(Daniel Crawford)  This week we had about 150 patients every day in the clinic except for Friday.  I was made to take Monday off from work to rest a little more from my recent illness, and Tuesday I returned to work.  Jessica and I saw 15-25 wound patients each day.  We have had a couple more colorful injuries recently.  One woman has a few lacerations on her palm/fingers due to a fight involving a knife.  Jessica and the twins sutured her and she comes in for cleaning daily.  Another man sustained a pretty serious 2nd degree burn to his outside ankle, which I had the honor of “debris-ing” and cleaning (I got to scrub off the charred skin and blisters. very nasty. a bit of blood).  Yesterday afternoon a woman came in very nonchalantly with a deep and wide 6-inch laceration on her foot from a puncture wound at a construction site.  She was very good humored and funny.  I like her a lot.  There’s another man with partial amputation on two fingers who comes in for cleaning.  And then we have lots of children with cuts and open wounds on their legs and feet.

I have found that the Sudanese people are wonderful patients (as far as wound cleaning is concerned).  They don’t speak much of any English, so that they don’t complain.  They don’t really understand or have a culture of medicine, so that can’t easily know when I’m doing something right or wrong.  And they also have an unbelievable tolerance for pain (some exceptions to the younger generation, whose culture is changing much faster than their parents’ generation).  They don’t cry.  They limit their screams or don’t scream it all.  It’s amazing.

However, there was on boy on Wednesday who needed a tetanus shot, who was afraid to the point of rebellion; he wouldn’t let us do it.  He didn’t fight, but he insisted ‘no.’  So instead, I told him, “If I get the shot first, will you do it?”  I asked him 2-3 times.  His eyes were so sad.  But I looked him in the eye, and he finally agreed.  So Jessica gave me a shot with sterile water in the shoulder, and then I gave him his tetanus shot.  Success.  Sebit explained to me the week before that the culture has a large fear of spears and dying by them; some patients greatly fear needles for this reason.  I don’t know what this boy saw or went through to make him so deathly afraid, but I’m glad he was able to overcome it.

(Jessica Leong) Living here in Sudan, I’ve learned to appreciate the little things.  The days can be long and hard here, spending 8 hours in the clinic in a small room with one window and no fan.  The day can often be overwhelming.  But…I’ve learned to look at things differently and I’m sure my perspective will continue to change as I’m only 1/4 of my way through my visit here.  The things I appreciate now…
…a breeze that comes in the room when the curtain is opened.
…the shower being bug-free.
…finding more gauze than I thought I had.
…sleeping in 15 minutes more than usual.
…the smile of a young child in the arms of its mother.
…hot tea in the morning.
…the cricket’s chirp outside my window as it sings me to sleep.
…licking the bowl and spoon after dipping marshmellows in chocolate.

(Jessica Leong) A busy day in wound care.  I seem to be the wound care consultant.  I’m not too sure how I got that job besides the couple weeks I’ve spent performing wound care on the Sudanese people that come into the clinic.  Anytime somebody comes in with a cut or bite or burn, I get the chance to participate in the decisions of how to treat it.  Melissa was working in registration that afternoon.   She came into my room asking me to take a look at this bite that this man had on his ankle.  I asked how it happened and she stated that it was from his girlfriend.  I immediately thought how bad this could be because of the increased chance of infection that a human bite has versus an animal bite.  I walk outside to see a man pointing to his ankle.  It looked a little bit swollen, but there were no teeth marks.  So again we asked what happened and again we got the same response.  The man was bit by his girlfriend.  “What kind of girlfriend bites a man’s ankle?” I thought.  Anyways, I had to believe the man.  So I look down at his ankle again, convincing myself that I must have not seen the teeth marks the first time.  But again, I see nothing except a small amount of inflammation.  I tell the man that he must wait behind all the other patients due to the fact that his injury was not very serious.  We ask again, this time the men around keep saying “girlfriend, girlfriend,” or so Melissa thought.  I finally figured out that they were saying “scorpion,” not girlfriend (the “p” and “f” sound very similar when spoken by a Sudanese).  Oh, well a scorpion bite!  That makes much more sense!  Of course this man is hurting.  Of course his ankle is swollen.  Of course he wasn’t bitten by his girlfriend.  Come to find out, the Dinka language does not have a word for girlfriend, so they were not even understanding us when we kept repeating back to them, “girlfriend?”  Oh the misunderstandings that occur between two people groups and two languages.  Girlfriend?  No.  Scorpion.

(Stephanie Williams) The other day, I asked Maggie (the senior Nurse-midwife and resident partner-in-crime) why so many of the women chose to deliver at home instead of coming to the clinic. Her answer was particular and I have to admit I wasn’t sure what to think.

She explained that when it comes time for a woman to deliver, the husband insists she deliver at home. She has little choice. But it was the reasoning behind it that caught me off guard.  She explained that here, a traditional midwives’ job aside from delivering the baby, is to illicit a ‘childbirth confessional’. Apparently, while the woman is in transition and especially as she gets ready to push, the midwife will yell at her. She will tell her that the labor is taking long because she slept with a man other than her husband. “Confess and you will deliver! Whose baby is this?!”

At first, I had to laugh at such a thought. It couldn’t be. Sure, promiscuity is the norm in this culture but really? Most woman I’ve seen in the pushing stage don’t have time to think, let alone make an intelligible sentence. So, I put it in the back of my mind to think about another day.

Then Bith came to the clinic to deliver.

She was a young mother expecting her fifth child and was evidently poor but oh so sweet and happy to be having her baby. She labored quietly and powerfully throughout the day and then barged into my prenatal visit sweating and ready to push. Not long after, she was squatting on the prenatal bed pushing with all her might.

She asked for her friend to come in and help with the pushing. Naturally! Her friend acted as a doula of sorts and immediately started massaging her back and encouraging her. “Chol! Push! Apathe Pei! Good work!” Everything was going well. Then all of the sudden the tone of her voice changed. It sounded like she was yelling at her.

I asked my mighty, mighty translator, Natali, to let me know what she was saying. He said that she was yelling at her to confess. Huh? “Whose baby is it? Who did you sleep with?” Yes. You guessed it. I was stuck in the middle of a ‘Childbirth Confessional’.

Naturally, Bith ignored her words and pushed with all her might. I, however, got all up in her business and told her to stop yelling such nonsense. I affirmed that the birth was not taking any time at all and that everything was very normal. This silenced her. She actually seemed happy to hear it.

No confession came but a  beautiful baby girl was born minutes later – sweet and sleepy and calm.

We started today off with Suzy giving her testimony at devotion.  Some of you reading this may be familiar, but it sure was new and inspirational to me.  In a nutshell, it was her personal version of amazing grace and the radical turning around of her life after she heard God calling to her.  To me, this message was one of utmost optimism and hope because I know that I’ve got many flaws that I would like to change about myself and things that I am not particularly pleased with myself over.  It was uplifting to have Suzy remind us all that God wants each and every one of us, no matter what the state our lives.

Life at the clinic is still one of new learning opportunities and offering ourselves in different ways to help the patients we see.  From a medical student’s perspective (like my brother John and mine), this experience continues to be quite the dream summer.  We see things in the clinic here that I certainly haven’t yet seen in my education so far.  My brother and I helped to treat a bad hyena bite, I cared for someone who was bitten by a poisonous spider, and I watched as the clinical director removed a worm from one patient’s leg.  Some of these are even things that I likely will not experience during my 4 years of medical education in America (which makes this exciting stuff for a med school nerd like me)!  In addition to the unique cases that we see here, I’m learning skills that I will not be formally trained in for another year or two back in the states.  This week, I sutured up my first wound, placed my first i.v. line, and gave my first intramuscular injections.  My brother John and I joke that we should save our money by holding off on our next 3 years at school and just staying here for a a few years, since we’re both learning at such a wildly accelerated rate.  The attached picture is of Richard and John, two of the awesome interpreters that we rely on daily in the clinic.  I think they’ll be very excited when they hear that their handsome image will be posted in cyberspace (I’m already anticipating being able to give them the good news tomorrow morning).

Last Saturday, we went to the market here in Tonj, which is essentially a collection of small huts selling different types of goods.  Some merchants sell clothing, others food, others doo-dads and knick-knacks and what-have-you’s.  This was quite a fun and novel experience for a bunch of Americans like us, who really don’t have anything to compare this to in the States.  For one, everything is bargained for (and we had the distinct impression that the starting asking price for a given good was jacked waaaaay up when they saw folks looking like us stroll up to make a purchase).  Another unusual thing was the hustle and bustle that breathes life into the market.  Kids running around, merchants trying to corral you into their hut, and even motorcycles riding through all contributed to a real vibrant (and distinctly un-American) shopping experience.