The Clinic

     I walk in every morning to a full waiting room. Forty small villages depend in this poste de santé for medical care and we will work until they've all been seen. General cases wait for the nurse, pregnant women and new babies wait to see the midwife.

Each patient first buys a ticket. Adults pay about $4 USD for their consultation and any prescriptions. "The government set this price", the nurse explains, "it doesn't always cover even the price of the medications to the clinic."

     After waiting their turn, sometimes 10 minutes, sometimes 2 hours, patients come in to see the nurse. Some cases are simple. As soon as a patient walks in the door: "le palu." Malaria. Other cases require a bit more investigation. Without much in the way of diagnostic equipment the nurse prods stomachs and feels lymph nodes, divining the source of illness from touch alone. 

Everyone gets a prescription for something. Vitamin C, quinine, iron, amoxicillan, ciprofloxin, ibuprofen. The orders are filled by the broadly-smiling pharmacist from the small dispensary. 

Any injections or minor procedures are performed by a trio of technicians. Each is a master at distracting children from large needles and knows exactly who needs their hand held for a moment. Masta, masta, I know, there, there.

     Like a trail of ants the patients weave through in this pattern. Most days there's a predictable rhythm. A couple malaria cases followed by an upset stomach then a scrape and repeat. 

Interspersed throughout the usuals though are cases that are more indelible in my memory. There are the victories I cheer in my head. Every vaccination is a win. The mothers who make every prenatal consultation then deliver a healthy baby with the supervision of a matron make my heart sing. A significant drop in this year's malaria cases shows the success of last year's educational campaigns.

Some cases, however, do more to shake my faith. A small child was brought in so sick with malaria that she could do little more than moan in pain, her fever was so high we surrounded her with ice packs. "She's been like this for days. Why didn't you bring her in sooner?" the nurse demands, "We could have spared her all of this."

      There was the 8 month old baby so malnourished that she was barely bigger than a 2 month old. Her mother stopped breastfeeding at 2 months despite the midwife's careful instruction. 

There was the miscarriage and the moto crash and the beaten pregnant woman and the old man who collapsed and the too-quiet baby.

      I sit and watch them all pass by, proffering a smile or a furrowed brow as required. Maybe a quick question here or there but mostly I have settled into the background of the clinic. I can't help much but I can learn and I will show up there tomorrow to see who's waiting.

A note: I've finished my internship phase for this semester and am back in Dakar but wanted to post some things I'd written in Keur Samba Guèye when I was without internet.