there have been no reported Ebola cases in Tanzania. 
   With that memory and knowing their limited resources the Sandy Christman Foundation decided to act last May to get PPE for BDDH.  The full extent CoVid remains a mystery but we are pretty sure HazMat’s while effective are not needed for this out break. With the help of Dr. Gresmus Sseboyoya we transferred $1500.00 USD to the hospital. Within a week the hospital purchased, masks, gowns, gloves, eye protection and sanitizer to prepare for the likely arrival of the virus. As of this writing the government of Tanzania is not recording CoVid cases or deaths. There is minimal or no testing done in Biharamulo and no facility to treat severe respiratory or multisystem failure from CoVid anywhere in western Tz. For further information on CoVid 19 in Tanzania or East Africa go to: www.https://coronavirus.jhu.edu/map.html
   At the SCF we remain ready to help BDDH and the people of western Tanzania as the situation unfolds.


Sunday, November 17, 2019

The Seventh Kingdom, Two Valleys Away.



11/17/20.      TWO VALLEYS AWAY
The clinic grounds

Preface: Futurist Kevin Kelly has talked ( see TED talk) about the Seven Kingdoms of life on our planet. You may recall from school Biology that all life on this planet can be categorized in 5 or 6 Kingdoms (depending on when you went to school). Kelly and others postulate how Technology is, or will be, a life form of its own thus Seven Kingdoms. We are not talking about religious or political kingdoms, this is biological kingdoms. Its stuff you either loved or hated in school. This story is about the boundary of the Seventh Kingdom.

   I went to visit a good witch doctor the other day.  His name is Pascal. My friend Ali took me. He came highly recommended (that’s always reassuring). Ali has used him in the past and many local people speak highly of him. He is way off the grid. We walked an hour and a half from the end of a dirt road into the jungle, maybe 6 kilometers. It was beautiful; a steep climb over 2 ridges and then we drooped into a lush green valley. No cell phone towers, no telephone or power lines. Water and sewer? For real? Here you’re on your own.
    When we got there things looked pretty normal. Pascal is a local healer aka a witch doctor. He is OK with either title.  As we approached his clinic he was sitting on a broken plastic chair in his yard. The seat was busted out but if you were careful you could still put your weight on it. He had 4 other plastic chairs in the same shape and a plastic table and some benches. They were scattered about the yard, tipped over at weird angles as if a big wind had blown thru last night (it hadn’t). The yard was hard pack reddish clay, nothing grew in the yard.  Pascal was busy with a big pile of local plants. There was a fire burning in the hot equatorial sun.  He was busy peeling a thin bark off them, saving the green stalks and boiling the bark.  As we arrived he continued to peel and then, after he finished the plant he was working on he got up slowly and greeted us. He was a gentle, smooth talking big man with a soft voice. He didn't say much and was not an overpowering presence. His eyes were ruddy and his teeth seemed in good repair. He was dressed in "fatigued" jeans and shirt and rubber sandals.  He was not alone.  In his yard were several chickens and ducks and several children. There was a single cow in a stick and log corral and 4 buildings formed the perimeter of his yard.
  There were 5 of us, my friend Ali, 2 medical students, nurse practioner and myself.  Pascal gestured for us to sit and make a circle as we balanced ourselves on the chairs, some with 3 legs all with missing pieces. Ali explained we were "doctors" and had come to visit him and see his practice.  He was OK with that. There were periods of silence where we all just sat and waited for a sentence to appear in the conversation. Pascal seemed to be translating Ali's Swahili, waiting 10 -20 seconds then responding with a soft thoughtful but short answer. Maybe his primary language was some 'local tongue”. There are over 60 dialects or local tongues in Tanzania. As we sat there I became aware of the sounds and smells Pascals home. There were sheep nearby, there was yelling and laughter of children. There was the smell of cows and cow poop very nearby, duck and chicken poop, and a cool green breeze as we sat in the shade of a big avocado tree. There were lots of flies and I wondered about mosquito's and night time here as I looked at the glassless and screen less buildings in front of me. His kids were nearby, dressed in hand me downs, shoeless, adorable and curious. They laughed and giggled as we shared digital portraits. Pascal’s wife appeared, she had a long red dress probably made from a Kanga. She was busy with kids, animals, planting and preparing food. Ali explained Pascal and his wife are both local healers and work together. I was introduced to his wife but her name was unpronounceable to me. I looked at Ali?  He pronounced a sound a couldn’t picture in my mind. If I tried to spell it would look like Ajebishewa, Maybe more like & (*$#@? |. I never did get her name right.
     Pascal's wife was more of a mystic; she did futures and clarified problems and troubles in your life and family. The medical students all had their futures read by her. I declined, deciding I liked uncertainty and besides I wanted to somehow ask Pascal about his herbs and " talk medicine" with him. With Ali's help we went into a dark un-lite hut and Pascal showed us his "pharmacy" There were at least 25 jars of stored herbs and plant extracts, most were in old Coke and Fanta bottles. Many of the herbs looked like ground up bark. I reflected that maybe Pascal is not so far off base here, Aspirin is derived from Willow trees and quinine, the original treatment for Malaria (rampant here), is from Chinchona tree bark.
  With Ali's translating Pascal explained he treats fever, sore bones and joints and headaches which by the way al all the classic symptoms of Malaria.  He knows about Malaria and diabetes and treats them with an herbal tea. There was a patient there who had broken his arm. Pascal had made a cast of bamboo sticks that surrounded his upper arm immobilizing the fracture and placed the arm in a sling. It was a beautiful piece of handi work and the patient was happy with the result. I asked how long will he keep that bamboo cast on and while the answer wasn't clear it sounded like days after the pain is gone. Thinking about it I'm guessing Pascal and his patient don't think of time in terms of days or weeks. This is not a calendar-based society. I asked what does Pascal do when someone is really sick and looks like they are dying. He didn't hesitate on this one, he is glad to send very sick patients to the hospital. I thought about that walk we just taken through two valleys and steep hills to get here, being sick, maybe delirious, maybe in the dark......
Broken arm set with a bamboo cast and sling

   Later as we sat under the avocado tree I showed Pascal a present I had brought him. I gave him my stethoscope. He knew what it was but wasn't so sure how to use it. After a quick 10-minute tutorial of how to place it correctly oriented in your ears, where to listen on the body and some quick pathology he seemed pretty happy to have it. I told him he had to practice every day. Wearing it around his neck he suddenly seemed to stand straighter, maybe a little more credible but still uncertain of its value to his practice.
  You might think it is waste to give an uneducated witch doctor who lives in the bush a $150.00 stethoscope. But try this. Pascal is the primary provider of health in this valley and probably several valleys around. He is educated, having learned what he knows from his grandfather, handed down in the oral tradition He knows his purpose here is to serve his people, to make them better and he is quick to say that. And he has “good reputation”, not on the Internet but here on the ground. Pascal brings medicine to the people, not people to the medicine. A stethoscope out here is also bringing medicine to the people.  While not technology it is a tool and a brick on the road to the Seventh Kingdom. Next year I'll bring a blood pressure cuff and see if Pascal has  a breakthrough medicine for that.
   It was a long hot walk back to the civilization of Biharamulo. I thought about how important it is to know our world and what is in it and about how close and yet so far we were from 21 century technology.  For Pascal and is family, the Seventh Kingdom has not arrived here but it’s only 2 valleys away.
Pascal and the stethoscope