USA

Waiting in dc on the last leg of a six hour layover that’s just been extended because the plane needs a tire changed. A Korean family across from me just opened up white styrofoam containers with kimbap and I want to ask if I can have one.
The trip home has gone by faster. Smoother. I’m sleeping better. Eating more. Less babies crying. I sit next to an Ethiopian boy who has just been adopted by an older South African couple. This is his first time on an airplane and I wonder what he’s thinking. His younger sister sits in front of him, with their new mom. Her hair is wild like Lisa Simpson and she is bouncing in her seat and turning around and gesturing to her brother. She is beautiful in a way that reminds me of Solomon’s Ethiopian queen. She has a granola bar in her hand and offers some to me. I’m impressed by this former orphans generosity. Later in conversation with her dad he says they came to addis for them, “we got em!” He says With a fist pump. He mentions that the girl is deaf.

I miss Malamulo. I miss the shoddy road to the hospital. The patchy vegetation and women in chitenjes walking with baskets or firewood on their heads. I finally learned how to tie my chitenje right on my last day too. I left in a rush, as I always do. Didn’t have time to process saying goodbye and that I might not ever come back to Malamulo. That most of the people there will never come to America. Will never leave Malawi at that.
I watched dayo walk back into the hospital as we drove away with the hospital transport and I was sad to leave her. Being in a foreign country is hard. Living with a bunch of 백인s is hard. But she loves Africa and so she’ll stay and extend her contract for another year. I’m so glad I met her.

I’ll be home in a few hours. Back to real life. Whatever that means.

Ten things

Ten things I’m looking forward to:

1. Paper towels
2. Shower curtains
3. Calling my grandma
4. Wine
5. The ocean
6. Paved roads
7. Skinny French fries
8. 4G
9. Conditioner
10. No. More. Mosquito. Bites.

I could name all the people but the list would be too long.

Paper towels tho. Forreal. I miss the sanitary-ness of it. Miss killing a spider and not having to clean it off the blue towel that jesiman probably uses to wipe down the table with later.
Other than that and the constant itching, though, I’ve been more than comfortable here.

I haven’t been writing about the hospital because I’m settling into a routine and routines are never fun to write about. Especially when a regular day is less than heartening. A patients family wailing, their sobs echoing down the large concrete hallways of the hospital. When I ask a nurse what happened she replies matter of factly that a patient has died. Her CD4 count was four. The next morning at M&M dr. Hayton talks about how we need to do more earlier on. Earlier than CD4 counts of 4. It shouldn’t happen in 2014, I don’t care if This Is Africa. So many of the patients we see are thin and wasting away. My pediatric size blood pressure cuff hangs loosely on a forty year old woman’s arm. Our hospital is better than the district (county) hospitals that treat poor people, but you could still shoot an AIDS documentary on our frail patients and solicit tears/money easily.

Find that cure. Find that vaccine, Charlene. Research is important. Cultural changes are important. Not giving up is important.

Three more days until I leave. These things always progress like this. “slowly, and then all at once.”

Zomba

Malawi reminds me of California in that one minute you can be in the desert and an hour later you can be in a thick green forest buying fragrant red strawberries on the side of the road.

We made friends with the German teacher girls also staying in the dormitory. They were Malawi travel pros, after being here for almost a year. Pia, Sophie, and Ana all carried huge backpacker packs and knew enough Chichewa to get a mechanic to help us out when our brakes failed on our way home. In exchange for a lift to Blantyre, they made us a French toast breakfast and gave us a few thousand kwacha. Together we headed south to zomba plateau.

Zomba is known for horseback riding and strawberries, but no one told me it looked like Portland. Dayo drove up the windy road and we climbed higher until we were up above the clouds. It was misty and damp with fern and ivy filling in the gaps between the trees. The mulunguzi dam made a lake with a baby waterfall on one end. When we were ready to leave the fog had started to roll in, heavy and all encompassing.

It was Eid when we came back so most of the shops were closed, including the hospital outpatient clinics. It started to drizzle on our way home and it didn’t stop raining for another two days

Adventure is out there

We saw so many elephants.

rolled out of bed at six and by 630 we were the last ones to board an open air jeep that looked like it drove off the set of Rambo.

This part of Malawi is dry. It’s the dry brown desert I saw from the airplane. The mornings are cold, but it’s hot by midday.

Liwonde national park reminds of the dry parts in lion king. Like after Scar took over. There are thorny plants called yellow fever tree and giant cactuses. We step on dry branches that snap under foot and our hair gets caught in withered branches.

After we paid our entrance fee (resident rate since most people assume dayo is Malawian and I’m part of her entourage) we stopped by a 4000 year old baobob tree which would take eleven of me to circle around. We passed impala and kudu and yellow baboons, which was nice but still felt like I was on a tram going around the San Diego wild animal park.

We were snapping photos of something in the antelope family when Hess told us we were coming up on big game. No flash photography. No sudden movements. No shouting.
We rounded a corner and saw them. Fifteen fat dusty grey elephants scattered about a forest. They were smaller than I had imagined, kind of like when you meet a celebrity. I got too excited and took fifty blurry photos as a baby elephant grabbed a tree branch with its grey trunk and shoved it unceremoniously into his mouth, showing us a flash of his pink tongue. Our group sat in silence watching them. They crossed the road ahead of us and lumbered on in single file line, making a new path in the yellow savannah. It was nice to see them in the wild. Nice to see them going about their daily lives without pandering to humans – doing tricks, balancing on a ball, or even being fed by us.

In the afternoon we did a boat tour. Which consisted of cruising up the shire (pronounced sheeree) river in a small metal motorized boat named the glen morangie. We saw ten different groups of hippos. Their beady perfectly round eyes just barely peeking over the water. Hippos are shy. They duck their heads under water whenever we get close and the white egrets that perch on top their heads fly off with a huff. The hippos are dark purple brown like a day old bruise, except for the fleshy pinks of their inner ears, which they wiggle often. I had no idea they were vegetarians.
On our boat tour there are three German girls who are teaching here, an Iranian nurse working with MSF, and a British couple of unidentified cause. no one is solely on holiday here in Malawi. All the foreigners in Malawi are here as volunteers or working for NGOs. We chat back at the camp and exchange origin stories. A Belgian homeopath who partners with a local hospital. He drinks tea and uses lavender citronella lotion to ward off malaria. Beautiful Dutch girls with perfect noses who are doing a rotation in a nearby hospital. They are 21 and halfway done with medical school. One has the most annoying voice and dismisses everything with a “fuck it”. The owner of the camp is Frederic and he looks and talks like a gaunt sickly version of Owen Wilson. All day He rolls his cigarettes and drinks the wine from the self catered bar. Living the life.

Better

It’s been such a tease to see emails pop up but not have enough time to sit around for fifteen minutes for gmail to fully download them. I know I should be more patient since it’s going all the way to space but i am so impatient.

After my grumpy days I listened to a visiting doctor give a guest lecture. At first I was a bit disappointed that she wasn’t teaching us about infectious disease or some other obviously practical topic. She spoke about the importance of reflection. Reflecting. In work and in life. Sometimes you really get what you need. Thank God for that. Capital g.

As I write this I’m sitting on the edge of liwonde national park. Blue mosquito net draping my bed like a princess canopy only the multiple holes in it are closed up with duct tape and band aids. There are eight twin size beds in our “domeatory” (spelling is not a high priority here) that is lit with candles.

Going to a safari in Africa was pretty much the only touristy thing I really wanted to do. Even if i wasn’t going to see the big five, When else was I going to have the chance to see elephants without a fence separating us?

The whole trip has been an adventure. Dayo and I feel like strong independent women, traveling without a man, taking the minibuses into Blantyre and renting a car. My first time driving in a foreign country, and in a former British colony at that. I turn on the windshield wipers more times than I can count when I mean to signal left. I hit every pot hole and almost hit every other pedestrian. There’s only static on the radio but I have so much fun talking with dayo that I keep missing the turns.

We left Malamulo at seven but by the time we finally get to liwonde safari camp, it is 230. It’s rustic and African and we love it.
An old man with square spectacles whose name is Hess takes us on a walking tour along with a Belgian couple and a German girl. He points out the giant baobob trees, silvery python vines that wrap around tree trunks, and the aptly named sausage tree which bears sausage (or sosegi as jessman and my grandmother would spell) shaped fruits dangling on thin stalks.
At sunset, the sun is neon orange, artificial alien Cheeto-orange, suspended in a purple haze lighting up the river and marsh where i stand ankle deep in elephant tracks and the wispy silk from the tops of bamboo stallks wave lazily around me. Its the most beautiful sunset I’ve ever seen in my life and there are hippos grunting on the other side of the bamboo brush and my heart is so full.
“What kind of god do I believe in? I believe in a magnificent god.”

On the way back we see a family of wart hogs. They eye us warily but keep on eating. They squeal and run when we get closer. At the camp, I shower outside as the sun says goodbye. By night the sky shows off with layer upon layer of twinkly stars. They’re bright in makwasa already but here. Here where there are only candles and one lightbulb in the kitchen the stars live up to their name. There is a fire after the best meal I’ve eaten in Malawi so far. No contest. We meet the sweetest German ladies volunteering in the German peace corps. One even invites dayo to her home in hamburg during her tbd European adventure. We talk about words and how every language has words for which there is no perfect translation. Like schadenfreuden: the happiness you feel at another’s misfortune.

Tomorrow is the game drive. I hope we see elephants.

Halfway point

The novelty has worn off.

Today marks two weeks. And it’s officially the longest time I’ve been in a third world country. I’m itchy. I am itchy all over from fifty six bug bites that I’ve scratched and have now erupted like rings of fire around my waist, ankles, and neck. They find every inch of exposed skin and bite me over and over in little clusters. I wish they made needles this fine and small and sharp. I wouldn’t be so afraid of getting shots then.
After satemwa I spent the next few days in a Benadryl haze. Drowsy grumpy and still a little itchy. Patients were sick and not getting better. Lab was returning sodiums of 200 and then 70. Both incompatible with life. I ate ten packets of candy I’ve been meaning to give to starving Malawian kids. Watched the first season of breaking bad in one day. I can still be selfish and indulgent in Africa.

Since the Amandas left it’s just me and the surgeons, Matt and Fekadu. Most conversations circle back to surgery in some form or another. Mobilization of this, proximal and distal control of that. I spend a couple days in the OR to feel like I’m doing something, even if it’s just to retract, hold, cut, or clean. I get the appeal though. The surgeries they do are awesome. Suave pull through for hirschsprungs. Three doctors intently staring into a three year olds anus, creating a new one in a few hours. Urethroplasty with a buccal mucosa flap. Screwing a mans jaw back together. It’s instant satisfaction. Okay maybe not instant, but much faster than treating TB meningitis.

There’s no ending to this story. Good days and bad days happen wherever you are. So it goes.

Satemwa

This is how you get to satemwa.

You wake up late and eat a little bit of lunch. Chicken and rice, since jessman knows that chicken is the only thing the uzungus seem to like. Dayo comes by around noon and together you walk along the uneven road, past the gate which is really just a spring loaded barrier with a rope on one end that the guard pulls to lower the bar once you’ve passed.
You walk some more, past a man in a tattered shirt which was once white. He is herding five cows who meander along the road. I am almost certain he does not own these cows.
You stop just outside the entrance of Malamulo, next to the sign with a painting of black Jesus and the 10 commandments. Because Malamulo means commandments.

You’re waiting for a minibus. Multi passenger vans with four rows of seats like the ones on a school bus. They criss cross the roads, picking up passengers at unmarked stops or just along the way. A handwritten side on a piece of cardboard sits on the dash, telling you where the minibus is headed. There is no printed timetable or map. They come when they come.

You follow dayos lead, grateful she is there. The three of you pile in, Matt gets stuck in the back. You bump along the road, picking up more people along the way until suddenly there are 15 of you in a vehicle meant for 11 along with three sacks of sugar cane that burst out of the small trunk and spill along the road. The driver plays tinny African music from his phone at max volume and you stare at the crack exploding like a firework across the windshield. A guy has to jimmy the sliding van door each time he opens it. Everything is rusty, cracked leather seats, and coated in dust. Ten different body smells attack your nose; the guy behind you leans over, elbows resting on your seat, his arm pits catching the cool breeze from the window and almost knocking you out.
You have to get off and change minibuses. You only know this because of dayo. When you get to the minibus depot, five different men rush up to you to get you on their bus while five others try to sell you macadamia nuts, roasted corn on a stick, or water sealed in plastic baggies.
You get on another bus. This time with 17 other people and there are four of you in one row, plus a boy in a school uniform who stands in between you and his mother. His long curled eyelashes blink unhurriedly and he plops macadamia nuts into his mouth, one after another, like he has no cares in the world.

When they drop you off next to the sign by Satemwa, you walk the two miles to Huntingdon house, a private residence turned bed and breakfast. Altogether the trip there takes two hours and costs 1.50.

Entering the grounds of Huntington house you feel like you’re in the English countryside. Birds chirp and wind rustles the leaves. There are no dogs howling or roosters being strangled. Black tea and French press coffee is served with finger sandwiches, pastries, and fancy cookies on a three tier dessert stand. There’s even chocolate cake and clotted cream. A Malawian man serves you outside, where the weather is beautiful and the cholo flies plentiful. A statue of an African butler holds croquet sticks, which a little French boy with blonde curls knocks over and then cries. It is the first place you have been where the uzungus outnumber the locals.

In two days you will have been in Africa for two weeks.

On the way back, Kareen, the young British manager, gives you a lift to the main road in the service truck. You sit in the back and bounce along the road, watching the sun set over acres of tea fields, buttery popcorn yellow melting on the green tea leaves as another day ends. A monkey scampers across the road.

This is Africa.

Talk

No internet for the past four days. Were all going a little stir crazy. Our plans to go to zomba plateau were sidelined since dayos friend changed her mind about letting us borrow her car. We decide to go to satemwa tea estate for high tea tomorrow instead.

We stay up and talk, Matt dayo and I. About the culture here that is known as being the warm heart of Africa, so friendly and peaceful, yet they inflict so much violence against each other. Women coming in to be treated for stab wounds after a knife fight. A man with a deep gash in his forearm he got while protecting his face from a machete. Men beating their wives. It’s not a problem unique to Malawi. But it’s in sharp contrast to the respectful soft spoken bending over backwards politeness they show on a daily basis. It reminds me of Korea in that sense. The formality and respect and expected decorum. That’s why the straightforward brashness of Americans can be so offensive to our cultures.
I started reading what is the what. About the civil war in Sudan. And in the opening scenes, Valentino, one of the lost boys of Sudan, is in Atlanta, getting robbed by African Americans. They call him Africa and tell him to go back home. Dayo talks about what it means to be African but not African American or black American. Matt and I don’t understand how the two histories are different, or why some people say Obama doesn’t represent black Americans since his father is Kenyan and his mother is white. We don’t understand the significance of slavery in differentiating the two; can’t appreciate the history of oppression African Americans grew up with. Dayo says most of her moms best friends were Asian, and it’s because of the immigrant connection. We talk about being immigrant children, always stuck with representing our family and our ethnicity. Matt talks about his embodiment of the American dream, his parents both blue collar workers, him heing the first in his family to go to college.
We talk about shootings in America. Aurora. Santa Barbara. Each country has it’s own set of problems.
While we talk, the power goes out, so we light my ikea candles and sit in the soft glow of the squat candles.

At night, in the alleged safety of my bed enclosed by the blue mosquito net, I see a lizard the side of my hand scurrying down the far wall. I watch it disappear behind the dresser and hope it leaves by morning.

Bite count : 17

Hodgepodge

Jessman has been noticing that I like tea with breakfast, so he’s gotten into the habit of setting out a kettle of hot water and tea bags in the morning. He’s the sweetest bambo (a word I just learned from Dr Crounse today: a respectful term for an man that means father), and I call him that because he’s about my dads age and it feels strange to refer to him as our house boy even though that’s technically what they call the help around here. House boys or house girls. They tell me it just denotes gender rather than disrespect but it’s hard not to feel disrespectful calling a grown man “boy.” There are a lot of things that are different here. Though there’s much more that’s the same.

Because there’s a nurse also named grace (it’s a common name, along with Agnes and margret and I don’t know how to feel about that), some of the staff call me Aguile (ok only grace calls me that really), to cut down on the confusion.

Aguile is braver than American grace, though. She kills spiders and only freaks out a little bit when she sweeps about fifty dead marching ants, each the size of a peanut, from her room. She haggles with the ladies selling bananas on the roadside and contemplates eating the donuts wrapped up in blue plastic bags sold by a little girl by the hospital. She doesn’t freak out the first time she places her stethoscope on a mans chest and fails to hear the steady (or unsteady) thump of a beating heart. I do turn away later that day, while watching the surgeons hammer a rod into a woman’s tibia, drilling perfect circles into her bone that look like hole punches on white paper. Dr. Fekadu wipes his sweaty forehead on the circulating nurses scrub top. An hour later the patient is breast feeding her baby.

Mosquito bite count: 10

We get home around eight, dr. Fekadu Matt and I, after walking up the partially paved road riddled with pot holes. It seems ridiculous that I got lost the first time heading back. We never made it to lunch, so we eat a reheated feast for dinner – salty fried chicken, mysterious veggie meat patties, a infinite pot of rice, and something that looks like collard greens that everyone eats around here. I think that if I could do surgery residency, I would. It’s so needed in mission hospitals. But my poor heart and mind and body wouldn’t survive. And that’s ok.

Moments in a week

Telling a family their grandmother suffered a stroke. A son turning away from the clinician with a scowl, shaking his head, angry sad at the way things turn out.

Women’s clinic. The nice courtyard. Women breast feeding openly. They bring their own exam table covers in the form of brightly patterned fabric they later tie around their bodies as shawls or skirts. An ulcerated cervix. An unnecessary yet mandatory biopsy.

Abbie refusing to say goodbye to Amanda. Because if she doesn’t say goodbye she can’t leave.

Reducing a para phimosis by stabbing an old mans foreskin about a hundred times and squeezing his penis until the foreskin slips over it.

A hundred adorable babies with the brightest eyes.

Morning fog hanging heavy in the trees surrounding a mountain.

Neurosyphilis always on the differential.

Dinner at the haytons. Tart crumbly lemon bars and thick corn chowder. Baby Jett’s wild squeals of laughter. Fifteen voices speaking at once. Someone saying religion caused the hiv epidemic in Africa.

A rainstorm brings the mosquitos out.

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