What's Up Doc?

[Les is more]

Looky what I found!!

 

Our own Doc47, our peripatetic do gooder, our very own doctor without borders, has a new edition of his book out!!

 

 

Here's what the cover says-

 

In 2006, David Levine, a family practitioner, went to The Gambia, a tiny country in West Africa, to do volunteer medical work for a year. He was assigned to the emergency department of the major hospital in the country. What he found in Africa – family, firm friendships, fascinating people and cultures, frustrations,

 

tragedies and triumphs – is the subject of this book. Adopted by a Mandinka tribal family, he lived in the slums of the capital and in a remote village. He traveled to Sierra Leone, a country healing from the wounds of a ten-year civil war. Traveling to Guinea with a traditional Mandinka musician/historian, he encountered crazed taxi drivers, art, music, ballet, and angry police. He contracted malaria not once, but three times. He was honored as the first “toubab” (the West African term for a white person) in living memory to visit a remote village in the hinterlands of Mali.

 

Here is a journal, packed with photos, that will take you on a journey to remote areas of a fascinating part of the world with a depth not often revealed to outsiders.

 

 

“ ...great storytelling. Dr. Levine takes us with him into West

 

Africa, where we come to know the warmth and beauty of its

 

family and cultural relationships as well as the frustrations and

 

losses of its ways of life and struggling medical infrastructure.

 

Dr. Levine shares not only his triumphs and successes, but his

 

mistakes and failures and vulnerabilities... a fascinating read.

 

Everyone should hear this story.”

 

– Steven C. Brown, international lecturer,

 

author of Native Visions and Sun Dogs and Eagle Down,

 

former curator of North American Collection, Seattle Art Museum

 

Pretty danged cool! I hope there's one of these under my Christmas Tree.

 

Here is Doc's email if you want one under your tree too.

 

toubabdoc@gmail.com

 

Do I have any affiliation? Yes. We're joined at the heart.

[beemerman2k]

This is pretty danged cool. Congrats Dr David Levine

[Bud]

Do I have any affiliation? Yes. We're joined at the heart.

 

That brought tears to my eyes as it can be said for many members here in Mr. Rogers Neighborhood.

 

Thanks for reminding us.

[yabadabapal]

Thanks for being there and doing what your doing Doc 47.

[Whip]

I got his blog update this mornin. Seems our Doc has not been feeling very well.

 

Wed. 8 December

 

 

In two seconds this afternoon my head cleared and I knew the malaria was over. I'd been lying in bed, getting acquainted with some of the critters I share the house with: a small, gray mouse in the rafters, a gecko of decent size considering it is minus its tail, an agama lizard, a variable population of toads, a rotating patrol of tottering, precise praying mantids and the various slim-waisted wasps and hornets that fly in, blunder up against the walls looking for lord-knows-what, then blunder out again. There's a ripe papaya in the tree just outside the window. I may have to take advantage of that. They taste wonderful if one can get past the smell.

 

 

Anyhow, my head suddenly cleared. The fever broke. There's still some residual headache but the body pain is mostly gone. It hit me suddenly last evening while I was visiting with neighbors: weakness and aching legs and I knew what I was in for. I went home and started myself on medication toot sweet and went to bed. Artemesinin with piperazine for the malaria and paracetamol (that's what they call acetaminophen (Tylenol) in the rest of the world) for the headache and body pain.

 

 

I've been looking at pieces of land to buy. Saw a likely piece, 40m square for CFA 800,000, about $1800. It's just bush right now and abuts my friend, Adam's, place. It faces the “main road” – read donkey cart track-- and would make a decent place to build a small house and put in some fruit trees and a garden. I've got a couple of other prospects to check out but this one looks good so far.

 

 

I'm not falling over on the bike quite so much lately. Letting a lot of air out of the tires before riding on the deep sand helps a lot. I rode to Ziguinchor to straighten out the customs duty for bringing the bike into the country. Ended up having to pay the equivalent of $450. Ouch!

 

The first half hour is all potholes to Diouloulou. After that the road isn't bad until just before Ziguinchor. There, the road traverses tidal flats and mangroves and, depending on the state of the tide, parts of the road become flooded. So, pick your route, hoist feet way into the air to get them out the spray and hope you don't drop into a hole. It's not like cruising the Interstate.

 

 

Where the road goes through a village the locals put logs and tires out in the road to create a zig-zag course to slow vehicles down. There are police, customs, and army checkpoints. The main army checkpoint is about 5 clicks before Zig. Soldiers in crisp uniforms shoulder M-16s. Other men in plain clothes examine papers, search. Everyone is pulled over. Documents examined minutely. Baggage is checked. The officer found some dried leaves in the bottom of my backpack that must have seemed suspicious to him. “Thé japonaise”, I explained. He dipped a finger in and tasted the leaves. Apparently satisfied they weren't contraband he waved me on. The inspection was very thorough; very professional.

 

 

There has been a simmering “rebellion” in the Casamance for many years. Technically, a cease-fire has been declared but there is still some random banditry. The roads generally close down at 7PM.

 

Senegal is a U-shaped country, separated by The Gambia into an upper and lower part. The upper two-thirds holds the capital and is dominated by the Wollof tribe. Wollofs tend to be striking: tall, slender, with high cheek bones and dark-complected. Mandinkas claim the Wollofs have hot tempers. The Casamance is a mixture of tribes with the Diolla (Jola) predominating. The Diolla have a long history of resisting domination by anyone else. The Casamance gets hind tit when it comes to fiscal allocations – or at least they think they do. They feel that preference in job allocation goes to Wollofs and people in the North in general. Much of the country's rice, cotton, and fruit comes from the Casamance and they feel discriminated against.

 

 

No car over 5 years old can imported into Senegal so that excludes my 20-year-old Mitsubishi. There are so many old beaters here because few people can afford a newer vehicle. They keep the old ones afloat. My plan is to get the Pajero into shape in The Gambia, sell it there, and do without a car here. The motorcycle should serve for most uses though it will be uncomfortable in the rainy season. When necessary I can hire a cab. In the long run it will be cheaper. And I plan to buy a bicycle as soon as I can find a decent one.

 

 

Thursday. the 9th, I think

 

 

So, I am reading JD Salinger's Raise High the Roof Beam, Carpenters and marveling how the guy could play a symphony in speech with italics. Usually women' s speech. Salinger had a long-time love affair with his fictional Glass family. When Seymour puts a bullet through his temple in another short story, A Perfect Day For Bananafish, I am devastated and return again and again to dwell on his motives.

 

 

Every now and then, when a puff of air comes in through the open window, I get a whiff of mustiness from the book. It's a collection of short stories from The New Yorker from the Fifties that I got from an exchange library in The Gambia last summer. With all the rest of my and Binta's stuff it ended up stored in an apartment she rented when I got thrown out of the country and the lease on our house expired. There was a skylight of sorts and homemade skylights tend to leak, even when built by people with skill and good materials. The history of this particular skylight included neither of those two elements. So, the skylight leaked, water got down and up into the furniture, my stereo speakers, my books. A mouse got into my autographed copy of Up Front. And, when I snuck into The G to help Ebrima pack my things for moving and I discovered all the damage there was that initial sinking sense of loss; of “Oh, shit! Not that one!” I grieve the loss of perfection, the loss of order, the slide toward chaos, the entropy of the whole inexorable process, and after a while I think “What the hell” and go have a cuppa tea.

 

 

Where am I going with this? Over the past years I have been learning, both willingly and by storm, to give things up; let go of my possessions. Heirloom furniture I thought I'd never part with. A granny's attic of items I'd accumulated over the years. Art work. Artifacts. Antiques. Mayan bowls. Militaria. Books. Tools. A fine, wooden boat. A treasured, handcrafted guitar. The gorgeous Velocette motorcycle I built with Ed and Geoff. A superlative Wheatstone concertina. A Philippine Insurrection-vintage bolo knife. A British general officer's sword from 1836. They've all gone.

 

 

Each move, each change in location or vocation, a gradual metamorphosis of casting-off. The furniture I brought to Africa now scratched and battered and – thanks to that skylight – water-damaged, is still usable but no longer prideful. When it comes time it can be done away with. The art works I still have and love? I know now that I can say goodbye. When I came to Africa I collected some fine ceremonial masks and other items. They, too, are up for sale. Family items passed on to members of the next generation. Divestiture of things. Divestiture of the emotions that go with them. Metamorphosis perhaps, but ain't no butterfly emerging from this chrysalis!

 

 

With the progressive failure of my hearing, even the music that has been an integral part of my being will someday go. But on this score (pun intended) I'm not sure what I will do. Can I continue to be happy with the memory of Shostakovitch’s Seventh or Abbess Hildegard's ethereal praises? No wonder Beethoven got so damned grumpy!

 

 

When Gandhi died his worldly belongings could fit in a shoe box. (But at least he could hear! Like me, he had big ears, but his worked!) Two of those items were books. If it came to the point where I couldn't read.....well, there you have it.

 

 

And so, I read this musty, expendable book of superlative writing from the most finely crafted of periodicals – my mother read The New Yorker throughout her life and claimed she had never found a single typo in all those years – and think Sic transit gloria mundi. Some day I, too, will be divested. Right now, though, I can still hear, still communicate, still help. Still feel clumsy when I try to learn the kora.

 

 

Four days ago I saw a neighbor's daughter with a bandage around her foot. I had language trouble getting a decent story but there were abrasions and puncture wounds. The foot was swollen and she had pain all the way into her groin, indicating spread along the lymphatics. We got the local medicine and dirt washed off and after some to-ing and fro-ing I managed to get her a supply of an appropriate antibiotic. Today the foot looks a lot better. The family wouldn't have done anything about it and she could easily have lost the leg...or her life. I'm still concerned about tetanus since she hasn't had a booster since infancy, 15 years ago.

 

 

It's a simple thing but not a small thing.

 

 

And the girl still hasn't smiled at me.

 

 

SHAMELESS COMMERCE DIVISION ANNOUNCEMENT:

 

 

For those of you who haven't ordered a copy of the new 2nd Ed. of my book TOUBAB: AN AMERICAN DOCTOR IN WEST AFRICA there's still time to get one to stuff down your favorite stocking. (Sorry, too late for you Hanukkah advocates!) Drop me a line and I'll send instructions. Profits, of course, go to WAME projects......good stuff!!

 

 

May you all survive the holidays with equanimity!

 

 

--

David Levine

Make a difference! Support WEST AFRICA MEDICINE & EDUCATION Check out our website at www.westafricamedicine.org

[FlyingFinn]

Wow.

[Ken H.]

Wow. Fascinating. Oh to have the courage...

[Kathy R]

The book will be under my tree

 

 

[Les is more]

Here's a face to connect with the name for you folks who haven't met him or gotten to know him.

 

The two of us at Torrey-

 

[StuGotz]

What a story.

 

Just one question though, and please excuse my ignorance.

 

Aren't Malaria innoculations available to prevent occurance of this disease? Are they region specific?

 

MB>

[Nice n Easy Rider]

What a story.

 

Just one question though, and please excuse my ignorance.

 

Aren't Malaria innoculations available to prevent occurance of this disease? Are they region specific?

 

MB>

No, there is no malaria vaccine. Several drug companies and the US's NIH as well as the World Health Organization are funding clinical trials of vaccine candidates but even the best to date give temporary protection at best. The Bill & Melinda Gates Foundation is investing heavily in this area and right now the most cost-effective measure seems to be distribution of mosquito nets for the beds (about $10 per net).

 

Malaria kills up to 1.5-2 million people a year worldwide and about half of these are children.

[doc47]

Thanks for posting this, Les. Hug comin' atcha!

 

Good answer, George! Despite what anyone (everyone??) thinks about Bill Gates, the Gates Fndtn. is doing some fantastic work worldwide, funding research against malaria, TB and AIDS (SIDA). He and Melinda could certainly have opted to do other things with their money (like build submarines a la Paul Allen) but they are instead doing serious humanitarian work. My hat's off to them!

 

"Malaria kills up to 1.5-2 million people a year worldwide and about half of these are children."

 

Good thing I'm not a kid!! I'd have never survived!!

 

Thanks for the kudos, folks! Ante up and buy a book!! Buy some for your friends.

If you don't have any friends buy some for your enemies.

 

 

[Francois_Dumas]

Hi Doc !!! Is that URL still the active one? I can't find the text Larry was quoting?

 

Hope you are doing better. We were very happy to have met you in SF, and we need to continue our talk about some 'technical' things to help you :-)

[Whip]

Update from Doc

 

27 January 2011

 

 

Some days I feel like throwing in the towel. WAME needs a bank account here in Senegal and so I'd gone to Ecobank in Ziguinchor two weeks ago to ask what was necessary. The nice person on the other side of the desk was most informative. I noted down all necessaries and returned home to assemble the documents, proofs of identity, etc. Remember now, it is a two hour trip from Kafountine, where I live, to Ziguinchor, where the bank is. The first half hour is over challengingly potholed tarmac that frequently encourages one to ride on the slightly less challengingly potholed shoulder. There are occasional forays off into deep, soft and welcoming sand. There are picturesque villages and estuaries with interesting bird life, but one is hard-pressed to do much admiring since staying upright on the road requires a constant application of one's concentration.

 

 

I have with me a thing that looks like a check for nearly ten thousand dollars. It is a financial instrument called a Banker's Acceptance; essentially it is a check, but it's a check written by the bank itself. It is money donated to WAME by the Sand Family Fund in the US and it has come by a very circuitous route. Since WAME isn't a registered charity in the US the money needs to be given to a legally constituted charity. My friend, Lady Kira Dalton, an extraordinary woman who represents the African Oyster Trust (Don't ask me why it's called that! They build nursery schools and clinics and do a fantastic job.) have agreed to accept the money for us and pass it on. It has come to AOT in the UK and to The Gambia with Lady Dalton, then been turned into a BA. It has come to me by meeting at an undisclosed place, after a very difficult ride on the bike through two kilometers of the deepest sand I've yet encountered and a ride in a dugout canoe across a river in the bush. Like something out of a John Le Carré novel only too damned hot for a trench coat.

 

 

At Diouloulou I stop at the premises of my friend, the tire-service guy, who has a compressor. This saves me having to pump up the tires by hand. The bike is far more manageable in the off-road conditions of the Kafountine-Dioloulou road with the tires underinflated. From Diouloulou on it's better to have proper inflation, hence the use of my friend's compressor. I often arrive in the late morning, so I also take the opportunity to go across the road and eat a plate of what I think are Jerusalem artichokes, boiled, skinned, salted, with hot, red pepper and lime juice. This treat is sold by a friendly Mandinka woman named Kumba. Only recently have I noted a pair of crutches under her kiosk.

 

 

Leaving Diouloulou, past the roundabout, I wave to the soldiers manning the guard post. They wave back, then I have to pay careful attention crossing the bridge because the road surface is lunar. On the other side it smooths out and remains so, except for potholes that are infrequent enough to catch one off guard. Attention is required. There are also goats, who are pretty smart and flee when they hear traffic oncoming, cattle – who yield to no one and could care less – , donkeys – ditto – sheep – like goats, only slower and dumber – chickens, dogs – who like to sleep in unlikely and dangerous places – and cats, who are no problem, being intelligent, cautious, and, even if you hit one, small enough to do no damage, at least to the motorcycle if not the cat.

 

 

Twice I've intercepted a very large troupe of baboons crossing the road. Probably more than fifty in that bunch. Babies riding on mother's backs clinging on either side with a tiny fistful of mom's fur. The dominant male is the last to cross and stays on the verge, staring back at me darkly from deep-set brown eyes. He is a formidable chief and takes his duties seriously.

 

 

Then there are red monkeys and green monkeys, usually crossing at a distance and vanishing into the roadside bush. Occasionally, though, one or two will linger by the road, probably BMW fans. The green monkeys really are green! A deep olive with white-bearded, expressive faces.

 

 

In two hours I am back in Zig and present my documents. The nice person refers me to the bank manager, a slender, business-suited Fula gentleman, Mr. Bah. He tells me that the documents are very nice. I am encouraged; happy, even. But they are not legalized. What is legalized, I ask. They must, he says, be stamped by the police in The Gambia to show that they are genuine. I tell him that no one told me they had to be legalized. Well, he says, they must be legalized or they are not acceptable.

 

 

I am biting my lip as I leave. So, I call my main man, my bro', WAME's administrator, Ebrima, and tell him I need LEGALIZED copies of the documents. No problem. Ebrima is always willing and cheerful. He spends most of the next day trying to convince the Banjul police to stamp new copies of the documents and they spend most of the day telling him no. Meanwhile, we are texting each other madly since phone calls are too expensive. I eventually suggest he go to some other agency to get the documents stamped, since what the bank really wants is a stamp (the French word is cachet) that looks official and they probably don't care whose it is. The next day the job is done and the day after that he takes the three-hour trip to the Senegalese border where I meet him and we hug and chat over coffee at a roadside stand. Then I ride to Zig...again. This time I pass, in addition to the customs and police and army checkpoints, and cows, chickens, monkeys, baboons, a large, heavily armed army patrol. There is an armored car with its huge gun, 50 meters further a technical with its .50 caliber, and another 50 meters on another armored car. Armored cars are like small tanks only with wheels instead of tracks. On either side of the road is a long file of soldiers in full combat gear, helmets, armor, carrying M-16s, grenade launchers and RPGs. I wave and give them the thumbs-up. Normally, soldiers will grin and cheerfully return the wave. Not this bunch. They are on serious business. A few nod but this is in deadly earnest. Soldiers have died recently in ambushes and battles. This is no drill. I pass on.

 

 

At Ecobank, the manager examines the stamps minutely. They are acceptable. Then he explains to me that I need to bring him the constitution and by-laws. Whoa! I say. Couldn't you have told me that before I made another trip? Well, he says, we only found out about it after you left the last time, he says.

 

You have my phone number. Couldn't someone have called to tell me?

 

Yes, he concedes, we should have done that but you (meaning me) should have known.

 

Known what?

 

Known we would want those things, he points out.

 

My lip is in shreds by now.

 

How was I supposed to know that? It is your bank and your rules.

 

You should have known, he insists. (Mea culpa! )

 

 

OK. Thank you, I say. My voice is rising. Under my breath I say, And get stuffed you little son of a bitch!

 

As I am getting on the bike he comes out of the bank. “And bring your official stamp,” he tells me.

 

It's in The Gambia.

 

Well, I must see it. You must bring it.

 

Like hell I will! We're done, you [censored]er! I say to myself.

 

 

I am hotter than the motorcycle engine on the ride back to Bignona. There, I make a snap decision. There is a branch of a different bank there. I go in and explain what I want in English and French to the bank manager, a very dark man with a huge belly. I show him the documents.

 

No problem, he says, and shepherds me to a kiosk with a pleasant young man. For an hour we fill out interminable forms in various colors. We paste three mug-shots of my face into various places, include various documents, sign, counter-sign and cosine trigonometrically. I give him the precious banker's acceptance, which holds the promise of a water system for the clinic at Sintet village as well as a new solar pump for the hospital in Kafountine.

 

 

Today I return to the new bank. We can not accept this, he says, waving the banker's acceptance. It is not from one of our partner banks.

 

Dear Jesus! I want to curl up and cry.

 

I take the banker's acceptance and all my papers and my ulcer and ride to Ziguinchor again and find the headquarters bank. I ask for the manager. I am directed to a chair outside an empty office where I sit for ten minutes reading a back-issue of Scientific American my sister has sent me. Eventually I figure something is wrong when a very, very young man comes into the office. Are you the manager? No, I am a cashier. I asked for the manager. Well, the manager's office is that way. He points.

 

 

Down the hall, the manager, a tall, portly, bored-looking woman is busily chewing gum. Unsmiling, she opens the door for me and points at a chair. She does not greet me or introduce herself. I tell her who I am and my mission. She appears signally unimpressed. She examines the documents, which by now are getting limp, and we banter good-naturedly back and forth about my problem.

 

No. That didn't happen. That's wishful thinking on my part. I am not feeling good-natured at all. I have to convince her that it is possible to do this. That I am looking for someone who can tell me what CAN be done, not what can't be done. That's why I came to her bank instead of the people I had been dealing with.

 

 

This really makes a big impression. She sends me upstairs to a secretary. She makes several phone calls. She tells me no it can't be done. She tells me yes, it can be done, but it will take 25 days. She tells me the endorsement doesn't have a stamp. (Lord help me! We're back to stamps again!) I tell her the stamp is in Banjul. Shesaysithastohaveastamp. IaskherwhereIcangetastampmade. ShethinksI'mjokingandlookspuzzled. Iamgoingcrazyhere. Iamgoingcrazyhere. Iamgoingcrazyhere. Iamgoingcrazyhere. Iamgoingcrazyhere. Is this the mad hatter's tea party? Will Toady show up in his motorcar? Did someone slip windowpane into my coffee?

 

Remember what the dormouse said!

 

 

I find myself sitting in the hot sand next to my gently ticking motorcycle. I am a nearly-sixty-four-year-old doctor and I'm sitting in the sand in a side street of a decaying colonial city in West Africa getting nowhere and I have the solution.

 

I will give the Banker's Acceptance to Ebrima and we will deposit it in the WAME account in the same bank it came from. We will keep the money there and disburse it from there. It will be cumbersome with me being in Senegal, and we lose the $109 it cost us for the BA. But it will be done. And there should be no problem with it. We could have done it cost-free if I had thought of it sooner.

 

 

Remember what the dormouse said.

 

 

--

David Levine

Make a difference! Support WEST AFRICA MEDICINE & EDUCATION Check out our website at www.westafricamedicine.org

[chrisolson]

Not much you can say except ... WOW !!!

 

 

On a more positive note, a critical and interesting observation that creates a powerful mental image (italics mine) ...

 

 

"Twice I've intercepted a very large troupe of baboons crossing the road. Probably more than fifty in that bunch. Babies riding on mother's backs clinging on either side with a tiny fistful of mom's fur. The dominant male is the last to cross and stays on the verge, staring back at me darkly from deep-set brown eyes. He is a formidable chief and takes his duties seriously.

[yabadabapal]

Thanks for sharing that Whip. Im actually so stunned from this story that I cant think of anything to say.

[Selden]

Straight out of Kafka. I'll have to see if I can find Doc's book.

 

Where are you getting these fresh blog posts? It looks like http://toubabdoc.blogspot.com/ hasn't been updated since 2009.

[Pilgrim]

Doc's been a friend for a fair number of years now. He's weird, and that's a good thing.

 

I have never known another person who could sing The Internationale from memory.

 

Pilgrim

[1MPH]

I complain if I have to wait more than 20 minutes at a bank over here. WOW Doc you are a saint.

[Paul Mihalka]

As I lived for over 30 years in South America (Venezuela) I can relate a little to that, but not nearly that bad. Here in the USA we don't realize how good we have it. I do.

[hANNAbONE]

mY bRUTHA Doc can also whack down some pretty serious stout ales, too.! DAMHIK

 

Kudo's to you my friend and thanks Leslie & Whip for supplying us with these important updates.!

[doc47]

Well, shucks, folks. T'weren't but a normal sequence of events here in Wonderland!

 

Did I mention about the rear-fanged African Beauty Snake I found in the living room? Lovely creature.

 

Anyone interested in purchasing a book....or several....should drop an email to Geoff Blanthorn at velogb@lycos.com. He'll tell you where to send the check, shipment of bullion, Banker's Acceptance, or deed to land in San Diego.

 

AND I want you all to know Hannabone has no concept of my capacity. He disposed of 4/5ths of every pitcher we ordered at Terminal Gravity Brewery. I never had a chance! I can't figure it out. He never stops talking....and still manages to outdrink me!

 

Pilgrim, next time I'll regale you with the Trotskyite parody on the Internationale.

[Francois_Dumas]

Alright, I wrote Geoff, lets see if this works :-)

[Pilgrim]

Pilgrim, next time I'll regale you with the Trotskyite parody on the Internationale.

 

And I'll accompany you on the guimbarde.

We'll sell tickets.

 

Pilgrim