An Interview with Expedition Doctor Tim Lyman...cont'd

When Greg complained about his eyes I looked at them and saw a film - a growth that occurs over the white part of the eye from irritation, usually from UV exposure. The interesting thing is that Greg can't use sunglasses while he's prospecting because he's colorblind. He can't wear UV protection and he's exposed to a lot of dirt and dust when he's looking for microfossils and crawling on the ground. So I gave him a pair of army tight-fitting goggles to keep the dust and dirt out. I told to wear a cap with a visor to cut down on the glare.

We also had some unexpected things - early in the trip all of a sudden everyone came down with urinary tract infections at the same time. And, the friction burns from the water slide the team made in Camp 2 were unexpected, too.

Checking the eye of team member Greg Wilson

What is the main difference for you between treating people out here and treating people at home?

That's an interesting question for two reasons. In the States doctors have access to medication any time. We prescribe things left and right. Here I had to balance the fact that we have a limited supply of medication for an expedition that's fairly long against the risk of waiting too long to treat something to where an infection got too serious.

The other main difference is diagnosis: there were a lot of things that would have been simple to make a decision about if we'd had diagnostic tools - like a microscope or a strep test. Some of the things I brought, like urine dip sticks, I couldn't rely on because reactants have gone bad in the heat. In the end I had to rely on my clinical judgment rather than diagnostic tools.

Did you have any specific concerns - in addition to snakebites and scorpion stings - because of our location in West Africa?

I knew in advance what main medical concerns are - cholera, meningitis, polio, malaria, hepatitis - all things you have to get vaccinations for before you can travel. Rabies concerned me. That was my first concern when Dino, the dog, showed up.

I came very close to bringing rabies vaccine, but the chance of it staying good in the heat is pretty slim. The risk of animal bites is actually greater in the cities, not out here [in the field]. And in the city we have access to the clinic. I didn't think there'd be a rabid camel wandering into camp.

How did you feel about the idea you might be asked to treat local people?

I hoped I would be able to treat some of the local people. It's so much more rewarding. All of the bureaucracy is not in the way any more. It's just you and someone who needs help or questions answered.

You spent time with nearly 100 local nomads during the expedition. Can you describe a typical scene?

Most often, someone would just ride up to the site on a camel, or a donkey, sit and wait. They maybe have heard the team has a doctor from someone else, or they hope that, as foreigners we might have medicine.

At that point, I was faced with needing two translators- English to French and then French to Tamacheck. Getting a history is challenging because you have to choose a very few good questions, as opposed to asking a lot of detailed questions. The environment is almost always less than optimal - it is usually a dark place with a lot of people around - in other words, not enough light and no privacy.

It was a real challenge getting histories. I never really knew what they expected or felt about the privacy of their bodies - especially women who might be Muslim. It turned out they were all fine with it - they would just say, "no problem."

Although I can't often change people's lives or serious medical problems out here, I think people need their fears allayed, need to have someone to talk to - it's not just a matter of giving pills. I don't minimize the amount of good you can do by just talking to people. It was rewarding, but very frustrating. In some respects I felt I could do very little, but I feel like we did a lot for the individuals

Photo by G.H. Lyon

What was one of the more interesting cases for you from a medical perspective?

I was very nervous about seeing one woman, who, according to the people around, hadn't stood in 10 months. We kept hearing about this woman from different people who visited the site, and based on what I was hearing I thought I wouldn't be able to tell her what it was - which would have been unsatisfying for everyone involved. It ended up being something completely unexpected.

On one of our prospecting days we ended up in an area near where she was and the local chief took us to her hut. I went inside the small, dark hut covered with straw and blankets. There was a young woman - 20 years old - lying on a mat. She didn't talk throughout the entire history and interview and barely moved. I got her history from other people.

In this situation I had to observe really carefully. I did a couple things - I wanted to hear her voice - it was almost inaudible. I listened to her chest, eyes, nose, mouth; checked her strength and reflexes. I also had to use some tricks.

For example, I told her I had to have her seated on the bed because I wanted to see her get up. I wanted to see the way she moved and to see if she could use her legs and what her strength was. That was the single most important thing.

I told her that I needed to look in her eyes in the sunlight and I needed her to stand outside. She did it unassisted - crouching to get out of the hut takes strength and coordination - and she stood there for a good five minutes.

I also watched her behavior to her baby. It was very bad - it was very unattached - no bonding at all. Her affect, her behavior, in particular, were the main clues for me that this was not a neurological problem.

I asked the translators to ask her one final - but very specific - question. "If the pregnancy was difficult for her. Not if it was difficult, but difficult for her. Make sure they ask it that way." Her answer was "Yes." "After the baby was born, was it very difficult?" She said, "Yes." To me that was a confirmation that this was a depression problem, and was consistent with a post-partum pregnancy.

Once you had reached that conclusion, what did you do?

The resources were pretty limited. I would have liked to know about her relationship with her mother and her husband, but I couldn't get into all of that. Trying to do some sort of psychotherapy was impossible, so what I could do was assure everyone around her that she was physically able to walk, but that this was a legitimate medical problem.

We spent some time trying to explain this in a sympathetic way that she needs help from them. I tried to tell her that "this will get better, but it will take a while." We explained it as a hormonal balance thing - that sometimes after a pregnancy there's an imbalance and it's not going to go away very quickly. I am sure in the States they treat it with anti-depressants.

I told them she needed vitamins. The only other thing I suggested was that she be gotten up twice a day - not in the heat of the day - and someone go with her for a walk. Sunlight can play a positive role in helping depression and she'd been in the tent for 10 months with no light. Those were my recommendations.

I wish I had a chance to talk with them again. I didn't know how they perceived these things I was saying. We talked to this one guy in camp and he assured us that these kinds of problems carry no stigmas, that these camps and families were very close knit and that we could talk to the husband about these things.

It's also interesting because I'd never seen a case like that or made that diagnosis before. So here was something for me that was as exotic as coming across a case of Typhoid fever.

Given all of the challenges of treating local people - and the expedition team - would you recommend this kind of experience to your colleagues?

I would tell them you can't be too afraid of what you might find. Ninety-nine percent of what you'll find are things you're already familiar with. And two cases of things I'd never come across before in my practice I was able to diagnose and treat.

What has been the most challenging part of this experience?

Finding my role was a challenge - to find a way to both fit in as a team member, side by side with 24-year old students in the excavation pit, but also, when I needed to, be professional as the older person for advice - medical and otherwise. It was a very interesting balancing act

I found the physical work much more challenging than I anticipated. I really did not know how much work was involved in collecting specimens. I knew about the little things - brushes, dental tools, hammers - but not about pickaxes, chisels, tunneling, trenching.

The heat added to it. The first ten days were hard for me but after that I got used to it. I have been in Death Valley, but nothing was as hot as what I experienced in Gadafawa.

What has been one of the highlights of the trip for you?

One of my most favorite times is when I go to bed at night and have time to myself. The sky is incredible. That's what I'll miss most. I'll also miss the team camaraderie. Despite the fact I wanted to kill people occasionally, it will be very emotional to split up at the end.

Would you go on another expedition if you had the chance?

Absolutely. A thing like this pushes your limits. You learn about what you're capable of - and you learn about other people in the world. I really knew I didn't know what I was getting into, but it was a lot more than I anticipated. The expedition caused me to work harder than I ever worked at anything in my life- physically and mentally.

My love of adventure travel is part of why I wanted to come - but the biggest reason was the chance to be part of a scientific team, be a part of the discovery. I'm very aware of the fact that collecting the specimens and the travel are just the beginning. I know for years papers will be coming out of this, mounted skeletons will be made of the new finds and put on display. To me that is what is so exciting - to be part of the beginning of this long process.

*All medical supplies for the 2000 Expedition to Niger were donated by West Suburban Medical Center.