FEB-C-6
A MIRACLE OF DRUG
AVAILABILITY
FOR A VERY RARE
CASE OF MENINGITIS THAT COMES IN BY NIGHT;
THEN, MY WEEKEND
STARTS WITH A LONG RUN AT DAWN,
PREPARING FOR THE
CELEBRATION AND FEAST LATER
IN THE DAY FOR
ACKNOWLEDGING ARRIVALS AND DEPARTURE
Feb. 23, 2002
At 1:00 AM I heard the Motorola walkie-talkie make a call to George Poehlman, my next-door neighbor, who was taking call. He went in to the hospital and came back an hour later. I was thinking of getting up early to run, and I had no idea how early it was so I tried to see what time it was to see if I should start getting my shorts and shoes on.
The Motorola walkie-talkies are exactly the size of US pocket pagers, and should allow two-way transmission—they are exactly the same models I had carried to Russia for George Service to facilitate communication between the guides while we were sheep and bear hunting. They are much better than “pagers” for this area, and can be sued on safaris when vehicles are within a few miles in convoy, as we regularly prove in the Himalayas.
When I heard next from George, it was 4:00 AM and he was called about a woman with a 4 cm dilatation who was not in trouble and he said he would see her first thing in the morning on rounds. I got up at five and tapped on John Sutter’s door at 5:30 AM. He said he thought he would rather sleep, so I took off on my own, and after wandering around inside the compound I found my way through some heavy puddles on the roadway headed toward the Jenda Road, the way we had driven in at the time of arrival. This is actually the road I had thought I was on before when we ran on Thursday AM, but that turned out to be the Tusa Road heading east away from Zambia. I decided as I was on my way, that I would try to run long and well this morning. I saw one picturesque sight and took a picture, and definitely should have taken a picture of the next event, which I passed. The first was an old man in tatters walking ahead of an oxcart filled partly with firewood, and the rest of the way with kids, who got a kick out of the flash photographs.
The second photo I did not take but should have was interpreted by me only after I had run past what I had seen. I saw three women headed out from the road into their fields, each with a hoe balanced over her shoulder and on their way to till the soil, with a stepwise pattern from low to higher to lower still in their heights. There first was an older woman with a stoop, yet a smile, and a wave. The next was a young woman with the tattered pieces of a school uniform, now in pieces as she shifted her hoe. Then there was the youngest girl, showing the most enthusiastic wave, also with the same size hoe on her back. I recognized the trio as a set of women headed out to till the soil before the sun came up overhead and made it very hot work in addition to being back-breaking stooping.
Only three steps beyond this cheerful trio, whose spotting of me must have been the only remarkable event of their day which probably strongly resembled the day before and would the day after, I realized what I had passed in that vignette. I was looking at three generations of the rural farm labor and the frustrated future of the “peasants” of now independent Malawi.
The NgoNgo was out in front, and her daughter had once had dreams of being more than a farm laborer and may have even registered for a semester of secondary school, but with school fees being a rate-limiting step to any future scholarship, the daughter probably had to drop out (hence her tattered school uniform pieces. But, there was no hope in hoeing corn that the third generation could attend secondary school, since the yield on that very large investment of labor was compromised by the fact that the farmers have had to fertilize with future profits on the corn, falling in debt, mortgaging their future on a cash input for a redundant product's devalued output. I saw a downward slope in the standard farm loans that was chewing off bigger parts of their yield and all of their next year’s fertilizer and hard currency requiring capital expenditures. I did not have very many cheerful thoughts on the future prospects of this three-generation trio, and I never had to ask them more than to spot them in their pose under the trees enroute to their office.
BECOMES
BENEFICIARY OF A SMALL MIRACLE,
GETTING
A SPECIFIC DRUG THAT PROBABLY ONLY FIVE HOSPITALS IN ALL OF AFRICA
I continued my run for a total of ten miles, one of the better runs since the interruption of my Mindanao mission with the assigned military guards, and came back, as the two students and George had gone in to make rounds. I heard from Betty the other story of the 1:00 AM call. While George was in to check on the first patient, he asked if there were any other recent urgent problems, and the ward nurse said they had admitted a man very sick. He seemed to have meningitis, which was true. Georges suggested they do a lumbar puncture, which they did, and the laboratory fellow did an India Ink preparation. There, in classic textbook fashion, are the fungi of cryptococcosis, a superinfection of someone no doubt compromised by the usual viral primary problem. The tests for HIV they do are only done in a very standardized protocol, called “counseling and testing” and these people are then told their results. Testing occurs on not everybody who comes in, but only for cause, and that has meant that the number of positive tests is high—78% of all HIV tests done here are positive!
With cryptococcal meningitis, there is no test necessary, counseling or otherwise, since this disease would occur ONLY in the context of AIDS or something else which would suppress immunity to that degree, and since this patient (and no other one in this area of the world) is a transplant recipient on immunosuppressives, nor has combination chemotherapy for cancer or leukemia, this is pathognomonic of late stage AIDS. Now, what to do?
There is essentially only one effective drug for this disease, and it is expensive, recently developed and unlikely to be found in any basic formulary. But, what had I hand-carried here to be sure that it got here and was not lost in transit? I had a small box of Rocephin, the ceftriaxone that turns out to be exactly the drug for the bacterial meningitis for which the other drug regimens have failed, so I wanted to be sure that this special drug made it here. In the box with the Rocephin were several other drugs, which I was at first disappointed to discover, since it seemed when I had first opened the box, it was all Rocephin—good as gold. But there were a few bottles of Bactrim and several other bottles of what was called Ancoban—a drug brand name I had not heard of, but which had the generic name flu cytosine. This turns out to be the only agent that could help this fellow, and there were probably no other places in Africa, surely not Malawi, which had any of such a specialized drug. So, here in Embangweni, the right drug is given to the right patient on the basis of what you may choose to call coincidence, as I had opened the box of mixed drug I had hand-carried in to be sure that the other life-saving drug agent made it here—and it turns out that every agent in the box has made a critical difference—and all of that already within the first few days of my being here!
A
TOUR OF THE VILLAGE,
AND
THE SEAMIER SIDE OF THE MALAWIAN
MALE
LEISURE CULTURE
After brief rounds of the wards to see the post-ops and intakes, we rallied for a walk to the nearby village and its “Trade Center.” I found on rounds that the Parotid Tumor post-op patient had a facial nerve palsy that I suspect will be transient, since we cut nothing near the facial nerve and only risked it with a suture ligature in that position which should be safe for the longer term. The grafts and the African melanoma patient are dong well, and the patients who were alleged to be C-sections have progressed through delivery under the able care of Mama Chima. She is the senior matron of OB, and has delivered more babies than I have seen in my life. She is a tough woman, who will climb right on top of women in reluctant labor and yell, “Push! Push!” She may be a bit short in anesthesia—she does both episiotomies and their repairs without benefit of local—but she gets good results. For example, Monday, she did or supervised ten deliveries! Two of those went on to C-section, which is about a 15% rate for this group, which has some degree of cephalopelvic disproportion, but the babies are so small, that if one of these kids were delivered in my area of DC, they would be whisked away to a newborn ICU. Here, a 1.8 kg baby is simply wrapped in a rag and handed off as a normal birth.
Mama Chima is the one who teaches the local “TBA’s” (“Traditional Birth Attendants.”) Since it had been the practice in Africa from time immemorial that a cadre of women delivered babies, one method is to make sure that these women did not do anything nasty to make the infant survival less—e.g., put dung poultices on the umbilical cord stump to lead to the high rate of tetanus neonatorum (= death) that I had seen in Nigeria. Each TBA graduate from the whole Three Days (!) Training to become a nurse midwife TBA gets a small kit with a bar of handwashing soap and some clean cloths to hold an infant and a special thread for the umbilical cord. If one of the women who are thus empowered as TBA does anything really nasty to the mother or child to jeopardize survival, the kit is repossessed. This gives rise to a public humiliation since everyone knows about it and they are on official notice that they are out of business. So, there are new standards to be met to stay a TBA in this Malawian community, with refresher updates and other things that must be done to stay in the good graces of Mama Chimba and her 42 years experience in delivering almost all babies that were delivered here in that time. I asked her how many babies she had delivered, and she responded, “You mean ‘Today?’” I said “No, in your lifetime.” OHH! I have no way of knowing—more than five thousand I would guess! Se says she might retire in 2006 and make rounds of all the TBA’s in the region to keep the standards up.
I thought to myself as I was standing in the Maternity Ward, it is ironic—here I am in the part of Africa I had described as the “Warm Ovary of Africa.” Should not my job be to decrease the burden of so many extra lives on this limited soil resource base? And here we are in a giant fertility program supporting child survival in every way we can, which may be counter to the best interests of the environment collapsing under the weight of the masses. One of the chief products of the Embangweni Hospital may be considered to be safe Motherhood, since, during my stay here, the Maternity has been the busiest service here, and second only to Maternity—and by now means coincidentally—is the NRU “Nutritional Rehabilitation Unit.” It is ironic. Go figure.
TOUR
OF THE TOWN
AND
THE GENTLEMEN’S LEISURE CENTERS
I picked up a hat and my sunglasses (a source of very great fascination to the kids around me since they could see their reflections in the mirrored glass—there are few mirrors around here—including for me.) We walked out of the compound and into the dirt road along the small shops and mud-walled emporia—“Tuck Shops.” We were on a mission to get toilet paper and a couple of rather typically Malawian souvenirs—a charcoal iron and the “chitengas” the cloth women wrap around themselves with everything from political candidates (like David Chisano’s portrait, I remember from Mozambique,) to symbols of modernity—like cell phones or Bic lighters. The ones I wanted were specific for Malawi, with a map and the symbols of Malawi on it and, failing that, a chitenga of Africa. WE saw one kiosk shop with a number of one meter chitengas flying in the breeze, but when I asked for the Malawi specific ones, they were plastic wrapped in the inside of the shop, and cost the astronomic amount of 300 Kwachas, which I declined to pay, since the others were 125 Kwachas. So, I came back without souvenirs because I would not spend $4.50 for a two meter chitenga of my choice, when one meter chitengas of not my choice of print pattern—and I got Elizabeth interested in the same items. So, when we came back to the shop where they were holding one charcoal iron for Betty, they had one more, and one chitenga of the African pattern. So, Elizabeth got those, and I ordered one iron, two Malawian chitengas and three African ones from the shop that said they could order a new stock, and will surely find me as the biggest customer of his month.
We circulated around the village shops—essentially mud-walled spots with some limited supply of goods out front, and then stepped into the market. There I saw dried Lake Malawi fish, like the chiclids they send off to aquaria, and pyramid piles of sema –the staple maize flower from which they make everything that gives them any nutrition poor calories—and stacks of salt, a commodity that, of course, the government would say is all iodized. Then we came to the more interesting scene in the middle of town on a mid-morning on Saturday.
This area is called “Don’t Be Jealous.” This must be what the men say to the women when they head down to this establishment, “Sanja Mu Laka.” This is where the high-test brew of Chibuku is brewed and sold for about fifty Kwacha a cup full, which is enough to put most men into a fire-breathing stupor. At ten o’clock on a Saturday morning, scores of men were lying around in whatever shade they could find already in the first planes of general anesthesia. A number of them clustered around me and wanted to be seen drinking with their good buddy the Wazunga. It is unlikely that I would be eager to join them for the warm and oily liquid smelling like kerosene in the coke bottles in which it was furnished. Our one purchase of the day (other than the bulk quantity of toilet paper and Elizabeth’s souvenirs) was a set of Fanta or cokes for each of us before we returned to get to lunch before the big festivities of the day began, for which the whole community has been preparing.
UNDER
THE “PHC TREE” IN THE PRESENCE OF
EVERY
DIGNITARY IN THE ENTIRE REGION
UNDER
THE AUSPICES OF THE “NKOSI”—
THE
PARAMOUNT CHIEF
I was musing about one of the little imponderables when I saw Jordie Mc Gill, who arrived with her husband Jim Mc Gill. Jim is the son of one of the founding families of this mission station, who was a surgeon who went on into community development. The young Mc Gill was the kid who would be found at the village campfires and belonged to the people of Malawi as much as to the Mission Compound as an “MK”-rather like Scott Downing and many other MK’s I have met. He is fluent in the Tumbuku, and good with his hands and a number of mechanical plans. He it was who had designed and built almost all the houses along the edge of the compound here that were the places that the expats lived. The dust road is proudly labeled “Mc Gill Avenue” not after the elder, but after the junior generation of McGills, since it was he who had built those houses. His father had been in the Kasai Province of the Congo before coming here, and I had met others who knew of his work. He met and married a Peace Corps Volunteer from the area where she worked in Uganda, named Jordie, whom I saw here with their three kids—come for the ceremonies of the Kennedys farewells.
I had to do a double take when I first saw Jordie, since she was nursing a baby, very prominently and quite publicly, with this small and very well dressed black baby at her breast. She would pull up her shirt, undo her bra and snuggle the baby while others would come and go around her. They also had two twin boys, who were about four or five years old. The twin boys were black Americans, born in Georgia where they adopted them in Atlanta. They may have been sons of a crack mother since they both have some degree of mental and developmental and asocial retardation. It was ironically easier to adopt the twin sin America than it was to get a child legally in Malawi where all the infants and children orphans are found. When it was known that they were looking to adopt a daughter, the Rodehavers found a child in an area whose mother had died in childbirth, and after all the earlier struggle, the McGills adopted the daughter after only two weeks of affidavits. Now, here she was with a black baby at her breast.
The mystery is solved when it is discovered that Jordie is a gung-ho ex-PCV who cannot possibly be seen to be feeding a child with a baby bottle. So, she carries a bag with formula on a strap between her breasts and has the child nursing from this source. It is probably as much for her own maternal benefit as for the public image she wishes to convey, as the baby is always rather publicly being fed.
This is the part that got me thinking. As I was in the Mindanao area, there were posters all around with pictures of how a child should be nursed in the language of whatever group was being treated. Here, there are even more prominent signs, along with big warning signs at the hospital entrance with a picture of a bottle and a nipple with lines drawn through them---“no bottle zone.” I wondered why there is such a fetish about showing pictures of women nursing with step-by-step instructions on how to go about doing it. Correct me if I am wrong, but have not women been doing this for eons? I may be missing something, but I am almost sure that these breasts have not come along with “Owners’ Manuals” for women who had never known just what to do with these accessories? How is it that an excess of these posters makes it possible for women all over the world saying: “Oh, so that is it! No wonder why I have been lugging these things around for so long to come in handy at a time like this!”
So, outlawing bottle-feeding seems a little heavy-handed in a society in which over ten per cent of the kids are orphans, since in the case of someone like Jordie, there would be a real problem, except for her creative ruse, to how to go about feeding this infant.
The McGills were apparently the tutors to the Kennedys on how to get started in Africa as new arrivals, so they are featuring as some of the “locals” in their departure ceremonies. The whole of the upper management of the “Synod of Livingstonia” is coming in, with all the bishops and leaders of the Presbyterian Church—the CCAP—Central Church of Africa, Presbyterian, that founded and controls this station and many more like it throughout Malawi. There is an organization called CHALM = Christian Health Alliance Missions, of which Embangweni is one of twenty of the primary health care centers in the nations, which delivers about 90% of the health care throughout the nation and owns over 40% of the inpatient beds.
All of the “presbytery” and all of the stations are gathering from the headquarters in the northern city of Mzuzu (where McGills live) throughout all the north are gathering to pay tribute to the Kennedys and their four years of service her at Embangweni where Neil has been the Medical Director, and as such, the head of almost every other committee in the community. Furthermore, the Nkosa—the paramount chief of this whole district—is putting on his own command performance in honor of the occasion. He is a boorish monkey-looking man with a very large actinic keratosis on his forehead, whose hereditary power as a TA chieftain (Traditional Authority) is unchecked or unbalanced. He has a nearly arbitrary authority, and everyone must pay very strict deference to him, which he surely does expect and demand. I asked in response to his disapproving stare when I introduced my medical students to him, what kind of “impeachment process” is available for a local paramount chief who slips his nut under the influence of absolute authority? It gives some comfort in the cumbersome processes of democracy, that the excesses of the leader are held in some kind of check, to be living in a society with the only government is the TA. Remember in almost any developing country, the central government has very little role in the protection or benefit of its citizens, since they are all “failed states” with only some from of traditional authority holding together the local rules and mores—no matter how unusual and idiosyncratic they may be. This was apparent when the local Nkosa would spot something just outside his limits of tolerance in the way someone danced or sang, not up to his exacting standards.
The Dignitaries of the Synod of Livingstonia had gathered, and as Secretary General of the Synod in a very strict hierarchy, it seemed that each of the three had taken the “upward mobility career pathway” of being “Head of Station” of Embangweni—the last three were at the head table and were seated at the front of all the ceremonies next to the Nkosa—Church and State. You could tell who ranked highly, since the chief bishop had Mama Bishop sitting at his side, rather regal and overstuffed in full dress and with a European-style hat, as did the Deputy Secretary General also have the authority to bring his “Bishop’s Wife” also basking in her acquired dignity of a lifetime of being mated with someone high ranking in the church. Each of the dignitaries were wearing suits and ties—taking a page out of the book of President-of-Life Banda, who lived all his life in a dusty tropical climate in a three piece dark suit. The only casually dressed Wazunga were those of us from the medical staff.
We sat at lunch, which did not start until after noon, when the festivities were officially supposed to start. WE took bets on how close to the official start the gathering would take place, and we walked over at 1:00PM to be among the first ones gathering at the scene. It seems that we did do something to induce the gathering, since when we got there, the carefully printed out agenda—listed to begin an hour earlier, could begin. I sat in the second tier, behind the chairs put out for the Kennedys and for the Nkosa and the various Secretary Generals and Deputies of the Synod of Livingstonia, so I could have the advantages of all the performers doing their dances and singing right in front of me without the necessity of acknowledging their fealty and not participating in some of the traditional dances that were part of the ceremony, when the Nkosa in his black suit and tie would rise and seize the Ngoni shield and Assegai from the dancers and enter the clumsy dance—with the thrill of ecstasy of the Shaka Zulu warriors, as if demon possessed by the throbbing rhythm of the drums. The little kids did it best—wrapped in civet cat skins, and carrying knobkerries which they would thrust up and a flourishing twirl of reversing the shield and tucking it back up under their arms, would stamp their foot and look upward with their eyes rolled back in their heads so only the whites of their eyes would show—like having a very public grand mal seizure.
I took pictures of the performances, and saw the different ages and stages of the various performers. A few of them were very high energy with kick dances and a lot of sweating jumpings and pivoting. Some looked like military drills without arms. One fellow had guinea fowl wings on his arms and guinea fowl feathers all over him and spots painted on him, and would dance barefoot to a drum rhythm that would cause him to vibrate stiff-legged. I taped the whole ceremony and the dances and took pictures on various format media. After about an hour and a half, under the “PHC Tree” (the “Wellness Center” to separate the Primary Health Care from the “Sickness Center” of the hospital) we, the dignitaries, were invited forward from the PHC Tree to go inside the chapel of the Hospital where the next phase would be held for a couple more hours of antiphonal singing, speeches and the dinner, as well as gift giving and responses from the Kennedys about this shower of adulation. This is what I call in many instances of my serving in poor countries the process of “Eating First and Most of the Best.” Everyone waits and watches hungrily as we are served the prime parts of the dinner fixed by the women and carried in while it gets cold during the prolonged ceremony. It was rice and “nsima” (ground bleached mealie maize flour) with din-din on top—some from of greens (peanut leaves) or gravy, and a small piece of “free-range” (i. e. “tough”) chicken.
One of the orator preachers was called upon to open and close the proceedings outdoors under the PHC Tree, and he did so with a flourish that involved all his body in a lifting and falling calisthenics as if choreographed. He wore a suit, and carried a big Bible, a prop, as far as I could tell, since it was never opened, and he ended in a decrescendo and a deep bow to the Nkosa and stalked off the dusty center stage in his best black suit. The hierarchy of the ceremony in the Chapel of the Hospital was under different auspices, but each of the speakers had to mark a very deferential opening statement addressed to each of the other dignitaries at the head table—all of which added an hour to the proceedings. The Master of Ceremonies would translate and make reference to the others and require the correct order of things to be done, including a registrar of gifts. The gifts would be presented by the slow-motion dance of the head-carried package brought forward and then presented with a grand announcement of who was the giver and a reference to the relative value of the gift. There were a great many Chitengas, with various designs, including exactly the ones I had been negotiating for earlier in the day. Also there were a number of woodcarvings and gowns with the same cloth made into the sizes appropriate for the two little kids of the Kennedys—Ben and Grace—little towheaded playmates to their African agemates. The ceremony went on and on with many chances for the final word, but no one willing to have some else have the honors. I taped the ceremonies and took pictures with the Kennedys’ own cameras, as well as a few of my own, so they will have a record of what had transpired here as they are in the UK finishing Neil’s pediatrics training and contemplating returning within six years to go to the faculty at Blantyre or to a similar mission station like Embangweni. The Nkosa stood up and commanded attention with blunt pronouncements, which could be seen as severe criticism anywhere else—like “Why have you been her for so short a time before you are leaving?” –I guess that is complementary, since I receive the often from the insecure myself. We all retreated after the last of the photos and songs with various officials, all of whom got piled into the designated Toyota Land Cruisers with the ambulance or CCAP logos on the side and their drivers drove off the large “Mamas” wives of the Presbyters and in the full flush of formality with all the honors observed, they had discharged their official duties.
It was great theatre for me, designed for a wonderful acting out in front of my cameras and tapes. Now, I should go off to see the local witchdoctors ceremonies of casting out evil spirits as a practicing anthropologist rendering unto each party equal time in my status of “participant/observer.”
PARTICIPANT/OBSERVER
Several items of note: which may have to be explained by some one else: One of the agenda items was a young girl of about sixteen from the secondary school, in a borrowed dress several sizes too large and wobbling in the dust in high heels at least five sizes too large, came forward to recite a “Poem about the AIDS epidemic.” She nervously performed in front of her betters, and was listened to attentively with hoots of laughter and derision at certain stanza punch lines. The minister who so dramatically gave the opening and closing prayers (that John Sutter described as “Christianity at the front and back ends with pagan ritual in the middle”) had mottled hands that were depigmented in a regular pattern of white spots (“Stigmata?”) looking almost like the patterns of henna applied to the hands in the Middle East under special circumstances. I found out later that he has vitiligo, and he is acutely concerned about it, since it makes him look less like a black man and might be associated with a negative prejudice against him as a leader of his African church.
There were several of the dancers
wearing blue and white chitengas that said the
”Scottish Church in Malawi 125 years”.
The Synod of Livingstonia officials made frequent reference to the
100-year history of this station at Embangweni, saying that it was founded by
Dr. Fraser, and a Dr. Loudon who was a FRIEND OF DAVID LIVINGSTON!
This name can still instill reverence in this area of the world, as I had held him to be one of my heroes also, against the derision I had met at the time I wanted to make a pilgrimage to his site of death in Zambia over the border behind me. The story of how he had died and his body was carried to England but his heart was left in Africa (under the Mobolo Tree—as you readers of “Out of Assa” would know--) was the analogy for what the Secretary-General of the Synod of Livingstonia made as his charge to the Kennedys—they could take their bodies out of Africa but by the wizardry of the powerful sorcery we Africans have worked, your hearts would remain here.
A number of the young men were wearing tee shirts that announced they were part of the “Shallow Well Team”—a group of the local villagers who make wells by digging down to about thirty to fifty feet, building a circular well of bricks and mortar, capping it with cement, and then installing a hand pump, a plastic or PVC pipe with a bicycle-pump like valve system—the limit to which a one-stroke cycle can lift water. The deep wells are drilled and lifted through PVC pipes by a two stroke handled pump which costs about $1500 after the drilling costs. The shallow wells project becomes the entire property owned by the village, with the funding for each of about $350, donated by a church group in Marion Illinois—and they have done this hundreds of times over in this area of Malawi, almost solving (at least outside the dry season) the problem of potable water, if you do not factor in the availability of healthy women to gather around the pump handle and head carry the water back to the hut.
I had another thought while sitting through the long ceremony: in contrast to the misery I see reflected in the wards right behind the chapel which is an everyday occurrence of reality here, this special celebration is as high a point in their lives as they are likely to get, as close to heaven on earth as they might hope to realize-with the sonorous overtones of the remarkably small choir dancing in an African swaying rhythm and prayers and praises resounding. It is like a funeral at which the honoree can participate in enjoying the celebration!
One of the little kids who dances is a very accomplished enchanted dancer, who appears almost comical, since he is very serious about his performance, and with his fellow dancers does a good eyes-heavenward with the entranced rolled eyes showing only the whites of the eyes. The difference is that he is fat—an unusual appearance here. So, of course, his name is “Albert.” The adjective is left off, but no one can see him without thinking of his convincing performance as “Fat Albert.” I thought I had seen two social bonding episodes today in which ecstasy and near-loss of consciousness was part of the ceremony—first was at the “Don’t Be Jealous” Chibuku binges and the second in the rhythms and dances of the mesmerizing ceremonies of “Church and State”—each “mind altering experience states.”
Since each speaker had to address the prior dignitaries on the dais before he could attend to us, the audience, a requirement of a full hour added to the program, there was a repetitive re-enforced learning of the rank and order of the hierarch in their society impressed on each of the audience—me to know who they were, and the rest, so that they would never ever forget who their betters were and the order of succession in who takes precedence. Very able people such as Mister Tembo of the Theatre staff is not judged according to the meritocracy of what he can do or what he knows, but his rank and station, so he mush come in at a bow, and give place to others above him in the African hierarchy—with the exception of the guests who are unmistakably superior, if based only upon the color of their skin. Neal is remarkably egalitarian and listens to his African counterparts with great deference depending on their indigenous ranking, and fitting into their pattern, wearing the African costume as one of them and submitting to their precedence is a quality that has endeared him to them. In one neo-colonial statement, the Secretary General said that knowing Neil Kennedy he had learned England.
What this whole event has done—even (or, especially) for the ex-patriates—has been to reinforce a “sense of community” upon the gathered group. As George Poehlman said “I feel much more at home here than I do at my own home or among my own colleagues.” I would add that I might not know the names of my neighbors, but I really have to know the names and ranks of most of the people around me here in order to know where the levers of what makes this institution work. This was like the shared grieving and rejoicing I had just experienced in Mindanao among the Tboli people in the mat and bamboo meeting house where everyone came together on the occasion of my visit, but in a very eventful week, in which Lydia’s father had died, and so had the wife of one of the women whose husband died a very unexpected and untimely death. Even though they were smarting under such loss, they did not focus on that loss to the exclusion of their joy at our visit so that the dances and the positive ceremonies that followed were heavy on the rejoicing end. We are here at the chapel having a praise and thanksgiving ceremony for a departing medical director, whereas I had heard the ululating cries of the women picking up two dead women from adjacent beds in the female ward—one fourth of its contents—the previous day, as the mortuary was doing a booming business, including one woman –the one whose daughter had died of malnutrition as she was seizing with the CNS cerebritis of HIV infection, so that the sedately dignified Ngongo had lost a daughter and grandchild to the HIV virus within a few days of each other.
These are very poor people. Yet the “present shower” that flooded the Kennedys was probably about a monthly salary for each of the people who gave them gifts—all very publicly recorded and acknowledged by the registrar of such gifts and the one to which each would be responding in a “give til it hurts” potlatch.
We, the apostate medical group, from varied backgrounds both socially and religiously for all I know, waited until all the dignitaries of the Synod of Livingstonia had departed, and then carefully tip-toeing around the posted sign informing us that we should abstain from certain activities, prominent among them being the association with the activities of the Trade Center where public drunkenness was often seen, and to abstain from witch doctor ceremonies in which the spirit worship was a prominent part—and the Big Three: no smoking, drinking alcohol nor sex outside marriage would be permitted on the compound or in the guest house. Without reference to any of our other sins (who is checking?—and you know I am an endurance runner and would be unlikely to smoke!) we gathered around later on Saturday night and toasted the day’s activities with the grape juice that had been lovingly tended in Zimbabwe and on the KLM, and Kenya Air flights I had taken during its aging process!