The Longest Days, Chapter 4: “Journey to the Center of the Earth”

Gus Ruchman - Senegal


March 9, 2011

Previously: I became acquainted with our hot canvas tents dispersed across several homes of religious community leaders and made friends from many walks of life. I struggled to find a small patch of floor on which to sleep, but was enthralled by Touba’s unique aura. Energy mounted like a pre-Magal powder keg:

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Sunday, 0 days until Magal: Restored by a much better rest (a whole four hours) than the night before I stretched my legs in the cool morning smog. Work had not yet started, but an older woman was waiting with her daughter outside the tent. I immediately recognized the symptoms of advanced malaria. The patient’s delirium was frightening, and I went to get help. In a matter of minutes we were on our way to the hospital, attempting to put an IV in her arm as the ambulance bounced and rocked from our abrupt stopping, starting, and off-roading.

When we had handed her over to the hospital we returned for breakfast and then went to work for the day. Though Seck returned to a different site I again worked in the tent outside the house. The conditions were less than optimal. Our “pharmacy” was a table covered in disorganized medicines (which I alphabetized for the sake of efficiency, only to become a mess again) and our “Salle de Soin” was a wooden table. We had no water source.

I did my best to keep clean what I could, but our cotton and gauze mingled with our other supplies, and our cardboard trash-and-used-needles box soon overflowed. Alcohol was in short supply, though I did use our bleach-soap solution to clean our few tools, an action I was surprised I was the first to take. I tried to create a few “sterile” surfaces with plastic covering for preparing bandages, which I used my pocket knife to cut for lack of a better tool. I remembered to keep my hands covered with the gloves I brought, sterilizing them between patients with my personal stash of antiseptic.

The sick, tired, and wounded crowded the entrance to the tent, keeping us busy with cases of malaria, infection, hypertension, fatigue, and other problems. I became even more acutely aware of the problem of antibiotic over-prescription that I have noticed elsewhere as we went through stacks of amoxicillin. Many patients for whom I would have thought water and rest would have been the most appropriate treatment received other drugs. Admittedly, I am not  a doctor (see previous blog posts), and stayed silent, only asking questions, as I worked with medical workers whom I had only known for a matter of days.

Some ailments were more serious. Throughout the day I recorded blood pressure, often for middle-aged out-of-shape pilgrims as well as for younger patients, usually women. For many of the middle-aged patients, I believe undiagnosed diabetes, a severe problem in Senegal only exacerbated by a diet based in sugar and oil, may have been playing a role in elevated blood pressure. For others, simply walking many miles in the heat and the crowds may have been causing dangerous fatigue. When I read 230/100 for one woman’s blood pressure, I had another doctor check that I had not made a mistake. He confirmed 230/100.

Of course we recommended that she go to the hospital, as we had for several others, but I suspect that few heeded the urgency in our pleas. One of the greatest frustrations of the work was knowing that, despite our grandest attempts, many patients would soon wander back into the crowds, endangering their health. Similarly, others would misunderstand the brief explanation of dosage and timing for taking medication or perhaps not return to a hospital or Poste de Santé for continuing treatment once our free tent had disappeared from the street.

Late lunch was more than welcome after sweating and breathing through a mask all morning, feeling like a benevolent Darth Vader. As I sat with friends of the recently passed Abdou Rachmane I poured every ounce of my focus into remembering customs and culturally appropriate manners. I am proud to say that I successfully ate meals with my hand, a testament to my improved rice-balling skills; I have come a long way since my initial attempt back at ACI Baobab.

Suddenly I was in the ambulance, headed for the heart of Touba. With several other medical workers I was going to visit the Grand Mosque. Before we exited the vehicle I was reminded that no shoes are allowed on the holy surfaces, so I descended barefoot like my companions. My feet touched the street and the door slammed shut.

We did not enter the mosque immediately. Instead we navigated crowds on trash-filled streets and sandy pathways to visit the site of the “L’eau de Source,” or holy water, barefoot all the while. A small mob pounded at the gates of the religious grounds, sticking hands through to obtain the sacred water or to try to enter. We pushed our way through, and showed our white doctors’ coats. At this point I first discovered the power of said apparel. The doors opened and our party of five was permitted to visit.

After my colleagues had drunk and bottled their fill we returned to the mosque, still barefoot. Once again using the power of the coat, we cut an endless line of people, ostensibly so that we could enter the mosque and then return to work. Please note that I was not the person doing the talking. We separated by gender and entered to stand on a line inside. It was packed like one gigantic sardine can. Eyes seemed to flit upon me and then return to meditative waiting as quickly as they had come. I could not have fit in less, except that I had, at the time, a freshly buzzed head and a chin beard.

Like a rollercoaster, we were suddenly moving. The entrance to a more central chamber approached and I touched the bar above me, following the lead of those ahead. As astonishingly beautiful as the Grand Mosque is on the outside, the ornate wonders of the interior shone upon the pilgrims with even more intensity. I struggled to keep my senses about me as I was swept along in the current. In Wolof, the expression for “inside” is ci biir, which literally translates as “in the belly.” I was, indeed, in the belly of the mosque.

In the final chamber I was invited/ordered by a man to squat at one of the many bowls of food, so I washed my right hand and took to scoops of ceebu yapp. I admit, it was delicious, and the oil residue remained on my hand into the evening. We reunited with the women, and were swept outside. As I turned around I saw the river of people flowing, relentless and unstoppable, from the otherworldly structure. I was buzzing.

On the ride home the ambulance stopped. 1000 large bowls of food carried on heads were being run through the streets. The ambulance driver debated with one of the girls who was not joyously singing at the top of her lungs whether or not he should respect the ritual or demand passage. I was relieved that we waited, all the while trying to imagine the sum total of hours required to prepare such nourishment for those who, for lack of another place to stay, sleep and eat at the mosque for the duration of the Magal.

The medical tent stayed open past 10 pm, though I do not know until what hour the young man with the IV in his arm lay on the floor, and work did not get any easier or any slower. After an entire day of festivities, people were even less healthy than usual. Still, after dinner I could not refuse an offer to go for a walk around the city. As I listened to the history of Mauridism for the thousandth time we walked by the cemetery and library, circling around back to the mosque.

From ground level the mosque and all those around it seemed to vibrate and hum. Having changed into the same traditional clothes I wore for the holiday of Tabaski, I looked a little more appropriate, which further confused those who saw us. Taking photographs with discretion was an impossible task. Suddenly I felt a firm hand grip my shoulder. I turned around, adrenaline pumps flooded for a split second. With a wide, bewildered grin, a musician-friend from Sangalkam greeted me with surprise. Senegal really is a small country, but the community is truly smaller.

We made it back through the markets, and the house was silent compared to the streets. Again I found the most unlikely sliver of floor on which to rest, and allowed my rib cage to compress as my spirit soared in exhaustion.

Up next: I awake in a broken-down vehicle on the side of a dark road, cold and lost. I wander into the nearest town alone, and finally hear the phrase “bëtt sett na” put into use.

Gus Ruchman