Volume 4, Issue 2 – Summer 2012
Peter de Schweinitz, MD, MSPH
Tanana Chiefs Conference, Fairbanks, Alaska, United States
Photography by Jeff Attaway
At first take, Susie was not the ideal nurse for a medical mission to Liberia. Though friendly, smart, and adept at inserting an IV, she had likely never sat quietly by a stream and read Zen and the Art of Motorcycle Maintenance, Things Fall Apart, or even Shakespeare. And though she was undoubtedly familiar with cultural sensitivity, I was unsure that she fully grasped the notion or that she cared to ponder its applications. Preparing for departure, I worried that Susie was an American bowling ball whose pins would soon be the people of West Africa.
Young doctor and middle-aged nurse, we made home together in a tiny village in Grand Cape Mount County, which abuts Sierra Leone. While the locals slept on mats on the dirt floors of mud-walled dwellings, we slept in the comfort and safety of a 1200-square-foot, American-style home with faux-tile floors and a refrigerator. A “house boy” (really a grown man with two wives and a few young children) hauled water from the stream to be used in our shower. The cook, a large woman with a colorful head-wrap, ignored our gas stove, and instead, prepared our meals outside, over an open fire. And a tall, bamboo fence and three guards (one by day, and two by night) gave us the gift of a sound sleep at night by protecting us from whatever violence might be left over from the war. The head guard, Marvin, dressed like the other men—in shorts, tennis shoes, and a baseball cap—but unlike almost everyone else in the largely Muslim village, he was Christian.
Perhaps he entrusted us with his story because he assumed we were his people. After all, we worked for a Christian charity. “One day the soldiers came into the village,” he started. I pictured a pack of drugged-up children and adults dressed like urban gangsters, brandishing rifles and machine guns. His father, the chief, was just coming home from the fields, machete in hand, when the motley band arrived at the market. “My father stepped forward to face the soldiers—he was the chief,” Marvin continued, “But they shot him dead. Then they cut off his member and laid it next to his head.” I did not doubt his disturbing story—from the shelter of charity headquarters in Monrovia, we’d heard dark rumors of child sacrifice and the ritual consumption of human hearts.
A twenty-year-old living in the capital at that time, Marvin returned home only to become deeply depressed. “I felt like I had a big darkness in my chest,” he shared. Unable to find relief in the Islamic practices of his childhood, he began to pray the way the Christians up the road taught. “The darkness, it lifted from my chest,” he said. For a moment, his eyes lit up with the enthusiasm of his spiritual healing. Then he quickly turned somber. “Because I converted,” he said, “the village would no longer make me their next chief.”
As Susie shook her head with indignation, I felt my heart sink and expand into an imagination of my own father brutalized. Later that evening, Susie, still contemplating Marvin’s injustice, called out to me from her mosquito net. “That’s just horrible!” she said.
I pulled a toothbrush out of my mouth. “Isn’t it?”
“What can we do?” she said, insistently. I stuck my brush back into my mouth and clapped a mosquito.
“I don’t know,” I said, rinsing the insect off my hands and down the drain with some water from a bowl.
Later that night I shut my book and placed my flashlight in the fold of my net. After giving the zipper an extra tug to ensure full closure, I lay on my back, reflexively considering the role of medical missionaries in an unfamiliar land. From where I stood, we had just accomplished on the porch the only thing that could be done for this kind of problem. We had borne “silent witness” to what could not be reversed. The idea of foreigners swooping in to actually do something beyond bandage wounds struck me as hubris.
The next morning I arose, showered, and ate cereal with milk. The eight-member team gathered outside the front door and rode off over a broken road to yet another remote village, where a hundred-patient queue awaited our care. We set up a row of card tables—two for the Liberian nurses, and one for me—and then called the first three patients into the single room. The work was sweaty and fast, but mostly simple. In the evenings we slowed down for a few hours of free time in the cooling air of our home base. While I spent my leisure reading religious philosophy or Liberian history, playing soccer with the youth, and praying at the mosque, Susie hung out at the house, often chatting with the guards, ever ready for action.
If a mother showed up at the bamboo gate, a limp baby folded into her chest, Susie revved up. “Go get Charles!” she would call, and a guard would search the village for the driver. Zooming past rubber plantations, mahogany and palm oil trees, ex-child soldiers, military checkpoints with their peacekeeping tanks, the broken railroad, and finally the mortar-pocked buildings of the city, the white Land Rover would take us the hour-and-a-half drive to one of the country’s few functioning hospitals, which had been restored by foreign charities like Doctors without Borders.
Tunneling through acrid halls, the smell of vomit on the nose, we would find a Liberian nurse who was invariably preoccupied with her children. “This baby is dehydrated and has a fever,” I, the doctor, would say, and then rattle off a brief history. She would glance up and shoot us a weak smile: “Okay. We’ll take care of him.” As we rode off again through the night, I often wondered just when that “care” might happen.
The next morning Victoria, a Liberian nurse just as boisterous as the American, would chaff, “Yes, Susie, I know the baby was sick, but what are we going to do when you leave?” The way the Liberians bounced hard off their words, it was hard to tell if they were angry. “We can’t run a 24-hour ambulance service!” I would just nod my head at Victoria and then run off once again to Monrovia the next time Susie made the call.
The next morning, Susie would complain to me, in the privacy of our living room. “What are we supposed to do!” she would say, her eyebrows dancing beneath orange bangs. “We can’t just let them die, can we?” I got a feeling that any speech beginning, When in Rome, do as the Romans, was bound to fall flat. Besides, I no longer trusted my own moral compass, which had been assembled in a land of leather couches, tax breaks, and Little League baseball. What stranger knows “right action” in a foreign land?
So I would waffle—“Yeah, they certainly could”—and then take another bite of my cereal. If Susie chose active intervention, I bent toward diplomacy.
It was on the Saturday before my flight home that Susie vetted her plan of redemption. On standard weekly respite from our rural assignment, we were sitting in the front room of company headquarters at the Eternal Love Winning Africa (ELWA) compound—a large village in itself—on the cleanest beach in Monrovia. On the weekends, United Nations personnel in their Speedos and bikinis entered this Christian compound to soak in the hot, West African sun. I had just come in from a swim and now sat in my damp bathing suit on a vinyl chair. Suddenly, Susie leaned across the small table and lowered her voice to a whisper. “I want to buy him one of those traditional white outfits,” she said, “the kind you see in the market downtown.”
I nodded. It seemed, at first glance, a nice gift idea. But her next sentence gave me pause. “You know,” she said, “the kind chiefs wear . . . . What do you think?” As I recognized her intention, I took stock of my objections. But lost in a field of unfamiliar ethics, I did what I usually do when uncertain: I shrugged, smiled, and nodded.
That afternoon after eating pita bread and hummus at a Lebanese restaurant downtown, we bought traditional masks and rugs as we snaked past the teeming under-roof market onto the main street, where we headed up a hill to a string of small shops. A layer of garbage, nearly a foot deep at the low point in the road, served to remind me of the many public services that had been obliterated by the war. No rail, sewage, water, electrical, or refuse, and we had arrived to provide medical care. Surely sanitation is more potent than medicine?
Despite the dirty conditions, Liberian merchants continued to offer up their beautiful wares. In a store no larger than a rich man’s closet, Susie sized up a white linen shirt against my chest: “What do you think?” she grinned. I shrugged and smiled my non-committal approval. I did not offer to pay. That night I lay awake in my bed, imagining how the village would respond, not only to Marvin, but to us, the meddling Americans.
On Monday we piled in the back of the white Land Rover and left the nonprofit oasis and Christian capital for the Muslim north. We stopped in at the house and then followed a dirt road through a bamboo grove to a horde of gleeful children and patient adults. After treating common ailments—backaches, scabies, tinea, dyspepsia, and malaria—we returned through the green vegetation, past the vacant market, and through the bamboo gate. The cook glanced up with no greeting from her wood fire.
After splashing water on my face and downing Jollof rice, I took my skullcap and beads and walked a couple hundred yards across the commons of the village to the mud-walled mosque. There, in the community’s sole house of worship—the only meeting place besides the market, to my knowledge—I stood, bowed, and knelt in harmony with the cleanly-robed men of the village. I felt at the time that these moments of bristling calm were the very reason I’d made this, my first, trek to Africa.
After salat, we smiled and walked slowly across the porch, reluctant to leave. A visiting official from the capital, surprised to pray with a fair-skinned, North American in trousers, asked me if I would be willing to serve as an emissary to the Western world. Both flattered and embarrassed, I knew he had no concept of my inconsequential status in my own society. Still, I gave him the address of the Christian compound—and then worried that he would actually make a visit. How would I explain the visit to my colleagues, who knew nothing of my Islamic leanings?
The local imam, a small man with tranquil brows, walked me halfway home. Over the last couple of weeks we’d sat together on his prayer rug, while listening to a fiery sermon from a city imam, and stood together, helpless, while the muscular youth fought with fists and even a bamboo pole over an informal soccer match at the dirt lot in front of our compound. “I want to learn to read the language of Islam,” he said humbly. “Would you buy me a Koran in the capital?” I knew that he had no money to offer and, though I usually feel uncomfortable with such requests—if I grant one, will the requests just increase?—agreed. “I would be honored,” I replied. What was five or ten dollars to me but a DVD rental on a Friday night?
When I arrived through the gate, I found Marvin and Susie sitting on the two wooden chairs under the awning by the front door. Their conversation suddenly stopped as they took me in.
Then Susie blurted, like a child on Christmas, “Guess what!”
I caught the guard’s eye. He smiled, but I couldn’t read him.
“Marvin wore it today!” Susie beamed. “He wore it and walked through the village!” She said it, as if he’d ousted Charles Taylor.
She’d done the deed, executed her incautious plan.
I imagined middle-aged women carrying water, seated old men chatting at the base of a tree, and children playing in the dirt as a lithe, handsome man, our protector, strolled the single road of the village—not in his usual shorts, American T-shirt, and ball cap—but in the loose-fitting pants, knee-length shirt, and a traditional, tubular hat: a one-man, royal procession. The adults would have immediately remembered his father, the chief, and the son’s heretical departure from glory.
I imagined Marvin sauntering past the astonished, gawking onlookers, mustering his resolve to honor, no matter the repercussions, his generous benefactor’s gift. I hoped that Susie’s brazen act had not further distanced Marvin from his community, or unwelcomed our charity from the village.
“Tell him!” Susie pressed.
I looked down at Marvin’s sneakers, worried about the damage that had been done. When Marvin turned his eyes toward mine, I saw that he was fine—more than fine, really. If I had pitied him for his life story, he undermined my vision with a confident smile. “It felt very good,” he said.
My rational mind, having been trained to avoid the semblance of white paternalism, could not accept his pleasure. “So you just put it on and walked through town?” I said, incredulous.
He chuckled, as if caught between gratitude and amusement at the bold American nurse. Somehow his ballcap and sneakers had hidden a portion of his dignity from my mind. He looked at Susie. “Thank you,” he said simply. When he nodded at me, I deflected his gaze into the dirt.
The next day at dusk the three of us walked the few hundred yards to the opposite edge of the village. As we passed the empty market, children vied for the chance to hold my hands while I checked my pockets for hand sanitizer. Mentally, I compared myself to Susie, who held diarrheic babies to her chest and ate with gusto out of the communal bowl. As we passed a stone’s throw from the mosque, I turned my face away, hoping that my new Muslim brothers, especially the imam, wouldn’t see me with Christians. I didn’t want to lose my new friends, who were certainly the same ones who upheld, by the force of tradition, Marvin’s fall in status.
When Marvin led us off the road, the children fell back. A few yards away, at the edge of the thick, tropical forest, he stopped by a shallow depression. A few years of rain had worked away at the earth’s crust of red dirt, revealing the vague contour of a rectangular box the length of a man. Only a foot or two of ground must have remained over the lid. As I imagined what lay beneath, Susie approached the chief’s son, who stared vacantly, for a moment, over the commons of town. The soldiers would have entered the village with this view. When he glanced back at us, his two foreign friends, I felt pricked in the chest, my pride now completely unhinged by his irrecoverable loss, and by Susie’s active response.
“Would you like to pray?” I said. He nodded, and then the two friends looked at me, as if I were offering my services. Maybe I was.
I said a simple Christian prayer—as my parents had taught me long ago—for the peace of a man, and for his son. When I looked up, Marvin looked pleased. The children were still watching, even more curious now. I smiled at them, but they knew to let us walk back alone.
We arrived at the gate as the last traces of orange dissolved from the sky. Marvin reassumed his role, guarding the compound from petty thieves, ritual sacrifice, and the dark unknown. Susie and I brushed our teeth, changed into our pajamas, and retired to the safety of our nets. I wondered if Marvin ever pondered what might have happened had he, the loyal son, not been away in the capital, seeking his fortune. Could he have changed the outcome? And now that the country enjoyed peace, I wondered if it felt odd to Marvin to provide us the protection that he was unable to provide during the war.
PETER DE SCHWEINITZ, MD, MSPH lives in Fairbanks, Alaska, where for part of the year he practices medicine and public health through an Athabaskan tribal organization, Tanana Chiefs Conference. He also lives with his wife and two children in Utah, where he writes, teaches, plays soccer and basketball, and snowboards. He graduated from the University of Virginia School of Medicine in 1998.