Healthcare

Sambo has a friend, Nhambe, who’s a teacher in a small community about 20k from Nacaroa. Nhambe and his girlfriend, Isuara, often come to Nacaroa to do some shopping, since Nacaroa is a city compared to where they live. Every time they come here, they ask when we’re going to come visit them in Nachere. So one Saturday we decided to go visit them. It was really cool to pass all of the super rural communities along the way, see the kids playing in the rivers, and realize that Nacaroa isn’t as rural as I thought. We had a really good time, but as we were leaving both Nhambe and Isaura started complaining of stomach aches. We didn’t really think much of it, because that happens all the time here. When we got home, we sent a text to say that we arrived safely, and Nhambe responded that he had diarrhea and was vomiting. We didn’t really think much of that either, because that happens from time to time and isn’t usually anything super serious.

That night we were awakened around 3am by someone banging on Sambo’s door to tell us that Nhambe was in critical condition, and was here at the hospital in Nacaroa. Apparently the diarrhea and vomiting had gotten worse, and either he wasn’t able to keep any fluids down, or they didn’t think about trying, so he got really dehydrated and started convulsing. Luckily, Isuara’s a nurse and lives at the health clinic in Nachere, so they were able to call a health technician (here a technician is above a nurse) to give him an IV. The technician thought that Nhambe was having a seizure, so he gave him some shot, which made him go into a coma and stop breathing. Somehow someone knew how to do CPR, or else guessed, or else Nhambe started breathing right around when this person tried CPR. So they called the ambulance (yes, they do exist here), but it was “unavailable”. I don’t know what it could have been doing that made it unavailable, it wasn’t transporting sick people. So they woke up someone important in Nachere who had a car, and managed to get Nhambe transported to Nacaroa in the middle of the night.

So we went to meet them at the hospital in the wee hours of the morning. As Nhambe is hardly conscious, has been vomiting and having diarrhea all night, the technician tells us that we should be making him eat. Because he expelled all the food in him, we have to insist that he eat to replenish it. Well, from my 2-3 hours of health sessions per week during training, and from my occasional consultations of my health manual, I was quite sure that you weren’t supposed to make someone eat under these circumstances. I tried to suggest that maybe he just try to drink a little water, but I was overruled. They made him eat some porridge, and he continued throwing up. Then he went to sleep, so they didn’t make him eat for a few hours. They debated what to make him eat for lunch, and decided on soup. Since I live really close to the hospital, and have a gas stove (much faster than using charcoal like everyone else here), and know a little bit about what someone in Nhambe’s condition should be consuming, I offered to make it. His girlfriend said that no, she would make it, but I told her to just stay by his side and that I’d be back soon, and left before she could try to decline again.

Back at my house, as I made soup (heavy on the broth, with just enough tiny noodles to fool the nurses into thinking it was soup rather than just broth), I showed Sambo my health manual. Under the diarrhea section it says, in underlined print, “DON”T EAT SOLID FOODS FOR 24-48 HOURS,” which is simple enough English that he could understand. It also listed food to eat, and foods not to eat, and when you can start eating what. It also said to take rehydration salts. Back at the hospital Nhambe ate some soup, aka broth. I asked the technicians if he could take rehydration salts, and was told that those were only for after the diarrhea has already stopped, which is definitely not accurate. On the packets it says, in English, French, and Spanish, “For the treatment of diarrhea.” They still said no. And Nhambe refused to do anything without consulting the technicians, and Isaura always concluded that everything the technicians said was correct. I wanted to just lie to Nhambe and Isaura and say that I had already asked the technician and that he had approved, but Sambo said that the technician would find out and get mad that we did stuff without his approval, and would stop treating Nhambe. I didn’t think that sounded like such a bad thing.

Nhambe continued in stable conditions, the vomiting stopped during the first day, but the diarrhea continued. On Tuesday-Wednesday I had planned to go to Nampula to meet up with some other volunteers, so I bought some antibiotics at the pharmacy there, after Sambo consulted the technician, of course. He started taking the antibiotics, but continued two more days with diarrhea. I also bought bananas for him, but of course he wouldn’t eat them without consulting the technician. I went to consult one, and convinced him that he should approve bananas, so we went to tell Nhambe. While I had been gone, another tech had entered, and had decided that bananas were bad. The scientific explanation: “Bananas are bad for diarrhea. They seem good because right after you eat them you don’t have diarrhea. But they’re really bad because they stick to the inside of your stomach, so then when you eat other food it all just comes out as diarrhea.” That is a direct translation, not altered or exaggerated. I wanted to just say, “That is absolutely not true,” but I knew that they would just get mad, not change their minds, and that Nhambe would still not eat them, so I just gave them a look that indicated I didn’t believe them, but didn’t say anything.

After two days of antibiotics the diarrhea stopped, so on the third day they decided that Nhambe should stop taking them. At the pharmacy in Nampula I got specific instructions from the pharmacist that he should take them for 7 days. I told this to the technician. “Yeah, but the diarrhea stopped, so he doesn’t need them anymore.” Isn’t it bad to stop taking antibiotics before the full dose? Nope. But can’t the sickness come back even stronger if it’s not all taken care of? Nope. But everyone knows that with the malaria medications you have to take all of them, you can’t stop once you start feeling better. Unrelated.

Around this time Isaura’s mom decided that the only explanation for this prolonged illness was that someone had put a curse on Nhambe, and everyone else agreed. (Medical incompetence/unsafe food or water couldn’t have anything to do with it.) So she went to a witch doctor to explain the situation. The witch doctor consulted some shells and bones, and concluded that someone in Nachere was jealous and hated Nhambe, and had therefore gone to a witch doctor to send some sort of bug his way. This bug provoked the diarrhea and vomiting. The antibiotics had subdued the bug, but it could, at anytime, reappear and make him start vomiting and having diarrhea again. (Never mind that unclean water can do exactly the same thing.) To remove the bug completely, Nhambe would need to go to a witch doctor also, to get some remedies and undergo some processes that would rid him of this bug forever.

Now it’s never wise to act on the opinion of just one witch doctor, so the next day Sambo and another friend went to see another witch doctor to get a second opinion. According to them the readings overlapped enough that it was clearly “africanism” (curses/black magic/etc). The second witch doctor, after hearing that Nhambe was sick, consulted the shells and bones and concluded that Nhambe was either feeling a dry stomach, a headache right in the center of the forehead, or aches and pains in the joints. Well, considering she knew was sick, those seem like some of the most obvious guesses, and she was wrong about the headache. Both of the witch doctors warned that this wasn’t the first time someone had sent a curse his way, and interestingly enough they both said the first attempt was an attack at the family jewels.

Since the readings “corresponded,” they decided that Nhambe had to go visit in person. The witch doctor asked him to bring some flour to make porridge and a chicken, live of course. He went with the same friend who had taken Sambo earlier in the day. Once they got there, the witch doctor (who was a very old woman who worked topless) put some of the flour in a pot of water over the fire and said that if it made porridge like it should, then the sickness came from God, but if it didn’t make porridge, that was a sign that someone sent a curse. Well, obviously it didn’t make porridge. Then Nhambe had to hold the chicken, still live, and if it acted dead that was confirmation that it was a curse. Obviously, it was confirmed. So he kept holding the chicken and the witch doctor said some chants and whatnot, and the chicken started acting more alive, which showed that the curse was leaving Nhambe. Then she gave him some roots and told him to boil them in a pot of water every day before he took a bath, and then after his bath he should use that water last to cleanse his body, and keep doing that for as many days as it took for the roots to not leave any color in the water. Then he braided some reeds to make a string that he was supposed to wear around his waist. I’m not sure how long that was supposed to be.

Nhambe is currently in good health. I unfortunately didn’t get to go along on the visit because the witch doctor’s hut was a little ways from Nacaroa so they went by motorcycle. Sambo has also decided that we can never go to Nachere together again, because he's afraid that someone might try to put a curse on him. I pointed out that several people have probably already tried in Nacaroa, and since they haven't had any luck in Nacaroa why would it be any different there? Apparently one's ancester's spirits can protect one from such curses, but eventually these spirits get tried, so it's better not to put yourself at risk too much.