An East African Materia Medica


Introductory notes: the plants referenced here are ones I have been using in the highlands of north-central Tanzania, at an elevation between 7,500 and 8,500 feet from sea level. The climate is generally moderate, with mornings in the 50s and daytime highs in the 80s. It is the rainy season right now - the flora will be different in the drier months (May to October). Generally, one could find these species in a broad area from lake Victoria in the west, north past Nairobi in Kenya, out to the Ethiopian highlands in the east and down past the Ngorongoro crater in the south.
I reference plants that I have been able to positively identify, gather, prepare and apply myself. Preparation notes are included. Botanical names, as well as Swahili (Swa.) and Maasai (Maa.) names are included if known. Clinical outcomes and observations are from my herbal practice in the context of Wasso District Hospital over the course of about four weeks of work. Patient volume varies; on a typical day there will be five or six patients returning for acute wound care, two or three new acute wounds of varying severity, two or three chronic wounds or infections, and between two and six cases from the internal medicine wards (chronic asthma, diabetes, hypertension, peptic ulcer, HIV and its complications).
Patient diets are generally similar, and quite simple: rice and cornmeal are the chief carbohydrates, and beans the chief source of protein. There are some tomatoes, cabbage greens and carrots used, and occasional meat (goat, beef). Sources of fat (used in abundance) are questionable, consisting mostly of refined vegetable oils. In the context of the hospital, dairy products are virtually absent. One conspicuous factor is the ubiquitous use of soda (often up to six or more bottles a day) which is in large part at the root of the cases of diabetes and gastrointestinal ulcer - the latter also connetected to the near-universal Heliobacter pylori infection and the frequent, indiscriminate use of antibiotics.
This inappropriate use of over-the-counter (black market) antibiotics, as well as prescribed antibiotics in the hospital setting, have led to both gastrointestinal disturbance and antibiotic resistance, particularly in cases of cutaneous staphylococcus infection (but also typhoid and pneumococcus). This makes the use of herbal medicine all the more valuable and important. Wound management in acute cases usually involves simply a liquid iodine solution, though in chronic wounds I used herbal treatment exclusively. Aside from that, unless otherwise noted in discussing specific cases, treatment used was entirely herbal.

Achillea millefolium (Yarrow): truly a wound plant like no other. Luckily, there is a fair supply planted as an ornamental in the hospital garden. Daily preparation involves gathering a large handful of leaves and a flowerhead or two, coarsely chopping, placing them in a bowl and using just enough hot water to cover the herb. Then the mixture is blended and the juice strained and pressed. Yarrow juice is used as a wound wash for chronic ulcerations in cases of leprosy, diabetic foot ulcer, or unaddressed infected wounds. Apply liberally to gauze and use to scrub and irrigate the wound, cutting away necrotic tissue as necessary, twice daily. Saturate and pack gauze into deeper wounds if prurulent discharge is present (wet-to-dry dressing, iodine alternative, very effective).

Zanthoxylum chalybeum (Maa: loisugi): a bitter, pungent preparation is made by collecting the bark (outer and inner, after removing knobs and thorns), cutting into coarse strips, and decocting about one cupful of shredded bark to 1/2 gallon of water for 15-20 minutes. The decoction is yellowish-brown and can be used to irrigate wounds (mixed with yarrow juice) and internally for peptic ulcer and as a bitter digestive tonic, dosed at about 2 ounces of decoction twice a day before meals. One patient (who began his treatment with two days of goldenseal [Hydrastis] powder, 1/4 tsp. twice daily before food but then switched to this decoction) remarked that his after-meal symptoms of burning pain were completely resolved. He had previously tried a range of antibiotic treatments with no success.

Bidens pilosa: I tried this weedy plant as an alternative to yarrow for washing wounds, with limited success. It seems to lack some of the topical astringent hemostatic effect of yarrow. However, it is quite useful taken as a juice for internal use, particularly in cases where vitality is weak, there is anemia and/or fatigue, or the tissue (internal or external) seems in need of drying or toning. When these constitutional signs accompany infection, Bidens provides valuable systemic anti-infective support. This was particularly evident in a case of leprosy, where yarrow and usnea powder helped the lesions considerably, but failed to completely resolve the issue until Bidens was added. The aerial parts are harvested daily from specimens that have just started flowering (no seedheads), the leaves garbled from the stems, placed in a bowl and barely covered with cold boiled water. Then the mixture is blended and the juice strained and pressed. Patients take around two ounces of juice three times a day. The juice will keep at room temperature for 48 hours, but any leftovers should be discarded after that.

Usnea spp. (barbata / longissima): this hardy and cosmopolitan lichen can be identified by the white inner fungal cord (medulla) and the green outer algal cortex which can be "stripped" from the medulla as one might do with electrical wire. It grows at higher elevations, hanging off old tree branches closer to the hilltops, blowing in the near-constant wind. Here you can find it by the bagful. I have been using it primarily as a wound powder, particularly in long-standing damp lesions where I leave it embedded in the tissue for two days at a time before cleaning it out with yarrow/loisugi mixtures. It helps to form a nice matrix for granualtion tissue, while preventing infection and drying suppuration very effectively. In the leprosy case, it actually embedded itself into new skin, forming a sort of hybrid usnea-callous that closed the wound while also providing excellent protection from the pressure and friction that caused the lesions to re-open (Mycobacterium leprae can infect peripheral nerves leading to loss of sensation, certainly the case in my patient). My preparation method involved sun-drying the lichen until it was brittle (thereby increasing usnic acid content, too), then just cutting it for 15-20 minutes with a serrated blade until it became a mass of green powder and tangly white strands. The mass gets passed through a mesh strainer to leave only a fine, green powder which is liberally applied to wounds.
A note regarding leprosy: dressing the wounds is often counterproductive. They are moist and ooze quite a bit, and enclosing the discharge actually retards healing. Twice daily application of usnea powder to replace any that fell off during walking does the trick after a week to ten days, along with Bidens internally and good foot hygiene. Patient was discharged with a big wad of lichen to use and apply as a spit poultice (small amount at a time) should any further wounds develop. He had been in the hospital for six weeks before we began herbal treatment. Antibiotics had been used (internally and topically), along with bleach soaks, to little effect.

Argemone mexicana (Maa: langanum): a britsly Papaveracea with a bright orange latex and beautiful flower, it usually grows as a weed in planted fields. It is used by the Maasai as an immediate antiseptic and hemostatic treatment for minor cuts and wounds - really useful on trail walks. The latex, which flows profusely when any part of the plant is broken, tastes remarkably like celandine's. I regret not having had the opportunity to try it in cases of cholecystitis, though there was one patient who did come through minor theater with that condition. It was a very instructive abdominal exam, with all the classic signs in the right upper quadrant and referred scapula pain too. Ultrasound was inconclusive in her case. She was sent home and told to avoid fats before we got a chance to start herbal treatment.

Zingiber officinale (Swa: ntangawezi): this famous rhizome needs no picture nor description. It is readily available, still covered in red soil, at the weekly market in town. I purchased a big pile of it for the equivalent of about $2. While I made the occasional anti-nausea tea (for Westerners), the main use of this plant was as an anti-inflammatory circulatory stimulant to support the healing of chronic diabetic foot ulcers. I had two patients whom I followed with this treatment, along with caring for their primary wound and conducting daily foot and leg massages to promote lymphatic drainage. The procedure for preparation was simple: grate the fresh rhizome (about 1 TBS), add about 1 cup boiling water, let steep five minutes or so, then saturate a clean cloth with the infusion and apply hot to the foot. Before applying, I would take the leftover grated rhizome and apply it to the dorsum of the foot, then wrap it up. This happened twice daily.
A note regarding diabetic foot ulcers: one patient developed the ulcer after stepping on an acacia thorn which pierced her flip-flop and went straight through her foot, emerging from the top a bit lateral and proximal to her big toe. The resultant abscess had to be surgically opened, and a chronic wound developed. It was about the size of a nickel when I first saw it, and the whole foot was noticeably edematous. She could not walk on it. Daily bleach soaks and antibiotics had not really helped for the five weeks she'd been doing them. Within three days of using ginger and eliminating the bleach, the swelling began to subside and peripheral pulses returned. After about a week, the foot was almost normal in size, and the ulceration had reduced dramatically in diameter and depth (yarrow juice + usnea powder). Her course of antibiotics had ended a few days before. After two weeks she was walking pain-free, the ulceration was gone and fresh pink skin remained, and she was discharged with a big bag of prickly pear cactus pads.

Opuntia ficus-indica (prickly pear, Swa: freisha): an exotic cactus, the prickly pear has naturalized extensively across the Tanzanian highlands. Some specimens I've seen are over ten feet tall, bristling all over with long spines and tiny, fiberglass-like hairs that are perhaps even more of a hazard than the visible thorns. The fruits are starting to ripen here right about now, and can be used medicinally, but I harvested the wide pads by scraping them clean of spines with my knife's edge, then cutting the pads. Some clinical research looks at the fire-roasted pads (used as a food source in the American southwest), but I just went ahead and juiced them fresh. A little water is added to the chopped, cleaned pads (scraped, washed, and towel-dried), then they are blended and the juice is taken, at doses of about 1/2 cup full, twice daily before meals. I used this juice, sometimes spiced with a teaspoon of cinnamon powder if available, for managing elevated blood sugar associated with diabetes.
A note on diabetes: this is a relatively new disease here. None of the Maasai I worked with knew of any diabetics in their community. The cases were in overweight, non-Maasai community members, and staff members at the hospital. Once again, it seems to be a disease of relative affluence connected perhaps to that wonderful American export, the sugary soda, which is shared at almost every social gathering and can be a bit of a branded status symbol. Blood glucose levels are measured here as they are in Europe: in millimoles per liter, unlike in the US where the units are milligrams per deciliter. The conversion is based on the molecular weight of glucose (one mole of C6H12O6 is 180 grams), so 10mmol/L = 180mg/dL. That's a pretty high fasting level! The guideline is 6mmol/L, or about 104mg/dL, for a fasting blood glucose. One staff member at Wasso Hospital went from 10.4mmol/L to 7.8mmol/L in less then a week using Opuntia and cinnamon (and strictly avoiding soda). This result was a bit amazing to me, but isn't out of the realm of possibility (she was certainly pleased). Some confounding factors: I'm uncertain whether she had drunk any soda before her first test (would definitely have skewed the result, but even after a soda your BG shouldn't be 180); two different lab techs conducted the two tests (you might say lab work is objective, but I'm not so sure). Regardless, her BG levels have been a lot better in the mornings with the Opuntia juice than suggested by past test(s).

Aloe spp. (vera, alata, ferox. Swa: msubili): This succulent, rich in soothing gel, is a classic burn remedy. To be honest, I used it mostly for our family and other Westerners transiting through the guest house - but was also able to apply it on the more superficial burns I saw in minor theater. It is excellent to relieve pain and speed healing for superficial burns, but I'm not confident enough in its antiseptic power to recommend it on full-thickness burns after the top charred layer of skin sloghs off. However, with extensive burns, one of the major risks after infection is dehydration - and aloe can help a lot for that. One child who had been sweeping the floor of her home was extensively, though not deeply, burned when her wrap caught fire. Both arms and the back and front of her torso suffered partial thickness burns, and the evaporative fluid loss was high. The healthy skin on her legs showed pretty substantial dehydration, despite a lot of drinking. We used aloe five or more times a day (training her parents on how to apply it), and silver cream just twice over a week, and there was no infection and much less dehydration.
Preparing aloe is fairly easy. You cut whole leaves, then remove the spines on the sides of the leaves (taking care not to cut too deeply and expose the demulcent pulp). Then, simply cut cross-sections of leaf, peel off the green parts, and mush up the gel in a container. Apply liberally to the affected areas. One note: the stuff is remarkably bitter. Wash your hands after preparing.

Phytolacca dodecandra (Maa: ol'diangorras): I was excited to find the orange-red berries of this local species of pokeroot. It grows vigorously, more vine-like than its American cousin, and has a thick and juicy root. With some coaxing, I was able to harvest a fairly sizeable chunk. From this I cut wide slices, which were then pounded and the juice strained out. I used about 1/2ml of this juice on myself at first, then closer to 1ml twice daily for an HIV patient who had lymphatic swelling in cervical, axillary and inguinal nodes. She saw some improvement from this approach - not a dramatic reduction in swelling, but a marked reduction in tenderness. I searched extensively for cleavers (Galium), but was unable to find this species outside of the Ngorongoro crater rim. Needing a lymphatic, I opted to try this Phytolacca and was not displeased with the results. The flowers smell amazing, kind of like lilacs. The Maasai (at least those I spoke with) only know it as a poison plant and warned me against eating the berries.

Eucalyptus globulus (Swa: Makaratusi): These trees were planted by colonists, and now there are some huge specimens, usually along main roads but often in the more secluded (and less fumigated) corners of the villages, by streams. Many trees have been cut down, especially those next to cultivated fields, as they tend to suck up all available water and can contribute to crop loss during drought. Nevertheless, the leaves are abundant and quite fragrant, and I would place whole branches, slightly broken up, in pots of steaming water for patients in the pediatric ward who had chest congestion. The steam smelled nice, nobody complained, and some of the patients remarked that they were breathing more easily after taking big inhalations of the steam. This was especially evident in a case of chronic asthma, aggravated by the dusty conditions here, where eucalyptus steam inhalation provided almost immediate relief. Use a towel over your head for maximum steam concentration.

Olea africana (Maa: ol'orien): These strange looking olive trees live quite a long time, and have thick, gnarly trunks that end in a burst of spindly branches, loaded with leaves and olive-like fruits with little seeds that mature to an unpalatable orangeish color. I harvested the leaves to use as a treatment for hypertension. This condition is relatively rare (most blood pressures were in the 100/60 range) but more and more folks are experiencing higher blood pressures and atherosclerosis these days - even in the Maasai community. I'm not sure exactly why this is. Nevertheless, I'd give out bagfuls of fresh olive leaves, with the instructions to chop or pound a good handful and steep in a pint of hot water, drinking daily in two divided doses. Results took time - at least a couple of weeks - but I was able to see a small but consistent drop (5-10pts systolic) in blood pressures for those taking these leaf teas consistently.
The Maasai used the leaves for malaria and fever. Given their anti-inflammatory and potentially antiviral effects (extrapolating from research on the European cousin of this tree), these traditional uses make sense.

Commiphora africana (Swa: mturituri): I was introduced to this species as a remedy for colds: the resin that exudes from the bark of older trees is traditionally steamed and inhaled. Also, the root of younger trees is wonderfully fragrant and actually sweet - a remarkable surprise. But seeing as how I couldn't find enough resin, and eucalyptus was working well for chest congestion, I recommended the bark of this plant be chewed as a remedy for high cholesterol and atherosclerosis. I am extrapolating here from research on its cousins C. mol-mol (guggul) and C. myrrha (myrrh), and it is too soon to tell what kind of effect it may have had, but between that and the daily 3-4 cloves of garlic I am optimistic. One gentleman accosted me for a consultation on cholesterol and atherosclerosis while I was buying bar soap to do my laundry at the little shop across the street. He needed some exercise too - I suggested some brisk walking and less hanging out at the shop drinking soda.

Urtica massaica: Oddly, the Maasai didn't have a name for this ferocious species of nettle, preferring instead to give it a wide berth on the trail. The stinging hairs on this plant are stiff and potent even after drying, and can be two to three inches long on the stem. The plants grow to over six feet in height, out in the full sun. The sting persists for 24-48 hours, depending on how deep you're stung, and caused an immediate urticaria rash on my skin (U. dioica just doesn't do that for me). So I started using scissors to harvest the green tops, pre-flowering, and would juice them to a dark-green-black frothy fluid. Delicious. I'd combine it with the juiced berries of Cyphostemma (see below) to make a nutritive tonic for anemic patients. One cupful a day seemed like a good dose. Good nutrition, especially for moms and kids, is really important here: many are anemic, blood is difficult to obtain, and malnutrition is rampant.
Another use of this juice was for symptoms of allergy and upper respiratory congestion in Westerners unaccustomed to the dust and allergens of this environment. Half a cup of fresh nettle juice, once or twice a day, reduced eye itching and nasal congestion. Overall, it is a very nutritious, very drying herb.

Cyphostemma serpens (Swa: mwengele, Maa: ol'kilenyei): this viney, trailing plant drapes itself over low acacias and on termite hills. It produces clusters of berries, which the Maasai harvest while still green to use as a food and especially as a tonic for children. The tuberous root can also be boiled and eaten, though I didn't try this. The fruits have an agreeable sour green flavor, and I expect they contain a fair amount of organic acids and perhaps even ascorbates - a great supplement indeed! So I'd harvest clusters of the berries and juice them up, often with nettles, to add into the diets of those needing a special boost. 1/4 cup of the blend for kids, 1/2 cup or more for adults, once or twice a day.
Traditionally, the Maasai add the fruit pulp to milk and feed it to kids to help them grow stronger.

The bitters: I used the bark of Acacia species for this purpose, primarily for myself, my family, and the Westerners with digestive complaints. I preferred loisugi for local folk, as it seems to be more of a tissue tonic for long-standing gastrointestinal inflammation. The acacias are bitter and, depending how they are processed, possess a varying amount of tannins which can be useful if there are digestive complaints accompanied by loose stools or diarrhea.

Acacia nilotica (Maa: ol'kiloriti): this is an excellent and useful tree though, like most Acacia species, it is viciously thorny. It has a characteristic shaggy, dark brown bark and rounded, yellow pom-poms for flowers. The Maasai go at the trunk with a machete, gathering the middle, soft, tannin-free bark layer. The outer bark is very astringent, and serves as an anti-diarrheal. The innermost layer is very bitter, and acts as a purgative. But the soft middle stuff - just right. At special dates two or three times a year, they boil handfuls of it in a goat stew which is eaten to "cleanse and renew the belly". It is moderately bitter, somewhat reminiscent of yellowdock root in flavor, and small sips (1-2 oz) of the decoction before meals improve appetite and regulate bowel function well.
I myself became quite fond of using the younger branches of this tree, adopting another common Maasai habit. Stripped of thorns, they make excellent toothbrushes and lack the inner purgative bark layer. So, after the morning run and before breakfast, I'd walk around chewing on a six-inch chunk of twig, swallowing the bitter and slightly astringent juice, and rubbing my teeth and gums with the juicy fibrous end.

Acacia drepanolobium (Maa: ol'munishui): nicknamed "whistling thorn" because of the big, dark, hollow galls that catch wind with a characteristic whistle, the Maasai use its roots as parturients to help expel the afterbirth. This is actually a big issue in the local community, with many women suffering prolonged post-partum hemorrhages that can be life-threatening. But I didn't use this tree for that. The inner bark makes another excellent digestive bitter, but it is a bit more pungent and almost numbing to chew, reminding me slightly of kava. Another traditional use is for sore throats, which makes sense (though no throats were sore at Wasso). I used an infusion of the inner bark, about 1 TBS per cup of hot water, with a little honey as a pleasant evening after-dinner digestif. Supposedly these trees, which can grow to 15 feet, are the giraffe's favorite food. I witnessed them browsing on some one afternoon. They have some tricky lips, getting around those thorns.
Walking through the bush, you move from green grass, yellow-barked acacias, red soil and a winding stream into denser forest with loisugi, vines, and epiphytes. Then you pass under a nilotica branch and find yourself on rich, black soil in a sparse forest of whistling thorns. There is a hiss in the air. The trees have a conical growth pattern and a grayish, mottled bark. This, along with the dark galls that look like black spruce cones, makes you feel like you just stepped into a grove of old spruce, towards the top of a mountain on the East Coast of the US. For a moment, the thorns look like needles. Then you see two Maasai kids, long sticks in hand, pushing goats through the thicket - and you're back under the hot sun.

Leonotis mollissima (Maa: ol'bibi): I first grew this plant back in Vermont, where I knew it as "wild dagga". I've smoked the leaves, and it is a mild euphoriant (very short acting). Here, it is an ever-present weed. If the bark of the whistiling acacia is a bitter with mild carminative action, leonotis is first and foremost a digestive antispasmodic, and a decent digestive bitter after that. It is a Lamiacea after all. I recommended the fresh leaves, two or three at a time, for intestinal cramps and spasms where it provides fairly rapid and welcome relief. It is similar to horehoud (Marrubium) in flavor and texture, and shares with it the presence of the bitter lactone marrubiin.

The aromatics: there are numerous scented plants everywhere. Most don't have specific uses, though the locals will rub them on their bodies as perfume, both to increase attractiveness and to repel biting insects. One aromatic plant, Hosnum suave, is eaten by hunters to improve focus during early morning hunts and also to disguise their body odor as the aromatic oils exude through their pores ("that's all the animal will smell", I was told). But there are a few that are, like most aromatics, used as diaphoretics, carminatives, and nervines - as pleasant beverage teas.

Ocimum kilimandsharicum (Swa: kirumbasi): spicy and rich in eugenol and camphor, this plant reminds me a lot of O. sanctum (tulsi, holy basil). It doesn't have quite as intense of a bite. Traditionally, it is used for fevers and upper respiratory infections where I have no doubt it functions as a mucolytic, diaphoretic, and antiviral (it is also rich in rosmarinic acid). I mostly recommended it as a tea, refreshing and carminative after meals, and also as a morning beverage for those who didn't want chai or coffee. It's stimulating and enlivening.

Lippia kituiensis (Maa: ol'sinoni): an indigenous species used by the Maasai for its carminative and diaphoretic effects, it is also called simply "wild tea", because its leaves make a delightful, airy, somewhat citrusy infusion that is excellent in the early evening after a day's work. I consider it a gentle local nervine, similar to lemon balm in its effects though less dry. There is ongoing research looking at its potential antimalarial activity.

There are many other interesting plants. Solanaceae: I harvested and dried Datura stramonium leaves, but was unable to convince an asthma patient that steeping them in Konyagi (some kind of distilled Tanzanian spirit that may start with fermented ginger root) was actually going to yield anything medicinal. Withania somnifera grows wild (I did point its root out to a gentleman who was interested in greater sexual vigor, translating the Ayurvedic name "ashwagandha" as best I could). Solanum incanum, the "Sodom's apple", is everywhere and used for everything from scrubbing pots (its gritty leaves) to dressing wounds (the fresh fruit juice), though I never felt drawn to using it. Lamiaceae: wild patchouli was an awesome discovery. Rosaceae: so many different kinds of wild hybiscus, red flowering, yellow flowering, delicate white flowering. Asteraceae: the important Artemisia annua and some of its cousins grow wild, a treasure against malaria. Very few if any plants are truly dangerous, if you're careful about where you step and avoid the thorns. Euphorbia candelabra, which drips a caustic white latex, may be an exception: it blisters the skin and causes temporary blindness.

In the end, I can only repeat what I've said before: plants are communion. If you get to know them, if you allow them to become a part of you by eating them, drinking their infusions, merging their tissue with yours like usnea in a wound, you become part of the land you're in. If you want to know a place, walk outside. Hold people's hands. Eat what grows. You'll never be the same.

So I leave you with one last plant.
Commelina benghalensis (Maa: engaiteteyai): this is a simple and common spiderwort, and grows in shady places. I'd find it covered in dew on my way back home, in the early morning. The Maasai ol'oiboni, or shaman-healer, uses it as a way to bless and protect those who have come seeking health. Dipping the fresh plant fronds in raw milk, he sprinkles the petitioner with the magical infusion, releasing negative influences and promoting wellness and growth. May your life be blessed. May no thorns find your feet. And may you have joy in simple things, wealth in those you love.


The Dark Side

The Maasai are semi-nomadic. They set up living fences, made of thorny acacia branches covered in spikes that are rock-hard and often six inches long. These branches take root, sprout again, and create an impervious barrier for the "boma" - an enclosed compound with round mud huts and ample space for the cattle and goats to stay safe during the night. Cattle is wealth - the daily ritual of grazing, up the rocky hill slopes to reach the open grass, where the wind is strong and you can see forever, moves life here. And in the evening, when the shadows lengthen and the air gets cold, you hear the bells again and you see the boys driving the cattle back to the boma, long sticks in hand, flowing red and blue wraps covering everything but the bottom of their skinny legs.
The old-timers will tell you with disdain that only animals eat grains and vegetables. To the Maasai, food is meat, milk, and blood. The cows are often bled daily, their life-essence fed to the children. And the family follows the needs of the cattle: they will leave the boma, and move to an abandoned living fence, setting up a new dwelling where they may live for a few months. Though they do not eat plants, they do believe in plants as medicine: everyone takes "ol-chani" (special trees), though many don't remember why. These herbs are often simmered with goat meat, particularly at ritual holidays, and thought to purify, strengthen, and balance they body and spirit.

The Sunjo are agriculturalists. One of the biggest Tanzanian tribes, they wear rich greens, yellows and blues and till fields of maize by hand. The grain, white-kerneled and rugged, is ground into a cornmeal that is boiled into "ugali", a cross between porridge and cornbread. It is rich and somewhat cloying, and is mixed with stewed beans, peas, eggplant, tomato and squash. In some fields you can even see bean vines planted between the cornstalks, twining up in a surprisingly new world way.
Every week, they travel from Sunjo in the East down the long dirt road to sell their goods at the market here in Wasso. You'll find everything from sugarcane to ginger, beans and grains and fruits, recycled sandals and Adidas track jackets, cell phones and gasoline. The banter is cheerful, the faces more round, and the negotiation skills superior. And you find concoctions, "changu", generally dark liquids brewed from a range of unspecified plants. They are sold for stomach troubles (particularly worms and amoebas), malaria and fever, and to build the blood. I find myself a little reluctant to try the formulas, often sold in recycled water bottles with no label.

I've had the pleasure of helping all these folks over the past weeks, and the work had been largely routine. There were wounds from motorbike falls, cleaning knees and shins scraped down to the bone and dressing them, stitching if needed; cleaning and removing the stitches from massive vertical cesarean sections; dressing head wounds in children whose arms are as thin around as a young, green sapling; splinting and slinging the ever-present distal humerus fracture. Yet another young Maasai came in with a lion bite, this time to both of his hands (only his right was fractured, and severely swollen). We are still helping previous weeks' injuries heal, and most patients who come through the minor theater with trauma are doing well.
I have been following my own group of patients. One showed up at our little house asking if I was around and if I had any remedies for the "sugari", diabetes. I was able to point her to a local species of Opuntia, and to the bark of the cinnamon tree - not a bad juice blend. The Maasai elder with probable leprosy is almost completely healed, using only herbal therapy. One small lesion remains on the ball of his left foot, but we hope to have that cleared up by early next week (if he would just stop walking). When he's discharged, he says, he will gift me a goat. The woman with a diabetic foot ulcer is also on the way to complete recovery, despite my own skepticism that we could heal her wound using herbs. But with twice-daily hot ginger compresses, yarrow washes, usnea powder, my own "changu" (details forthcoming soon), and the strict avoidance of bleach soaks, we're seeing daily progress - including the return of a good dorsalis pedis pulse. Many have come in for other troubles, like their severely malnourished children, and lack the funds to take care of the open wounds they themselves have. One young mother, for instance, came to me while I was working out in the grassy space between the hospital wards. Her child was in the pediatric department with pneumonia. But she had a deep, somewhat infected wound on the inside of her big toe, incurred while chopping wood for the boma. She healed quickly - young, strong, and otherwise healthy - and free of charge. So all things considered things are going well, and I am again reminded how excellent herbal medicine is for wounds, as well as for chronic disease. You just have to apply it diligently and consistently.
So another big part of my daily rhythm is gathering plants and preparing medicine for my folks. I am using a lot of fresh plant juices, which are excellent though time-consuming to prepare. My mantra has been "ninaenda kuanda dawa sasa" (I go to prepare medicine now), while I disappear from minor theater during a lull. But I am so grateful to have this opportunity: exploring the land, gathering, making, and applying. I often harvest plants and stick them in my camelback during runs. We come back together as a family at the end of the day, and share simple (and greasy) meals. We sleep deeply. In many ways, this is the life.

This morning was no different. I joked (half through an interpreter) with the Maasai elder that it seemed that a side-effect of his herbal regime was strong morning erections - something he'd been missing. Good enough. I felt the near-scalding warmth of ginger tea on my hands as I wrung out a fresh compress before applying it. I smiled at the kids whose wounds I have come to know as I clean them and re-bandage them, usually about every other day. One of the most heartbraking cases has been that of a five-year-old whose entire right arm suffered full-thickness burns from a synthetic jacket that caught fire and melted onto him. I use aloe on the superficial burns on his chest, but we are using silver cream and vaseline gauze everywhere else. I have to remove and change the bandages daily, and lots of tissue gets removed with them. He whimpers quietly, under his breath, as his mom holds him in a big, white blanket. I can see his pain increase day after day, as more tissue sloughs off. But this morning, like every morning, I still got him to smile after I was done by puffing up my cheeks, sticking out my tongue, and crossing my eyes. White people are weird. These kids are so strong.

Then the first call came in. I knew someting was off when I saw Father Thomas, the hospital administrator and chief medical officer, run across the courtyard from his office. People don't run here, especially at work. Then the 4x4 ambulances started going out. All of them. I was told to gather supplies from the farmacy: gloves, tape, surgical blades, and to make sure we were well-stocked with gauze and bandages. I went right to it. Staff was briefed on the incoming multiple casualty event.
A week or so ago, a Maasai tribesman had been caught as he attempted to graze his cattle in a Sunjo field. This, apparently, was an act of provocation and the Sunjo tribesmen cut him down - killed him. In a story that repeats itself here like the seasons, the Maasai planned and executed an act of retribution. Every morning and evening, a small bus travels from Sunjo to Wasso carrying about a dozen people. This morning, it had been ambushed by Maasai with Somali (American??) machine guns, and machetes. There were mostly high school students on board, a Sunjo driver and some other folks. Apparently, one of the kids walked right up to the Maasai gunmen and attempted to explain that they weren't tribesmen, that they had no quarrel. He was shot in the head.
I ran to the front entrance of the hospital with two boxes of gloves. Someone put a robe on me. Then the ambulances started offloading casualties. We wheeled them into minor theater as they came in, car by car. Anne and Father Franco directed rapid triage - is he alive? I checked for breathing. Nothing. Radial pulse was weak and thready, intermittent. Then I noticed the exit wound on his skull. Soon there was no pulse - we had to move on. Another young man was dead on arrival - a massive slice across his neck had severed his carotid artery. He didn't even make it into minor theater. Anne and I started working on the driver - a large man, probably in his thirties. As I cut off his pants, I saw his foot was fully turned inward, tissue was everywhere, blood was coming quick from his lower leg. As I attempted to elevate his foot and apply pressure, it just flopped free, disconnected from the rest of his leg. He screamed in pain. So I got a splint and secured his leg in place, continuing to strip off his clothes. No other wounds. He pulled at me as I held his bloody jeans and told me "money, money in there". I packed gauze into his leg, trying to slow the bleeding a bit.
Meanwhile, a girl had a deep wound on the top of her head. She was marginally conscious, had a pulse and was breathing well. The skull had been compromised, but hopefully not too much. Father Franco was stitching her up, calling for more lidocaine and yelling "cut" periodically. I helped as I could with local anestesia and scissors, while staying with the driver. Another girl had a smaller head wound, and Teresa, a visiting OBGYN resident from Germany, was stitching her up. She seemed stable. Yet another woman had a gunshot wound to the right leg that had shattered her fibula. Other patients were being treated outside of minor theater, one with a bullet in his pelvis, another with an uncomplicated gunshot wound to his upper leg. They were ok.
Anne had to leave to act as one of three surgeons in major theater attempting to repair the shattered fibula. I stayed with the driver, applying pressure behind his knee in an attempt to restrict blood flow through the popliteal artery. He was going into shock, and we got fluid going into him through a deftly-executed IV (the nurse was so smooth, calm, precise - amazing). While squeezing behind his knee, I squeezed the bag of saline. The foot was pale. His lips were going pale. He was getting cold; we covered him as best we could. A unit of blood arrived, typed and matched from the sample taken from the IV port, and they were ready for him in the major theater. Anne, Father Franco, Dr. Peter and the team would be in there for hours.

I let him go and took a moment to breathe. The young girl Teresa had helped was resting in minor theater. Two other patients came in, walking on their own or with just a little assistance - I was so grateful to see this. I cleaned and dressed a simple, small head laceration (boy do they bleed though) in a woman who was seven months pregnant. How was her baby? Could she feel it move? Yes, everything seemed normal. No cramping. No vaginal bleeding. I shaved between her tight braids, cleaned and dressed her wound. She was shaken, but fine. Another man had a small arm wound that was most likely a graze from a bullet - lucky. No stitches needed.
Cleaning up minor theater felt like an honor and was a welcome respite. We worked slowly, methodically, in silence, mopping up blood and bleaching every surface. When we were done, I looked at the blue gown that covered me from my neck to my feet. Blood. I took it off, folded it, and put it into the bin where we dump contaminated laundry. I walked slowly back towards the entrance of the hospital, now under high security. Police with machine guns. People everywhere, crying. Blood trails on the concrete pathways. There must have been over a hundred people outside the front entrance of the normally quiet hospital.
After checking with Father Thomas I walked out, almost on autopilot, and crossed the parking lot to our little house. My daughter was waiting there, home from school for lunch. I just gave her a big hug for a long time.

All told, there were eleven casualties. Two died. Four had major wounds. Five had minor wounds. I will tell you, herbal medicine is fantastic, even for first aid. But the team at Wasso hospital worked smoothly and well today, exemplifying the best that technological medicine has to offer, even in such a low-resource setting, and I am so grateful. When I returned to the intensive care unit to visit the driver and the other three major casualties, all were stable - although I bemoaned the complete lack of narcotics, even a simple opium poppy tincture (next time I will bring an unlabeled bottle). The driver's pulse, which had been so strong and almost flooding when I first took it, was barely noticeable at the radius. In many ways, this is the life. The land is wild and strong. The tribal ways are pure and uncluttered by heavy modern baggage. But there is a dark side too.