Alumni in action: A letter from Africa

A letter from Africa

by Jeremy Brown, BSc'73, MDCM'77

It's a very long way from the Roddick Gates and a long way from the Strathcona Building.... I remember those times, those places and people. I remember Phil Gold and Wilder Penfield and Mrs. Nelson who tried to teach me English Lit.

Such a long, long time ago. But it is what I learned at McGill that has led me here and has allowed me the life I live. At McGill I learned how to learn. This is what has kept me moving onwards. Now, as I roam across most of sub-Saharan Africa, it is this one crucial ability that allows me to make some sense of what I see.

When I first came to Africa, I was awed by its beauty and thrilled when I first heard a lion roar, a sound that seemed to be called forth from deep beneath the plain. But my work would soon show me another side of the continent. I began my latest West African visit by accompanying a patient to the otorhinolaryngology clinic at the "university hospital." There I witnessed a clinic devoted to draining ears. Two ENT specialists sat on chairs. Each had a kidney basin, a syringe with a needle, a bottle of penicillin meant for IV use, scissors, a pair of forceps and a long ribbon of packing. The patients came, one by one, and sat across from the doctors who removed the pus-soaked packing from their ears with the forceps and threw it in the garbage. Then they washed out the ear with the contents of the syringe, picked up some new packing, cut it off of the roll with their scissors and dipped it into the antibiotic solution before re-packing the ear. They went from patient to patient in this manner, never washing their ungloved hands, and using the same instruments.

Jeremy Brown takes a break from medical chores at an Indian Ocean resort once frequented by Hemingway

It's a dirty, smelly town, the buildings are mostly low and made of cement, dripping with rain or condensation and stained with black fungus. The roofs are corrugated iron. The roads are narrow and filled with potholes. The temperature is unbearably hot and the humidity is stifling. The area receives four metres of rain during the unrelenting gray of the rainy season. Garbage is strewn along the sides of the streets. The drivers are outrageously incompetent and the evidence of profound poverty is everywhere.

Beggars approach you in the street, often showing obvious signs of advanced disease. I heard about leprosy and river blindness at McGill, but the reality is over-whelming. The centre of the town is dominated by the presidential palace, which has been badly shelled by the army. The only relief from this universally depressing scene is the ocean, but all the beaches are fouled with filth and garbage. The tap water, of course, is not potable and the region is malarial with an astounding array of infectious diseases and parasites easily available.

My job, as medical attaché to the Canadian mission, includes responsibility for making sure that Canadian personnel in sub-Saharan Africa have access to some form of reasonably safe medical care. Being from McGill medical school, my training is universally recognized, and I can work in French. I travel from country to country and meet with the doctors, inspect the hospitals and evaluate everything from the competence of the doctors to how the dentists sterilize their drills. Some of them don't sterilize at all.

But it's not just for the sake of Canadian diplomats that we have a doctor here. I have been called upon to travel all across the continent to provide assistance to Canadian visitors in trouble. This, of course, is a consular service but when the "trouble" has a medical dimension, I'm on the next plane to wherever a Canadian is in need of help. It's one of the services your tax dollars pay for and it has dropped me in the middle of some heartbreaking situations.

The place where I am based is a startlingly beautiful country but the city where I live is a little difficult. I have a nice house and a housekeeper and a gardener. All the diplomatic trappings.

But the reason for the gardener is to keep down the grass and shrubs, because if you let them grow, then the snakes come. We've found green mambas in the front garden. My 12-year-old daughter might die if she were bitten by one of them.

We didn't want to have a housekeeper but he's been with the house for 12 years and it was his only source of income. He needed to eat and to feed his family. He needed to pay school fees for his children to attend primary school. If we had decided when we rented the house that we didn't feel comfortable with a servant, then he would have been out of work. So we pay the $150 a month, we "loan" him the school fees for his children and we pay his medical bills if he gets sick.

Certainly there are some state-funded health care facilities but there are many more private facilities and, if you get sick and you haven't the money to pay for a doctor or a hospital bed, then you may well die. If you want your children to learn to read and write, then you must pay school fees. There is no free education and very minimal publicly funded health care.

It's true my house is lovely but all the windows are barred and alarmed, there are guards in front and behind and, before we go to bed, we must remember to lock the "rape gate" that bars off the sleeping quarters. There are about 50 armed carjackings per week in this city and, lately, there have been disturbing reports that women and young girls have been raped by the carjackers. Rape is a vicious and destructive crime anywhere, but in countries with a high prevalence of HIV, it is even more frightening. We don't go out much after dark.

Despite the often grim conditions, the vast majority of the Africans I have encountered are kind, gentle, polite and civilized people. The climate where we live is wonderful with cool nights and bright sunny days. The countryside is magnificent, not jungle, but rolling grassland, and the culture of the people is fascinating. I've taken my family on many safaris and seen lion, elephant, giraffe, zebra and a seemingly endless assortment of "grass eaters."

The coast of Kenya is spectacular and the Indian Ocean luxurious. I particularly enjoy the Ocean Sports Hotel in Watamu. A great place for deep-sea fishing and one of Hemingway's favourites.

But the breaks, when we get down to the coast or off on safari, are the exception. Much of my time is spent traveling to other countries in Africa, visiting very "third world" medical facilities and witnessing human suffering of terrible proportions. Many hospitals are filthy concrete structures with up to six patients in a tiny room on bare thin mattresses, little or no cleanliness, little or no infection control and patients lying on the floor waiting to be seen. The smell is often overpowering. The level of care in these facilities is abominable and nursing care is absent. Hospital patients receive no food other than that which is brought in by family members. If there are no family members, the patients go hungry. Blood is not safe for transfusion, there is no hepatitis C screening and HIV screening is inadequate.

One often finds a few dedicated doctors trying to carry on in the face of virtually no equipment or medication. One country I visited was said to have a state-funded health care system. When I visited the hospital, I found that the staff, including the doctors and nurses, had not been paid in over a year. They were still coming to work and doing their best to care for the sick but working with no medicines, no equipment and no supplies. The patients were hungry and so were the caregivers.

I'll shortly be leaving Africa. Living and working on this continent of tremendous contrasts has been an experience beyond anything I expected in my professional career. I've traveled from east to west and north to south. I've seen startling beauty and devastating tragedy, I've seen human beings display impossible cruelty to one another, and I've seen others whose grace and generosity made me feel humble.

They say Africa changes you and that is so. I will never be the same man I was and never the same doctor I was. When I am an old man, sitting in a chair and dozing, I will remember the luminous eyes of dying children, but I will also remember the rolling beauty of the Maasai Mara, the Serengeti, Mount Kilimanjaro.

And I will hear the roar of a distant lion.

In early June, Jeremy Brown and his family were transferred to Austria. Dr. Brown's first novel, The Serpent and the Staff, was published last fall by Picasso Publications.