Thursday, November 26, 2009

About Ali...

Ali stands before me today atypically embarrassed. He’s not quite making eye contact and shifts uneasily from foot to foot. Most of the locals have a deferential way towards mzungus but Ali is also the shyest guy in camp. Eventually you find out what a nice bloke he is and to appreciate his cheeky sense of humour - but it takes a while.

Today is different though. The last time he looked so sheepish was when he’d ironed a hole in the collar of my shirt. Such things happen when you’re using a charcoal fired iron. Embarrassed though he was that day, it wasn’t the end of the world for me and after all, it’s hard to be annoyed with someone who works so hard and means so well.

Ali is the assistant cook and the guy who keeps the camp running when Mathias the main cook is away so we have a lot to do with him and he has earned our trust.

Meanwhile, as I’m wondering what’s up today, I’m reminded as if for the first time, just how short Ali is. Valerian has brought him up to the recreation hut where we’ve just finished lunch and the contrast between the big Tutsi and the little Bantu is striking. Ali isn’t a pygmy but he’s short even by Bantu standards at around 150 cm. Standing next to the lean 183cm Valerian the contrast is stark.

Normally they would be here to see Pete. Pete is after all, camp manager till he and Tim leave on Friday. But no, they bypass Pete and come over to me as the three of us stand to greet them. I’m pretty sure it’s not a shirt this time. After the last one, I’ve asked him to not iron my shirts so I’m thinking I’m safe on that count (but you never know… after all, TIA - this is Africa). Valerian has the better English of the two and is more confident as well so he speaks first. Ali continues shuffling from foot to foot looking slightly embarrassed. Turns out that Ali is feeling unwell but doesn’t want to be any bother. Pete used to be the medical fundi but because of my medic background he has been usurped as the local.

Ali doesn’t look unwell. Typical of people here, he is fit and lean in a way that those of us in developed nations only achieve with hours of exercise. But looking fit doesn’t really mean anything here or anywhere else in the world. Of more concern to me is that the locals are a hardy bunch, well used to living with and overcoming illness. As a result they won’t disturb anyone unless they’re feeling really crook so he has my full attention.

Despite me being the “doctor fundi” (according to Valerian) it’s a collective diagnosis with Valerian, Tim, Pete and I standing with Ali on the floorboards of the rec hut. With the big tutsi’s help, Ali explains that he has had chest pain and a cough for four days. Valerian (who is a bit of a medical fundi himself from his experience caring for his cattle) suggests flagyl for the chest and stomach but I’m reluctant to hand out antibiotics without trying other options. Ali’s not coughing at the moment and so a little more questioning reveals that he has been constipated for 4 days and has stomach pain. Tim has some laxatives in his kit so we give a couple to Ali with instructions to come back tomorrow and let us know how he’s feeling.

The next day, the four of us manage at diffeent times to ask him how he’s feeling and he responds “kidogo” (a little) each time, meaning a little better. Turns out he’s been to the toilet and so his stomach is feeling much better. He doesn’t like to be a bother of course so I ask him about his chest and he admits to still having pain there. More questioning (this is like extracting teeth by now…) reveals he’s tired because he’s been coughing all through the night when he lays down. “Hmmmm…” I think to myself “more going on here still” so I take him up to the med hut and put a stethoscope on him. Ali stoically puts up with the cold stethoscope and breathes deep. Sure enough, he’s got fluid rattling in the bottom of both lungs which suggests a chest infection. He’s still getting around OK and the nearest Doctor is a days drive away so I ponder a little more on the best approach. The wait another day and see approach didn’t help. We’re taking him out on Friday which is only a few days away now and can stop at the clinic then if he’s no better, but in the meantime…

Like most remote camps, we have a basic but well equipped medical setup which is designed to deal with most emergencies and tropical illnesses so I root around in the medications box and come up with 4 different flavours of antibiotics. Sadly none of them are the one that I’m really looking for and 2 of them I’m pretty sure are not going to help so I grab the two that look most promising and head back to the office with Ali. I’m only a fundi in training on this stuff but luckily I have an expert close at hand. Google knows all. In the space of a few minutes, I’ve picked the one that looks most effective for a chest infection in this region. Pausing (atypically for me) to read the instructions, side-effects and contraindications, I take them to Ali and start to explain the dosage and side effects. Ali’s responses (nodding, nodding, nodding) help me to decide that this is a flawed plan from the start, so we go over to Valerian to translate. Ali is beaming by now and judging from his posture, the placebo effect is working already. He seems to understand the side-effects etc and promises to tell us if he breaks out in a rash, etc although to be honest he seems to be bemused that we should think that this would ever happen. The expression on his quizzical face seems to say that “what are you worried about. I know you wouldn’t give this to me if it wasn’t going to fix me up in a flash”. I wish I had his faith but I’m not about to disillusion him on this point nor to go into the history of side effects of medications even if I thought he would comprehend what I was getting at.

The next day Ali is only “kidogo” again but clearly has more spring in his step. Sure to be placebo after only 24 hours but hey, I’m a big fan of placebo – and clearly, so is Ali. Looks like the miracles of modern medicine are working for Ali but later that day, Mathias the head cook comes up to me in the office with ‘sore joints, headache, fever’. What’s the story with our cooks???? Is this a kitchen pandemic? I know they’re not after a sickie because neither of them would take a day off without having a death certificate, so seriously do they take their role of keeping the 15 or so of us fed and watered.

As with Ali, I ‘pull a few teeth’ to extract a bit more info and as we’re walking to the med hut, I ask him what he thinks it is. “Malaria” he responds quick as a flash. “Well, why didn’t you just say so” I’m thinking… I ask him a few more questions and turns out he’s had it a few times before. Exactly how many times I have no idea and probably neither has he but like most malaria patients, he knows the signs and symptoms of malaria in his own body. Job done. An easy fix with a couple of malaria tablets and a good lie down. I go through the side-effects etc with him which also bemuses him. So trusting… I choose not to labour the point and he goes away happy.

Ali meanwhile is beaming by day three. Neither of them take so much as an hour off work and continue to work from 6am to 8pm each day but they are both happy as schoolkids with a new bike.

I think I might miss those two next week...

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