Not A Doctor


When is it time to stop playing Doctor in West Africa?

“I write one page of masterpiece to ninety-one pages of shit. I try to put the shit in the wastebasket.”
― Ernest Hemingway

I think every expatriate I know has a copy of the book “Where There Is No Doctor”; and the book can get you out of sticky situations if you are isolated from medical help in a rural area. I am not personally comfortable using it to diagnose others, but I have used it over the years to help eliminate some things from the equation in my own sicknesses.

My jatigi (the person responsible for me in the village), Musa, was complaining to me about severe muscle cramps. He said that when they work in the fields he is almost doubled over with them, and at night his legs take cramps all night. Indeed, they do very hard manual labour, farming with tools as primitive as the stone age, stooped over all day.

However, I knew what the real issue was. Water. It is alarming to see how little water most Africans drink. When it can hit near 50 Celsius in the sun, how can you work all day and not drink water? Malians might take a small sip, when we are downing litres.

However, as I soon learned that even water is not enough sometimes. I too fell victim to bad cramps many times after a day’s work in the village. One time I almost fell off the motorcycle going home because I was cramped up all over my body and was not able to hold myself on the motorcycle. It was scary to be in a condition where your whole body is spasming. I was drinking enough water by volume, but the real issue was that water alone was not enough. I needed to add oral hydration solution to the mix. Now I always go to the bush with a bottle of homemade oral rehydration solution, and no more muscle cramps.

So I told Musa about it. He asked me to mix him up a bottle to try. My wife made the brew and on the next trip to the village I gave the rehydration solution to him. Later he told us how well it worked. He praised the wisdom of we westerners for knowing such things. We used a local two litre water bottle called Diago, and my wife gave him the recipe, explaining how many bottle caps of salt and sugar to add, with the juice from one or two hand squeezed oranges. all combined, this gives you the balanced electrolyes a person needs. Musa, was very happy his muscle cramps were cured.

However, villagers also talk about another kind of cramps, or lack thereof.

Constipation is a constant subject of health in the villages around Sikasso. They talk about not being able to take a shit with perfect strangers like they are talking about the weather. They do not seem to have much stigma around this subject in their culture. Of course, the cramps are, in part, due to the poor rehydration practices, combined with poor diet, a diet with few vegetables.

Anyway, I arrived at the village to do garden site inspections with dozens of women in our food security project. As is custom, I stop to greet Musa to exchange greeting and share news. It’s a little catch up time, after which we are both free to go work at whatever it is we have planned apart.

Musa began telling about his severe constipation, how he is aching because he has not able to shit for three or four days, all backed up, and can’t sleep.

Of course he asked me, “Do you know anything I can do about that.”

“Sure do”, I said, “do you have any ripe papaya out in the field?” I asked.
He responded in the affirmative, so I continued, “Well go pick a good sized Papaya, not a small one. Eat the whole thing in one sitting, drinking two litres of water at the same time. That should fix you up.”

Four days later I was back to the village and at Musa’s house. We exchanged greetings and Musa went right into how I saved him. The morning after our last conversation he went and found his ripe papaya, brought it home, and drank a whole two litre bottle of water as he ate the whole papaya, just as I advised. He said, “It’s not easy to drink that much water, but I got it all down.”

The results? By dinner time Musa said things were moving. In fact, things were moving so well it was almost like he had diarrhoea, but it was not a sickness diarrhoea. He said by late afternoon he was totally cleaned out from constantly shitting all afternoon, the constipation was gone, the pain is gone, and he feels so much better.

You had to see the depth of his enthusiasm as he recounted every detail of the story, it was incredible to hear and see his expressions. Not often I see Malians this excited, but Musa really was. He was a believer now.

“How do you westerners know these things?”, he asked . “First the salty water, now this, and it is all so simple!”, he exclaimed

My reply?

“Musa, there isn’t a person in the world who can eat a whole papaya while downing two litres of water, and not shit.”

There is my medical advice for village constipation.
Share the word, spread the medical wisdom.

However, if asked, you never heard it from me.

I don’t play doctor.

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