Mes chers amis et ma famille,

A father brings his almost 4-year-old to see me for a third seizure. The father is dressed in traditional Muslim attire for which I have not yet acquired the vocabulary to describe accurately, and during the history, he mentions that after the most recent seizure, they took their boy not to a hospital but to a medicine man who was able to abort the seizure by making some sort of beverage from the leaves of a plant. Yet due to the seizure’s recurrence and increasing duration, he says they are coming to me in the hope that I might be able to help stop the seizures.

Despite the boy’s cuteness, he eyes me with distrust from the moment he enters the room. I offer him the dinosaur-shaped reflex hammer I’ve brought with me as a means of pacifying small children, but throughout the interview he sits silently planted on his father’s lap, rarely looking away from me – until the moment he realizes that I’m going to examine him, and he begins sobbing, becoming hysterical. It dawns on me that he is afraid and that I am the first white man he has seen, but I share a laugh with his father and the resident translating for us. After crouching to his level, playing with bubbles I’ve also brought, and demonstrating what I’m going to do first on his father, I am still unable to win him over, but I’m at least able to get him to cooperate enough for the exam.

Later, as I’m preparing to head out for the day, I run into the head of the neurology department again. He briefly asks how I am and if I have seen the pediatric unit yet. When I respond in the negative, he summons someone with a rapidity almost like he’d snapped his fingers, and suddenly I have an escort over there. Our conversation lasts for less than a minute. My escort, one of the neurology interns, speaks little to no English, and so we rely on my French. The pediatric unit is located across a small courtyard in the north block of the hospital; as we leave the neurology ward and cross outside, he points out several other units to me: cardiology, otolaryngology, physical therapy, and the maternity ward. Upon entering the building where the pediatric unit is housed, we run into a man who appears to be the head the department of pediatrics. My escort introduces me as a doctor from America. Following a cursory introduction in the hall, I’m shepherded upstairs and into an office opposite the second-floor landing. 

Inside, there’s a spacious room featuring a wooden desk and a rectangle of leather couches. I take my seat on one of them and the intern sits beside me, the pediatrician sitting opposite us in a rolling chair he pulls away from his desk. As no one else in the room speaks English, we speak French. I do my best to understand his introduction and explain my purpose for coming here. Among the many words in his response is the French word for meningitis, to which I assent enthusiastically. I hope that I have been sufficiently understood. He asks me if I want to start right now or tomorrow; I ask for a tour of the pediatric unit and state I would be happy to come back tomorrow.

He leads my escort and I down a corridor on the second floor, which is flanked by a series of rooms housing patients with various illnesses. The rooms are organized by age and diagnosis, with the younger children downstairs. At one point I ask what kind of patients they see here, and I can tell from the slight frown with his response that this was apparently a silly question. He shows us down the hallway, pausing only to point out the disease shared by each room: in one room, there are children with tetanus; in another, several children with a diagnosis of “coma” appear frozen in their bed; at the far end of the corridor, there is a room where he tells me they’re treating children with tuberculosis, and I instinctively pull away from the open door, used to a hospital where such patients are kept isolated in negative pressure rooms. As we hurry back towards the stairs and down to see the patients on the first floor, I see a mother in one room administering a soup for her son through a nasogastric tube. Another resident had told me earlier that they don’t have enough nurses for all their staffing needs, and so the hospital relies upon sharing the caretaking burden with families, who seem to almost move-in to the hospital with their family members.

We reach the first floor having acquired several other residents to our tour group. There are introductions but it’s hard for me to say very much. At the far end of this corridor, there is a closed door that leads to the NICU, which I’m told is not currently operational because they’re having some issue with their oxygen tanks. As the pediatrician explains, he points to a duo of giant blue canisters through a window. Every time he finishes speaking, the intern has a way of parroting back what he says to me in French, which I assume is supposed to be for my benefit. I want to tell him that I’m not stupid, I just don’t speak French, but I only nod. At the apparent end of our tour, the pediatrician asks me to come back and work tomorrow. Sensing I’m getting roped into something different than what I came here to do, I explain again as well as I can that I came to do research on patients with meningitis, and I would be happy to see these patients, although my lumbar puncture kits have been indefinitely confiscated at the airport. I cannot tell from their response whether I have been understood, the meeting ending suddenly and the pediatrician going off to do some other thing.

The intern leads me outside and back towards the neurology unit, which borders the public road that separates the north block from the south block of the hospital. As we walk, he tells me that the emergency department and the rest of the medical units are across the street. When I ask him if I can see them, he laughs. I ask him why this is funny and he shakes his head; I assume I’ve made another grammar or pronunciation error. We make our way across the busy street to the gate of the south block, where there is another line of patients and a man standing by the door. As I follow the intern past them, the man greets me with an air of genuine warmth. 

After a brief tour of the ten-bed ED, the intern leads me back outside and I realize that the south block is far bigger than I had thought. We pass under an archway I couldn’t see from the street and into a series of courtyards that are bordered by two-story buildings, each connected by a walkway. He points out more units to me: trauma, pulmonology, urology, hematology, surgery… I ask him questions as we walk and after a moment of mutual laughter our conversation begins to feel friendly. I ask him how many patients the hospital sees a day and he isn’t sure. We pass a building thrust to the far corner of the block and partially covered by trees which he tells me is the morgue. I ask him how many patients it sees in a day and he isn’t sure either. 

Everywhere we go in the south block, there are patients and families sitting on the ground or standing against the walls. It doesn’t take long for me to realize that nearly every set of eyes is upon me, and it’s hard not to feel uncomfortable. If I happen to make eye contact with one of them as we pass, I say hello, and they’ll say hello back to me. We run into other residents he knows, and when he introduces me, each conversation goes something like this: how are you, my name is so-and-so, thank you, and then they begin asking questions at a pace I can’t keep up with. When I say I’m sorry but my French isn’t very good, it feels like they keep on laughing and then turn back to the intern to say something that concludes the interaction. At one point we enter somebody’s office who feels extraneous for me to be meeting but I get introduced to anyways, and when he asks me how I am, I stumble and say thank you. A grin spreads across his face that lingers when he turns back to the resident that this time does make me feel stupid.

I’m glad to have seen the whole hospital, but by the time the tour concludes, I’m ready to be done, I’m ready to go back to my hotel, and I’m ready to communicate with somebody I know in a language I understand. There’s a steep learning curve traveling to any country and trying to navigate the cultural differences – that’re always surmountable but nonetheless present – and after two weeks here, there is still much I don’t understand. Yet as I know that the medical community here has scarcely had a guest like me, it must be challenging for them, too. I just hope that this will continue to be a positive experience for all of us, but on the more trying days, all I can do is remind myself of why I came here and keep trying to do the best I can to make the most out of this experience.

I remain well, and I hope you do, too.

Bien à vous,

Le Gringo

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