_____The next morning we all awoke early. Our guides began making coffee and toast for breakfast. Emerging from the tent, the daylight afforded us a better view of where we were. We were surrounded by a bunch of little dunes. The big dunes are about three hours by 4x4 to the south-east. Becky had been there and said that one of the dunes took them an hour and a half to climb. Big dunes! Our guides began rounding up the camels. We mounted up and immediately my body felt as if I had ridden all night. It hurt. I kept trying to think about something other than how bad my rear was hurting. On the way back to Zagora we went through the palmeraie. It was very beautiful. Mom's camel had some trouble with the irrigation ditches and had to be pulled across. When we got close to Zagora we got off and walked. Even with the blisters on my feet it felt better to walk than to ride on that animal. I do not think that I will ever ride another camel.

Once back in Zagora Becky and I went to visit the Health Minister at the spetar. We had made an appointment the previous day to visit with him. We came in and I explained that I was a medical student and was interested in international health issues. He spoke perfect English and was delighted to show me around and talk about medical problems in Zagora. The province of Zagora has 300,000 inhabitants, and only 31 doctors, and 81 nurses. Half of those nurses are at the spetar and the rest are in smaller villages in the province. The other problem is that only 4 of the 81 nurses are female. This is because most women in Morocco do not leave their homes very often after puberty and thus have no formal education, much less the opportunity for a medical education. The high percentage of male nurses and the conservative culture combines to form Zagora's second largest health problem: Obstetrical complications. It is not widely accepted for male nurses to perform gyn exams on women. In addition most of the population lives in remote villages with no access to prenatal care. The infant/mother mortality rate in all of Morocco is around 4%. The Minister speculated that it was probably much higher in Zagora provence. This is approximately 6 times the U.S. average and even higher in Zagora provence. We then talked about the leading problem in Zagora: Chlamydia Trachomatis or just plain Trachoma. The Chlamydia bacteria is the most common sexually transmitted disease in the U.S. and is responsible for a large percentage of cases of infertility. However, in the developing world Chlamydia bacteria most commonly infects the eye and is called trachoma. Trachoma infections are the leading cause of preventable blindness in the world. In Zagora most of the transmission is from flies and from infected dust. Before I arrived the trachoma infection rate in Zagora was 48%! That's almost one out of two! October was trachoma eradication month. The health department went out and gave doses of donated antibiotics to 90% of the population. At any rate I was in awe of all that we take for granted in this country. While we were touring the hospital (all 76 beds) I saw things that I would never see in the states: raging goiters, typhoid fever, TB ascites, sand viper bites, and lots of more common ailments that they were treating with the best methods available. The main point that the Minister made to me was that the people in Zagora don't need any more medical equipment. They need soap and water and the understanding of why it is important to keep clean. Until that happens there can be no real progress. This is a huge public education problem. It was a very interesting visit that has definitely changed my views on international health care.

That night we had another low key evening with good music, good food and interesting conversation.

Copyright Seth Toomay 2000

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