Tell me what you see

What are you doing right now? Um, I’m driving. Tell me what you see – what you’re looking at right now.

Oh, okay. It’s just started getting dark. I’m pulling up to a road block. I’m staring at the giant metal spikes in the middle of the road ready to puncture my tires. As a private vehicle, I can just go around and don’t have to stop at the police check to pay a bribe like the matatus (public minibuses). Now I’m turning off the highway and onto a dirt road towards my friend’s house. I see a guy in uniform with an AK47 hanging off his shoulder. He must be a guard or solider. And now there are three teenage schoolgirls walking towards me. It just rained so it smells like wet dirt – that earthy smell that hits you as soon as you arrive in Africa but slowly fades into the background until it rains and reminds you. Now I’m turning down a really bad road to my friend’s house so I have to hang up and pay attention to my driving.

It all seems so normal to me now. I don’t notice how a snapshot of my life here in Kenya is so far removed from my life back in the U.S. until a friend from thousands of miles away points it out to me with the simple request that I describe what I see one random evening.

I’m returning to the U.S. in a couple days. It’s been eight months. I just assumed that the transition back would be easy. I’ve gone back and forth between the U.S. and East Africa for eight years now. I should be used to the culture and reverse-culture shock by now, right? But maybe I’m not.

In fact, maybe it’s getting harder. The toggling between two lives in some ways makes it increasingly difficult to fit in anywhere. After living in Tanzania for two years, I was able to see how I could carve out a life in East Africa.  Now, after living in Kenya for another several months, I am able to see how that life will always be on the periphery. I will always be an expat and treated as such by the people here – no matter how long I stay here, no matter how much I try to assimilate. That doesn’t mean I don’t belong but I have to recognize that this is not my home. But then I go home, and I’m again relegated to the periphery. I’m the girl who runs off to Africa. I’m not going to settle down into a stable, normal life, job, or relationship. My regular stints in Africa make me “interesting” but set me apart and awkwardly interrupt my American life.

As I prepare to return ‘home’ again, I’m preparing for the happiness of seeing my friends and family again, but I’m also preparing for the sadness of seeing how much I missed while I was away. I gain so much by coming to Africa but I also lose a lot. It’s invigorating and it’s painful. That’s what I see. That’s what I’m looking at right now.

The Cube

My roommate left. I moved out of my house. I grabbed by backpack and moved into a coworker’s house. We call it “the cube”. That’s literally what it is. A cement cube with painted blue walls. A curtain neatly divides the bed and the cooking area. A TV is propped in the middle of the room and entertains us with terrible Spanish and Kenyan soap operas on the rare occasions when the power works. And I’m learning all sorts of lessons here.

Lesson 1: How to go to the bathroom.

When you go to the bathroom, do not ever EVER look down. Ignore the movement of maggots below and keep your head up. But not up too high. Then you might see the prehistorically-sized rat jumping from the roof into the moving pit below. Just look forward.

If you find yourself unable to tolerate the bathroom for a long call in the mornings, other options available for those who are clever. For instance, you can make your way over to the Guest House of the Insect Research Center and gingerly sneak into the bathroom for a more genteel defecation experience. Doors usually open around 6:30am but don’t make this a regular routine or an equally clever receptionist may start to inquire where you live.

Another option for the fainted hearted for a short call is simply to squat in the lawn. This is the usual method for children (who then continue to play where they have squatted, likely accounting for the movement in the latrine), but is often also employed by adults at night.

Lesson 2: Harnessing the Rain

Fear not the thundering of the rain on your roof. Though it may sound like the tin roof is about to be swept away to Oz, along with the cement walls, leaving you with nothing but a mosquito net around you, fear not. Though you may feel the rain dribbling in your ear at night regardless of which end of the bed you place your head, fear not. Though you may have images of electrocution as the power suddenly returns and you see a pool of water around the power cord, fear not. Fear not the rain, for rain is a good thing.

When you start to hear the pitter patter on the roof, quickly grab your basin and run outside to collect your rainwater! No hauling necessary. Just set and wait and spell.

Of course getting your water is only the first step. Once you have your water you have to be smart about it. Make sure you keep track of which basin, bucket, and jerry can is for drinking, cooking, washing, and bathing. Don’t wash your stinky underpants in the cooking water. Don’t take a sip of the washing water. Respect your chlorine purification powder or else you are likely to pay your respects to the pharmacist for some cipro powder.

Lesson 3: Where to Take a Shower

You never knew there were so many options for places to take a shower, did you?

Option A – In the lake. While this option is mildly appealing because the water is plentiful and doesn’t require hauling, collecting, or using sparingly, there are several drawbacks to the option. Firstly, laundry, dish washing, and body washing are all taking place in the same little patch of water. (Oh, and did I mention the kids head down here, too… and you know what that means.) Hmmm. Still feel clean? Secondly, do you know what happens at night when a light is turned on? That’s right, all the little bugs are drawn to the light. The same is true of a floursecent white body – all the little neighborhood children (and some adults) will find their way down to the lake to gawk at the light.

Option B – In the bathhouse. Slightly different from the bathhouses in SF and ATL. A bit more cramped. A bit less flashy. Probably no less dirty. A reasonable option if you get someone to clean it every now and then, but slightly claustrophobic for my tastes.

Option C – Outside behind the row of houses. A lovely option after dark. Grab your basin and your bar of soap and suds away in the moonlight! My personal favorite. Quite liberating. Quite refreshing (particularly if you are too lazy to heat your water first). The only catch is you really need the buddy system for this one. A good friend to keep a look out for wandering neighbors is critical!

Option D – Inside the cube. You’ve got all the privacy in the world with this one, girl. But you’ve also got splashes of soaping water all over the floor, no matter how carefully you try to rinse yourself! Of course, this is just brings a potentially new lesson in mopping.

Lesson 4: Creating a Symbiotic Relationship with the Wildlife

“Did you hear that last night? There was a hippo outside our window. I swear. I heard it making those hippo noises and chewing on the grass right outside our window! No, that was definitely NOT a donkey. It was a hippo. What do you mean where did a hippo come from? It came from the lake. Where is the donkey going to come from? Hippo. I’m sure. I wanted get up and take a picture from the window but I didn’t want to wake you. Girl, next time that hippo comes around, I’m totally waking you up and then you’ll see. There was a hippo outside our window.”

When in doubt, don’t go outside… no matter how badly you have to pee.

Of course there is some wildlife that you can’t avoid just my staying inside. They will find you. They will enter your house. They will crawl into your bed. They will bring their friends. And then… they will tickle you. That’s right. They will tickle you. The only way to fight back is to squish your arms to your sides and tickle back. But if you befriend this kind of wildlife – by skipping rope and singing silly songs about shadow bunnies – you will be amply rewarded with little songs in the night and shy smiles during the day.

Lesson 5: How to Keep Your Door Open

This one is easy. You just use a rock. Just make sure you do it. It lets the blessings come in.

My Work in Kenya: Cervical Cancer Screening

I’m working with a pilot cervical cancer screening and prevention (CCSP) program in a rural area of Kenya on the shores of Lake Victoria.

I first became interested in this topic while working in Moshi with Minjeni Women’s Group (some of you may recall the original ‘moshi moments’ stories). During that time, I learned that cervical cancer – one of the few highly preventable cancers with early screening!!! – is the leading cause of cancer death in women in Eastern Africa. And no one knows. So women get diagnosed when the cancer has reached advanced stages and all that can be offered is palliative care. Oftentimes even getting palliative care is a challenge. So women are dying. They are dying painfully. They are dying unnecessarily. They are dying without anyone saying a word. And when you hear a story like that, it’s hard to forget.

I couldn’t forget. Throughout medical school, it kept coming back to me. We had tried to link women in Moshi to screening services, but the screening services were practically non-existent. We failed. But I couldn’t forget. In medical school, I got involved with some research examining provider’s knowledge of the HPV vaccine, I joined forces with a similarly crazy med student to start a women’s clinic offering pap smears to homeless women (and now trying to offer Garadasil, the HPV vaccine), and I kept thinking about the women back in East Africa dying of a preventable cancer.

It only seemed natural that when I started to look at research fellowships back in Africa, that I would hone in on cervical cancer screening projects. And so I found my way into a research project in Kenya run through Family Aids Care and Educations Services (FACES), a partnership between UCSF and the Kenyan Medical Research Institute. I received funding through the Doris Duke Clinical Research Fellowship and launched myself into a year dedicated to improving cervical cancer screening in a little place on the lake.

So that’s how it all started. Now I’ll tell you a bit about what I’m “supposed” to be doing and what I’m actually doing. For the fellowship, I designed a study to look at how we can improve patients’ understanding of cervical cancer screening and thus improve screening uptake. My study design is a randomized control trial of an educational intervention. That’s a fancy way of saying that I am dividing women into two groups – one group gets a short health talk about cervical cancer and the other group doesn’t. Then we compare the two groups by surveying them about their knowledge and attitudes and then checking to see who ultimately goes for screening. It’s a simple idea that I spent months pouring over the details of how to execute. And then I spent several more months waiting for approval to start my project.

See, all clinical research must first be reviewed and approved by an ethical review committee before it can commence. This is generally a good thing. It serves as an important check to ensure that patients are not being put at undue risk for harm and that they are properly consented about any research in which they participate. Unfortunately, it can also be the bane of a researcher’s existence. The waiting game in Africa is notorious and naturally, ethical review is no exception. So I have spent the first three-quarters of my fellowship (yes, 9 months) waiting. Waiting is not so bad when you know you have to wait. What is challenging is the continuous string of “tomorrows”… the anticipation that approval is just around the corner… the frenzies of preparation that are ultimately wasted. As the cycle repeats itself, you finally learn to stop preparing, to stop expecting. And when you finally release your expectations, a subtle calm creeps in and a way forward emerges.

For the last several months, I have been visiting our screening sites. I’ve mainly been learning how to drive on insane 4WD roads and fix my car when it breaks - seriously two of my biggest accomplishments this year. I’ve also been trying to understand what is going on at our screening sites and trying to provide support and ideas for improving screening, but never launching into full-blown program management mode because every other week I thought I’d soon be pulled into full-blown researcher mode. And then a little over a month ago, I gave up. I fully released this idea that my intended study would ever start. And I ramped into program evaluation and improvement mode.  I started thinking more long-term, more big-picture. And I loved it. I don’t regret my first several months here. I think my expectations of starting a study helped keep me in a place where I was able to observe, build relationships, and slowly understand the reality of the barriers to screening. I found myself pulled into the service delivery challenges at the various health facilities – the systemic challenges of inconsistent supplies and staffing shortages that chronically plague the health-care system in Kenya. I stumbled upon the science of program implementation.

So I am now in full-blown program evaluation mode, trying to figure out how a small research-based screening program can be scaled up and ultimately be incorporated into a national screening program. Big dreams. It will take time. But I’ve learned how to wait… until tomorrow. In the meantime, I’ll practice driving through the mud.

Reflections on A Genocide

Walking down the streets of Kigali the absence of smog, traffic, garbage, panhandlers, roadside peddlers and touts is striking. The buildings are beautiful and new. Plastic bags are nowhere to be found. People are friendly. You feel safe. Corruption hasn’t emptied the coffers. Development has taken off. You don’t feel like you are in the middle of an African capital city. You don’t feel like you are in Africa. (Almost.) Even the open air markets seem orderly.  Perhaps a bit too orderly. Perhaps a bit too controlled. But quiet, beautiful, and safe nonetheless.

It’s hard to imagine that a genocide of over a million people occurred in this tiny country less than two decades ago. It’s hard to imagine, but it’s impossible to forget. Most of the adults here lived through it. Looking at men and women my age, I can’t help but wonder what they experienced 18 years ago. But I don’t dare bring it up. It seems too sensitive, too close, too painful to bring up with a stranger on a taxi ride or on the side of the street. It’s not just the normal political banter that you can toss back and forth. It’s too deep, too raw, too personal.

So I went to the Rwandan Genocide Memorial in Kigali. And there you are confronted with the horrific history of this place. The ethnic divisions established by the Belgium colonial rule, the subsequent decades of violence and discrimination, the systematic brainwashing and careful planning of an annihilation of a people, the blatant lack of a response by the international community, and the loss of over a million innocent lives. I walk through the memorial, reading every word, looking at every picture, taking in a deep breath over the rows of mass graves. I hold it together. Until I reach the final exhibit.

The children. Pictures of children, under which is written their names, their ages, their favorite foods, their favorite games, and then how they were killed. How they were murdered. An 8 year old boy beaten to death by a club. A 4 year old boy machetted to death. A 7 year old girl stabbed in the eyes and the head. A 9 month old girl burned in her mother’s arm in a church. He liked to play soccer. Her favorite food was chocolate. How did this happen?

How can we do this to each other? How are we capable of such violence? This is not a single, isolated event. It has happened over and over again. What makes people turn on their friends, their loved ones, and treat them with such brutality?

It’s strange being in Rwanda, asking these questions, especially on this particular day. Today is March 4^th, 2013. Today is election day in Kenya. Five years ago Kenya’s elections turned violent, with over 1,000 people killed. As one tribe turned against the other, as the roadblocks were put up, as the machetes were wielded, as the churches were burned, as neighbor killed neighbor and husband killed wife, it looked like Kenya was on the brink of becoming the next Rwanda. The violence was brought under control, but the issues were not resolved. And now Kenya is preparing for round two. Most Kenyans are proudly voting and desperately praying for peace. But their idealism is gone. Workers migrated back to their home region to vote, criss-crossing the country. Mamas stocked up on food, water, and phone credit in anticipation of a potential shut-down. Businesses ran down their stocks in case of widespread (or targeted) theft. Everyone hopes, but no one believes. Because they know it can happen… again.

How does this happen? How do we stop it? What makes us capable of such violence? What makes up capable of love and compassion? And what makes one person risk their life to save a fellow human being while another person joins the violence? And if placed in that situation, who would you be? Who are you now?

I left Kenya during the elections. I have that option. I can’t vote. I can leave. Is that right? Can I say this isn’t my fight? Can I say that I’m more likely to be a burden than a help if things get bad? That’s certainly how I felt the last time I was in Kenya during the election violence. Do I believe that? Yes, I do. But there is still a fluttering of guilt, a feeling that I abandoned my fellow humans… a reminder that the world fled Rwanda.

Croc Lady

“I just imagined the crocodile chewing on my head and I couldn’t take that imagine, so I started fighting again.”

-       Shirley, age 84

So I finally got my glimpse of a Kenyan Cowgirl. Introducing Shirley, one tough cookie… or maybe we should be more direct and just say she is a total badass!

Yup, Shirley is 84 and lives alone on a little island on Lake Biringo. She has spent the last several decades living on that lake, raised her kids on that lake, and swam in that lake everyday for thirty years.

And about ten years ago, she was out swimming like usual when a crocodile attacked her. And she fought it off. She describes how at one point, she looked down at her arms and saw what a tortured mess they were and thought, “well, I should just let him take me, but then I just imagined the crocodile chewing on my head and I couldn’t take that imagine, so I started fighting again.” She won.

As she sits at the table, her right arm curled uselessly again her body, a wine glass carefully held at the end of a disfigured left arm, she chuckles and says “aw, I knew that crocodile and I don’t blame him – he was hungry”. That’s quite forgiving of you, Shirley. She continues, going up to bat for the creature that tried to eat her, explaining that it had been a tough year and there was little food for the wildlife at that time; saying she should have noticed the signs and known better. They caught and killed the crocodile and he did in fact have an empty belly. Still not sure if I would be as generous as her towards it though.

Shirley: Kenyan Cowgirl, Crocodile Survivor, Genuine Badass.

So when you think you’re in over your head and you can’t handle something… think about how it could be worse… how you could have a croc chewing on your head… and keep fighting… like Shirley.

Anthropological Study of the Kenyan Cowboy Tribe

There is an interesting little tribe in Kenya called the “Kenyan Cowboys” or more colloquially known as the “KC’s”.  Often overlooked by anthropologists, this small group has a fascinating culture quite different than their neighboring tribes. There origins are European, quite often British, but they and their forefathers were born and raised in Kenya and thus they are uniquely Kenyan.

Their reputation is not the most flattering. They are known for being a bunch of “loud, privileged, racist drunks.” Born and raised in Kenya, they often prefer gallivanting around the bush, running far away from the quickly expanding urban sprawl. 

Although they may be a bit wild in more ways than one, they are also quite handy and can usually fix your car, your tractor, or your broken window. They can find their way out of a sticky situation (that they probably created themselves). They can get a job done and get it done well. They manage a variety of businesses, from tourism to agriculture. They understand many of the systemic problems that plague East Africa better than many of the “non-racist” philanthropists that come in to throw money at a bad situation. They care about the environmental and social issues around them, even as they rudely call for the “help” to serve them their tea.

They contribute a great deal to Kenyan development but are not regarded as true Kenyans by the government. Many do not own Kenyan passports and must buy work permits every year in order to remain in Kenya, many cannot vote or in some way feel disenfranchised from the electoral process. They are loud, obnoxious, and rude in many ways but must quietly bow their heads in many others.

They are white Kenyans, they are the KC’s.

So when a dozen KC’s rolled into Mbita one weekend, the anthropologist in me couldn’t help but put on my participant-observer hat and study them. Little did I know, that I was about to witness a rare and sacred ritual of the KC’s: the stag party. It took me awhile to figure out exactly what ritual was taking place. When introduced to “the stag”, I figured that was just a nickname. It wasn’t until well into the ritual that I realized a “stag party” is our version of a bachelor party. Anthropology game on!

As a young female attending a bachelor party, it is difficult not to alter the natural environment, but such is the plight of a ‘participant observer’ (note: this is truly an anthropological method and not something that I just made up!). I believe my presence did not dramatically alter the natural course of events. The KC’s proved themselves to be extraordinary drunks, menaces to the locals, and crude sexist pigs. (Though I wonder if this would be any different at a bachelor party for men of any other tribe.) Although I cannot and will not excuse this inappropriate behavior, when removed from the group chaos, some of their better traits were also revealed. One-on-one, they could fix my car, clearly articulate strategies for better environmental management of the country’s natural resources, and proudly talk about their little kids (note: although this was a stag party, all of the men were married or nearly married). And so with time, my horror over the drunken savagery transformed into a reserved fondness for these notorious tribesmen. Now I just wish I could get a glimpse of the womenfolk…

Mud & Rocks

There were points where I just stopped and thought 

“I can’t possibility do this,” 

swiftly followed by the realization 

“But I have to. I have no choice.”

I’m at our farthest sites, four-hours away from home driving in good conditions any direction. It’s pouring rain. The roads are only going to get worse. My co-pilot doesn’t know how to drive. So it’s up to me to get us home. To navigate through the mud. And it’s not just any mud...

It’s that dark clay mud refuses to let your tires grab hold. The kind that sends you sliding from one side of the road to the other, that occasionally tries to turn you completely around. The kind that leaves you leaning on your horn, praying the children with get the heck out of your way because you really can’t control where this car is going and trying to break is pointless. The kind that tests your arm speed – just how quickly can you correct and recorrect your direction? The kind that would be fun to drive in if you weren’t terrified that you’ll slide too far to one side and end up sideways in a ditch. 

And they you end up in one of those gullys on the side of the road. Not a huge one, thank God. You’re still upright. But you’re stuck. And your non-driving co-pilot tells you that you need to get over to the right. You look and him and look at your steering wheel. The wheel is turned as far to the right as mechanically possible and we’re not moving anywhere close to the right. You get out. You get in. You pass your mud-coated loafers to your co-pilot and slip your bare foot back on the pedal. You throw it into the lowest gear, give it a bit of gas, and pray as the car finally crawls to the right… and now you’re playing this game of correcting and sliding once again, trying to balance the car between the ditches on either side of  you. The ditches that are getting steeper and steeper – the kind of ditches that you don’t have a prayer of getting out of.

And just as you start to think you can handle this, you come up to that spot. You new it was coming. It’s tough when the weather is good. It’s one of those “I can’t possibly do this” points. Where the road narrows to the point that a car can just barely keep two wheels on the ground. And half of that road is in a ditch about 2 feet deep, filled with water. And the other side is a cliff. So you’ve gotta go slow enough not to slide even an inch. And fast enough so you don’t get stuck in the mud. So you look. You breathe. You realize “But I have to. I have no choice.” And you go. But you don’t get the balance of speed quite right. You err on the side of going to slow and now you’re stuck… in the mud… with mere inches on each side of your tires. And you breathe. And you check that, yup, you’re already in the lowest gear and the 4WD has kicked in. And you rock. And you pray. And by the grace of God, you climb out of the mud and up the next hill. And you feel like an absolute champ. Until some guy who was watching (not helping) you this whole time, calls through the window, not to congratulate you, but to ask you for money. Sigh.

But it’s not all bad. The stretches of mud are occasionally interrupted by slopes of boulder fields. It’s kindda like a game of chess, where you have to think 10 steps ahead to figure out how you are going to get down without hearing that terrible sound of metal crunching against rock. Where once again you have to find the balance in speed – slow enough to avoid bottoming out against some boulder beneath you but fast enough to get over the boulder in front of you. Of course, you inevitability get it wrong. And you hear the crunch. And you get stuck. And you try to rock uphill and once again you pray, pray that that crunch wasn’t the fuel tank. And you watch the fuel gauge. Steady. Steady. One boulder field down. Seven more to go. Back to the mud.

Four maybe five hours later, after the road has turned into a river, after the wheels start to rattle with mud, after you’ve visited all your sites, after you admit to your co-pilot that you’ve never really driven in mud before (at least not this kind of mud), you arrive home. Alive. Exhausted. Exhilarated. Spiritually awakened (there was no way you did this without a troupe of driving angels!).

When do we go back to the field? Tomorrow?

 Mbuzi taking the rocks on a GOOD day.

Back to Mbita

Back to the idyllic views of the lake

Back to smells of sun dried sardines

Back to swarms of lake flies

Back to cooking in my own kitchen

Back to burning pots of beans

Back to bugs in the rice

Back to my little group of friends

Back to calls of “mzungu mzungu”

Back to nights spent on skype

Back to our private local gym

Back to duct taped dumbbells

Back to gazing up at spiders

Back to the routine of work

Back to fixing my car’s bumps and bruises

Back to todays built on “tomorrow’s”

Back to working

Back to waiting

Back to living

Back to laughing

I am happy to be back to Mbita

Traveling

It’s strange to be on the road

Not sure where you will sleep

Or if you will get a shower

Who knows who you’ll meet

Who knows what you’ll eat

But you find the next place

And pose for your snaps

Amongst ruins and castles

You imagine the battles

And the prison chain rattles

You point at the menus

Sending up a small prayer

Not sure what you’re eating

But you chew and you smile

At the red and brown piles

Sharing stories with strangers

In pantomimed prose

You connect for a second

But then travel along

To find the next person

And mime the next song

It’s lovely to be on the road

With so many stories untold

Ethiopian Adventures

Ethiopian Adventure

Ah, yes, the end of a multi-week adventure ends in the daunting task of writing what happened. The lists of places that you saw, the people that you met, the fiascos you encountered and overcame. A rambling list that, after the fact, is often not very entertaining to anyone who wasn’t there (and often not even to those who were there).

Here’s the cliffnotes on the “where and what we did”:

Take Off: Woon Cho and Joelle meet in Nairobi and travel to Addis where they are set to meet a couchsurfing host who has bought their tickets for their next flight (leaving at 7:30am). But Joelle wrote down his phone number wrong, so they are stranded 10 meters from his house at 2am w/o phone or internet. Somehow it all works out.

Lalibela: Christmas Eve and Christmas morning spent at a super sacred site for the Ethiopian Orthodox Church. 11 churches carved out of these giant rocks in the 14^th century? How’d they do it? The angels did it. Ya know, I think I actually believe that one. You’ve also gotta be blessed if you can make it through a service from 6am til 3pm in a hot, claustraphobic church without eating and trying to get time with the priests’ rattles (I swear there is no pattern!). Yup, Joelle nearly fainted and nearly threw up on a pilgrim after just an hour in there!

Gonder: Do you have hot showers? Yes. We’ll take it. Um… where’s the water? Maybe tomorrow. Right. Castles and Kitfo (raw ground meat that we have sent back twice to be cooked more thoroughly as we imagine our brains spotted with tapeworm cysts).

Bahir Dar: We did the obligatory Lake Tana Monasteries, taking in the Byzantine depictions of the Madonna and Child, John the Baptist suckling from a goat, and various Ethiopian priests leaning on their staffs or chillin’ under umbrellas (this culture is in love with parasols!). Then we make it out for a night of traditional dancing where we make friends with some girls who collectively speak about 20 words of English, grab a tuktuk to a second club and in the process lose (and find) one of the girl’s shoes in the middle of the road, and eventually end up with Joelle getting dance lessons and being scolded for shaking her hips and not her shoulders. And then, we caved, leaving the cultural experiences behind in favor of gin and tonics on the lakefront and massages at the spa. Love Bahir Dar.

Addis Ababa: After her shoulder-dancing lessons, Joelle now thinks she’s a professional dancer and tries turning two potential pickpockets at the Mercato* into friends by grabbing their hands and forcing them to dance with her when Gangham Style comes up on someone’s phone. (She miraculously makes it out of the market with all her stuff!)

*Mercato: Arguably the largest open air market in Africa, selling everything from clothes to curios, spices to spare parts, and notorious for pickpockets.

Korea (via Addis): The Korean cultural experience then comes into full swing as pile into Tim and Laura Love’s LoveBug (yes, these two have the last name Love and have a rocking 1970’s VW bug) for a dinner of Korean deliciousness. This is of course followed the next morning by visiting the swanky Korean mission hospital in Addis with Tim, complete with authentic Korean classroom chairs, cafeteria food, etc. Too many cultures coming at me at once!

Back to Ethiopian Addis: We finish off with a cooking class since both Woon Cho and Joelle like to eat themselves sick on Ethiopian food and dread going back to the bland diets of Rwanda and Kenya. The sweet spice of berbere and shiro fills the kitchen as do tales of Haile Selassie, the self-unproclaimed  Rastafarian second coming of Christ. (So I’m told…Haile Selassie actually went to Jamaica and told the Rasta’s that he was sorry to disappoint, but he was not their next Savior – they didn’t believe him.) And then comes the coffee… roasted, ground, and brewed in slow delicious ceremony – even the adamantly non-coffee drinker (Joelle) cannot resist the deep chocolately flavor.

Dodola:  Going off of about 30 minutes of sleep apiece (Joelle b/c she went out on New Years Eve and Woon Cho because she tried unsuccessfully to meet a friend on a layover at 3:30am at the airport), the Bobsy twins make their way to catch an illegal minibus heading towards Dodola. Looping the city for an hour, with a stinky rag-cloaked fake minibus conductor and a fake passenger watching Asian porn on his stupid phone (shining oh so bright in the night), we nearly cheer when our two least favorite people finally disembark the minibus just as we are starting to pull away… chased by a motorcycle cop. We careen down the street, “safely” losing ourselves in the early morning city traffic. Seven hours and a few more twists and turns later, we make it to Dodola, a one street town and our launch point for the Bale Mountains.

Bale Mountains: Community-based ecotourism on a horse – for shizzle! Four days riding through mountains on a horse – have I died and gone to heaven? Ok, so sure it’s freezing cold some nights, but we’re at 3800meters and looking down over a sea of spectacularness! Sure, I’m dirty as stink, but we climbed 17km one day, dodging all number of tree branches and made it! Sure our guide tries to trick us that the white wolf (pointing to a domestic cat) only eats white people, but we saw two red wolves for reals! Sure, my butt and thighs and shins and everything is SORE, but we got to gallop for 3.5 hours like freakin’ cowgirls! Best. Trip. Ever. When can we do it again?

Merry Christmas: The Ethiopian calendar is very much confused. In Ethiopia, it’s currently 2005 (yes, you are seven years younger when you visit there). And New Years is in September. And Christmas is January 7^th. And 1AM is really 7AM. You can see how this gets tricky. But not tricky enough for us to miss Christmas! Gathered around the Love table (again, that’s Tim and Laura Love), we dined in true Ethiopian style with a freshly slaughtered goat, shiro, doro wot, and of course finished off with an Ethiopian coffee ceremony. Merry Christmas everyone!

It Shouldn't Be Like This

(Please note: this blog post is not for the faint of heart)

I have no idea what to do. Nothing I do is right. Everything here is wrong.

This blog post probably won’t make much sense as it is a rant of fury and sadness and guilt and frustration. Life here can be so incredibly horrible. I can’t imagine being an African woman living here. I don’t know that I would survive or that I would even want to survive.

At one of our site visits today I met a woman who came for cervical cancer screening. She is a widow. She is a mother of seven small children. She came to the clinic today because she has had malodorous bloody, watery vaginal discharge for the last three months. She has never experienced these symptoms previously and she has not been sexually active for over one and a half years (and yes, I actually believe this patient). She was seen at a neighboring dispensary and given treatment for cervicitis (for a presumed STI – which I don’t think she has) and told to follow up at the health center for cervical cancer screening.

 The instant she laid down and spread her legs for the exam it was obvious that there were some much bigger issues here. Her entire uterus was protruding from her vagina, raw, infected, and exquisitely tender. She said she had been trying to push it back in, but is kept prolapsing back out of her vagina and it was becoming too painful to push it back in. My diagnosis: complete pelvic organ prolapse with a secondary infection and irritation of the uterus/cervix due to environmental exposure. I try to gently clean her with some sterile saline, but this is clearly futile and a cervical cancer screen is clearly not going to be very effective or useful at this point. She needs to get to a larger hospital to be seen by a OB/GYN and be evaluated for surgery.

So what am I supposed to do? Do I just tell her she needs to go to the hospital? I think she knows that already. The hospital is far away (about 45 minute drive) and she doesn’t have money. I know that if I tell her to go to the hospital that she won’t make it there. She will sit at home for another three months, in pain, probably scaring away any potential help by the ever-increasing odor that is emanating from her vaginal area. I don’t know what to do. So I call the district hospital reproductive health guy that I know and ask what I should do. He tells me to bring her to the hospital and that she will get seen and treated there. Ok. I don’t think about things much farther than that. I know that this woman needs help far beyond what this little health clinic can offer and that she probably won’t get it if I simply tell her to go to the district hospital. And I know that she shouldn’t have to live like this, that if I were in her shoes, I wouldn’t want to live even one more day in this condition. So I take her.

Of course I forgot about that little “law” about taking people to the hospital. Apparently, if you bring someone to the hospital, you are responsible for them – for their hospital bills, food, lodging, etc. I begin to realize the error of my ways as we get closer to the hospital… as we stand in line for registration… as it’s pointed out to me by a colleague. Now what? I don’t know. I thought I just needed to bring her to the hospital and she would be taken care of. That’s what I was told in simple terms and so my mind was just working in those simple terms. Duh – forget you were in Africa? Apparently so.

So I back peddle. I say, “hey, let’s get her evaluated by a clinician here; they can come up with a treatment plan and estimated costs; I will give her money for transportation home tonight; she can follow up at the health clinic with one of the nurses who I can then communicate with about creating a plan for her.” My colleague shakes his head and says to me, “You knew this. You knew that if you bring someone to the hospital, you are responsible for paying for them.” He’s right. I knew. I guess I was “supposed to” leave her there and verbally refer her to someone else. But I just couldn’t imagine going home and leaving her in that state. I tried to hold back tears the whole ride home. How does one live with that? Abandoning the patients who clearly need help? I just couldn’t imagine living like her. Or perhaps I could – and that’s the problem. I could imagine how horrible it would be to go home at night with a uterus hanging out of my body, raw and infected and painful and smelly, once again turned away from a health center where I was asking someone, anyone to please help me.

I finally arrive back home and climb out of my car, which now reeks of infected vaginal secretions. I then remember that I didn’t just irrationally make this decision by myself. I called the district hospital reproductive health guy to ask what I should do. HE TOLD ME to take her to the hospital. So I call him up and tell him how I was told that either I pay for her treatment or she wouldn’t receive any care. He informs me that the hospital policy is that patients will receive care regardless of their ability to pay. They can get treatment and then bills can be sorted out later if the person can pay. I call up the nurse and tell her that this is what I was told and ask her to call me after the patient is seen by the clinical officer.

The next phone call goes something like this:

Nurse: “The patient was found to have pus in her urine so she was told to get some antibiotics for an urinary tract infection, but the pharmacy is out of stock and she doesn’t have any money so she was only able to get Tylenol.”

Me: “She has pus in her urine because her entire cervix/uterus/etc is infected because it has been hanging outside of her body for three months! Did anyone examine her?”

Nurse: “Let me have you talk to the lab tech.”

Lab tech: “Yes, the patient had pus in her urine, so she needs treatment with antibiotics.”

Me: “May I ask who saw the patient please? And what is their phone number?”

Clinical officer: “Yes, the patient had pus in her urine, so I prescribed antibiotics for a urinary tract infection.”

Me: “Did you examine the patient?”

Clinical officer: “She had pus in her urine….”

Me: “Did you examine the patient?”

Clinical officer: “The patient didn’t have money to buy gloves so I could not examine her. If a person needs a speculum exam, they need to purchase the materials. This is a district hospital – that is how it works here.”

Me: “Did you even ask the patient what was wrong? Or the nurse that I talked to about what this patient’s problem is? She has grade 4 pelvic organ prolapse. Her entire uterus is hanging out of her vagina. You didn’t need a speculum to see the problem. You didn’t even need gloves to see the problem. She just needed to lie on a table and open her legs a smidge and you would have seen that the problem was bigger than a urinary tract infection!”

Clinical officer: “She didn’t have gloves so I couldn’t examine her. Don’t worry, I told her to come back tomorrow with money.”

FUCKING HELL! I’m sorry to curse on this blog, except that I’m not. She can’t come back tomorrow. She lives miles and miles away and can’t afford transportation and has seven kids at home alone and she was just treated terribly by you. There is no way she is just going to pop back in tomorrow with a bunch of money for gloves and a speculum and whatever else you think you need. She needed you to listen to her for a couple minutes and maybe just take a small look. She needed someone at the hospital to HELP HER. But no, she was turned away because she couldn’t afford to buy a fucking glove.

And of course now I feel like I should have stayed. I felt like I had done too much and caused a problem and now I feel like I did too little and abandoned my patient. But I still think she should have been taken care of regardless of whether or not I was there to watch and make sure that an exam was done and that an appropriate management strategy was developed. This patient should have been taken care of at the hospital. But she wasn’t. She’s wasted an afternoon, will arrive home late to her children, and will have nothing to show for it expect maybe even less faith in her ability to get care. Why bother going to a hospital here? You won’t get the care that you need. You’ll just waste your time and money. Better to suffer silently at home. That’s shit. That’s absolute shit. People shouldn’t have to live like this.

I’m pissed off at myself, at the clinical officer, at the hospital, at the system, at the global community for allowing this to happen. I’m sad that this woman will return home tonight, without any treatment and without any hope. And I’m overwhelmed that she’s not the only one.

My New Nickname

Granny. That’s the name my little troop has bestowed on me. For real? I may be the oldest one in the group, but I don’t think I’m THAT old yet. But apparently my love of trip planning and my penchant for cooking up a storm of food to make sure all my little chickies are full has been interpreted as maternal, even so far as to be GRANDmaternal. I suppose that’s better than my new Dholuo name which means “she who knows how to eat fish”. We really need to work on these nicknames!

A Walk in the Woods: Kakamega Forest

Kakamega Forest used to be part of a larger forest that stretched across the continent of Africa. Unfortunately, due to human encroachment, all that remains of this once magnificent forest are small patches of forest reserves in Kenya (Kakamega), Uganda (Bwindi), DRC, etc. Nonetheless, the forest is incredible.

The forest houses 9 different species of monkeys. We saw at least four and I got to spend a lazy hour watching a troop of black and white colobus monkeys in the trees above me. I think they were just as interested in me and I was in them. A couple brave souls kept peaking their little black and white faces out from behind the leaves to stare at me, slowly inching closer and closer, and then getting scared and scurrying back up the tree. I gently clutched my car keys, hoping they would realize that I didn’t have any food and we could stay in this mutual standoff of “look but don’t touch”.

The forest also houses 35 species of snakes. Eek! But don’t worry, only 18 of them are poisonous. Our guide then proceeds to inform us (I think he was trying to reassure us) that there are snakes everywhere, we just don’t see them because they run away from our vibrations. There are even snakes living in the tree house that we are sleeping in. In fact, if you don’t have rats in your home, you most certainly have a snake. Never before did I think that I’d be wishing for rats in my home!

And the butterflies. I can’t even remember how many different species there are here, but they are everyone and they are beautiful! From spotted brown ones that really do look just like leaves to scarlet red ones to tiny white ones… they swirl around the air, gently landing on you and then fluttering away. I love them. My grandfather used to say that when you see a butterfly, it is a loved one who has passed away coming to visit you. So whenever I see these beautiful creatures, I always feel like I’m in good company.

Of course there are patches of forest with less pleasant insect encounters. Like the row of guava trees that have dropped their now-fermenting fruit, creating both a putrid-sweet aroma and swarms of fruit flies. And the safari ants…. We are lazily walking through the forest, looking up at the trees, chatting away, when suddenly our guide yells out “RUN!!” What?!?!? That’s not what you want to hear emanating from the mouth of your calm, soft-spoken forest guide. After a few minutes of frantically running through the forest, we stop and he tells us to check for ants in our pants. He reaches over and plucks an ant off my shoe. I find another one in my trousers. Tony finds two all the way up in his shirt. Safari ants. Swarms will quickly crawl up your trousers, bite and hold on, forcing you to drop your drawers to remove the little biters. Nasty little critters.

And naturally, every forest must have it’s token Viagra tree and breast-enhancing bugs. I suppose there are a few universal motivators in life – things that cross cultures and generations. Our guide kindly warned us not to place the bugs on our breasts because when they bite (causing the breasts to swell), it hurts like hell and you’re likely to start crying. Why do we do this to ourselves?

Happy Hiking!

Road Trip!

Road Trip!!!! Taking Mbuzi out for his first camping trip – let’s see how he handles it!

Of course first we’ve gotta prep. Planning and packing food and water, picking up a charcoal stove and a couple bags of charcoal, throwing a couple tents and blankets in the trunk, grabbing a machete and a shovel (for bushwacking and digging the car out of the mud, not for any more sinister activities!). Running around Mbita Town, grabbing all our supplies, I’m totally in the zone. I may look like a frantic flurry of activity to outsiders but I’m calm, focused, and absolutely loving life when planning a trip. Perhaps I should have been a safari guide, not a doctor. It’s not too late…

With the car stuffed to the brim with supplies and passengers, we head out. One hour ferry ride, 90 minute drive, and then navigating the insane traffic in Kisumu. Somehow we made it to the Nakumatt (giant shopping center) where we attempt to buy a more detailed road map. No such luck. But we were able to pick up a few ‘drinks’. So off we head, with a rough Lonely Planet map to guide us and a prayer.

The next few hours are tense. I’m not accustomed to the highway driving in Africa – the one lane that is supposed to accommodate two lanes of traffic, the insane passing on these narrow winding mountain roads…. I find myself in perpetual conflict: am I brave enough to try to overtake this slow moving lorry or do I sit behind it, breathing in it’s horrible exhaust and run the risk of not making it to camp before dark? Oh, and the speed bumps! Seriously, they come out of nowhere and are in the most inopportune places – oftentimes at the bottom of a steep hill – and they are rarely painted so you don’t see them until you are just about to bounce over them. I may have bruised the tops of my passengers heads a few times on unexpected speed bumps. Pole sana (So sorry)!

After a harrowing ride, we finally make it to Kakamega Forest and try to find our hostel. It’s just grown dark as well pull into the forest. We see a man on the side of the road. Probably just an ordinary farmer, but we’re utterly convinced that he’s sketchy and refuse to stop and ask him for directions. Which means we proceed on to what appears to be a ghost town. Dozens of seemingly abandoned houses scattered through the forest. No lights. No sounds. No welcoming committee to the hostel. Sketch! We’re sure this place in haunted now. We retrace our path and try another road. This time we find a hoard of children and a father who seems less sketchy, so we have him squish into the car and he escorts us back through the haunted village, through the sketchy gate that we avoided last time, and finally to the hostel – with people!! Phew. Made it.

An Athlete

The measure of an athlete is not how fast or how far she can go. The measure of an athlete is how strong she is, how much she can endure… when she is not winning, when she is hurting, when she keeps hurting... and when she keeps fighting… for no one but herself.

I was injured almost three years ago. I went from training for triathlons and playing any sport I could find to having difficulty getting through the workday. Over the last few years I have struggled with this injury, physically and psychologically. One of the more difficult elements of this injury was that I felt like I was loosing an important piece of my identity.

For years I have clung to my identity as an athlete. It was something I could always come back to, something that made me feel like everything was going to be ok. I could always count my legs and a pair of tennis shoes to take me away. I could go fast and I could go far. And then suddenly I couldn’t.

The last few years have been a roller coaster. At points I have pushed and pushed, demanding that I get better, insisting that I will one day run fast and far again. At other points I have throw my hands in the air, finally accepting that not everything can be fixed, that sometimes you need to recognize what you cannot do and then refocus on what you can do. Trapped in my black and white thinking, I felt like there were only two possible answers: either cling to this shadow of my former athletic self or accept that I was no longer an athlete.

I felt cheated. Why did I, an athlete, have to have athletics taken away from me? Why not someone who didn’t care about running and biking and climbing all over? Why not someone who identified themselves by their art or their music? Why me? Oh yes, I went down that road.

And then I learned a new word: reframing. Rather than be angry that this happened to ME because I was an athlete, I reframed the argument as “Thank goodness I was an athlete because at least I know what is a training hurt and what is a bad hurt, I know how to exercise, I know my body.” I told myself that as bad as it might seem, if I hadn’t been an athlete, it would have been even worse.

But I was still thinking that my identity as an athlete was a thing of the past. It taught me what I needed to help me through this, but it was no longer a part of me.  That doesn’t mean that I gave up trying to heal as much as possible; I was still committed to following up with my doctor, to trying new approaches, to doing my physical therapy exercises, to doing whatever little athletic things I could do. I just released the hold on my identity as an athlete. And it was liberating. I felt at peace.

And then one day it snuck back in. I’m not sure exactly when or how. Perhaps it was in the middle of my physical therapy routine; more likely it was in the shower (that seems to be when I get most of my inspiration). But one day not so long ago, I realized that I still AM an athlete. I cannot run for even five minutes without causing pain that will last for days. I hurt doing many routine activities like driving or dancing. I don’t like going to the gym and seeing all the machines that I cannot use.  I haven’t used my tennis shoes in years and struggle with a few laps at the pool. I cannot play recreational sports much less compete. I cannot run fast or far. I cannot run at all. And I may never run, bike, play volleyball or rock climb again. But I AM AN ATHLETE.

You see, I realized that I didn’t really know what an athlete was. I thought an athlete was someone who could run, bike, and swim fast and far, dive for a volleyball, jump for a frisbee, train until their shirts were drenched in sweat and their muscles ached, outmaneuver an opponent, get a personal record, win a race.  I thought ‘grit’ was about waking up early to pound the pavement until you nearly collapsed, then finding the strength the bust out a few dozen pushups and crunches, and waking up the next day to do it all over again.

I didn’t know that what really made an athlete were the in-between moments. The moments of defeat… of injury. The discipline of knowing when to push and when to rest. The wisdom of seeing the race not in terms of minutes, hours, days, weeks, or months, but in terms of years and decades. The patience. The perseverance. The struggle, not for the personal record of a lifetime, but the personal record of today – be that a 2 hour marathon or a walk around the block. I didn’t know that ‘grit’ was about trying and failing and failing again, about finding your own measure of success and pursing it with focused determination.

I finally realized…

The measure of an athlete is not how fast or how far she can go. The measure of an athlete is how strong she is, how much she can endure… when she is not winning, when she is hurting, when she keeps hurting... and when she keeps fighting… for no one but herself.

I finally realized that I am an athlete.

(Well, I never said I was a stylish athlete.)