And a Little Traveling Music, Please

Mabaruma on the Northwest Coast

Psychiatry afforded me the opportunity to see a part of the country that I had never seen.  It was a short one hour air flight but would take more than a day to get there by boat.  (Ah yes, thank God for planes!) Usually two psychiatric residents go to run the monthly clinic at the hospital.  This time I went instead of one of the residents; this meant that Dr. Jackie had to do the work of two while I played tourist.   

Here are a few stories and some pictures.

This is the "downtown" market area
on the Kaituma River

It is hilly and the air was fresh.

Mabaruma is in Region 1 - Barima-Waini  (formerly Northwest Region) and is the regional capital.   It is a small, friendly town in a heavily forested area and I do mean forested.   Five feet off the road you really couldn't get through.

Jackie and I stayed at Broome's Guest House.  (It did seem that almost everything was named Broome, as they were one of the first families to develop the town.)   We were greeted by one of the daughters and shown our room before we had another breakfast for the day.   We were certainly well fed and could even request what we wanted for meals.  (I requested potato fries instead of the usual plantain ones.)  They went out of their way to make us feel like we were at home.

Our lodging.... and I loved the colours!

The dining room.  It seemed that there
were always interesting people from everywhere
to chat with at every meal;

A view/ from my balcony.

Somebody had to Work

Main Hospital Reception Desk and Emergency

The main entrance to the Mabaruma Hospital

No, Jackie is not the file clerk;
 it is her consultation room.

After breakfast we headed to the Hospital where Jackie would spend most of the day seeing people.  Some walk a huge distance every month to be at the clinic.   I sometimes feel overwhelmed by the difficulties of having a mental illness in Guyana (or anywhere). This day Dr. Jackie saw a young man who was doing extremely well and was looking at moving to Georgetown to go start university.  Jackie told me this later because I quickly disappeared on a minibus to go downtown.

Downtown Mabaruma

It was a quick trip "downhill" to the market area.   I started to walk around and see the sights and I soon got to chatting with the shopkeepers about their products and customers and lives.   They were interested in the strange white guy as it seemed that most visitors just look, and walk by them ..... and as typical of all Guyanese, they have relatives in New York or Toronto.   Many didn't mind having their pictures taken though they had no way of ever seeing them. One store owner had a cousin in Toronto and was going to send me her email and I would send the picture on to her Canadian family -- but I doubt it.  So here is a picture of her and her mother (?) in case the relative is a reader of my blog 😁

 


Blogger and Pictures - YUCK!

I can't get the pictures to stay where I want them... and I utter small ejaculations that the priests with whom I live have not heard in the Presbytery before.  So almost all the pictures are online at:

https://photos.app.goo.gl/1xgzB6XGLKki4akk6

This may be too many pictures even for my most ardent followers.  I will post "Faces of Mabaruma" and my "Artsy Collection on FaceBook soon.

Now I feel better...

Some Thoughts on Mabaruma

Mabaruma is next to Venezuela and is one of the places that has taken the brunt of the economic catastrophe that has happened there.  (I will leave my political opinions aside about the causes of the disaster there.)   There are homeless Venezuelans throughout the town and the hostels are overflowing and there is no work...  And in some ways the Venezuelans are like Americans.   They are a proud people who were once at the top of the economic heap and they still act like it.   They project to the Guyanese (mostly Amerindian) that though now penniless they are still better.   Even I could see the hostilities that are being built up ..... and which usually come to a head on the weekend when people drink too much and some violence and property damage occurs.   At the local levels, we are all quick to identify who is "not us" ..... as with Americans and Mexicans, Canadians and our refugees, even at the small town level,  as in my home of Ayr in Ontario, we are quick to see who is not an "Ayr-head".   It is such a deeply entrenched feeling that no wonder we think God must have intended it when we were created.   

I met many people who have lived their whole lives in Mabaruma,  They were never sick enough to be sent to Georgetown for treatment nor were they the smartest who could go to school there.  I know I have lived in small communities before, like West Pubnico, Nova Scotia where most families had been there for generations; however, most of them have traveled throughout the province or Canada or even farther.  For many in Mabaruma, their whole known world is Mabaruma.  I cannot even imagine who they really are or even who I would be if that town was my whole life.  I was about to slip into arrogance and say that I was the one who is better off ..... but I am not sure.  I think the people of Mabaruma are just like people everywhere.    They try to: make a living, take care of their family, yell at the teenagers, get tired, angry, laugh and cry ..... and play.  Some even gamble; I lost a couple of hundred Guyana dollars in a game of cards.  Actually, I gave it to one of the guys to play for me as I really did't have a clue what they were doing.   My player lost quickly!

Fourth, political correctness in speech was unknown... and yet there seemed to be less hostility to one another.   One guy at the card game was called "Monkey".   As soon as I heard that, I was waiting for the fight... It never came.  And there were similar names that would have caused a big reaction in Canada, though maybe not in Trump's America.  WE are certainly more careful with our speech, but I am not sure we are more accepting of another...

Enough...  Thanks for reading.

John

I Must Be in Heaven

A Surprise Worth Writing About

I am living this year at the Presbytery for the Roman Catholic Diocese of Guyana.   I wasn't sure what to expect;however, it is wonderful.  It is large and airy.  There are three priests living here on the third floor: Pastor Monty, Michael and Andrew.

I have my own bathroom; there is a small kitchen where I have put my coffee pot! And a refrigerator for cold water and beer!  There is a lounge area with a tv that gets specialty channels, including English Football.  I'd be excited about this but Man U lost today.😱

What I am really excited about and usually had to wait till I got home to get any...    [No, not that.]  Hot water.   Funny story:  I had taken several showers and I noticed that I must be getting tougher as the morning shower was not as cold as I remembered.  May have been a brilliant engineer who put the water tank on the roof to get warmed by the sun.  Then, Wednesday I was cleaning up some dishes in the main kitchen and I noticed that the water was hot!  I fell on my knees and would have kissed Father Monty- if he had been there.   Now I don't have to wait as long as I would to have the sun heat up the tank.   Such luxury!

Twins?  It is always good to see Bhiro.
/before my Guyana haircut. 

I have been walking to the Public Hospital; however, I do need to get a taxi to get to Mercy as it is quite a hike ..... however, many times I have had a ride from Bhiro or a colleague.   All in all it is working out well.   And after 9 am, if I do walk my shirt is soaked very quickly.

My New First Year Students

This is my first time ever to be here for Nursing Orientation Week.   So naturally I told them that they were clearly the best batch I had ever seen at orientation.  It never grows stale; I remember, way back when, giving my friend Raj a book inscribed "To My Best Resident of 1979".   He was the only one.

There are a few missing from the collage... but they are coming "Just Now", i.e., sometime ….. some time …..

I did have some time during their orientation to hand out the Tablets to which many of you contribute.  This year's batch was extremely thankful.  I heard several official speeches of thanksgiving.   Many have never received anything like them.   I make sure that they know I didn't buy them and that they are from my family and friends - and some even from people who just want to see me go away for awhile.

The Guyanese people are many things and mostly they are grateful for anything that can assist them.   I too appreciate all your contributions to my efforts here.

I have also started getting all the printing that we need for the course.   I need to do it at the Nursing School as I do not have access to a printer here ..... and my laptop is already programmed to be connected to it.

Another piece of good fortune is that the classrooms have been repainted and extra outlets have been added to keep the tablets charged.  As well, it seems there will be a new high speed router in the classroom.  Holy Smokes! I won't have anything to complain about!!

And the Reason that I Came Early

The Psychiatry Master's Programme that I helped shape and guide through the University of Guyana will now be in a position to graduate its first psychiatrists... if the pass their final exams.    I have come down to help them with the reviews and focus!   They like most students have realized the closeness of the exams, so are studying hard.   I go to ward rounds, sit in on their consultations with clinic patients and spend an hour of so in a more didactic session ..... and then go home for my nap!  I am not used to working all day ..... and really not even a full day.  I am getting back in shape though.

 A mix of medical students and psychiatry residents.

I forget to get a picture of the potential three graduates.

A Real Ethics Case

I do like to teach at the bedside and I have been given opportunities so far.  I was in clinic with Stephen Henry when a surgeon came in because he had an emergency psychiatric consult.  A 73 year old man had been admitted six days earlier with pneumonia, underlying diabetes; he had developed gas gangrene  and needed an immediate foot amputation.   The gentleman had repeatedly said he did not want the surgery; however, a family member from the North had given the surgeon consent to do the surgery .....whoa!   The surgeon knew that was not the best form, but wanted some support for not doing the surgery.

Dr. Henry writing his consult note.

Stephon interviewed the man and he was responsive, though quiet and weak .....   He was asked if he wanted surgery to amputate his foot.    The patient had also said on admission that he didn't want any more surgery, and although it was not documented, most staff had heard him say that.

He lives with his wife of many years who had not been in to see him because she is unwell; there, were no other family members in the country.   His pneumonia meant there was a serious risk in proceeding to surgery and there would be increased pain from the amputation if he survived.

It was the first time there was a discussion on the ward with nurses and doctors about the ethics of refusing a treatment. (And the resident was ready to be a Consulting Psychiatrist!)    I did suggest that they find some way to bring his wife in before he died.  She was there that night.  The end .... almost.

A surgical resident came down to psychiatry the following morning because "his staff" person wanted to know whether, if the patient became incompetent, they could accept the family's decision to proceed with the surgery😕😕.    

I would have loved to think that the love of ethics had blossomed in Guyana, but I know that the driving force was to have a stronger case if the family got upset after he died.  In any case, it has been a good first week.

Thanks for reading.

John

Next week's blog may be late as I am going to the Guyana Interior, Mabaruma, with Psychiatry on Friday and will be back sometime Saturday.