Doc’s Stories from Africa

I met ‘Doc’ in the flesh in Benicia, CA, near San Francisco, last year on the ‘BMW Party’ that Jacqueline and Richard threw for ‘us’ BMW Sports Tourer riders and forum members. David Levine, Doc, is living in various parts of north-western Africa, voluntarily helping local people with his medical skills. I have admitted it before, I oculd never get myself to do that. So I truly respect him.

I promised David to publish at least some of his reports, or blog posts, that he sends from down there. It is the least I can do, and it is very interesting reading too. David also wrote a book about his adventures in the area that you can buy from my webshop. All proceeds go to Doc and his volunteer work in Africa.

Senegal Log

May 4, 2011
Daily Bread

Isatou, who keeps house for me, left half a fish – the front half, with the bumpers and headlights – and a salad for my evening meal. The fish had been nicely fried and, while not being quite as delicious as when hot, was, like chicken, mighty delectable cold. I looked at that cold, stiff fish on my plate with it’s now-opaque eyes and I said, “Thank you.” to the fish.

Rock Star

A young mom showed up this morning on the porch with two small children; one in arms and the other standing wide-eyed and amazed. The one in arms, a luminous-eyed three-year-old, had a strip of cloth wrapped around his right foot. With Malang, the gardener and Isatou as onlookers, we unwrapped the child’s foot to find either a burn or scrape just above the 3rd, 4th and 5th toes. It was well-infected with blackened, necrotic tissue between the toes and a crust of dried sand and…well, whatever. You get the idea.


So, after a soak and a wash with soap got everything a little cleaner, with Mom and Isatou pinioning the little guy, I proceeded to debride the dead tissue. Everywhere I touched blood began seeping. It hurt and the kid let us know it hurt. I used the tweezers and tiny iris-scissors from a vanity kit I picked up free at a medical meeting years ago. Funny how some of the most seemingly insignificant objects can be so valuable for so long!


It was traumatic for the little guy and probably no less traumatic for the rest of us. I applied a generous dollop of Neosporin, while murmuring a prayer to Psoriasis, god of dermatology, that he won’t have a reaction to the neomycin component. This caution – neomycin sensitivity – is one of those things that they warn you about in medical school but I have yet to ever see a case of or know anybody who has seen a case of. It may be one of those things that happened to somebody in the foggy recesses of the past and has come down as gospel ever since. There are many examples of these knee-jerk medical urban myths but doctors continue to pass them on as gospel.


Then came the dressing. I found a packet of gauze two-by-twos to separate the toes, but what to wrap it in? No gauze roll. No Kling. I rummaged in my drawers and came up with a black bandana from Joe Cocker’s ranch in Colorado. It sported a silk-screened full-dress Harley and I’d been saving it in new condition because I figured it would be collector’s item some day. At this moment I looked at it for a minute, then said “What the hell!” and cut it into strips. Foot bound, I gave him 50 francs to buy “mintys” for himself and his brother. I’ll see him tomorrow for a dressing change.

Thanks for the gift bandanna, Joe!
John McPhee Redux

A ways behind my house is an orchard of towering mangoes. New growth and old growth on the same tree are sharply differing shades of green and, just now loaded with pendulous, rose-and-green fruit on the ends of long, dangling stems. The colors are heart-stoppingly vivid.


Between it and the house are two or three rows of citrus: mandarins, lemons, and oranges. No grapefruit for some reason. The mandarins and tangerines, and tangelos are long-gone but two trees of oranges closest to the house still have extraordinary fruit. They must be a juice orange of some variety; perhaps valencias. (That name always sounded noble.) Oranges, despite the name, don’t have to be orange to be ripe. These fruit range from orange to green to a shiny, leathery brown! They are juicy, sweet, and clear. “Afternoon of the Faun” for the taste buds.

I will miss them when they are gone.

Years ago, John McPhee wrote a great little book called Oranges. It is a lovely read and very informative. Sometimes, reading about something one takes for granted, something commonplace, brings a whole, fresh perspective on one’s day. My friend, Steph Farber, the Unofficial Mayor of the Theater District in Tacoma, introduced me to that book, and to John McPhee’s writing.   McPhee’s other books are well worth-while. Thanks, Steph! You’ve always had great taste!


My ex used to make a Guinean recipe – Republic of Guinea, not Guinea Bissau, for you geography mavens out there – that she called “ebeh”. I am familiar with the ebeh made in The Gambia which is based on a recipe from, if I’m not mistaken, Ghana. It is a seafood chowder with crab, other fish, cassava (manioc), hot pepper, black pepper, lots of lemon or lime juice and palm oil. Its sharp, citrus taste combined with a bite of hot pepper balances out the fullness of the palm oil. Ebeh is often made for special occasions, like naming ceremonies or weddings or is sold on the street for treats.


The Guinean version Binta loved to make, and that I loved to eat, was completely different except for the palm oil. Palm oil is squeezed from the fruit of the oil palm and has been a staple of African diet for thousands of years. The fruit can be red, white or almost-black, but only one color to a single type of oil palm, thank you. It is soaked, boiled in 50 gallon drums over a wood fire, then the men pound it to a mash with big, wooden pestles. (Watch out for the guy with the big pestle!) After that it is pressed for the oil. Good-quality palm oil has a lot of sediment. Around here it is laboriously made by Balanta tribespeople from Guinea Bissau.


Palm oil forms a basis for the Guinean recipe and the rest includes dried, smoked fish, ripe mangoes, a bit of hot pepper, and lime juice. The combination of the sweet mango with a smoky atmosphere was startling but quickly became addictive.

She left me in November. I sure do miss that ebeh!
I’m being a wise-guy. I miss her, too!
* * *

One by-product of passing into one’s sixth decade is that surprising things pop up on your skin. Liver spots, varieties of sun-damage, the melted-wax-looking things called seborrheic keratoses, cherry nevi looking like a single raspberry pip. I developed this “thing” on my lower back that was initially quite inflamed though not infected. Gradually it hardened and condensed until it was the size, shape, and consistency of a pencil eraser. I still don’t know what it was but tender, it was. I put up with it for several months and finally went to the local clinic and asked one of the technicians if he’d remove it for me. We made a date for the next day.


I brought my own Neosporin and dressings. At the clinic pharmacy we purchased a syringe, local anaesthetic, Betadine and needle and suture. They had me lie down on the grotty exam table and cleaned the site with the Betadine. The lignocaine (lidocaine) was injected (ouch!), the pencil eraser excised with a scalpel blade, and the divot closed by hand with a curved needle about 3 inches long and some sort of absorbable suture that is only marginally appropriate for skin closure. But, it’s what they had!

It was all over in twenty minutes and the bill came to less than $6. Beats Medicare!

Digital Doo

I am so starved for any intellectual sustenance. I spend 50% of my waking hours reading. The scary thing is that it’s difficult to get books in English. And this place is impoverished even for decent books in French! Even in the schools, textbooks are rarely used. They simply aren’t available. The teacher writes the day’s lesson on the board. The class copies it meticulously into their notebooks, then they memorize the material. I doubt there is a lot of discussion or debate.


I’m working my way through a half-dozen Scientific Americans my sister, Shari, sent me. And some old copies of New Yorker. That was my mother’s favorite. She said that in all the years she had been reading that magazine she had yet to find a typo. Not one. That may not be a tribute to the literary heritage they’ve fostered but it does make a statement about their anality.


 Two of my all-time favorite LPs — Yes, those are those vinyl platters we called records. Remember them? – are Stan Freeberg’s The United States of America, Part 1. The other was the second album of Michael Flanders and Donald Swan, At The Drop of Another Hat. I don’t know if Donald Swan is still around but Mick Flanders died in 1975. They were famous for their songs, especially The Hippopotamus Song, The Gnu, Have Some Madeira, My Dear, were witty, sophisicated, multi-layered, and subtle.


Which puts me in mind of the book I’ve been rationing myself so as to spread the enjoyment over a longer time. The Most of The Most of S.J. Perelman is as thick and delightful as Friar Tuck but nowhere approaching the good friar’s broad humor. Instead, this most literate of commentators constructs multi-dimensional strata of humor with a nonchalance that inspires admiration and envy. He ranges from allusions to ancient literature to the most modern of (his) times. Steve Martin edited the book as part of a series on humor and humorists. Perelman was a gem, multifaceted, polished, elegant. They don’t cut ’em like they used to.


I am only just beginning to try to find ebooks. It looks like you can have what you want for free if the book is more than 75 years old or so, but keeping up with favorite contemporary authors (Ian McEwan, Wm. Boyd, Jhumpa Lahiri, Natalie Angier) requires funds…and, I think, one of the ebook readers. Kindle won’t (doesn’t?) work here but I’m discovering there are other readers that can be fueled on the computer. I’ve got to investigate the e-collection at my library back in Port Orchard, Washington. (And remember: WASHINGTON does NOT contain an “R”!

Expired Drugs

I wonder if the expiry dates on many medications are gratuitous. They are there because some government regulation ended up written in stone instead of serving as a guideline.

It is a fact that many medications are effective and safe for years after their expiration date, just like canned goods. I’m sure the pharmaceutical industry itself benefitted as a result. The old stuff has to be throw out, even if it still works, and one has to buy fresh stocks. It may be a good idea but it is applied inflexibly. And that is contrary to nature, whatever that is.


Third World nations are very sensitive about the West “dumping” out-of-date medications on them. And the people (at least in The Gambia) are very Expiry Date-conscious. They think they are getting stuff that isn’t any good or might even be dangerous! They think the Western companies that send the medicines benefit from it directly. Maybe there’s something to that.

It certainly heightens their cynicism and paranoia about white people and the relationship between the haves and have-nots.[1]

May 5

The little guy came back on his mother’s hip this morning, all smiles, no bandage, foot filthy. The infection looked better but the wound was packed with sand. We did another soak and washing and then the poor tyke had to be held down so I could do more debridement. I cut away a couple of square centimeters of dead skin to a concerto of screaming from the boy. Glopped the whole thing up with more Neosporin and used what was left of Joe Cocker’s do-rag to fashion another covering. Things would certainly be easier with real bandages.


I was in town last week when there was a sudden commotion in the streets. Drummers and people dancing, young men dressed comically as women and young women in men’s outfits. Male dancers in baggy, colorful pantaloons with bandoliers of beads crossing chests and shoulders and everyone celebrating and having a great time.

“Qu’est-ce que ce pass?” I asked my companion.
“Initiation”, he told me. “The small boys have come back.”

The six- and seven-year-olds have been “in the bush” being instructed in the arcana of how to be Jola men. They have also been circumcised. During their time in the bush the village has been visited by kankuran. These are forest spirits, shaggy orange from head to paw and armed with two “coup-coups” (machetes) which they will use on anyone trying to interfere with the initiation in any way, or even showing disrespect.


I was in a restaurant on the main street one night when the word came that a kankuran was coming. Lights were doused. Curtains drawn. People peered out the windows cautiously, ready to pull their heads back in should the spirit appear but none did and after ten minutes or so they turned the lights back on and resumed drinking their Gazelle beer.

My brother, Essa, told me that when he was initiated he saw a kankuran disappear and reappear in the top of a tree.

But today the boys are back. They are cheerful and playful and pleased to be at the center of things. One of the families in town is sponsoring them and a bull will be killed and shared in their honor.

No such fuss is made of girls, mind you. When they are taken away to be “circumcised” it is done quietly by the old women and is never spoken of, at least not to men.

Qat Quandary

There are a tribe of black and white cats around the neighborhood. Holstein cats[2]. There’s one sweet but promiscuous mama cat who lives near the Big House somewhere who is responsible for the abundance. They come begging at lunchtime and dinnertime. Yesterday a new one showed up. Thin, but healthy- looking with a deformed left foreleg.

On closer inspection it turned out the leg wasn’t deformed, it was broken. Badly. At the elbow with a sharp piece of bone sticking out. We’ve got more than enough cats around here and my first thought was “put it out of it’s misery”. There’s no way that leg will heal. It will infect and die and the cat will die a lingering death along with its mauled forelimb.

But the cat doesn’t appear to be in any misery. It gets around just fine and this evening came up to me and insisted on being petted with such powerful urgency that I was amazed. How could this be?

Few people ken to the suffering of animals here. Most of the dogs have had at least part of their ears eaten off by flies. Donkeys are regularly beaten by their drivers. Animals aren’t named any more than one would give a pot a name.

And so I am torn. Should I try to surgerize that mangled limb? Amputate, perhaps? I’ve known plenty of three-legged cats and dogs who lived dog’s years. Let nature – whatever that is – take it’s course? At the least, I could take off that jagged spur of bone so the wound could close.

Qat Redux

That stupid cat refuses to die! In fact, he is ravenous, healthy, and ignorant of my predictions and expectations. Butt-head appears at mealtimes, head-butting my ankles to let me know he wants a portion of whatever I’m eating (He doesn’t like bananas.) Meanwhile, the shattered remains of both foreleg bones protrude from his right elbow, surrounded by blackened tissue, and he could care less. His pale, yellow eyes are bright and his fur is sleek and groomed.

I’m sure there is no vet anywhere in the Casamance, even in the dusty, hot, crumbling colonial “metropolis” of Ziguinchor. I am very tempted to find out how to anaesthetize the cat and do an amputation.

This is really dumb! There are so many children here whose families can’t afford medical care. What am I doing worrying about this cat?

[1]I highly recommend the novel, The Constant Gardener. Tough to put down!

[2]My old college roomate, Michael B. Jennings, told me the Oklahoma State Police cars used to be black and white. Maybe they still are. They were popularly referred to as “Holstein Fords”. Maybe you have to grow up in the country to appreciate the humor.

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