It is 5 o’clock, and the alarm is ringing….Wait, it is Saturday morning and my alarm shouldn’t be going off.  Oh, a phone call from Terriann.  Tanu’s wife, Fatimata is having labor pains almost 6 weeks early, and could I come and check things out.  We have been worried about her pregnancy, because her blood pressure has been dangerously high for most of the past month, even though this is her 5^th pregnancy.  She did get some medicine about 3 weeks ago,but it is still not a good thing, a little late to affect 9 months of pregnancy.  She doesn’t live far from our place, so I went to her house.  She was obviously in a lot of pain, and it was apparent that she was in labor.  I did not know exactly my function, since normally the female relatives help with this, and male attendants are unheard of in this country.  But, just in case, I went back to get our 1 OB set up with cord clamps, a scissors, and suction bulb.  I was gone about 5 minutes, but by the time I got back, there was a baby lying on the floor, still attached by the cord, but with no signs of life.  It was a male, perfectly formed, but with evidence of the skin deteriorating, suggesting that the baby had been dead in the uterus for a day or so.  I made a few feeble efforts to do cardiac compressions, and suctioned the baby, and stimulated it, but it didn’t work.  There was no response to any of the stimulus, and I ceased all efforts.  I made an effort to cut the cord, but the mother refused to let me.  Apparently,when they deliver, they leave the cord attached until the placenta comes out.  So, that was fine with me, and since it was obvious that my services were no longer needed, I went out on the veranda to wait with the father, Tanu.  I did not talk to him about what was going on inside, as I did not know the protocol.  After a while, the ladies came out and told the father.  This time,there was no weeping or wailing. Apparently, this is quite a bit different than when a living person dies.  So after sitting there for a period of time, I came on back to the house. By now, it was 6 am, and it was too late to go back to bed, so I put the coffee pot on, and started the day. 

    Later, in an effort to clear out the cobwebs, I started on a long run.  I had wanted to run to the neighboring village of Jendi, but the last time I tried, it was too far, and I never made it.  So, with breakfast out of the way, the chickens fed and watered, and with the house safely locked up, I started out.  This village is a fishing village right on the river Cacheu.  The day was overcast, providing relief from the African sun, and there were birds galore.  There were no other houses on the path at all.  Only an occasional person walking along the trail, going to our town, or a couple of people working in the matu, or fields.  I ran past some impressive fields of peanuts, one of which I would estimate was close to 8 acres.  Pretty impressive for hand tilling and planting, and it looked ready for harvest. There were impressive parakeets, long and sleek, that flew away in flocks,as I ran past. I was thinking that I need to pinch myself to really make sure that I really am in Africa.  It hurt, so I guess I am.  The village of Jendi was farther than I had been told, and seemed to take forever in getting there.I wasn’t even sure I was on the right path, as it really wasn’t more than a foot path. Finally, I made it…no tin roof houses here, all thatched roofs. I decided to come back to explore the town later, and decided to turn around. A good run, and a good way to clear the cobwebs out of the head, after an early start to the day. 

    I took a little nap after lunch, and feel back to normal now. Blogging is impossible right now, as the internet has been out for the past week down here.  I may have to go to the neighboring town to put this on.  I really need to include some pictures as well. The first part of this blog was written on Saturday, October 20, and itis now October 24^th, and this will probably not be sent for a couple of days.

   If I get a chance, I will include some pictures from the baby dedication for Tenig’s new baby(He is the native nurse at the clinic).   He was 8 days old at the time of his dedication, and there was a little ceremony associated with that, and of course a festa, or party associated.  Some of the pictures are of me eating at the festa, and until I caught on, I was eating with the wrong hand, the left…Oh well, a faux pas that shouldn’t be repeated….

    The team of YES guys will be leaving this week to go to the neighboring town of Cabiu.  This is about 25 miles away, I think, so there coming back and forth will be limited. When they move, Beryl and I will also be moving down to the mission house, to make room for the new family, and workers coming the first of November.  Also, I am really looking forward to the arrival of daughter Kristin, a week later.  She will be here almost 2 weeks, a good introduction to Guinea Bissau.  I think she will find it quite similar in culture to Sierra Leone, although a different language base.  The same tribes live here that also lived in Sierra Leone. And of course, a big difference is that we are in the country, while shewas in the city.  Balanta, Jola,Mandinka, and Manjako are some of the main tribes and languages spoken in this area.  (I am not sure of spelling).  Most also speak Kiriol, the language of trade, which is corrupted Portuguese.  I am far from fluent, but am surprised that I can make my way around quite well in the country, and getting better at knowing everything someone is needing.  There are multiple night time visitors, which always start, “Kon, Kon” there version of knock, knock.  That is the signal that someone is at thegate wanting something, and late at night, it is usually someone needing medical attention.  Since the gate is right by my room, I am usually the one who hears and attends to the needs. 

    I have felt myself getting irritated a couple of times in the past couple of days with the constant needs, but then I realize that is exactly why I came here, so I try to do my job with the joy of the Lord in my heart.  The work itself is not all that hard, as sometimes we are finished with clinic by 10:30 or 11 in the morning on light days.  The rest of the time, it is walkins only, and some days are busier than others.   The other night, a man who apparently has been going downhill for 3-4 months, at least by history, came about 10 o’clock.  Suddenly, I had about 7 family members in the courtyard as well, and when I checked him, he didn’t seem to be all that sick.  Often the number of bystanders is inversely proportional to the degree of sickness, at least in my experience.  His complaint was dizziness and vomiting, and it had just started…, and I was wondering if alcohol could have contributed to his sudden deterioration. That is just like the ER back in Alabama,that someone who has been drinking suddenly thinks they are about to die, so you just don’t know.  I gave him some meds, and today, he was back in the clinic, wanting something else, and looking as fit as a fiddle.  So I suspect the news of his illness has been greatly exaggerated, as Mark Twain might say…

    Yesterday, I had the excitement of accompanying 3 other members of the group, as we journeyed to the capital of Bissau, where we met with one of the Ministers of Health, in an attempt to get the clinic certified under government regulation.  It took about 3 ½ hours to get there by big bus, and I had to stand most of the journey. I started out in a seat, but what do you do when there are ladies with a baby on their back standing right beside you. I couldn’t help but give them my seat. The monotony of the trip was broken up by the need to stop at 5 government check points and walk past armed guards. This was both on the way and on the way back. There was some unrest in the capital last week, and because of that, they had stepped up monitoring.  When we got there to the checkpoint, we had to exit the bus, and walk about 200 yards up to where the bus came and picked us back up.  I say, stepped up, sort of lightly, because at most of the checkpoints, they did not stop many people at all.  As an American, I got to show my passport a couple of times, but mostly I tried to walk with crowd, sort of hard if you are “branku”, a white person.  I realized that it was mostly a formality, so a couple of times when I was told to go stand in a line to get checked out, I left after waiting a reasonable period of time and joined all the other travelers who didn’t have to do that,and that was just fine.  The advantage of the certification is to make us more legal, and also there would be the possibility of qualifying for medication from the National pharmacy, which would take some of the guesswork out of supplying the medical needs of the clinic.  It often depends on someone in America guessing what we need, and sometimes the decisions are not very accurate.  For example, I brought a lot of Lice treatments, and when I got here, I realized too late (I already knew this too)that Africans very seldom get head lice….So you live and learn.  It is quite common to see scabies, but the shampoo is not strong enough to treat that…

   Well, I will sign off with my ramblings…Tomorrow, I may get to go and use the Internet in the neighboring town…we will see anyways.  Thanks to all of you for making it through this prolonged stream of consciousness,,,

Two families in the village have had deaths in the family in the past 2 days.  Both of the deaths were in the capital city of Bissau, but the funerals and the mourning were held here in Catel. Both houses were only a few houses away from us, so we got to hear the full crying and mourning that goes on.  They bury the person the first day, usually without a casket.  They dig up the veranda that surrounds each house to keep out the rains and water, and that is where they put them.  It is easy to tell when someone dies, because of the unearthly sing song wailing that begins.  It is almost like a song, but think of a song with notes impossibly high, at times, and then other times a lower voice.  I think this is almost exclusively the women who do this, but it goes on for hours, so much so that you wonder how much the human voice can take.  The whole community gathers in respect at the house, but there it is mostly everyone just gathered around in solemn grief, around the house.   

I stood, silent, in the hot African sun, as sweat poured down the small of my back and the front of my shirt, and thought about that death, whether in Africa, or elsewhere, is triste, or sad.  And the funerals in Africa must be a lot more similar to the funerals of the Bible than ours.  I just thought about the time that Jesus stepped into a funeral procession like that and healed the dead person.   And the way everyone gathers, I realized that Jesus msissing the funeral of Lazarus in the Bible was a rather significant event..a lot more significant than we think in our culture.  Because, here, everyone stops whatever they were planning to do, and it will be stopped for a couple of days or even longer until normalcy is resumed.  

 Yesterdays funeral was for a 26 year old man who is a brother to one of the younger leaders in the church.  So even though I did not know him, I felt that I should go there.  Today, they will probably kill a cow, and feed everyone, and more or less have a celebration, but the main event was yesterday.  But I was awakened this am at 6 by the crying, and sing song voice.  Did it go on all night=–I donºt know, but it was there this am.

As far as how things are going in general? I am enjoying myself.  I have gotten into the routine, and now feel comfortable treating a patient without an interpreter.  However, sometimes in spite of my excellent –ahem–Kiriol, it seems like I have a difficult time getting my point across.  And so then, I have to call for help.  Sometimes, the same words said by someone who speaks Kiriol really well seem to carry more weight.  And then there was the day 2 days ago.  Tenigs wife had her baby, so he wasnºt working, and Terriann left the clinic to check on the baby, so I was there by myself.  Then, as sometimes happens, another person shows up at the clinic, Domingus, who felt called upon to translate for me.  However, his translation did not do much good, as he was only repeating the same words in Kiriol that they had just said.  I understood most of them anyway, but with him translating, it did slow down the process.  He is a bit slower, one the special persons that God puts in our path.  I could add a lot more to that, but I think that I have said enough.  I think all of us have them, and they are truly one of the least of these, so let us not shove them aside.

   It has been a long time since I have had a lot of night call.  Since 2007, I have been blessed with physician assistants (you know who you are!) who have taken most of the night calls.  So now, in Africa, I find that I am on 24 hour call all the time.  The other night, I was awakened by Tening, the nurse from here, whose wife is about to deliver.  Since her last child was born in the field, I thought that he wanted me for that.  But it turned out that the local shopkeeper, Botch, who had been recovering from malaria, thought he was dying.  So I trudged out in the middle of the night, with the African sky looming bright with stars and constellations, in the moonless night.  I didn’t have time to enjoy them, as I was wondering what sort of emergency that he was having.  When I got there, Botch was lying down and restless, moaning with left sided back and abdominal pain.  He was acting like someone with a kidney stone back in the states, so I got him to get me a urine, and trudged further in the dark down to the clinic.  But there was not a bit of blood in the urine sample, which makes a kidney stone a bit less likely.  But it still seemed like a kidney stone to me, so I trudged back to my house where I knew there were just a couple of Vicodin that would be good for this pain.  Then I trudged (hey, there is a lot of trudging, but that is what I call it when it is very dark and you are feeling the path with your feet) back to my house and got him 3 of them.  I told him to take 1 now, and 1 every 3 hours through the rest of the night.  Then back to bed, as the moon was just rising in the east.  Beautiful, but it took some time to get back to sleep. 

Almost 3 weeks.   That is how long I have been in Catel, Guinea Bissau.  This past weak I had my first real meat since being here, (that is not counting some canned chicken that is the spam of chicken, but tastes not as good!)  I had told one of the ladies in the church here that I wanted fresh fish, which is available at the curbside impromptu market, so I bought from her 7 fish for 500 cfa, the unit of money, of which 500 is a dollar.  So I bought, cleaned and fried them for lunch.  I had some flour, cornmeal substitute, and pepper and salt, plus Lawrys seasoned salt.  It was not bad, if I may say.  They also sell larger pieces of fish that I want to buy for blackening….  I would say the fish was as good as bream, and my roommate, Beryl, also said they were a real treat.  This week, I expanded the minds of the locals with boiled peanuts, made in the south Alabama tradition, and they all pronounced them very good.  I am enjoying lots of fresh okra, roasted corn on a charcoal stove.  The corn is shucked and laid right on the coals, and sort of is a substitute for my popcorn craving.

     My schedule always has something in it.  Today, I made the trip to Sao Domingos, the town about 10 miles away that actually has electricity, and an internet place.  I hoped to upload some pictures, but donºt have a lot of time for alot.  So I will download a few and see how it goes…..