Monday, December 7, 2009

The Waiting Room

When I visit Ndiago's health post, a miracle staffed by able and educated men and women, I usually spend some time in the waiting room. Three tiled benches built out of the walls line three sides of the room; doors lead outside and into the doctor's office, a few examining rooms, and a pharmacy. For an American traveling abroad who might be forced by accident or illness to look for medical help, this place might be a reassuring sight. But the people in my village don't see it that way. My host mother, for example, let a pus-dripping open sore fester for two weeks before finally coming in, though I had been pleading with her to go since the first signs of infection. Furthermore, the cachement area for this health post covers around twenty villages, many of which are far away enough to be tough trips for the seriously ill. But despite this difficulty and the enormous reluctant to make the trip, the waiting room is often packed by mid-morning. After all, there aren't a whole lot of doctors to go around in Senegal, about one for every 10,000 people.

Ndiago is a pretty small village, and though it's not too remote it's still pretty far off the beaten track on the national highway. Most people come and go by horse-drawn carts. So the village might not immediately strike the mind as a place where two worlds are meeting and trying to become comfortable with one another, in spite of some considerable differences. Here, little bits of my world are easily assimilated into Senegalese daily life. I'm the only one who things "Houston" brand cigarettes in red and white Marlboro-esque packages are funny. Girls wear traditional printed skirts and ragged t-shirts with HOLLYWOOD emblazoned across the chest in silver sequins without a trace of irony. Almost every public transit auto sports colorful stickers of Madonna's face, Barack Obama's name, and the Mercedes logo. And all of this with no sense of absurdity, no interest in the ideas behind the images, and no discomfort at all.

But one place where such collisions between two cultures seem to sit less easily on the Senegalese soul is this waiting room. The idea of a waiting room itself doesn't translate too readily. In the States, when you want to see your doctor, you call up and make an appointment. The waiting room is where you get stuck if you're early, or if your doctor's running a bit behind schedule.

Ndiago has about 275 people living in it, and out of those perhaps ten of us could be absolutely depended upon at any point to know exactly what the time is, exactly what day of the month or week it is. Someone will occasionally ask me what day of the "white person month" it is (for example, the 31st of October) but I've never seen that information put to any use. Time, for most people in the village, is figured differently. The call to prayer comes five times a day. If you want to leave the village, you catch a horse cart between sun-up and the beginning of the hot part of the day, or you wait until the heat breaks in the afternoon. The big market in our road town is every Wednesday. Every Friday, the men of the village go to the mosque to do the first afternoon prayer together. Muslim holidays are announced by the moon's phase and ratified by the authority of the marabouts, whose dictum mainly spreads by radio and word of mouth. When I call a meeting, plan an event, or set up a time to talk with someone, I do so by making reference to the prayers.

The system of calling to make an appointment just wouldn't work here. Instead, people walk or ride in to Ndiago in the early morning, even before the post is open. They take their seats in the benches and wait. As each person walks in, perhaps with a child slung across her back or guiding an elderly relative, he or she pauses to greet those who are already seated. Each newcomer greets, asks after the health of common friends or relatives in neighboring villages, finds a place to sit. The greeting ritual is so highly formalized that someone who is seriously ill will, when asked about his or her health, respond that everything's in perfect shape. Nobody is a stranger here. The men and women talk about recent events in the villages: last week's baptisms, the soccer matches between the young men, the peanut harvest. In doctor's offices across America, patients awkwardly sit with at least one empty seat between them and their unknown temporary neighbors. No conversation, no eye contact, no greetings. There's no physical room for avoidance in this waiting room, no way to stay out of contact with the people seated next to you.

All this is true, of course, in a lot of public places in Senegal: schools, for example, and public transit. You're squished together with a lot of strangers, so you might as well make conversation. If the physical reality of the situation is such that it's impossible to feel the peace of solitude, you may as well give up denying that you're not alone. But here in this waiting room, where people come with sometimes terrifying illnesses, the crowd seems invasive. If you're scared for yourself, your child, or your parent, maybe the greeting ritual and patter of conversation grates at your nerves. If something you don't understand is making you sick, maybe what you want is a little bit of solitude and quiet to think it through. You're dealing with apprehension, fear, pain, and a whole host of other emotions. It could be difficult to sort those things out while diligently taking part in a description of all the gifts given on the occasion of a recent wedding.

But this is where Senegalese and American culture clash, and this is where the waiting room, which at first struck me as a bizarrely and inappropriately transferred Western-ism, starts to look like a perfectly designed space for the role it has to play. No one in Senegal seeks out solitude, unless they're very elderly and choose to spend most of their time in prayer and preparation for death. No one chooses to strike off into the wilderness all by himself, far from family and friends. I used to see solitude in Senegal as something to be avoided for practical reasons: the community of the village supports and sustains all the individuals within it, and no individual could survive for long without its framework. But maybe such a closeness is also an emotional necessity for the Senegalese. To be alone is to accept that your death is coming, or to seek it out prematurely. In a time of sickness, a close-packed waiting room where you sit elbow to elbow with neighbors and acquaintances would be reassuring, when you look at it this way. All those people squished in next to you are your life, your way of continuing to live. The doctor and his medications might provide some help and comfort, but I think there's a way in which a return to health and well-being starts here, in this waiting room, where it's impossible to be alone, and so perhaps impossible to die.

Love and guts,