(August, 1995)

Come along with me this Monday morning on my weekly trip to our clinic at Tilden Fulani.

The quarter mile from the house to the gate of the hospital compound is the bumpiest part of our journey. After greeting the gate guards and waiting for a break in the busy traffic, we turn right and head into the center of town, then onto Bauchi Road, leading us by the University of Jos. As usual there is a police checkpoint at the edge of town, one of four we'll pass through on the way. Most of the time they just wave me through, or ask where I'm going.

Now we're on the open road toward Bauchi and the northeast. It's a two-lane paved highway that has seen better days. Parts are still in good condition, but there are treacherous potholes, and whole sections that are deteriorating. You can see what a beautiful view we have as we wind down off the top of the plateau. Fields, green hills, and odd rock formations stretch off in the distance. Farmers are on their way to the fields, carrying their hoes on their shoulders. Fulani herders drive their cattle toward the best grazing, and here and there women are roasting ears of corn to sell to passers by.

Here we are. This little mud building is the clinic, not much bigger than 15 by 18 feet, with three rooms. A few patients are waiting, perched on the low porch wall or sitting on the wooden bench. The two health workers, Kate and Rhoda, come out to greet us. They're here every day, while I come weekly to supervise and see the patients with more difficult problems.

This, the first room, is the medication room. A small table in the corner is covered with containers of medicines--chloroquine for malaria, antibiotic tablets, antacid, pain relievers, vitamins, allergy pills, a variety of syrups for children, and others. A bucket of clean water sits under the table, as there is no running water.

Duck as you go through the door into the exam room. There are three chairs, but one is missing a leg, so I know you won't mind sitting on the examining table, and I'll sit on this little cabinet. I start by reviewing some of the past week's patient records with Kate and Rhoda. "Look at this one," I say, "a 24 year old woman with fever and headache. I'm very glad you gave her oral chloroquine only, and no injections. That's great." One of our problems is that many patients (and even health workers!) prefer injections to oral medicine. They think the injection is stronger, much the same as North Americans tend to think of any prescription medicine as better than over-the-counter products.

Health worker Kate Achumba examines a child in the clinic.

"But here is a patient with an old wound, two weeks old, and already healing, yet you gave penicillin injections. Do you think that was really necessary?"

After discussing a few cases, it's time to call the first patient. It's a nine-month old boy with fever and diarrhea. He was treated in the clinic Thursday and is improving. He is underweight, though. "What are you feeding him?'' Like most children his age, he is only eating a starchy corn gruel, "pap.''

"Mama,'' we explain, "your baby needs more to eat, especially body-building foods, like beans, soy beans, and spinach. And you should give him food at least four times a day.'' But poverty and tradition conspire against our advice.

Next is a very old woman complaining of general body aches, and episodes of shaking of her whole body. She doesn't speak Hausa very well, and it's hard to tell whether she is describing chills, seizures, or something else. We call in a relative to translate into her language, but it is still unclear and the relative doesn't know any details herself. Well, it's a problem that has lasted for many years already, and the woman looks pretty healthy, so we decide to leave well enough alone. We just give her a pain reliever for her aches.

Not many patients come in one morning, maybe 8 or 10. It's farming season so people put off medical care in favor of working the land. Also, this clinic was in a way rescued from the brink of collapse only a few months ago, so the number of patients is only gradually increasing.

In the rest of the morning we see a little girl covered with scabies, a reticent 15 year-old bride for a prenatal visit, a woman with itching eyes, a child with malaria, one with pneumonia, a woman with tuberculosis, a pastor with asthma, and a woman bitten by a possibly rabid dog. Finally we're done. Sometimes we have to refer patients to Evangel Hospital for tests or more advanced care but not today. So I make a list of what I need to bring next time, tell the workers good bye, and we head back to Jos.

I am no longer involved directly with the Community Health Program itself, but this work does go on much as described here.