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!