Off The Beaten Track: Can You Own A Culture?

Anthropologist Mary McCutcheon received her doctorate from the University of Arizona, where she researched the land and marine resource tenure of the Pacific island of Palau. After a fruitful career at the Smithsonian and George Mason University, Dr. McCutcheon now spends her time as a docent at, appropriately enough, the Smithsonian’s Hall of Human Origins—a place where she just might find the answers to some of society’s most perplexing questions. 

I certainly didn’t expect to upset my friend Demei when I told him what I had done. It was 1991, and Demei was the biologist working for the government of the Republic of Palau, an island group in the Western Pacific. I was an anthropologist who thought I was an expert on ownership of property, such as land, agricultural products, and marine resources. I clearly didn't know everything on this subject.

Palau on the globe

When I first arrived in Palau back in 1977, I lived with one of the paramount chiefs in a village called Melekeok. Because I was walking all over the island looking at farms and plots of land, I also collected plants and pressed and dried them in my homemade kerosene-fueled plant drier. I would always ask Dirruleong Kebang, the paramount chief's wife, what these plants could be used for. One day, I'd collected a sprig of something that made her eyes brighten. This, she declared, was ukelel a chedib, an herb that cured stomach ailments. She described how to brew it into a tea and all about its remarkable curative properties. I jotted all this down in my notes as I pressed the sample between pages of the Pacific Daily News.

Dirruleong Kebang with her husband,
Secharuleong Kitalong

Some weeks later, Kebang looked sick. I asked what was wrong, and she replied that she had a terrible stomachache. She then asked if I had any medicine for this (hoping I'd come up with a bottle of the universally respected Pepto Bismol). I smiled and hastened off to the spot where I knew the ukelel a chedib grew. I gathered a fistful and brewed a strong tea. When I presented it to Kebang, she laughed and happily drank it. She declared that she felt much better, but I suspect it was the delight and laughter that cured her more than the potion I had concocted.  

Melekeok as seen from the sea

A decade passed. My plant collections and field notes found eternal homes in the herbarium at the Smithsonian, where I also found a dull job as a bureaucrat. One day in March 1988, I was asked to host a day at the Smithsonian for a group of Micronesian historic preservation officers. The person from Palau was my old friend, Moses Sam, so I invited him to stay at my house during his time in town.  

I prepared a talk on the importance of stretching the job of historic preservation to things other than buildings and historic sites. I stressed the significance of plants, crafts, folklore, songs, and other kinds of traditional knowledge. As an example, I told the story of Kebang and the ukelel a chedib tea. That night, Moses came home for dinner and told me how especially meaningful my anecdote had been to him. He had had a bad case of Hepatitis B and thought he was close to death. His liver had been failing, and he’d had no appetite or any energy at all. His grandmother suggested that he drink a strong cup of ukelel a chedib every day. He took her advice, got well, and went back to playing softball. He’d gained weight and felt terrific. The credit went to his wise grandmother and her ancient herbal cures. When Moses told me his story, I just laughed and would have completely forgotten it, had it not been for a tiny story in the Washington Post the following week. 

  

Click article once to enlarge.

I was reading this article, absent-mindedly, while having my English muffin and a cup of coffee when suddenly I realized, "Damn! That Phyllanthus is the same genus as ukelel a chedib.”

That day, I tracked down Baruch Blumberg, the American physician mentioned in the article. He'd discovered Hepatitis B and, as a Nobel laureate, he was not hard to find. Our correspondence eventually included his assistant, Dr. David Unander. A couple weeks later, Unander came to visit the Smithsonian herbarium that housed my samples of Phyllanthus palauensis. He also had a chance to meet the foremost expert on the genus, Dr. Grady Webster, who had also spent a lot of time at the herbarium. Unander thought it was possible that the Palauan species had even more powerful properties than the South Asian variety he had been studying. I couldn't help feeling proud of myself.

Phyllanthus marianensis, a close relative of Phyllanthus palauensis
(known in Palau as ukelel a chedib)

It was during my next visit to Palau in 1991 that I went to visit Demei and told him my ukelel a chedib story, expecting that he would appreciate the contribution that a Palauan tradition might have in the world of medicine. But instead, his eyes squinted a bit, and he glared at me with disgust. Who did I think I was taking his culture’s traditional knowledge and spreading it around all over the place? I stammered an apology as my face burned with a blend of anger and shame.

In fact, I doubt that my information ever made any difference in this research. A quick look on the Internet shows that research on potential cures for the virus continues and show promise, but there is no mention of the Palauan species. I don’t think anyone is making buckets of money from the active ingredient of Phyllanthus yet, but still, this episode marked the beginning of my sensitivity to what could be called “cultural intellectual property.” Individual or corporate intellectual property is what we protect with copyrights and patents. But what is a CULTURE? It’s not exactly a group of people, but rather the values and social rules that bind a group of individuals together. How can a thing such as culture have rights?

The author with JohnWayne Kentaro,
Kebang's great grandson, in Palau 30 years ago

There are lots of other areas where cultural intellectual property is treated as a public good. Consider folk music, traditional dance, legends,
curing rituals, motifs in art, needlework, jewelry design,
and costume. More and more, these kinds of “plagiarisms” are
making their way into courts where finding justice is not easy.

The problem of using knowledge from medicinal plants is more nuanced because of the
potential life-saving power of this knowledge. We'd like to think that all people would generously part with secrets and folk knowledge if it could save lives, but the truth is pharmaceutical companies are seeking profits and exclusive patent rights. Their shareholders might be oblivious of the real “research and development” that goes into a product as they cash their dividend checks.

Moses Sam

In this day of world migration and intermarriage, the boundaries around any cultural group are blurred. The best way to handle such challenges is to make sure that large percentages of profits go towards something that benefits the place and whoever might live there. But even deciding how these proceeds should be spent becomes problematic when different individuals claiming to have authority over cultural knowledge disagree.

When Kebang died 12 years ago at the age of about 106, she was the oldest person in Palau. Moses Sam died in 2009. I heard he had died of liver cancer—a consequence of hepatitis B.

Off the Beaten Track: Healing Stings

Marianna with her honey frames

Our guest today is Marianna Holzer, a third-generation bookbinder, who also happens to be Heidi’s sister. She owns the Holzer Bindery in Hinesburg, Vermont, and specializes in book restoration and preservation, a topic that she wrote about for us earlier this year (you can find her bookbinding post here). Marianna is also a beekeeper and her post today is all about the medicinal uses of bee venom. Marianna can be found at the Holzer Bindery website.

 

Nearly twenty years ago, I suffered a mysterious health crisis. One day, without warning, I went completely blind in my right eye. Gradually, my vision came back and then it happened again -- six months later I lost the vision in my other eye.

After much testing and a few other episodes, I received the diagnosis: Multiple Sclerosis (MS). This was a condition I knew nothing about, but after learning as much as I could, I became quite depressed and fearful of when it would strike again. Fatigue is common problem in MS, and I had that in spades. I had always been a very healthy person and loved being outdoors, counting gardening, hiking, and bicycling among my favorite activities.

A friend told me about a man in a town not far from us who had helped folks with MS by stinging them with honeybees. This sounded pretty far out, but I was ready to try anything in order to feel better. My husband, Rik Palieri, and I drove down to Middlebury, Vermont, from our home near Burlington to meet this man, Charlie Mraz, and to learn about the bees.

Charlie Mraz

Charlie, a tall, gray-haired man with a twinkle in his eye, was an old-time Vermont beekeeper who had recently turned 88. As a young man, he had suffered from rheumatoid arthritis until older beekeepers told him that bee stings would be a good remedy for this condition. He wrote their advice off as an old wives’ tale until he was accidentally stung on the knee by his own bees. The next day, he realized that he felt much better. He began intentionally stinging himself with the bees and found it helped so much that he began to offer the same treatment to others.

One day a woman came to Charlie saying that he’d treated her for arthritis only to discover a few years later, when her symptoms returned, that she had MS. Since the bee stings had kept her symptom-free for so long the first time, she thought she’d try it again, and sure enough, it helped!

 

Charlie ushered us into his home where he was helping a woman with severe arthritis by holding bees against her hip and her leg until she received several stings. He then turned to us. He asked me a few questions about my symptoms, allergies, and medications. I asked him if it would hurt. He gave me a test sting on my leg and waited a few minutes to see if I would have a severe reaction. While we waited, he told me about acupressure points and meridian lines (healing pathways in the body), pressing on these points to see if I was sore. Every time I said “ouch!” he chuckled and marked the spot with a red wax pencil. He gave me 7 or 8 stings, telling me to start out slowly with only a few stings, and then he taught us how to handle the bees ourselves.

The next step was to go out to his bee yard to collect bees in a jar to take home. We walked up a few steps to go outside, and the woman he had treated when we arrived turned around and went down the stairs, paused, climbed up them again and paused once more, a quizzical look on her face. After going up and down several more times, she turned to us with tears in her eyes and told us that this was the first time she had been able to climb stairs without pain in many years. It gave me hope.

Charlie gave us an old mayonnaise jar into which he had put a little honey, covered with a tissue, and then added a cardboard roll for the bees to cling to. He clamped the jar over a hole drilled into the side of a hive and the bees flowed into it. He slid the jar off the hive and screwed on a perforated lid. Charlie sent us home with this jar full of bees and told us to get tweezers to hold the bees while stinging.  He said we should come back when we needed more bees or to call if we needed advice or support.

The honey bee treatment I learned from Charlie Mraz is called Bee Sting Therapy or Bee Venom Therapy. It is a form of apitherapy, a holistic medicine that relies on natural products of the beehive to improve and maintain health and to alleviate pain and disability, whether from injury or illness. There is even an Apitherapy Society dedicated to promoting this approach to healing. Products of the honey bee include bee venom, honey, pollen, royal jelly, propolis, and beeswax. These amazing insects have been used in alternative, or complimentary, medicinal therapies for thousands of years.

Marianna's bee hives

Honey bees and their healing venom have changed my life. My husband, Rik noticed a lightening of my spirit right away, I have more energy, more hope and feel empowered, as I have now found something I can do for myself.

 

To keep up with my treatment, I became interested in beekeeping and soon had hives of my own. I loved sitting by the hives and watching those busy little creatures coming in for a landing, loaded down with nectar and colorful pollen sacs on their legs. I felt a return of my love of nature, and rejoiced in gathering the honey to share with friends.

Come join me in watching these busy little workers as they gather nectar for the hive in the following video of my bee yard (set to music by Rik Palieri from his CD, Music in Me).

What’s Old Is New (and Sometimes Fake)

By Supriya Savkoor

It’s 3,000 years ago, and you decide you would like a new nose. Where would you go to get one? If you guessed the holy city of Benares in India, on the banks of the Ganges river, you'd be right. That's where the great sages prayed, and Hindus, Buddhists, and Jains pilgrimaged—and yes, sometimes got nose jobs.

It’s true. Back then, you could could have gotten a nose job or almost any other kind of cosmetic surgery in Benares (now called Varanasi), as well as had your hernia fixed, a caesarian, cataract replacement, prostrate removal, tonsillectomy, or a root canal.

That’s because Sushruta, often credited as the Father of Surgery and also the Father of Plastic Surgery, was from Varanasi, where he taught, practiced, and wrote a seminal series, the Sushruta Samhita, on the art and science of surgery sometime between 800 B.C and 300 B.C. With 184 whopping chapters, Suchruta’s compendium is exhaustive. He described more than 300 surgical procedures and 120 surgical instruments and classifies human surgery into eight categories. He detailed not only surgery but geriatrics, pediatrics, obstetrics, fetal development, psychiatry, and ear, nose, throat, and eye conditions. Overall, he classified some 1,120 illnesses and diseases, as well as 700 medicinal plants and 100 medicines prepared from both plant and animal extracts. And he explained how to examine, diagnose, treat, and give a prognosis on many illnesses and diseases.

In the surgery field alone, Sushruta created tools and techniques to make incisions, conduct probes and extractions, cauterize a wound, perform amputations, pull teeth, and drain fluids. He categorized in great detail the different ways bones dislocate and fracture and even how to measure and fit artificial limbs. He successfully used ant heads to stitch up intestines.The ants would bite into the wounds and act as clips, then Sushruta would twist their bodies off, leaving the heads intact to keep the wounds sealed. Bizarre, maybe, but it worked.

Perhaps most notably, he and his students reconstructed noses, genitalia, earlobes, and other body parts on victims who had these parts amputated as part of criminal or religious punishment. In particular, cutting off the nose was a common punishment for adultery in those days, so nose reconstruction was in high demand. Sushruta created a procedure known as forehead pedicle-flap rhinoplasty in which he used skin from the forehead to repair or replace skin from the nose. Plastic surgeons still use this method today.

Indian doctors and healers relied on Sushruta’s compendium for generations, but the earliest surviving manuscript, known as the Bower Manuscript, comes from the 4^th century A.D. In the 8^th century, the original Sanskrit text was translated to Arabic and traveled to Mesopotamia, Persia, and Egypt, and by the 15^th century, to Europe. Along the way, in Turkey, surgeons even used Sushruta's techniques to perform breast reductions. (Makes you wonder, who was getting breast reductions in the Middle Ages? The Real Housewives of Istanbul?)

A rendering of an apparently painless cataract removal from
an 8th century Arabic translation of the Sushruta Samhita. 

In the late 1700s, when the British annexed parts of India, physicians began studying Indian surgical methods, plastic surgery in particular. One of these doctors, Joseph Constantine Carpue, spent 20 years studying Indian rhinoplasty—nose jobs—and is credited with performing the first major rhinoplasty in the western world (in the UK) in 1815. The forehead pedicle-flap technique Sushruta invented is now known as the Carpue operation. (Insert your own sarcastic comment here.)

Doesn’t it give you a little chuckle that this holiest of places, from one of the world's oldest civilizations, is also the birthplace of plastic surgery? It does me.

The Power Of Many

When I started travelling, my eyes opened to all the wonderful possibilities for healing there are in the world. I witnessed eastern and western medicines working alone and together and saw people rely entirely on faith with remarkable results. But it wasn’t until a few years ago, when my three-week-old daughter lay in an ICU in a Canadian hospital, that I experienced the meeting of two worlds – the medical and the spiritual – and how those two combined, can make a difference.

My daughter contracted a type of meningitis that is very rare. The medical profession couldn’t work out how she got it, and they didn’t hold out a lot of hope for her to survive, let alone function like a “normal” child. If she made it through the first 72 hours, they expected her to have numerous disabilities. Not one to give up easily, I asked friends and family around the world to help us out. I didn’t care what people believed in, whether they prayed, read tarot, or spoke to aliens, I needed their spiritual support in any way they saw fit. 

A friend of a friend, Alys, happened to be in New Zealand at the time, attending a gathering held by a Brazilian man I’d heard about over the years. João de Deus (John of God) is known for helping the infirm heal and people travel from every corner of the globe to see him. He rarely travels outside of Brazil, so it was pure luck (or was it?) that Aly was with him at the time of my daughter’s illness.

Here’s Alys’s experience in her own words:

When I was in Brazil in 2005, I felt drawn to spending some time at a particular meditation centre in the middle of Brazilian plateau. This place had an outward focus of spiritual healing through connecting with the divine entities of the Casa De Dom Inacio. It's a fairly typical representation of spirituality in Brazil, albeit on the miraculous side of the scale. The energy is powerful and subtle, it is the embodiment of love and chaos as old patterns are torn off. It's a washing machine for karma.

I stayed in touch with the energy of the Casa after I left after staying there for six weeks. I later participated in the John of God event in Wellington when João de Deus came to New Zealand in 2006. I'd been carrying a crystal round with me from the casa in 2005 and when a special friend of mine that I'd met in Abadiania (the Casa in Brazil) told me about a friend of his that had a sick baby in hospital, I dedicated the crystal to this baby and took it with me to the three days of meditation. 

The whole event was geared towards healing our spiritual karma and finding the peace within our process. With the dedication in place, I wrote a poem after the event for baby Rebecca and sent the crystal off to her parents in Canada so they could place it by her side while in the hospital. I had never met the parents, but it felt an honour to pass the crystal on to such a loved child.

John of God, born as João Teixeira de Faria, discovered his healing abilities at the age of 16. For more than three decades, he’s worked out of the Casa de Dom Inacio, a healing centre near Abadiania, south of Brasilia, in Brazil. People with all manner of illness travel great distances to visit him – people with cancer, auto immune disorders, arthritis, injuries from sports and accidents, emotional disorders, including depression, schizophrenia, and addictions... the list goes on. He also works with people who have problems with their family and loved ones, and many look to him for guidance in repairing their fractured relationships.

Each year, tens of thousands of people visit this Casa de Dom Inacio, with 500-600 people lining up every day to share even a moment with him. He doesn’t profess to be tied to any one religion, in fact, he says he incorporates all religions, even though Brazil is a predominantly Catholic country. John of God says anyone who believes in any higher power is welcome. Through the casa there are symbols and pictures from many religions, including Christianity, Judaism, Islam, and Buddhism. 

John of God doesn’t have any formal medical training, yet he is known for helping many desperately ill people heal. In numerous interviews I’ve read, John of God tells people he’s a simple farmer who wants to help people. He says he can’t look at blood and won’t even get a flu shot, he hates needles that much. But when he’s in healing mode, the sight of blood doesn’t seem to register. 

Unlike other mediums, John of God doesn’t claim to cure everyone. He never asks people to stop taking their medication or to stop treatments like chemotherapy. He also doesn’t ask people who are gravely ill to make the trip to Brazil, he does, however, offer to heal by proxy. Thousands of people from all walks of life swear healing by proxy has worked for them as a result of John of God and his work.

At the casa, John of God has hundreds of volunteers help organise the visitors and nurse the sick, as well as pray for eight hours or more every day in special healing rooms. With that many people devoting themselves to others and sending nothing but love and prayers to the heavens, it’s a little hard not to be affected in some small way.

What I’ve learnt over the years is religion can take many forms – some official, some not. Sometimes it’s a god, sometimes many gods, sometimes it’s a feeling a person has, or a way of life they lead. Western and eastern medicines can both heal, and sometimes the combination of both disciplines and people’s positive energy coming together can make great things happen. 

When my daughter was desperately ill and needed all the help she could get in the medical and spiritual sense, she received it in many ways. The wonderful doctors and nurses worked hard to bring her back to health, and she had the love and prayers and positive energy of hundreds of people, many complete strangers, who believed that faith and love can bring about healing. Personally, I think the world needs both western and eastern medicine, and the positive energy of many to help heal.

My daughter is now a bright, healthy five-year-old without one single disability the doctors thought she might develop as a result of her illness. When I look at the beautiful white crystal capturing the early morning sunlight on my daughter’s window sill and see the twinkle in her brown eyes, I know that it doesn’t matter what people believe, as long as they believe in something, it can change people’s lives.  

Persia's Renaissance Man

Once a millennium or so, certain civilizations produce a genius who is so far ahead of his era I have to wonder whether time travel is possible after all. Fifteenth-century Italy produced Leonardo da Vinci, whose agile mind still impresses us five hundred years after his death. Eleventh-century Persia had its own Renaissance man in the form of Abu Ali al-Husayn ibn Abd Allah ibn Sina, a mouthful of a name that is thankfully often shortened to Ibn Sina or Abu Ali Sina. In the West, he is known by the Latinized version of his name: Avicenna.

Born in 980 A.D. in Afshana, a village near Bukhara in present-day Uzbekistan (but part of the Persian Empire at the time), Avicenna had a thirst for knowledge that quickly outstripped the capabilities of his many tutors. He memorized the Koran by the age of 10, an accomplishment that earned him the title of Hafez (just like the great Persian poet of the same name).

Avicenna began studying medicine at the age of 16 and became a practicing physician at 18. His medical skill drew the attention of Nooh ibn Mansoor, the emir of the Persian Samanid Dynasty (whose capital was Bukhara). The emir suffered from a mysterious illness that baffled the royal physicians but proved to be no match for Avicenna’s skills. As payment for his successful services, the young doctor would accept no reward except access to the emir’s vast royal library. For a man with Avicenna’s insatiable curiosity, a library was worth far more than all the emir’s gold.

Trouble came in 999 when Turkish invaders booted the Samanids out of Bukhara, and Avicenna had to flee. He embarked on a series of wanderings through the Persian Empire that lasted the rest of his life. After short stays in various towns such as Nishapur (Eastern Iran), Merv (Turkmenistan), Gorgan (near the Caspian Sea), and Rey (just south of Tehran), he ended up for a longer period in Hamadan, where he became the court physician to the local ruler.

When political turmoil forced Avicenna to pack his bags once again, he fled to Isfahan and took another job as court physician. This nomadic life in no way interfered with Avicenna’s scholarship, for he wrote over 450 books, only half of which have survived. They cover a wide range of subjects, including geology, astronomy, mathematics, psychology, physics, and music. (Avicenna believed that music was conducive to healing.) As well as a scientist, he was an accomplished poet, writing in both Arabic and his native Persian.

The two works that form Avicenna’s greatest legacy are the Book of Healing, a scientific encyclopedia that covers logic as well as a range of medical and natural sciences, and the Canon of Medicine, a compendium of all medical knowledge available during Avicenna’s time, augmented by his own observations. The Canon, a huge, million-word volume, was used as a medical textbook at European universities for 700 years.

The Canon of Medicine in Persian

Due to these two impressive books, begun in Hamadan and completed in Isfahan, Avicenna is often called the “father of modern medicine.” In fact much of his approach to medicine, as documented in the Canon, would be familiar to us today. He recognized the contagious nature of certain illnesses, such as tuberculosis, and introduced the concept of quarantine to halt the spread of infectious disease. He discovered that alcohol kills germs and devised experimentation rules that still form the basis for clinical drug trials today (including the need to test new drugs on humans and not just animals). Avicenna also believed in the mind-body connection, hence his interest in the healing power of music.

Avicenna died of an intestinal disease in 1037 on a return trip to Hamadan, where he is buried. Iranians today view him as something of a national icon and one of the greatest Persians in history, a status I was able to observe first hand on a visit to Avicenna’s tomb several years ago. We arrived on a religious Shi’ite holiday (the birthday of the 12^th Imam), and the place was packed with Iranian tourists—entire families with children in tow. As the kiddies raced around the oddly shaped tower that sits atop the tomb, their parents unpacked picnic lunches and prepared to make a day of it.

Inside the mausoleum, the tone was reverent as people spoke in hushed tones and quietly read the inscriptions bordering the great man’s tombstone.

In addition to the tower (built in 1954 but modeled on a similar structure from Avicenna’s time), the complex includes a museum, a library, and an exhibit of medicinal herbs documented in the Canon of Medicine.

So the next time you pat antiseptic on a scrape or put on calming music to smooth away the day’s stress, think of all we owe to the inquiring mind of Persia’s Renaissance man.

And if you’d like to hear Avicenna speak about his life and work, check out this video where he reaches out to us over the space of a thousand years (as interpreted by the actor, Roger Worrod):

Off the Beaten Track: Inside South Sudan

Dr. Lanice Jones is a Canadian family physician, world traveler, and adventurer in every sense of the word. She recently spent two months as a medical volunteer in South Sudan, and on the eve of that country’s historic vote, she shares her experience with us.
 

While I have had the privilege of working and studying medicine on several continents, my last two months volunteering in South Sudan have been a life-changing experience. South Sudan is the poorest country with the highest maternal and pediatric mortality that I’ve worked in. It is isolated by lack of roads and infrastructure, lack of supplies, and lack of skilled staff. Yet the culture is vibrant, passionate, and filled with hope that the vote on January 9th will result in independence and a better future.

South and North Sudan suffered a 17-year civil war that ended five years ago with the signing of the Comprehensive Peace Agreement. The civil war was complex, as North and South Sudan have different ethnic groups, different religions, different languages, and in the middle of the conflict, oil fields that span the border. With the signing of the CPA, South Sudan was supposed to have more autonomy, better resource allocation and a greater political voice, but most South Sudanese would state that their hopes with the CPA have not been realized.

At the heart of the separation conflict lie the border communities that contain the oil reserves. The oil from South Sudan is sent by pipeline to refineries on the coast of North Sudan, and from there, the bulk of the oil is shipped to China. China has been trading oil from South Sudan for weapons for North Sudan for over a decade. The president of North Sudan, Omar Hassan Al-Bashir, has been indicted for war crimes against Darfur. He has a long history of military aggression. Meanwhile, South Sudan has military support and training from America, although this is a more covert operation. 

Lanice assisting Dr. Benjamin with a
gunshot wound to the foot

The doctors I was working with are some of the Lost Boys and Girls who fled South Sudan during the war, seeking refugee status. Cuba had accepted many of these child refugees, educating them in preparation for returning to help rebuild South Sudan. Unfortunately, when their education was completed, Sudan was still at war and these young adults came to Canada and America. In Canada, they worked in menial jobs as our government doesn’t recognize their medical education as being valid.

When North and South Sudan signed the CPA in 2006, a group of Cuban-educated physicians approached the University of Calgary, asking for help to return back to South Sudan. My university created an education program in Canada and Nairobi to upgrade their medical knowledge and skills, and I’d been one of their teachers. Now it was my turn to be the student.

I spent two months in South Sudan working alongside my colleagues in three different hospitals, and I was part of a one-week educational camp with specialists from Sudan and Canada focusing on obstetrics, pediatrics, and anaesthesia.

Patients and family members with

their makeshift tent at the

Marial Lou hospital compound

On a daily basis, I was humbled by the skills of my colleagues, as they ran hospitals with minimal laboratory support, no x-ray facilities, limited supplies, and minimal staff. Yet they saved lives each and every day. One day in particular, a 13-day old baby arrived with a fever of 102 degrees, comatose with infection from a difficult birth in a mud hut. In an American hospital, that infant would have been in intensive Care, with round-the-clock, expert nursing staff, an infectious disease and neonataology specialist, and continuous oxygen and monitoring. We had no nursing staff, and I and my colleague Dr. Ajak took turns every six hours to check on the infant and administer intravenous antibiotics. This may not sound so difficult, but imagine getting up in the dark, with no electricity, pulling on gum-boots to avoid snakes and scorpions, creeping by flashlight along a flooded pathway to the hospital, beating off swarms of malaria-infested mosquitoes to attend to the infant curled up under a mosquito net with his mother, and no one speaking English! Within three days, the little one was alert and nursing well and was discharged a week later with no obvious ill effects.

Another afternoon, I was called to see a woman in labour, and was told that a doctor who was not part of our education program had indicated that she had a huge abdomen from extra fluid in the uterus. As it was her sixth delivery, which is another risk for bleeding, I was teaching the community health worker how to prevent bleeding after delivery. We turned our backs to get the medication ready, and out shot a tiny baby, clearly not at term. I grabbed the infant and rushed to a rickety table with a dirty ventilation bag, mask, and re-usable suction bottle. The infant was blue, not breathing, and had a very low pulse. I ran through a resuscitation protocol while the “nurses” watched in amazement. Most didn’t know anything about resuscitating sick newborns. I peeked back at the woman on the broken old delivery table, and her abdomen was still huge – clearly not just from extra fluid!

I rushed back, put on a clean glove, and examined her, confirming that she had a second twin waiting its turn to be born. I requested that they call in the other doctor, as I was still attending the first sick infant. He returned, re-examined the woman, announced that she had a twin, that the mother was not contracting, and walked out of the room! There I was, having never delivered twins before, with one unskilled community health worker, one sick twin, a second one on the way, and the other doctor simply walked out. In our hospital, any twin delivery would be attended by a team of doctors and nurses for each twin and the mother.

Once I had the first twin stabilized, wrapped in a skimpy rag and passed off to a family member to hold, I prepared to deliver the second twin. This little one came out pink and screaming, a blessing, but by the time I’d delivered the placenta and ensured that the woman was stable and not hemorrhaging, the second twin was grunting and in distress. I had to bludgeon my way into the operating theater to “borrow” an oxygen concentrator, and I insisted that they keep running the generator to keep the concentrator on until the little twin’s breathing returned to normal. Having just got the second twin sorted out, with both getting a mixture of sugar water for feeding as there was no formula in the hospital, I was called back to see the mother, who was now comatose, feverish, and seizing from presumable malaria, which had likely triggered the labor!

A month later when I returned to this community, I managed to track down this mother and her twins, and visited them in their tukel, or thatched mud hut. Both babies were alive, and while still scrawny, they were nursing, taking extra formula, and gaining weight.

While the world watches, South Sudan will vote this Sunday, January 9. My sense is that the majority will vote for separation. With oil revenues at stake, while President Al-Bashir states he will abide by the vote, I fear that conflict will erupt. My colleagues will continue to provide the best care possible under horrendous conditions, but I fear for them and their communities. And I hope to return to help.