Adventures in Africa

home again

noreply@blogger.com (shaunistar) — Sun, 08 Feb 2009 23:13:00 +0000

this note is somewhat delayed, but wanted to close the swazi section with the safe arrival notice. the trip back was a lot less painful than the trip there, and my bags even managed to make it back when i did:) i spent a week with the fam mired in the zombie-like trance of jet lag. i don't know how much fun i was to be around, but no one seemed to mind. now back to work where the reverse culture shock continues. hoping i can hang onto the revitalized super-charged gratitude i have for the love that is to know and be known, a comfortable bed, a variety of clothing options, and a car that vrooms when i want it to. it's a good life, people:)

parting words

noreply@blogger.com (shaunistar) — Sat, 24 Jan 2009 14:16:00 +0000

baylor clinic has been home base during my stay in swaziland. yesterday, i caught the kumbi (spelling?) for the first time. it's small van public transportation that conveniently stops right across the street from the clinic. only costs 4e which is about 40 cents. guess i didn't close the door hard enough since it started to slide open before the next stop. the other passengers didn't seem to be too disturbed by it, maybe hypnotized by the blaring disco music.

roommate and i met up with some folks over at cafe lingo which had some pretty yummy pizza and buffalo wings. they also happened to have some live acoustic guitar/singing performances going which were actually quite good. then we caught up with the rest of the gang at yet another braiie (sp?). swazis love bbq and i do, too:) i've been nauseous and sick to my stomach most of this week, but it hasn't stopped me from eating my fill. food was good, but it was rainy and cold and itchy since i seem to be a mosquito magnet. we left after a bit and watched a dvd. i think it was shark vs evil, very likely the single most ridiculous film i've ever seen in my life. yes, even worse than the spirit. oh my...

then back to the charming cottage i've called home for the past week and a half. the fact that it is next door to the clinic is wunnerful, but i won't miss the bathroom door that sticks, the slow shower drain, or the non-existent dryer. it's nice that there's a washer. we didn't have one of those in gabon, but i'm gonna smell like eau de bbq smoke on the very long flight home because i don't have enough time for my sweater to hang dry.

we went to the mediterranean, an indian restaurant with a big screen, for inauguration day. the time difference worked out perfectly for us to watch it live on cnn. swazis love obama, too. i thought it was funny when the swiss nursing students in gabon would say, “bonjour, les states” when addressing rachel and me. then last week i told this swazi guy i was from the states and his immediate response was “oh, the obamas!” the cover of the swazi times the day after inauguration actually said obama wants democracy for swaziland. i knew there were a lot of high expectations for our new president at home, but i hadn’t thought of all that the rest of the world is expecting him to do especially for them.

thursday i had my first outreach trip to st. philips, and it was great. after a long ride on a bumpy road, we landed at the compound that includes a church, elementary school, high school, two clinic sites, and orphanage/hostel. the sisters are doing excellent work out there. that’s me in the picture with sisters barbara and diane, left to right. sister diane is wearing two memory sticks around her neck alongside the cross. not exactly the way i’d expect a nun to look, but she’s got to be one of the funniest, quirkiest, hardest working people i’ve ever met. if i were staying longer, i would have tried to return monday to do health screens on the orphans returning from their homesteads. they call it a hostel because the kids live in the community during the summertime. they try hard to keep the ties in place. that means they ensure there’s enough food, and they get their medicines on time even when they’re out in the boonies.

we only saw two patients on the trip, so there’s still room for improvement in the country wikipedia says has the highest prevalence of hiv in the world. i hear numbers that range from 26-42% with the higher end likely representing the prenatal visits. the pregnant women tend toward 39-42% while all comers end up on the 26% side of the spectrum. the data we cite most often are from who 2006 with a prevalence of 38.8% in adults with hiv as a cause of 64% recorded deaths. for kids under five, hiv causes 47% of recorded deaths. those numbers are ugly, but i've been fortunate to see some kids helped by antiretroviral medications during my short stay. i have been asked about other ways to help, and one i know of is at www.goneruralswazi.com. this program supports swazi women and children. in the end, it always seems to me that empowering women and children economically and educationally is the first right step out of oppression.

swazi in a nutshell

noreply@blogger.com (shaunistar) — Fri, 23 Jan 2009 12:43:00 +0000

during my three weeks in swaziland, i’ve learned a little basic information that i thought i’d share. first things first. the kingdom of swaziland is a small land-locked nation between south africa and mozambique. it is the only absolute monarchy in africa (and i’ve heard it’s also the only one in the world?). it is divided into four regions: hhohho (mbabane is here – that’s where i live), manzini (that’s where the airport is), lubombo, and shiselweni. swazis, originally known as the nkosi (king) dlamini (surname of royal family), first settled in shiselweni. during the reign of mswati II, the nation became known as swaziland (land of the people of mswati). alongside the continued rule by kings, swaziland has been a protectorate of the boers, brits, south africa, and then the british again until independence in 1968.

the process of king selection is quite interesting. the king is always a dlamini and never intermarries, so the king has lots of wives who are not dlaminis. the swazis are one ethnic group with multiple clans, so the king is supposed to choose wives from different clans to foster unity. after he dies, the royal council chooses among his surviving wives looking for high rank and status. the chosen woman, now called the queen mother, must have only one son who is unmarried. he will be heir to the throne. so it’s not that situation we’re used to seeing in fairy tales where the king and queen are husband and wife. the king and queen mother in swaziland are son and mother. those are the people who have power. all those other wives fade into the background. if the heir is still a child, the queen mother will serve as the regent until her son is old enough to govern. the current king is mswati III. his mother, queen dzeliwe, was regent 1982-1986 while he studied in england. he was only eighteen when he became king.

speaking of school, you have to pay fees to go to any level of school here. there is no free public education. i’m pretty sure you have to have uniforms too. not all parents can afford these expenses, so every kid doesn’t get to go to school. all the kids just took a big test, and the highest scoring of the country were featured on the front page of the swazi times. education is valued. it’s just not available to everyone.

the first fruits are celebrated in the incwala ceremony where the king and his warriors do a traditional dance. there’s also some water collecting and bull slaughtering in there. the umhlanga or reed dance is a ritual where mostly teenaged girls (topless – this is considered normal, and lots of girls like > 20,000) present reeds to queen mother as a show of respect. i’m told king uses this venue to choose his wife. i’ve never seen the sibhaca dance, but it makes me think of my little brother since it’s popular with young boys who perform in teams for special events. that’s your shout out, classicboyadams;)

beyond goodness

noreply@blogger.com (shaunistar) — Mon, 19 Jan 2009 18:15:00 +0000

dark chocolate and obedient internet. mmm mmm good. “it’s perfect. it’s more than perfect,” i hear myself think. all that’s left is to count ten fingers and ten toes, but i’ll settle for three of five bars. it works and i’m plugged into the rest of the world again. i may be cold and the heater is slow to warm and i somehow didn’t bring very many warm clothes, but i feel like i’m me again in some way that is as disturbing as it is comforting. the rain is raining cold rain. no one else seems to be cold, but i’m cold as always. maybe i’m getting sick, but i don’t feel so bad. i ache all over, i mean all over from frisbee. i have no idea how left shoulder got in the mix; i’m a rightee, and paraspinal muscles are squawking. i feel like i can’t drink enough water to quench my thirst. surrounded by water, but dry oh so dry. i’ll either dilute my blood chemistries or allay my ungrounded fears of kidney damage from muscle breakdown. neither is remotely likely. these are just the musings of a medical mind left to play. i’m winded and blaming it on anemia and over-exertion and high altitude. my marrow can only crank out so many red cells so fast. i think i’m compensating by taking huge breaths, kinda kussmaul breathing, but it’s not a diabetes thing. yes, it’s good and bad to be able to diagnose yourself. my second dresser drawer is a mini pharmacy of over-the-counter meds smuggled, i mean carried, over from the us. i will probably never need these things, especially since i remembered them this time, but maybe they will be helpful for my roommate who seems to have come down with a case of the runs. been there, done that. determined to get out of here without gastrointestinal disease. which is another reason i’ll never drink myself into dilution. i’m discriminating against tap water and i refuse to spend millions on bottled water. but no worries, i will calculate my fluid requirement and it will be okay. yup, i’m kinda digging my new digs. the heater is sputtering out a 3-foot radius of warmth and the clinic wireless reaches just far enough to satisfy my inauguration curiosity. i’m crying because this election thing, it’s so good, and for me, goodness is high praise. my favorite fruit of the spirit. who needs heat and water and normal tidal volume anyway? my watch has stopped working and it kinda doesn’t matter. it’s all good, people. it’s more than good. it’s perfect.

this week in pics

noreply@blogger.com (shaunistar) — Fri, 16 Jan 2009 14:39:00 +0000

swazi landscape with a modicum of humidity. this is the transition pic bewteen the big fog and the clear-headed gorgeosity of friday. quite lovely.

monday was michelle's (seated on left) birthday celebration at the lugogo sun hotel restaurant complete with all-you-can-eat buffet. chefs were at the ready to whip up stir fry and crepes. yum yum:)

that's where i used to live. i moved on wednesday to a humbler abode, but right next to work (e.g. right next to internet:)) now i have a roommate and share the bathroom which is a definite demotion, but the old tv came with me, so i won't have to miss oprah...

went to satellite clinic at rfm hospital thursday. this child is 3 years old even though he looks closer to a one-year-old. they call this "stunting" because his weight-for-height is well matched, but 9.8 kg and 80 cm is not normal for his age. he's not just making a grumpy face. he has vision problems and is often looking out at nothing with right eye esotropia (inturning) that is not easily seen in this pic. each pic is taking 15 mins to download so we're gonna skip the one with the really good esotropia. his speech is limited to mama and baba which is clearly developmentally delayed. he's a good example of the havoc wrought by malnutrition and limited resources.

saturday played ultimate frisbee for the second time in life under the scorching african sun with my out-of-shape anemic body at high altitude. so exhausting, but so much fun. motivated to work out for real now....we'll see how long this lasts. and my arms and legs appear to be two different colors. lol. something to work on later.

after frisbee saturday, we took off for the game park at malolotja. very beautiful. pictures do it no justice. had bbq and more bday cake and the best flan on earth in massive quantities. that's a different kind of malnutrition. planned to go birdwatching and hiking sunday, but the dense fog descended once again and thwarted those missions. did get to see a bit of wildlife up close from the cabin as pictured.

tea breaks and handshakes

noreply@blogger.com (shaunistar) — Wed, 14 Jan 2009 12:31:00 +0000

i am so exhausted i can hardly type. today was actually a fairly efficient clinic day. charts are grouped by family, one to three patients per chart, and we called about 100 chart numbers in six hours. if i don’t sit down and write now, i may never catch up. as it stands, i have quite a few observations that could easily be expanded, but there’s not enough time for all that. that said, today’s entry will be a hodge podge of sorts.

i’m told mrs. reynaud’s class (my sister’s class) is following my misadventures in swaziland:) so this entry is dedicated to you guys. might make for some entertaining discussion points. and i know everyone is waiting for pictures, but i’ve only recently come into repossession of my camera, right when the fog of eternity and showers of infinity descended. in addition, it’s kinda against the law to take pictures of government buildings unless you have some special permission. but i’ll see what i can do.

that brings us to rule number one: try not to get arrested in a foreign country. it’s sad to be cuffed for a kodak moment. also try not to say things against the king within earshot of his top ministers which i did. lol. i didn’t know the minister of foreign affairs was sitting at the next table. there’s just a lack of this little thing we take for granted called freedom of speech. this guy who writes political opinion articles in the times of swaziland (national paper) was dragged before the king for his views. then he “decided” to write this apology article in the paper basically explaining why it’s good for everyone when the king is not angry. a little too old testament for me, but no more rants on that until i plant my little feet back on american soil.

i was talking to one of the baylor drivers, and it seems that some swazi people are ready for a president with political parties, but his majesty is not so ready. this is hearsay, but i’m told one king had 100 wives and 600 children! i don’t know how he could keep up with all those people. the current king is only up to about 14 wives. (there is a lot to be said about the position of women relative to men here, but for now i’ll just mention how it makes controlling hiv that much more difficult). now i understand why there are so many dlamini’s. he must have been one of those fruitful kings.

rule number two is try not to die in a foreign country. some people ask me about the dangers working with hiv-infected patients, but i think the real threat is bad drivers. sadly, two of the cuban doctors died this week in a car accident. i think they were sitting in the flatbed of a truck that suddenly got a flat tire. yesterday my taxi driver was in a near accident. our little corolla almost got smushed. gotta buckle up, people!

rule number three is try to learn about the local culture when you’re in a foreign country. it’s sometimes kinda hard to do when america has a way of popping up all over the globe. i still watch oprah at 5:45pm (although i’m about to move to a tv-less place), but it’s followed by isidingo (which i think is a south african soap). there’s also joel osteen and the apprentice on tv and anita baker and mariah carey on the radio. there’s a shell gas station and a kfc next to the nando’s which is local fast food offering both french fries and spinach as sides. i tried these greek cheese/avocado oil pringles that taste just like regular pringles. i’ve tried fresh lychee, but i’m not excited about chicken intestines. we’ll see. i usually try most things. people eat porridge and the support staff seem to take tea break all at the same time. no coffee breaks around here. i suppose that’s a leftover of british rule. i’ve got a long way to go to dig into swazi culture. for now, i’ll work on my handshake, a three maneuver interaction not unlike all those european kisses.

they have faces

noreply@blogger.com (shaunistar) — Mon, 12 Jan 2009 12:43:00 +0000

it’s hard to believe a whole week has passed. the weekend has been quiet and stormy, brooding, as if nursing some old wound. the lights have gone out several more times since that first blackout. i’m fine enough living alone in the middle of so many unknowns, but being plunged into darkness holding a metal pot under running water and showers of lightening makes me feel like a sitting duck. i tell myself death by electrocution is a low probability event. comfort in statistics. i feel my way upstairs to my stash of candles and matches and am amazed by the amount of light one little candle emits. i sing “this little light of mine” in french because french is home to me and faith is home to me, and it makes me feel better.

i finish washing my pot. i hate dirty dishes. they multiply like gremlins. and besides, i need the pot to soak my beans. i am pleasantly surprised this morning that my boiling sugar beans (white with red spots) smell like red beans (which is what i was looking for in the first place). for a person who does not claim homesickness or loneliness, for the moment, i bring a lot of home to me. few things are more new orleans than red beans and rice. the weather is nasty, but i thrive on the scent of water in the air. it makes me feel alive, like the air is living. it probably is alive, filled with mold and fungus and bacteria, but i’m okay with that.

it makes me think of the branches on the wall in the computer room. it was completely unexpected, but one day last week i said to myself, probably out loud, “they have faces.” suddenly some forgotten, dead, driftwood was alive with eyes and arms and legs, man’s art on top of god’s art. i thought of our clinic babies, how each one is unique, but in essence not so different from babies everywhere. it’s in the eyes. barack obama talks about it in dreams from my father, “the curiosity they displayed toward every new face, seemed the equal of children anywhere.” he’s watching kindergarteners at carver elementary in chicago (actually same name as segregated school some of my family members attended). the principal remarks, “the change comes later. in about five years…when their eyes stop laughing. their throats can still make the sound, but if you look at their eyes, you can see they’ve shut off something inside.”

i guess that here, we’d like to keep that something on, but we’re more preoccupied with simply keeping them alive. the eyes shine alright, despite ophthalmic herpes, despite cutaneous hpv. some thirty to forty percent of screened pregnant mothers here are hiv positive which makes for plenty positive babies. despite our best efforts, so many die. from far away, they may look like something unrecognizeable, but i assure you, they have faces and names and mothers and fathers who want only the best for them.

to generalize further, halfway through residency, i remain appalled by the way some parts of society treat children. i’m sickened by the number of abused children, neglected children, and abandoned children. i don’t understand how our government did not support s-chip when the entire budget for children’s health care comprises the slightest of slivers in the grand scheme of american health care. come to ben taub (county hospital in houston) and look at the faces riddled with eczema gone too long, nostrils flaring with asthma out of control, and runny noses that are honestly best seen in the doctor’s office, a less expensive venue. then tell me that all you see is a system you didn’t create pinning people you don’t know to the wall of indifference.

let there be light

noreply@blogger.com (shaunistar) — Fri, 09 Jan 2009 06:10:00 +0000

it’s raining tonight. okay that is an understatement. heaven has cracked open and is bleeding down electricity with a startling rapidity. trees are swaying in ways that threaten structural integrity. the entire night sky is like one massive dying light bulb flickering between pitch black and daylight. they say swaziland is known for its violent storms and crazy lightening. the thunder can hardly keep up with it. the lightening has stolen my lights. i have a candle burning and a computer screen that can glow for at least another sixty minutes.

i’ve always loved storms. i’m sure that has something to do with growing up in the new orleans area. hurricane evacuation was our snow day equivalent. i remember playing in the rain under fat droplets and a sky gone mad. the old folks used to make you hush when it was storming because god was talking. they’d cover all the windows and mirrors, so the lightening didn’t kill you. it’s hard not to believe in god in a place where the power of nature and your relative powerlessness juxtapose themselves so keenly and so often.

when i went away to college i didn’t understand the existence of godlessness or the persistence of the bay area’s wintertime drizzle. it was infuriating. i wanted the thing over. just have a big storm. get it out of the system, and move on. however, i also realized as i grew older that storms aren’t all fun and games. people die. things get ruined. as i listen to god talk and remember why i love their eyes were watching god, i’m wondering how my patients are doing. there is a boy with chronic diarrhea whose mother cannot afford the supplies to boil the river water or properly cook for that matter. she was in tears and the nurse had this long conversation that she later translated in the most offhand of manners. she supposed that the lady’s tears had something to do with poverty. another understatement.

i’m also taking inventory on my patience. i started off real cool about the no luggage situation. i knew it was impossible that the bags would arrive when i did, but i did not expect them to take a whole week to come. i begin to chain call the airport and send an angry, irrational email to delta. i’m acting like an american. i have expectations from which i cannot easily extricate myself. i like my stuff. i love my shoes. i’m buying a few replacement items and borrowing some. when i show up to clinic in borrowed blouse, cheap slacks, and tennis shoes, i don’t want to cry, but i have no peace. it’s that deep. it’s hot in swaziland, and i note the male orphan wearing the oversized turtle neck dotted with tinkerbells. i watch the child i’m weighing step out of scuffed church shoes with no laces. i’m embarrassed by my materialism. i admit to myself, again, that what i actually need is so much less than i expected. and as i type that last sentence, the lights come back on.

clickety clack

noreply@blogger.com (shaunistar) — Fri, 09 Jan 2009 06:10:00 +0000

i have pets. drosophila. they live in the kitchen. they like to roost on the drying dishes previously known as clean. even after they changed out the refrigerator, the winged vermin remain. that first day, they call in the cleaning lady since the house is unclean, the bed without linens. the place is otherwise quite spacious and architecturally pleasing with circular and arched windows. since there is no food, one of the drivers amuses himself watching me try to grocery shop foreign brands, meal plan, and convert emalangeni into dollars all at once. i suppose i ask stupid questions. why are they called sugar beans if they aren’t sweet? where are the cheerios? did you see the feathers in the egg carton? he was a good sport about it. when i get home, the kitchen still reeks. my stomach is talking to me, so i set about the task of cooking a meal all the while dreaming of a magic bleach wand and a short fruit fly life span. at least there aren’t bed bugs like in gabon…

those first few days there are so many cultural novelties to capture my attention. my favorite: siswati is a click language! who’d’ve thunk it. murmur murmur murmur click murmur click murmur murmur click. i love it! i don’t understand the words, so i make a game of listening for the differences in mama clicks, papa clicks, baby clicks, and granny clicks. i remember learning about the !kung and their click language, but never really expected to stumble upon one up close. if i write click one more time, i’ll have my own click language. lol. and hairstyles. this one is new on me. some of the ladies wear tiers of short tracks to make full-bodied close-cropped cuts (instead of using them for long tresses). it’s cute when you leave out the royal purple highlights. what else? women wear fancy heels for daytime errands that i’d save for special events. pedestrians travel in packs and regularly tempt fate by flinging themselves into heavy traffic whenever and wherever. worse than boston! drivers nearly run people over just to make it through a green light. taximan has this annoying habit of calling me “mama”. there’s actually a drive-thru kind of deal where you can buy minutes for your cell phone. other things appear to be like gabon in that i wake up to the rooster’s incessant crowing, women and children seem to do most of the carrying (e.g. firewood, water, food, etc), women breastfeed openly, you can buy all manner of produce along the side of the road, and people “buzz” you (they hang up after two rings so you can call them back using your minutes). also like gabon, and the states for that matter, the waiting rooms are always full of women and babies. (i guess the men are working.) but here, two times already, i’ve heard those rooms erupt in the most beautiful singing, in harmony and everything, as if practiced. it kinda click makes me wanna bottle it up click and take it home with me click.

a trek and a half

noreply@blogger.com (shaunistar) — Wed, 07 Jan 2009 06:05:00 +0000

03 jan 09 1230

it's a new year and i'm off to swaziland. one year ago i couldn't tell you where on the globe such a country could be found, but here i am on my way to a city i can't pronounce. at least there should be less of a language barrier this time around. makes for less of a headache though i plan to continue my forays into french-speaking territory. this delta flight out of new orleans is slow-going. first leg of a 3-stop flight and already delayed. too much fog. i'm hungry, but if they're serving up peanuts and pretzels, you can count me out. who needs sick and bloated on top of sleepy and anxious? not the kind of full feeling i'm going for. now captain is defining "ground stop" for us which essentially means we're not going anywhere anytime soon. nothing is flying into or out of atlanta for now. so dakar, johannesburg, and manzini appear to be poorly formed mirages on the all too distant horizon. it's raining and my throat is dry. folks are roaming about the cabin now like we're at camp. thank goodness for a charitable seat mate with lots of fruit snacks. think i'm gonna make it...

1515

literally made it onto second flight just before they shut the door and push off for the runway. still can't believe those people served no in-flight beverage at all! nada. not one drop of water. not even one lousy pretzel or peanut! for the sake of keeping a family together, i lucked into an aisle seat in the 2-seat row in place of my middle seat in the 3-seat row. thank you, jesus! flight attendant is asking me to take my seat as i'm trying to place my bag in the overhead compartment. i know i appear to be a bastion of upper body strength, but the guy could have at least offered to help out before herding me into a seatbelt. on my second piece of gum which i guess is gonna be lunch.

1800

desperate times call for desperate measures. when snack time comes around, i gobble down the salted peanuts as fast as i can. no room for snack snobbery at 33,000 feet and thank god for cran apple juice despite the requisite high fructose corn syrup that the corn people of america will tell you is not evil. whatever. between my peanut butter and cranberries, all i need is a stick of celery for fireants on a log. i forgive drill sergeant flight attendant who is actually prompt and courteous in delivering aforementioned snack. later i realize that given the height differential, it was probably easier for me to stow my own bag. dinner is served: potato flakes undissolved and cheese like velveeta, bbq chicken mishmash all of which i devour in one fell swoop.

one day delta's in-flight entertainment system will be a spectacle of wonder, but not today. there's a function that lets you create a playlist from different cd's except they're all mislabeled. you choose rihanna's "take a bow" and get mary j's "just fine". the movies are mislabeled but i end up with nights of rodanthe, a lovely romantic comedy that's missing the plastic sappy happy ending i wanted - more of a romantic tragedy. probably not the best pick for a doctor on her way to volunteer in a foreign land. sleepy again. time for a nap...

04 jan 09 0205

layover in dakar was a bizarre experience of watching and waiting. at least it worked out that i didn’t have to give up my aisle seat. i don’t think anyone got on, but some people got off. then these uniformed men came to match each piece of carry-on luggage with a passenger. they also removed each seat and checked it for god knows what. at last we take off. by the time of this entry, i’m having a hard time holding my ink pen, so i’ll leave out the somewhat incoherent details about breakfast. was starting to feel sick on top of sleepy.

05 jan 09 0100 central/0900 south african

they served us ice cream in the middle of the night – good ice cream too – haagen daas vanilla caramel brownie. not excited about that at 0400. then there was food advertised as “sandwich”. traded starvation for stuffed beyond belief. watched half of sisterhood of traveling pants 2 before landing in johannesburg. lo and behold my bags were nowhere to be found. i must be blending in since people start talking to me in some language i don’t know (afrikaans?). had some trouble finding shuttle, but made it to the hotel alright and finally showered. hallelujah. slept really well for four hours then not at all for another four hours. ate breakfast. scrounged up some toothpaste. hotel desk clerk apparently didn’t understand what i meant when i asked if they had deodorant. “sure, there’s some in your room,” he said. not so. i thought this whole english-speaking thing would make life easier, but didn’t factor in thick, barely intelligible accents and english words with different uses. for example, “still” instead of non-carbonated, “lift” instead of elevator. they also say toilets instead of restrooms which i guess would seem like a bizarre use of english if they landed in the states. well, pretty soon shuttle will be here to bring us to the puddle jumper that flies to manzini. goals = finding food, water, shelter, and deodorant.

07 jan 09
oh and what a tiny airplane! there were probably 20 of us. we landed almost as soon as we took off. matsapha international airport is the smallest airport i’ve ever seen. we deplane on the tarmac into the terminal – no need for a jetway – pass the phalanx of customs booths (with one agent in attendance) and arrive at baggage claim in about 50 paces. it is somewhat of a baggage graveyard with idle bags strewn about on the non-rotating luggage belt and piled high in a huge walled-off cage. my hopes for luggage miracle disintegrate as i exit the sad scene. to their credit, the airport workers are much kinder than any i’ve met elsewhere. one convinces me to wait for all the luggage to unload before leaving and, quelle surprise, it does not come. they direct me to a short line where i can declare my bags missing again. when i don’t see my taxi, they let me sneak behind the counter to use the office phone. taximan was already at the airport so pick-up is speedy. first impression of swaziland: sound-of-music hills and dales. everything is the color it’s supposed to be: bright green hills, sky blue skies, white cottony clouds, really quite beautiful. we are driving on the left side of the road and i keep feeling some vehicle will surely plow into us any moment. i realize that the things i worried about most before the trip were not problems after all. i got switched to better seats on almost every flight. got more food than i could stomach. didn’t have to negotiate taxi fare since the hotel shuttle was free and taxi into mbabane was paid by voucher (flashback – i paid at least ten times a fair fare when i first landed in gabon). didn’t have to mangle my body carrying heavy luggage – since i no longer have any - or finding small change to tip someone to do it for me.

taximan drops me off at the clinic which is a modern, but welcoming edifice. it’s so clean and organized compared to lambarene (suddenly i’m comparing everything to gabon) that i’m feeling poorly dressed and haphazardly coiffed. in time, dr. joyce drops me at my new abode which is a nice two-bedroom condo with a putrid smell and fruit flies inhabiting the fridge...

back in boston

noreply@blogger.com (shaunistar) — Sun, 05 Nov 2006 20:08:00 +0000

made it back safe and sound. 90-minute delay out of paris became 30-minute delay upon arrival in boston. it’s cold, but high-speed internet is oh-so-blessedly accessible. i miraculously won first place in the clinical science division of the region 7 student national medical association research forum. woohoo! it’s a good life, people. the end.

bye bye schweitzer

noreply@blogger.com (shaunistar) — Sun, 05 Nov 2006 19:54:00 +0000

that's main pediatrician, dr. bonito, in the white coat

the flopposite

noreply@blogger.com (shaunistar) — Sun, 05 Nov 2006 19:51:00 +0000

okay, i couldn’t leave the country without telling you about our goodbye party last night. unlike the thank-you party for the neighbors that was a total flop, this one had all the magic and warm fuzzy feeling of a well-hosted soirée in a well-situated venue. all these french words...guess i’ve been here a while. friends, neighbors, countrymen, labo peeps, docs and nurses from medicine, surgery, pediatrics, and pmi, as well as administrators showed up for the event. the house looked more like a home than it ever has with the sitting areas and spare decor we were able to muster together. castel, regab, coca, and d’jino flowed freely...a lot more freely than the fanta that’s still collecting ice in the fridge. it became the joke of the night, rachel trying to get folks to drink fanta. it really is just sugary orange water, but i digress. awkward pauses at the beginning became animated conversations and people from so many different groups actually mixed and mingled. there were swiss, germans, americans, gabonese, cameroonese?, and french of course. i gave up trying to remember how many greeting kisses for each; i think it’s two for gabon, three for france, and four for swiss, alternating cheeks. at least five different languages ebbed and flowed. the thing was a raging success...a lot better than my goodbye breakfast-turned-lunch with the ant-invaded pastries at pédiatrie. that was stressful. this was a blessing. the goodbyes were genuine and heartfelt...and just what i needed to properly take my leave. thanks to everyone who helped me to survive, learn, and grow here. you have my most sincere gratitude.

(in the picture is pediatrician isabelle on the far left and internist sylvia on the far right)

au revoir-o

noreply@blogger.com (shaunistar) — Sun, 05 Nov 2006 19:42:00 +0000

it’s that time. time for farewell-wishing. fromagie is dusting schweitzerland with white cottony puffs. it’s my favorite tree here (formidable, ancient, cypress-like) and it seems to make wishes the same way we do with dandelions. the voyageurs are waving in the wind as if to say goodbye. the palm-like leaves fan out in great arcs. and i can’t leave out the trees with the hallelujah arms thrust heavenward. it’s like they’re having church in the hills. guess there are some things i’m gonna miss about this place. the nine overnight mosquito bites do not figure in this number. but i will miss my newbabies, sicklers, and regulars. i will also miss the beef brochettes at la reférence, french fries at ahidjo, the omnipresent beignets, the gateau kids, the poisson poisson boys, several new friends, the pineapple, the mangos, the night sky, the early morning light, and fish cooked every way under the sun (and under the sand). that means i’ve had to learn how to eat fish with bones and thick-skinned mangos.
i have not yet mastered the gabonese “o” that is almost indiscriminately attached to the ends of words (e.g. oui-o, j’arrive-o, à la prochaine-o). i love it! actually there is some rhyme and reason to it. it’s usually attached when the words are intended for someone at a distance or to add emphasis. but my favorite is the isolated “o” of accusation and/or disbelief. i’ve also learned at least five ways to say something annoys me. like the expression of grief, this is not a place where feelings are hidden.
i had to chuckle to myself the other day when i heard myself say, “si ça va, ça va, mais si ça ne va pas, il faut revenir.” some kind of nonsense, but essentially, “if it’s okay, it’s okay, but if it’s not okay, you have to come back.” “ça va” is used very frequently in practically every tense. after i said this bit to the patient, i was graced by the presence of one of big pharma’s tentacles. don’t worry. i was nice to him, probably a lot more tolerant than i would have been back home. he didn’t really have any pediatric meds to peddle, but he was interrupting me on one of the recent rare days i was seeing patients independently. my liberation had evolved a lot more quickly in pmi where, yesterday, i was actually the most senior medical staff member on the excursion. the same day i saw the pharmaceutical representative, i was offered some anti-transfusion literature by a jehovah’s witness. he’s giving this to me after i’ve seen three kids with hemoglobins of three in one week. i believe in transfusions. once you start getting these kinds of visits, you know you’ve been in one place long enough.
during my time here, i’ve diagnosed myself with gastroenteritis, lactose intolerance, malaria, scabies, delusional and illusional parasitosis, depression, adjustment disorder, anemia, and viral upper respiratory infection. that’s half right on and half paranoia. although, since i went fishing, i’m waiting for the schistosome-induced terminal hematuria...it’s rough being a medical student. but as they say here, ça va aller (it’s gonna be alright), literally, it’s going to go, and so am i...au revoir-o!

double party

noreply@blogger.com (shaunistar) — Tue, 17 Oct 2006 17:56:00 +0000

last weekend we got invited to our own party. a couple days before the word had gotten around to us that we were apparently hosting a dinner. maman sophie was doing all the cooking. and what a feast! she made rice pimenté (spicy), feuille de manioc (like greens), chicken in peanut sauce, crocodile, fried plantains, unfried plantains, eggplant, fried carp, and even french fries. the crocodile was much better than that at chez leonie (maybe the lack of glistening scales and four-digit paw helped). other folks added drinks, salad, and dessert. yumminess. and of course maman sophie held court as only she can, regaling us all with her personal commentary on gabonese traditions, politics, and lifestyles. add to that a little hospital gossip and you’ve got quite the entertaining evening.
the funny thing is that we had already planned a small get-together for the next day. we wanted to thank our downstairs neighbors for inviting us over for dinner a few weeks ago. well, unfortunately, folks, that one has to go down in the books as a big flop. guillaume was on time, our willing connect to all things gabonese. he’s helping me with my souvenir hunt. maman sophie arrived and helped liven things up. but the real guest of honor (downstairs neighbor) was marooned at the hairdresser’s all evening. by the time she came, everybody was tired, so we had to issue her a rain check. i was particularly done after the ants invaded the cookie bowl.
there are also many vignettes from the hospital that i just haven’t had time to record. i saw a kid with superinfected zoster so bad one ear was larger than the other. somehow, he was discharged before the necessary hiv follow-up was organized. there was a newly orphaned infant at pmi who was malnourished and being cared for by her older sister. since their mother died of “vampire alcohol” poisoning, the sister quit school to take care of the baby. i’m still kicking myself for not giving the kid more bread. a meningitis kid went awol because the mom blamed the vampire more than the microbes. a grandmother rubbed mint tea leaves over a baby’s external genitalia to calm the discomfort. dr. bonito had to clean up the mess with betadine. somebody brought a dead kid to the er and the staff was very upset: “come see what you brought us. she’s already gone.” the attempted resuscitation lasted all of thirty seconds. the family picked up their kid and left. my presentation on neonatal hyperbilirubinemia (jaundice) actually went pretty well. hallelujah that’s ancient history. time to organize goodbye parties and budget out the last francs. only two more weeks...by the way, i got invitations to interview at mass general and st. louis. woohoooooooo:)

food and fire

noreply@blogger.com (shaunistar) — Tue, 17 Oct 2006 17:45:00 +0000

it’s been a long time, my friends. there has been stress in the valley. internet has been on its last leg, but officially kicked the bucket a week ago. folks say it’ll take another two weeks before the necessary cable arrives from germany. so the slow labo wireless is a no go. there was a week where i accomplished nothing requiring a computer until i found someone who knows about the internet café. it’s not too far, the price is reasonable, and the connection is actually faster than the one at the laboratory. the problem is that it’s not open on sunday and it’s hard to get there during the week. if you’re me (which means you’re someone who’s trying to apply to pediatric residency online and submit an honors thesis proposal that requires a bit of logistical olympics) then this is still a tough row to hoe. i am, however, happy and relieved to announce that after two and a half months of striving, my residency application was officially submitted this morning. woohoo! i also applied for match (the system that matches applicants with training programs) and finished my end of the honors proposal. let’s hope the rest of that works out.
as far as news on the homefront, the rainy season is in full swing. it has swallowed up what used to be beach. the mangos are fatter and falling all the time. it’s a wonder no one’s been seriously injured by one yet. the never-ending supply of small children find great joy in knocking mangos down with other mangos that often fall on our roof even at seven in the morning. thanks, kiddies. one of the biggest mango trees is just outside the réfectoire that nearly burned down last week. the oven caught fire. i was the only one in the dining area. i noticed the smoke, but thought it was coming from somewhere else. eventually, the kitchen lady came to save me. some guys dragged the burning oven outside. we ate cold food for a week until the new stove arrived. we had been told to expect three weeks of bad food, so, needless to say, i was so ecstatic when regular food came back.
on the subject of food and fire, we had a nice riverside cookout back when there used to be a beach. our gabonese friends, guillaume and aléka, treated us to traditional eats. they wrapped seasoned fish in foil, buried it in the sand and then built a fire over the whole shebang. it was actually quite tasty, somewhat undercooked, but tasty all the same. rachel and i were in charge of the rice. we were very proud of our handiwork, having spiced it up with tomatoes and onions...mmm mmm. there’s another potluck affair tomorrow at our place to bid a fond farewell to french buddy olivier. he will be leaving gabon thursday. he actually arrived here the same day as me in the same van. hard to believe his 2.5 months is nearly up. even harder to believe my 3 months are coming to a speedy close. but before they let me out of here, i have to give a presentation in french. it’s gonna be on neonatal jaundice. that’s wednesday. wish me luck...

cooking with gas

noreply@blogger.com (shaunistar) — Wed, 20 Sep 2006 11:32:00 +0000

butane to be exact. this morning was the first time i made my own hot breakfast, oatmeal and orange juice. we finally got the table-top range working, so i’m trying it out. things are looking up. hard to believe we’re half-way through our time here. the initial gi distress and mystery cough have subsided at last. either i’m building up immunity or harboring chronic diseases. regardless, i’ve been here long enough to write a bit about the hospital scene.
patients must be accompanied by a guardian. this is true for the adult patients, too. the guardian cooks for, cleans up after, washes the clothes of, and takes the temperature of the patient. they have to bring their own dishes, linens, thermometer, and carnet de santé. the carnet de santé is actually a little piece of genius when used the right way. it is essentially a medical chart that the patient keeps. when the doctor sees the patient, he automatically has a record of recent hospitalizations and vaccination record with growth chart. prescriptions also get written into the carnet.
la pédiatrie is basically one long corridor. when you walk in the front door, the waiting area is to your right and the two consultation rooms for clinic are to your left. you walk farther down the corridor and find the aforementioned salle de soins to your right and the head nurse’s office to your left. two more steps and you’re on the inpatient ward. there are 20 rooms with curtained entrances and 2-3 beds apiece. i have to prepare myself when i enter the room with the very emaciated marasmus baby. i was embarrassed the day i turned around and nearly jumped with fright at the sight of this baby staring at me like a hollowed out chocolate easter bunny. there are two private rooms that have 2 beds each, but their own bathrooms unlike everyone else who shares one. right now there’s a 34-year-old mom in one of the private rooms who just reached a dozen kids with her new twins. for the fragile ones, we have 3 incubators shared between the 4 beds in the 2 incubator rooms. unfortunately, most deaths happen there. lastly, there are 2 isolation rooms for particularly contagious illnesses. currently, we are in the process of moving our 2 isolated patients to other rooms since the isolated room may be reinfecting these babies who continue to spike fevers.
the hospital is not a dull place. in the morning, you will almost always hear the call, “poisson, poisson” (fish, fish) just outside the window. this is a fishing kind of place, so it’s fresh and always for sale. my favorite is the gâteau kid who has to be all of five years old hauling a basket of small cakes for cent francs, cent francs (100 francs (20 cents)). there are other hubs of culinary free enterprise if you know where to look. there’s also a convenience store on the hospital grounds where patients/guardians can purchase food and incidentals like the ever-present celtel phone card.
we spent a great part of this morning trying to work out payment arrangements for patients who need to be discharged, but cannot afford the cost of hospitalization. i don’t think anyone pays the full fee. just getting to the hospital is often expensive enough because patients come from all over. i know many don’t fill their prescriptions due to financial reasons. we try to give out samples if we can. our two-doctor team has been working out a lot better than when there was only one doctor for inpatients, outpatients, er visits, and cesarean sections. tomorrow i’m gonna try to set up shop in the salle de soins and practice phlebotomy. wish me luck...

sunday in sindara

noreply@blogger.com (shaunistar) — Wed, 20 Sep 2006 11:19:00 +0000

do you know the way to sindara? if you do, then you wouldn’t wear a white tank top and white hooded sweater like me. you wouldn’t have labored four hours washing, setting, drying, and styling transiently flawless hair. lol. i thought it was beautiful in an antique photo kind of way. the rusty color that tinged the roadside foliage. i didn’t realize i was looking into my future. you see, after you head south from lambaréné and pass tchad, it’s all over. the road that is. there is no more. you get a dirt path with the characteristic iron-laden red soil. well, after some time on this dirt path, you begin to notice that your white shirt is not so white anymore and your face looks like a one-sided foundation mismatch nightmare. you have to keep the windows down in the taxi or you’ll suffocate from the heat. and thusly, my friends, is how we made our way to sindara.
once we get there, though, the notion of beauty returns. sindara is the opposite of sin. its claim to fame is a catholic mission, l’église des trois epis. rachel, olivier, and i met up with sophie and benoit (more hospital folk) for a 30-40 minute walk to see the waterfalls. there was a lot of water and a little falls. i drew pictures in the coarse grain sand, chatted with sophie, and extracted the huge ant with its fangs enmeshed in my pant leg while the others played some soccer. one of the mission guys was nice enough to cook us up a speedy meal since there was nowhere to get a hot plate of food. our new mission friends made a paparazzi of themselves in sending us off in a hale of camera flashes, god’s blessings, and requests for emailed pics. after the day’s events, it was actually comforting to come back to brochettes and d’jino (“grapefruit” soda) at la référence in lambaréné.

typical clinic day

noreply@blogger.com (shaunistar) — Wed, 20 Sep 2006 11:00:00 +0000

my weekdays begin at 6:30 am to a chorus of every little birdie, every chickadee, every rooster in the mango tree. the mango tree frequently drops premature mangos like bricks on the roof, but i digress. to the réfectoire by 7 am for bread and choice of coffee, tea, hot cocoa. rounds start any time from 7:45 am to 8:30 am. usually, i’ll find at least one dehydrated kid with diarrhea receiving iv fluids in the salle de soins (er/procedure room) who came in overnight. sometimes an asthma kid is there getting a nebulized medication. we check out the premies, then the rest of the inpatients followed by newborns over in maternité. this is usually done by 10:30 or 11 am.
consultations go until noonish. we commonly see scabies, malaria, gastroenteritis, otitis media, bronchitis, buruli ulcer, anemia, and sickle cell with the rare varicella, hepatitis, and appendicitis. we triage quite a number of patients over to surgery who have hernias and abscesses and less common issues like vaginal atresia. sixth fingers get tied off in maternité and regress of their own accord. frenula (tongue anchor) that venture near the tip of the tongue get clipped by the head nurse. anybody who needs labs gets blood drawn and returns for the afternoon session of consultations.
we enjoy a rather generous lunch break usually 12:30 to 2:30 pm. i copy lab results into charts before we see the patients. i cringe every time i copy blood group results fearing i’ll write the wrong thing and some transfused baby will die. the potential for human error is immense. we see the patients from the morning first and then everyone else. the day finishes anywhere from 5 to 7 pm. dinner is at 7pm, another family style affair. initially it was awkward sharing meals and social life with the doctors and administrators of the hospital, but they have become a kind of family. the food at the réfectoire has been getting better and better as far as lunch and dinner are concerned. all i have to say is crêpe aux champignons (mushrooms) and île flottant...mmm mmm good. makes up for the eggplant two days in a row. if it’s a quiet night, i.e. there are no goodbye parties to attend, rachel and i will enjoy an episode of six feet under, our latest favorite entertainment featuring a dysfunctional family in the funeral business. lights go out around 10:30, 11pm. then it all starts again...

city of freedom

noreply@blogger.com (shaunistar) — Sat, 09 Sep 2006 16:38:00 +0000

libreville is the capital of gabon. it was our very first stop in gabon, but the lethargy of travel prevented full appreciation. consequently, we decided to spend a weekend getting to know this libreville people seemed to always be sneaking off to. my other goal was to find a salon with clean water, reliable electricity, and some expertise. people who received my i’m-going-to-gabon celebratory email know i’ve been pondering the hair thing from the beginning. so if i wasn’t apprehensive enough about that, the harrowing ride into town only added to the anxiety. rachel and i were crunched into the front passenger seat like siamese twins with the unbucklable seat belt wound around us like a full-body noose. we were frequently face-to-face with drivers in the oncoming lane as we sped around the slower-moving traffic. the repeated soundtrack of reggae, hip-hop, and chipmunk voices singing “i’m so lonely” had a hypnotic effect that helped take the edge off.
once civilization reappeared, we were relieved to find a clean room with an adjoining bathroom at the maison liebermann. we roamed around a bit where i sampled one of my favorite gabonese treats, the beignet. it’s just like the new orleans one (sugary, doughnut-like) except it’s shaped like a ball. the government buildings were artfully done and local markets similar to those we left in lambaréné. then we wandered into mbolo and were mbowledover by its vastness and lavish variety of fineries we’d long stopped dreaming of. it’s essentially a very expensive super wal-mart. yes, i did buy seven-dollar cheerios and soy milk. eating bread every morning is not my thing. c’est pas mon truc, as they say here. that’s when we started a new expression: ici, c’est le luxe! (it’s luxurious here). no wonder folks like libreville...
we visited the national museum which was chiefly filled with masks of the different gabonese ethnic groups. the associated ceremonies and traditional medicine added great depth to my understanding of the culture. we browsed at the open-air artisan market and stumbled upon a decent salon where i made an appointment for the next day. the rest of the weekend is filled with good eating from dolce vita’s pizza and hazelnut/pistachio gelato (yummy) to middle eastern falafel to pain au chocolat and the wacko owner of the chinese restaurant. when we discovered the exorbitant price of the chinese buffet (roughly $28) we gulped down the water we had already ordered and prepared to find cheaper eats. well, the waiter had us talk to the owner who was determined to make us happy. he was hyper and ingratiating in an ultimately likeable way. he literally ran back and forth shuttling our à la carte meals and reheating things before we asked. he brought left-over buffet desserts and gave us discount coupons when we left.
other entertainment included matthias, our austrian travel buddy and piano player extraordinaire. we talked our way into piano privileges at the swanky meridian hotel. rachel and i followed up his schubert and bach masterpieces with our “heart and soul” duet. i played the only song i still remember, “heart of gold,” and this ugandan guy offered me a drink to hear me play it again. apparently he hadn’t heard matthias because later he joked that he should have given it to him. ha ha. we also went to butterfly where the earthy decor and techno beats were only upstaged by the ceiling-to-floor mirror that let people dance with their own reflections. we called it a night pretty early.
finally, i did succeed in my quest for a coiffeur. mathieu was middle-aged, white-bearded, and english-speaking. there is a science to the use of relaxing chemicals, so i brought my own products and explicit instructions. happily, it’s over and i still have hair on my head. even though i was sick, the 3.5-hour ride back to lambaréné was more comfortable. jazzy gershwin looped every 45 minutes. i kept waiting for a voice to say “a customer service representative will be with you any minute...” yep, libreville is full of services...for a price. everything you can imagine. i guess it’s true that freedom is never free.

infection prevention in action

noreply@blogger.com (shaunistar) — Sat, 09 Sep 2006 10:32:00 +0000

our french friends, cecile and delphine, work in the atelier d'expression (art therapy worksop). with the help of the kids and a local comedian/director, they put together a lovely theatrical piece on aids (sida) prevention that started its tour on hospital grounds and ended at the carrefour d'isaac (as pictured). the other picture shows maman sophie doing what she does best, telling the mothers all about malaria at another session of the pmi (protection maternelle-infatile).

more than gravity

noreply@blogger.com (shaunistar) — Sun, 27 Aug 2006 14:27:00 +0000

sigh. to be a leaf on a tree overlooking the ogoue river just after dusk. faint points of light peeking out from the heavens. lampposts on the premier pont (first bridge) casting splashes of yellow on the calm waters. easy cool breeze seeping through moist air. it’s noiseless. it feels like peace. it smells like life. it’s what i’ve been looking for all week, a quiet hidden perch. a place from which to watch and think and grow without interruption. private moments are rare. as i soaked up the perfect moment of stillness, the breathing canvas no photo could truly capture, i thought of other moments of exquisite, extreme awe. the desire to even kneel at the feet of the lord. to be in his presence. the often transient inexplicable lunacy that is love. somehow it’s all mixed up and the same to me. like flying, free-falling, but weightless, breathless, unafraid. we all come back down to earth at some point.
today was another pmi (protection maternelle-infantile) day. that’s when we visit the villages and offer preventative medicine. the driver said something that stayed with me: “la terre est dûr, mais ça pousse quand-même.” the earth is hard, but they (the flowers) grow anyway. the bright pigment of the petals struck a stark contrast with the pale stones and brush at their feet, a curious finding indeed. didn’t even notice them before...it’s right on the path where i trudged home one night, my mind preoccupied with the day’s pediatric tragedies. i’d been surprised by the unmistakeable deep down belly laughter coming from the families having dinner. there is poverty and people are dying, but something stronger is alive and sustaining. maybe things fall apart and the center cannot hold, but something somewhere is definitely keeping it all together. oui, la terre est dûr, mais ça pousse quand-même.
yesterday, two babies died. it’s not infrequent, but i feel like the story needs to be told. we were nearing the end of an afternoon of sickle cell follow-ups when the only doctor, edouard, was called to the emergency room. i took over the clinic until i heard the commotion of people screaming and objects falling. turns out it wasn’t just objects, but also people falling. i just missed being clobbered by one woman who collapsed at my feet wailing and flailing. beyond the gauntlet of mourning family members, was a 4-month-old girl receiving rescue breaths and chest compressions. she had been sick for days, was just now coming to medical attention, and was fading fast. i looked on in absolute horror as edouard glanced at the clock. he was gonna call it. grandmother was pounding herself on the chest and back crying “aiyo, aiyo”. family member x was giving extremely long, forceful breaths to the baby and gently trying to slap her out of it. he had to call it. time of death: 5:45 pm.
as grandmother scooped up the tiny lifeless body and left the room, the team turned its attention to the 8-month-old girl with burns almost everywhere. (later i was told it was likely stevens-johnson syndrome). after managing some tricky venous access, transfusion was started in record time. i thought she had a chance. well, you don’t have to know normal values to know the hemoglobin of 2 and glucose of 1 were bad news. she didn’t make it through the night. i wasn’t there when the family was told. now i understand what rachel meant when she said the expression of grief is very different here. i mastered the art of silent crying when my friend died, but i felt the way those convulsing, crying women did yesterday. it’s made me wonder what it’s like to wear sorrow on the outside and trust in something outside of me to hold it all together...

ouch

noreply@blogger.com (shaunistar) — Sun, 27 Aug 2006 14:14:00 +0000

this takes muscles i don’t feel like using. that’s what i thought to myself as i trudged down the steep incline separating the réfectoire from chez moi. every stone on the path seemed to be intentionally placed to force contracture in aching places. i feel like i could sleep forever and that has less to do with the physical muscles than it does the emotional ones. yes, the new country smell is gone. being pushed emotionally, spritually, and linguistically is beginning to take its toll. like exercise, the only way to get stronger is to keep at it. what if i only get stronger in places that will never be of any use to me later on? i suppose i have to remember my goals. learning peds, improving french, growing in faith. i find it hard to believe that any of those will be useless in the future. i guess i forgot it was a process that feels really bad before it feels any good. i feel so naked without my distractions, my life, my people, my stuff. all that’s left is me. i put so much out into the world. not sure if i put enough into me. i know i was loving the life i was making for myself in boston. i’m not sure if i’m loving the me it left on the inside. without all the stuff, without all the trappings, without all the front, what remains? i guess what i still have is what ben carson found to be the essential marketing attribute: being able to build it all again. they can take it all away in an instant and i can build it all back up – probably not in an instant – using what i have on the inside, using what cannot be taken away. and i guess that’s why i’m really here. figuring out how to get more of what cannot be taken away...

strike up the band?

noreply@blogger.com (shaunistar) — Sun, 20 Aug 2006 17:32:00 +0000

i’ve been in many parades. that’s the legacy of eight years of flute-playing in and around new orleans. however, i never expected to find myself in one in gabon, overheated and nauseous. sick or not, i wasn’t going to spend independence day in bed. i thought i’d just hang out in the wings and watch the spectacle march by. that said, we didn’t make it off the hospital grounds without getting t-shirts with the schweitzer crest emblazoned on the pocket and “mon hosto” (my hospital) encircled in a big red heart on the back. that made us a part of the pack and the pack was headed to the parade route.

i finally figured out that parade was more of a verb than a noun in lambaréné when i saw there were more people in the parade than there were watching it. apparently that’s where the fun was. truckloads of identically clothed revelers, drinking, laughing, singing, were all headed to the starting line. groups of women in matching traditional dress migrated over as well. our little group made the 45-minute walk over to the market area, waited approximately one hour, and paraded all of two blocks. lol. it was good because i’m not sure i would have made it much farther. synthesized big band music poured out of the speakers at the grand stand where various dignitaries were seated, but i’m telling you after the grand stand, it was all over. rank and file were broken. banners rolled up. boisterous chanting fizzled into desynchronized chatter. we rolled ourselves over onto the banks of the parade to watch those following us. there were student groups, female muslim groups, businesswomen groups, etc. after a while, i realized it was really more fun to be in the parade than to watch it, so we headed back for lunch.

rolling with the hippos

noreply@blogger.com (shaunistar) — Wed, 16 Aug 2006 12:59:00 +0000

there’s nothing like espresso in évaro. the jolt of caffeine helped offset the mind-numbing effect of the 90-minute boat ride. we were on a mission to see hippos, but somehow ended up at a kind of emerald city at the end of the muddy brown river. the hotel we docked at was some kind of exclusive, secluded tourist magnet with beautiful artwork and all things polished and modern. uniformed waiters appeared out of nowhere brandishing beverages. it’s apparently quite expensive to stay at this hotel, upwards of $200 per night.
we roamed around the grounds a bit, taking special notice of the colorful flowers and occasional four-legged creature. i suppose checking out the hotel was useful as a rest stop, but i was glad when we got back on the boat to resume the hippo hunt. our tiny boat bobbed up and down in the wake of others speeding by. after about twenty minutes of coasting along, we finally saw a baby hippo rear his head from the water. we slowed to a halt and took a ridiculous amount of photos of the whole hippo family. unfortunately, we never saw more than the ears, nose, and eyes, so the pics are not so great. i kept replaying gory scenes from jaws in my head, thinking that one would pop up next to the boat. however, given the distance sufficient to ensure bad photos, we were never in any real danger. the ride back to lambaréné did not seem as long as the reverse direction. we ended up walking most of the way back to the hospital since no taxis were in sight. turns out there was a wedding with lines of plastic lawn chairs sprawling themselves across the road. everyone we passed by seemed to be headed to this event.
we took the same bridge that night that i took today to go to the market. i’m noticing that i’m less disturbed by the intermittent lack of railing alongside the sidewalk. if you don’t pay attention, you could walk right off the bridge into the river. i’m also getting used to eating fish with bones, eating chicken as the roosters crow, and seeing chunks of monkey and crocodile laid out at the market. can’t say i’m completely at ease with the startlingly immense diversity of insects, a kind of darwinian microcosm unto itself, but i’m definitely looking at the animal kingdom in an entirely different light these days.