Segbwema, Kailahun District, Sierra Leone
Monday June 12, 2017—Dispatch 3
By Randy Thomas Jones
Today I’ll return to the story about how contact tracing, maps and public health all connect the dots that form an arrow pointing us to come here to the verdant and vibrant atmosphere of West Africa, to gather people with Android phones, to find motorcycles with their drivers, and make maps of places that can literally be “off the map.” In many cases, being unrecognized means that voices from the hinterland are not noticed, and this is the first step to helping people say to the administrative systems of the modern world, “We are here.” In a way, an analogy could be that if one called for an ambulance in the modern world, one would expect to be asked, “Where are you?” And given an answer, to expect them to arrive. In low-income settings, sometimes the difference between being known and unknown is a difference between life and death.
One of the things that becomes apparent after some consideration is that the creation of maps and an unambiguous gazetteer (which lists not only village names, but the association with higher administrative districts) is much better done before a crisis hits. And of course, registrars at clinics and hospitals have to understand why it is necessary to use them, and be insistent on a full answer when asking, “Where are you from,” or, as sometimes is the case when someone brings in a friend or relative, “Where is this person from?”
Dr. Monk is developing his portfolio to focus on both UK-based medical practice and Global Health for Alternative Certification in Core Medical Competence, enabling him to tailor his studies to his interest area of epidemiology, infectious diseases and microbiology. He’s a congenial ball of fire when he invites us to the local bar in Segbwema Thursday night, and he and Ivan happily trade stories, both of them enjoying the meeting of minds with similar obsessions. Ivan considers him a great resource as a friend to the project—the more typical situation is that doctors don’t pay that much attention to public health (again, that old bias of the consequentialists). Doctors, and quite rightly, tend to be Kantians.
Friday morning we walk up the hill from our guesthouse to meet Monk. Or, more precisely, he arrives at 8:00 in the morning with a typical British enthusiasm and a warm invitation to the canteen at the Nixon Memorial. A breakfast that is unusual, for the Western palate, composed of fish and rice, but I do remember the “Egg and Bread” from my visit to Ghana last year, and determine to track that down whenever possible!
What started out seeming to be a quirky interest in records turns out to be only the “responsibility of care.” I’m getting enthusiastic about records myself at this point, and there is a certain kind of devotion to the practice that is as important as remembering to feed all of your children, and not leave one hungry.
Leveraging the goodwill that Monk has built, we make some very casual inquiries as to the possibility and interest for adding any columns to the intake books. Currently, the disambiguation of towns with the same name is done informally, depending on Betty and Daddy’s admittedly formidable memories. There are complications to this; one of the master books is a federal record that has a specified format that doesn’t meet standards for current best practice. But the answer is a tentative and provisional, “Yes, possibly.”