The Kitipa boma

"The house is like a dark womb - and heavy, smoky - with a giant red eye at its core."

This boma - a Swahili word that means fence, or fortification - was about a two hour drive from Wasso hospital. We rode with ten other people in a broken-down Toyota pickup, pausing at river crossings to fill the radiator with the thick, greenish-brown water. The Maasai call their homes "engang" - the dwelling - and we arrived just before sunset, after walking about half a mile over short grasses and rocky outcrops.

Kitipa, the patriarch, was waiting, resting on a stoop just outside his home. The huts are arrayed in a circle around a thorny fence that holds the cattle at night - safe from the lion's attack, guarded by young men of the boma. Kitipa's hut is first on the right of the entrance to the cattle enclosure, a place of honor. We gave him our hand to shake, Uli bowed her head in respect and he touched it lightly. Then we moved on to his first wife's house, the next one on the right. She is the mother of my friend Nicholas, who invited us here.

"We will go into the house now," Nicholas said. It is hard to describe the home well. A small wooden door guards the entrance - about five feet tall and two feet wide. There are no windows. The outside is covered in cob made of cow dung - worn-down patches are updated with fresh dung from time to time. Thicker sticks are interwoven with a special branch - a wattle, of sorts - which serves as a scaffold for the cob. On either side of the door are branches of the sandpaper tree, Cordia monoica, placed there to protect the home from storms.

We entered into a very small antechamber. It was very dark. Immediately the senses were overwhelmed by an oppressive, acrid, hot smoke, only somewhat relieved by bending over and keeping the head low. Right in front of us, a small door led to the calves: their room occupies a third of the house. A left turn, then a right turn, led to the central dwelling space.

Here, surrounded by three gray stone slabs embedded vertically in the ground, the hearth fire was glowing. Two built-in beds, enclosed almost completely by some wattling, faced the fire and also served as sitting places. Built-in wattle shelves held cups, metal plates, calabashes of milk, tools - but you couldn't see anything, even after our eyes acclimatized to the dark. The ceiling had a crisscross network of sticks, wattle, and twigs disappearing into the darkness. Smoky cobwebs hung everywhere. The beds, made of thin sticks laid across a support structure, were covered in rawhide.

"We will not be cooking in here," Nicholas said. "It would be too hot". I was grateful. We were joined by Nicholas' brother Mangoiye, whom I had helped through a deep, feverish illness last year, and spent hours drinking hot, sweet milk, eating beans and rice, and telling stories of Maasai rituals, childhood and marriage, strange shape-shifting flesh-eating demons, warriors and cattle - all while sitting around the unblinking red eye of the hearth-fire embers.

Time came for sleep, and we reclined on the rawhide beds. It was warm, pitch black, and we could hear the low breathing of the calves. Nicholas bolted the door shut, from the inside, with a short stick polished from years of use. I fell asleep quickly - though Nicholas reminded me that at least one of the young men from the boma would be outside, guarding the cattle, keeping them safe inside their acacia thorn enclosure.

The season had been dry: no rain to green up the grass, to fatten the cattle. Almost everyone we talked to, from Wasso to the outlying bomas, complained that crops were failing, animals were hungry, rain was missing. But when I got up that night, slid the long, smooth stick out of its leather guide, and went outside to go to the bathroom, I was grateful for the cloudless sky. A huge field of stars, the galaxy silver and rippling, bright blazes of meteor trails filled my view from horizon to horizon. No human light in sight. I went back inside, overwhelmed and yet somehow so peaceful. I bolted the door, imagining what a privilege it would be to sleep out under those stars, resting with the cattle.

The next morning we woke with the roosters. A bright shaft of sunlight pierced through the home from a small hole in the eastern wall. The inside was so smoky, so dusty - you could see the beam like a shaft of pure glittering gold. We touched it, played with it like little children. Then, after some hot sweet milk, we walked outside. Mangoiye and boys were branding calves, using red-hot irons from a fire started by friction (using myrrh-tree fireboards). Immobilized by ropes, the calves made no sound as their skin, singed, let off trails of smoke into the morning air. Before walking back to the main road to get a ride back home, we talked of trees, medicine, colonial times and old games Kitipa used to play. He has many cattle, many children - a rich man.

The road home was dusty, hot and sunny. We were glad to return to hospital work, our home and our friends (and a hot-ish shower). That night we sat and talked by porch light, telling stories of the Maasai: the heat, the smoke, the dirt, the milk, the stars. We had made plans to return, speak with those who know more of the medicine trees, spend more nights in the dark of the boma home. Maasai life. If is difficult, conservative, in many ways oppressive. But in many places it is still an intact tradition - mostly, at least - and it feels special to interface with such a slice of human experience. It was an honor and a privilege.

The next morning, we experienced another privilege. The call came in - lion bite! We rushed to the minor theater. A young man, Maasai by dress, was lying on the table. Anne began chest compressions - his heart had stopped - while I took his head and positioned it to open his airway. Suddenly, he drew a huge, raspy breath. Intermittent, struggling breaths followed. I found a rapid, thready pulse on the carotid, Steve counted beats per minute on the radius. 145. We inspected his body: nothing on the legs, but his left arm had a series of deep punctures. Then we came to his head. Eye - lacerated. Pupils - fixed. Fracture above the nose. Through two gashes on either side of his head, white matter, thick and sticky, was exuding. We all realized his injuries were overwhelming: the lion had hit him in the head, his breathing sped then slowed, his heart was jumping fast and erratic. So, over the next twenty minutes, we held him as his breaths came fewer and fewer between, as his heart rate slowed, his pulse weakened. Sister Philippina poured holy water over his forehead. "Because we believe God is great." Steve lost the radial pulse. I lost the carotid. Robin stopped hearing heart sounds. He was gone.

Then the story came in from the family. He had been outside, underneath the stars, the night before, guarding the cattle in a boma's acacia enclosure. A lion had come and surprised him, he didn't have a chance to protect his head. The lion then took a cow and retreated into the night. The man was strong - he struggled a long time, refusing to give up - but in the end passed on to the fields and forest. As we felt his pulse slip away, a light rain started to fall, beating on the hospital's tin roof.

Wasso beat

Rhythm courses blood red
In waves of morning clouds
Marked by cattle bells.
The day breathes hot and wide,
Shadows race across the hill
Until they tire into long blue threads.
Then the cows return, in line,
Brown and white and black,
Driven down the long cracked wash,
Dusted rusty red.

Herbal Medicine in East Africa - our first week

The last leg of our journey to Wasso was on a small, six-seater airplane. In fact, we needed two planes to carry our team of four herbalists, one medical doctor, two medical students and my daughter Uli. It was a beautiful day to fly. A slight overcast, with a cloud ceiling at 7,500 feet, prevented the jarring updrafts that can make for very bumpy rides. We kept low, just under the clouds, flying close to mountainsides covered with cedar forests. Crossing over the Rift Valley, we flew just north of Ol Donyo L'Enkai, the Maasai volcano god, and over the spectacular Lake Natron which was swirling with all sorts of colors: blue to muddy brown, pink, white, emerald green, and all the shades between. As we approached the highlands of the Serengeti (Wasso is on the Eastern edge), the clouds and land met and we flew closer and closer to the hills.
Our pilot, Pat Patten, leads the Flying Medical Service and has well over thirty years of service under his belt in this part of the world. Everyone knows him, and he serves not only as a physician but also as a sort of messenger between the far-flung communities in the area. To signal our arrival at Wasso hospital, he flew down close, pulling a hairpin turn right over the hospital on his way to the long, grassy airstrip. "Only a few termite hills left of the center line," Pat remarked. "Should be a smooth landing." It certainly was. We were greeted at the airport and rode the short distance to the hospital in a land rover and on the back of an open Toyota pickup. It was Easter sunday. The town was still.

After the long weekend, we began our work at the hospital. We were lucky to have had a few days to explore, building our improvised apothecary from the abundant local plants. I noticed that everything seemed about a month behind where it had been last April. Perhaps this was because of a long drought: the rains hadn't come when expected, and rather than beginning in February had waited until March. But now, after just a few strong thunderstorms, the land had burst into green. Resurrection plants were blooming. The aloe sent up tall, riotous red flower spikes. The acacias were covered in delicate, fern-like new leaves - a stark contrast to their long white thorns. We collected Usnea, Bidens, aloe, local mallows and nettles and even a species of Spilanthes. We picked leaves of holy basil off bushes that were ten feet tall. As we were walking by the stream, we found an old Acacia nilotica. The bark is used for intestinal complaints, and has a fantastic combination of tannins and demulcent starches, along with bitter compounds. I'd been chewing on small twigs for myself, and wanted to collect some for patient use. But as we were looking at the tree, an elderly Maasai couple came up to see what we were doing. The mzee (elder) began to explain that the inner bark of the main trunk is the best part to use. But as he attempted to harvest some with his panga (machete), the bibi (grandmother) pushed him aside and pulled out a stout hatchet, long-handled with a metal head. She made short work of the trunk, stripping the rough, dark outer bark from the soft middle layer which we collected for medicine. We left with a backpack full.

Now here for our first week, we are beginning to get into a good workflow. Minor theater is always busy, especially in the mornings: crush wounds with fractures from stonework; burns, cuts and lacerations. An infant with an extensive wound, from the hip to past the knee, revealing underlying muscle and a completely visible knee articulation. A tibia fracture right above the ankle. We are using honey, aloe, and usnea powder and cutting down on iodine (and completely cutting out the bleach that is still used by hospital staff). But perhaps more importantly, herbalists are following physicians on morning rounds in the inpatient wards - male, female, and pediatric - to take case histories, conduct physical exams, and formulate plans for herbal support. We take turns harvesting and preparing medicine, juicing plants and brewing teas and decoctions, for dispensing on the wards. Many blends are nutritive - Urtica and Chenopodium - for the ever-present malnutrition and anemia. Others support organ function, enhance circulation, and provide herbal antibiotic support, using primarily Bidens pilosa, Leonotis species, and Usnea (the latter for urinary complaints). There are a few cases of cholecystitis, with thickly coated yellow tongues, for which we are using a rough, bitter plant in the genus Aspilia. Ginger compresses provide anti-inflammatory support. And finally, respiratory cases of asthma, bronchiolitis, and tuberculosis receive twice-daily fresh whole-leaf eucalyptus steams. One barrel-chested man who may perhaps have obstructive pulmonary disease and pleurisy is always of good humor, smiling and laughing after his steam treatments. The obvious crackles in the lower left lobe of his lungs have disappeared after two days. A three-year-old boy, bright-eyed and curious, has stopped coughing from a combination of antibiotics and herbal bronchiodilators/antispasmodics.

I am extremely grateful to Steven Byers, Iris Gage, and Rob Shapero for their work at the hospital. By acting together as a team, we are able to reach all cases that are amenable to herbal support in a way that would be impossible for a lone herbalist. We spend hours wild-haresting in the countryside and making simple medicine. We help hospital staff by cleaning, folding gauze, and treating wounds. We improve the quality of life of patients who rarely have access to pain and inflammation control. And today we will walk the countryside accompanied by my friend Manasse, who was born and raised just a few miles from here, received his degree as a nurse midwife, and has been studying and practicing herbal medicine. He speaks English well and also knows the Maasai language, so with his assistance we can begin a more systematic catalogue of local medical knowledge - relying on recordings to document informed consent. Our long-term goals include training local staff to continue the practice of herbal medicine here. Everyone is so receptive and interested: our role is to help the hospital administration to realize the benefit of traditional knowldege, judiciously applied, for improving patient care. If we succeed, we will be out of a job here. And that is by far the best possible outcome.