I returned last Friday from a visit to Bere’ Adventist Hospital where my daughter works as a volunteer nurse. I am trying to understand my experience there and to learn what it offers to teach me about myself, other people and cultural interaction. To get to Bere’ I flew 7 hours from Washington D.C. to Paris, then 5 hours from Paris to N’Djamena, the capital of Chad. The next morning we rode by bus for 5 hours, to Kelo and traveled the last 50 kilometers to Bere’ by motorcycle. The whole trip including layovers took about 42 hours.

Bere’ Adventist Hospital is a small 50 bed hospital. There are a number of government hospitals in Chad that are larger and better equipped, however, patients frequently pass these hospitals en route to Bere’.

The nurses at the hospital obtain vital signs and perform patient assessments, administer medications, manage IVs and catheters, and dress wounds. The nurses do not feed or bathe patients, wash clothes, linens, or bandages. All of these tasks are performed by their families. The patients sleep in open rooms holding as many as eight beds. The adult patients are assigned to these wards according to diagnosis irrespective of age or gender.

When the doctor orders treatment for the patient, the family must go to the hospital pharmacy to purchase the necessary supplies such as IV fluids, IV catheters, antibiotics, dressings, and oral medications, etc. These supplies are all kept in small cardboard boxes underneath the beds. If there is no money to buy these supplies, the family may choose to impound a bicycle, cooking pot, or other valuable so that the supplies may be purchased on credit. The costs are miniscule by 1st world standards ($2 for a Rocephin injection) but are substantial when one considers that 500 francs ($1) is the usual daily wage.

There are no curtains. There is no privacy. Not only do family members overhear conversations between health care workers and other patients, family members or other patients may be actively recruited to serve as translators, asking personal questions and relaying sensitive information to the health care workers or giving the patients instructions on behalf of the doctor or nurse. Enemies sometimes find themselves in adjacent cots.

One feels that one is awash in a sea of humanity. People are sleeping on the beds, beside the beds, and underneath the beds. They are sitting on reed mats on the porches, cooking over fires in the courtyards, and hanging laundry out to dry on clotheslines. They are watching one another’s children and one another’s dressing changes. Medical conversations often pass through two translators.

During the few days I was a part of this it seemed that my emotional reactions were intensified. When a young Arab woman lost her pregnancy and then died a few hours later, I wept as I watched her turbaned husband sobbing at the foot of her bed. I wept again as I helped a Gumbai woman take her first hesitant steps after eight years of walking on her knees. Unfamiliar with the medical illnesses that are common in this region or how to treat them, I nevertheless felt compelled to attempt to help in some small way.

What created the intensity? Were my emotional reactions heightened by cultural differences between myself and these patients? Did my inability to communicate verbally make me more observant of non-verbal communication? Was I more sensitive to the feelings of these patients because of their marked lack of privacy? Was it simply because the whole situation, (smells, clothing, practice) was so unfamiliar that my senses were in overdrive?

This heightened empathic response was not unpleasant, indeed it was intoxicating. But does this emotional state actually make one a more effective caregiver? Was it created at the expense of good judgment? What are the corollaries between my experience in Chad and that of immigrants working in Brooke Grove’s facilities? These are some of the questions that I am still pondering as a result of this experience.