Who we become

A few nights ago I dreamed of love. We were singing together and this man had a soul touching voice. It was a sure love, a new love and so comfortable. I didn’t want to leave that dream. The real world is a lonely place. I can’t seem to find my way here. And when I am driving through the city, looking at the thousands of people I don’t know, realizing in cities and towns across the world there are hundreds of millions of people- so many of us, how is it possible for any one of us to be so alone?

It is often that my perspective zooms out to such a scale that I see only humans, and we are horrible to each other. It is as if we are not of the same species. We do not see how we are related. We do not care for each other or tend to our sick or frail. We are a sorry lot, us humans, lost in searching and fighting for things that are inconsequential. We can’t even see it.

Yesterday I passed another person on the street- I am not sure who he was- a forgotten? A throwaway? I can’t even be certain of the situation. As I drove past I saw a man on a motorcycle looking down at him and shaking his head and then driving away. I don’t know if the motorcycle had hit him, or narrowly missed or just stopped to see if help could be offered. It wasn’t clear in those few quick seconds. 

I saw a woman walking by. She looked, kept walking and looked back again. She had a baby on her back and a large bowl of bananas on her head. She was carrying a small table or crate in her hand. None of us seemed to know what to do. Myself- I drove by. I looked, I wondered, I panicked in a way. Yes, it was panic because I did not stop. A steady hand would have stopped and offered help. The street was oddly empty. Usually there are a bunch of sellers on this stretch of road. It is one of the very few places where the street sellers persist. But in this moment, I drove to the corner, made the turn and there was nothing. No one.

I hate that I do this. Drive by. The man had been lying on his stomach, his head oddly facing the ground. He appeared to be having a seizure, his body convulsing in some way. His legs were jerking and his torso rose off the ground. Everything about the movements were unnatural and wrong. He was alone. I did not stop. What would I have done?

My most recent medical training was in CPR- what to do if someone is not breathing- not how to handle convulsions. I am still never really clear on what to do with trauma. It’s not my strong point. I am very, very squeamish and afraid to see blood or bone and organs exposed. I think I am most afraid of being out of control. I cannot fix those things.

In Africa, the situation becomes even more complex because there is no 911. And even if they do purport to have an emergency number (112 or something similar) it will take a long time for anyone to show up. Further complications include being foreign, being white and not knowing exactly what happened. These all sound like excuses, and they are. They are the reasons that prevent me from stopping. Being foreign means that I have a greater chance of somehow becoming implicated or blamed for the incident. Being white suggests I will pay for everything and not knowing exactly what happened means I can’t offer a defense.

They are all good and valid excuses, but none of them make me feel better about myself. It’s not the person I want to be- the person that sees a need and just keeps driving.  I am coming to realize that medical issues are not my area of strength. I am really not equipped to offer much in the case of broken and bleeding bodies. It’s hard to accept this. Sometimes I feel like the only worthwhile thing is to be a medical healer. We do it to each other, this breaking of bodies. War and fighting and anger. We ruin lives, we starve each other, we create situations of horror that don't have to exist. In these times, the immediate need is physical. Nothing else matters when you're a life on the edge. 

But there are other types of healing. And some of these other areas are where I feel more capable. As a healer, however, it is shocking to drive by someone in need and feel unable to assist. It is an overwhelming sense of dread and powerlessness that cuts down to the core and plants a little seed. It stays there long into the night and the day and resurfaces every so often to remind you of who you were in that moment. And who you really are. Not a healer after all, but just someone who drove by.

I passed the area again later in the day and he was gone. Someone had stepped in. Either to offer help or to clear the body. I can feel positive about that- not like the child in the road, whose body remained despite a busy street and plenty of onlookers.

It is situations like these that make me wonder if maybe I am not cut out for African living anymore. Maybe I am full up. When you are constantly facing hardships and battling inequality- facing simple problems that suddenly become insurmountable, it’s not easy to like who you become.

Parts

Tedd Arnold has a funny book about a boy who's afraid of losing his body parts. He followed it up with More Parts , an equally amusing book that deals with expressions involving loss of body parts. The little boy imagines the worst until his parents explain at the end that all these idioms can't be taken literally.

The humor, of course, lies in the premise that losing our body parts is something that really happens and it can be scary- if we don't understand the natural processes of our bodies. While the West likes to attribute the "foolishness" of body part harvesting to Africa, and Abidjan itself  has had its hard times, there is no lack of conspiracy theories in the US about about the victimization of the black community or even planned parenthood's role. The fact is, worldwide organ trafficking is a lucrative business.

And the majority of us never even give it a thought. Although Medicare says they cover part of the costs, (notice that medications for after treatment are covered for a limited time, even though the American Society for Transplants reports that medicine will be required for life) there are endless stories of fundraisers for families trying to receive care (and what's up with organ registry list fees?!) and even an organization dedicated to the cause for children.

All of these images went rolling around my anesthesia-hazed mind on Saturday afternoon as an orderly wheeled me out of recovery in search of a room. "Her parts are there," he said to his partner, motioning to a small covered container. It was closed securely, labeled with my name and personal information and held a good sized piece of tissue that had, only hours before, been tucked safely inside my body.

I'm sure no one was hatching plans to steal my vial in the middle of the night and whisk it off to the highest bidder....no bidders for this particular harvest...but nevertheless, I was disturbed to have an inner piece of me exposed to the outer public. Obviously it had been sitting on the shelf just above me while I'd slept the afternoon away in the post-op area.

If this were Kinshasa, honestly, the story would be more about hospital conditions or medical interactions. But here in Abidjan, true to form, the only complaint I can offer is in insurance procedures- or maybe it is doctor procedures, it's really hard to tell.

The clinic itself is bright and shiny in all the right places. There are procedures and precautions at every turn. I think it is a familiar experience to the etranger and inspires confidence. I don't have much experience with hospitals or illness, so I don't know if all the tests they made me take were routine or over-excessive Ivorian regulation. Likewise the extended no work recovery period allowed by law. I am not sure how much is medically necessary, but the fact that the law allows for it- requires it even- is welcome for someone like me, who would probably otherwise just return to work the next day and push on through. Honestly, a break is welcome. Needed even.

Things had been going so well, in fact, that the sight of my tissue in a jar beside me was all the more alarming. "What am I supposed to do with that?" I asked the doctor. "And is it going to be ok...just...out in the open?"

The doctor has not won any bedside manner accolades from me in our brief time together. He raised his hands and shrugged. He told me he had to take it out before he could request that it be analyzed (Really? What else would one do with extracted tissue?) and suggested it would be fine until Tuesday (Monday was a holiday.) I tried to do a bit of a google search, but even the grand master of information had no helpful results to offer on "tissue storage after biopsy." All I could find was that the specimen should be stored in 10% formaldehyde solution. No one else seemed to have the experience of being sent home with their insides in a jar. I am not sure if I will have any belief in the results.

Seeking out the insurance ok paved the way for a new adventure- me wandering the business district of Plateau, 72 hours post surgery, feeling like I might fall over at any minute. I was battling my desire to walk as little as possible and conserve taxi money. Generally, those are not compatible ideas. To top it all off, I'd mistaken the name of the reference hotel. I headed towards the lagune area and the Novotel, thinking it was the Ivotel. This involved a 20 minute walk across town, when in actuality, the taxi had originally dropped me off surprisingly close to my destination.

After determining my error, I hailed an orange cab and had it bring me back to where I'd began. So much for going the economical route.There I found the insurance bureau and made my way up the elevator, through the doors and down a hallway into the small office of a woman addressed as "doctor." I was surprised to find a doctor working there. But then relieved. But then realized it didn't matter much because this person was not my doctor and so had no knowledge of any of the tests, results, or processes leading up to this moment.

It took her about 30 seconds to read, sign and stamp my paper. "That's it?" I couldn't help but ask. I was incredulous. Once again I repeated my protest that this whole procedure was simply not logical. The law affords me more than 2 weeks for recovery but the insurance company has me out and walking around less than 3 days after the surgery to obtain permissions- that could have easily been included in the initial inquiry.

She just looked at me and cocked her head. "You are tired. Don't you have anyone to help you?" It reminded me of the absurd question by the intake nurse when she motioned me through the surgery block doors. She'd looked at my bag and asked if I hadn't brought my parents with me. My parents? I am the parent.

It is one of those things I find infuriating about Abidjan (and surely other African cities are at fault too. Kinshasa had her share of ridiculous forms.) It is the space for parent names. I suppose if you are from a whole family that functions, maybe this is no big deal. You fill in your mother, your father, their birth dates and move on.

For me it is an emotional undertaking. The father line always leaves me conflicted. Since I have found out my biological father is most likely dead, I think it is easiest to simply write 'deceased' there. But the angry adolescent in me surges up every time. My mother? Why do I have to write her name here? She hasn't taken care of me since I was 10. What could she possibly have to do with any of this? I wonder what true orphans do.

In Africa, the assumption is that everyone has an auntie or uncle or cousin or some stand-in family that will fill the role. As an etranger, and an extremely private person, there are not many to ask to fill this role. I am my parent.  They will laugh at me here, not quite believing I am serious. It doesn't help that the whole experience has me feeling exposed and vulnerable, which leads to an abrupt rudeness that I can't quite stifle. Add in the "I don't do hospitals or medicines or doctors" and I was basically a wreck. Luckily, I was too tired to offer much resistance. Or even any word at all. I took my paper with it's red signature and made my way over to the lab to drop off my parts.

The Low Point aka Living on a Dollar a Day

Being an adventurer is not for the faint of heart. It requires you to have courage and strength and forever see the positive in whatever life throws at you. The fact is, that’s not really me. While I certainly aspire to all of those things, and maybe sometimes romantically imagine myself that way, I haven’t quite truly developed those qualities yet, not deep inside where they have roots.

I realized this as we were riding around town completing a few errands. I’d been feeling discouraged about the school situation for the boys (definitely not one of the perks of the contract it turns out,) a few other standards of living I haven’t quite figured out how to make happen yet and our financial situation in general. We passed two old women sitting, sleeping really, by the roadside. They had their blankets spread out and their beggar bowls nearby. I reflected for a moment that my life was in a tad better shape than theirs. I hadn’t it made it to the roadside yet.

We stopped at a clinic to pay off a small debt. I seem to have developed a penchant for dancing with death and after only 3 months here have faced my second malaria attack. I had a 40° fever on and off for a week. When Doliprane no longer seemed to be having any effect, I finally made my way out to the clinic. For reasons long and short, good and bad, real and ridiculous, I found myself without the money to pay for any treatment, not even the fever reducing perfusion I was seeking (I’d already started quinine for the malaria.) The doctor offered to let me pay half and scolded me for being in such a situation in the first place. She was absolutely right. Being without insurance or cash for medical care in Africa can quickly turn deadly. I was extremely grateful and somewhat stunned by her offer.  So, as soon as I found the means, I was off to repay the debt. On our taxi ride home, we passed a naked man sitting in the middle of the road. Another moment of reflection. “At least I haven’t reached that point,” I said to myself, trying somehow to see the positive. I realized it didn’t say much about my current state if I was comparing myself to old beggar women and naked men in the road.

I have recognized that poverty is the real spirit breaker. It’s easy to be positive and see the sunshine everywhere when you can afford the comforts that everyone else has. Once things get tight, discouragement and negativity start to kick in. So many aid organizations talk about Africans living on less than a dollar a day and you wonder how they can possibly do it.  It’s meal by meal and lots of walking. It involves bartering with neighbors, making small exchanges and taking on debt. The juggling game that those living in poverty anywhere quickly learn how to play. The ultimate in Wimpy…. “I’ll gladly pay you Tuesday for a hamburger today.”

This recent bout of discouragement found me longing for comforts from another world. Things I hadn’t really thought of or missed in years. A diner. A breakfast diner to be exact. I’ve been dreaming of scrambled eggs and pancakes with orange juice and a cup of diner coffee- the endless cup.  I want to buy a loaf of bread that comes in a bag and has 50 slices at least (and then I realize it’s not fresh bread and I’m probably better off with these tiny loaves that need to be replaced almost daily.) I want to buy fruit out of season and most of all I want New York cheddar cheese- sharp. Extra sharp.

I want the comfort of knowing there is an emergency room, open and obligated to take me in any time of the day or night. And I want free schools. I’m not sure if this means I am ready to make a return trip. As much as this latest illness has worn me out, made me feel like quitting and going home, I still couldn’t figure out where that would be. And obviously, we’re not in any position to move anytime soon.

So, on with the adventure. The boys have been handling things amazingly. There are always lessons to be learned. Mohamed has finally developed some money management skills and begun to look at and compare prices. With Christian away, he’s taken over some of the household responsibilities and he chooses to take on a lot of the baby care duties as well. We’re developing our ability to have patience and be happy with less. And Nabih, our favorite food connoisseur, has taken to praising even the simplest of meals and continues to eat with gusto no matter often we have rice or rice or more rice. I guess we’re still hanging in. I’ve been thinking of October as month when things should start to improve and I keep reminding myself we’re in it for only a year. Then we can start that grand search again where the world’s the limit…. or maybe we’ll have already found ourselves well down another path by that time. For now, just trying to get to October. 

Another hospital story- for my nursing friends

There are two kinds of stories you can never tell enough of in Kinshasa. Because if you're not suffering some weird ailment, you're probably stuck in a traffic jam of one kind or another. My Western mind will never get used to seeing a car come barreling down the road with it's lights on and aiming right for me. In my lane. I'm ready; years of defensive driving courses have prepared me to respond to anything in the road but I'm never really expecting it. Something about a car in the wrong lane is always surprising.

Just as, while I am aware of the medical situation (or lack thereof) in Kinshasa, my Western mind remains stubbornly surprised at the way things work. A friend of mine recently made the trip across the river and back again to his hometown of Brazzaville. Apparently, the trip can be made at night, under cover of darkness, by way of pirogue. A canoe, basically. This version of the trip requires no documents but a $10 pay-off to the military on this side, again on the other side and maybe $10 to the canoe driver. One must also be prepared for battle. It's a rough trip.

He came back the roundabout way by Matadi to pick up a car and drive several hours to Kinshasa. That's where he ran into trouble. Thieves, bandits and military check points all along the way. Some guys mugged him (to use a New York term) and stole his watch and some clothes just after arriving at "port." Of course, he fought back a bit and somewhere in the scuffle managed to bang up his leg pretty good. He had a small cut there and paid little attention to it- more worried about the cold (after losing some of his clothes to the muggers) and getting the car back in one piece (the police confiscated the backseats in return for payment of some kind of "tax." We're still waiting to get the seats back. He has faith, I remain in doubt and have since suggested installing some wooden benches and making a taxi bus out of the whole thing.)

A few days later, the bruised up leg started turning red and swelling to unbelievable proportions. The pain was unbearable and the coloring terrifying. He went off to the hospital, only to be returned, only to search out another. I did some research online and came up with my own diagnosis. The hospital found a blood infection and began administering a variety of antibiotics. There wasn't much improvement.

After a few days, when talk of finding a traditional doctor began, I decided to speak to the doctor myself. I was quite relieved to hear her name the infection that I'd found on the web and have her answer most of my questions. I went home, did further research and found that healing often took time and the swelling might be a come and go thing. I was comforted by cold, hard facts but also slightly alarmed. Cellulitis has the potential to be dangerous- resulting in amputation or death. The doctor and I had spoken of signs to watch for that would signal a turn for the worse. I was mostly worried about amputation. Things always seem to happen too fast and too slow at the same time, resulting in grave situations that could likely have been avoided in a better equipped country.

But my friend, and his friend, and the patient in the next bed, and even one of the doctors all insisted that this was something you cure traditionally. I could do nothing but examine my own beliefs. I don't discount traditional medicine altogether. I do believe concentrated, bad energy can result in tragic consequences. I just wasn't sure someone had intentionally cursed him, although speculations about who it might have been began immediately.

When you arrive in Africa- well, the hot and humid countries- you can feel the heaviness in the air.  The first time I had an open cut I remember thinking 'Cover it up, things are living in the air.' You can practically feel them moving around. Personally, I think it was something in the dustiness of the port town, maybe coming off the river that got into his skin. And while the traditional wash may help the swelling and redness, I'm not convinced it can get into the blood and tackle the infection there.

So I was relieved when he was easily convinced to continue his rounds of antibiotics. At this intense stage, he requires several different kinds - one of which is an injection. Money issues- and personal comfort- required that he leave the hospital. Not to mention, the staff there weren't too pleased that he kept leaving and coming back. He wouldn't be able to continue the traditional course of medicine if he stayed in the hospital.

However, leaving means he needs someone to inject him. Not just a jab in the backside but into the vein. Yeah- that's not a skill I have. Last night we took the medicines and needles and went in search of a hospital with electricity (our first stop was too dark and he had a bit of fear that they wouldn't be able to see well enough by candlelight to inject him without too much rooting around and pain.) It wasn't too hard to find a clinic with lights and we went in, presented the items and he was given a shot. Very few questions asked. Which is when I really began to understand the differences in circumstance and even see some similarities.

I had found comfort in arming myself with facts, added to my basic knowledge of the workings of the human body. I even printed off some pages in French for my friend to read. While he doesn't have the background knowledge that Americans seem to gain through school and public service announcements ( and trips to the doctor where we ask endless questions and expect clear answers) he was able to get enough information to know what he needs and to self manage those needs. Out patient care. It could turn out to be quite efficient, allowing him to access medical care that he can afford. Apparently the traditional healer is not asking for payment (I'm sure they'll set up a barter system or some kind of gift giving) and the doctor charged a mere 1500FC for performing the injection. A system that has sprung up in the absence of a universal medical care program that ensures the sick will receive attention (money is always one of the first questions to come up before any kind of treatment is begun- no money, no treatment.) 

I'm still trying to merge the Western and traditional schools of thought, exploring how I really feel about each one and examining the different values, beliefs and skepticisms that spring up- part of  intercultural living I suppose - merging the best of both worlds. Maintaining one's own beliefs and understandings of the world while not discounting another perspective. I'm sure I'll have plenty of time to develop my thoughts when I next find myself stuck in one of those crazy traffic jams.