19 November 2017

Evidence-free


DRC

        South of the Equator, rains come in the morning. In terms of living in Africa, truly living, I've been in a very narrow band on either side of the Equator, but on the mirrored side from here (Mvangan), my favorite thing was the sound of rain on the tin eaves at night, going to sleep to that. Morning rains were rarer, but they at least delayed going to work -- and meetings would either happen on time, happen hours late, or not happen at all. I wasn't a doctor, then. The plan tonight was for a bonfire/ effigy burning in honor of Guy Fawkes day--though there's one English volunteer in this post, we've decided to celebrate everyone's holidays. The rain makes it a little more difficult today.

            Rains in the morning. Rainy season that was supposed to start a month ago, (also by the internal calendar I keep by heart from Cameroon -- from January, dry season, small dry season, small rainy season, rainy season). Precise dates over decades and centuries governing planting, harvesting, and when that changes (global climate change), you don't know when to plant, it might be too early or too late, and the crop might either exist less, the same, or be destroyed. Nearer to here, insecurity during the (north of the Tropic of Cancer) summer, meant that people fled their villages, are returning slowly, and will not be able to plant this year, or partially, or not at all, or because of the delayed rains it will be okay.

Zone sans Evidence

          Au sud de l'Equateur, la pluie vient le matin. En termes de vivre en Afrique, vraiment y habiter, j'ai été dans une bande étroite, des deux côtés de l'Equateur, mais au côté miroire d'ici (Mvangan), ma chose préférée, c'était le son de la pluie sur les toits en tôle la nuit, m'endormir à cette musique. Les pluies matinales étaient rares, mais au moins ils retardaient le travail -- et soit les réunions se feraient, soit ils seraient des heures plus tard, soit ils n'existeraient plus. Je n'étais pas médecin, à l'époque. Le plan ce soir* c'était pour un feu de camp/ brûlure d'effigie -- il n'y a qu'une anglaise à ce poste, mais on a décidé de célébrer les fêtes de tout le monde. La pluie nous complique les plans aujourd'hui.

*5 novembre

            La pluie le matin. La saison de pluie qui devait commencer il y a plus d'un mois (aussi, par le calendrier interne que je connais par cœur depuis Cameroun -- de janvier, saison sèche, petite saison sèche, petite saison de pluie, saison de pluie). Des dates précises pour des décennies, des siècles, qui gouvernent le temps de semer, le temps de cueillir, et quand cela change (changement climatique globale...), tu ne sais pas quand semer ou planter, ça pourrait être trop tôt ou trop tard, et la récolte pourrait être moins, la même, ou être détruite. Proche d'ici, la situation d'insecurité pendant l'été (au nord du tropique de cancer), veut dire que les gens ont fuit leur villages et ils retournent lentement (ou pas du tout), et ils ne pourraient pas planter ou semer cette année, ou partiellement, ou pas du tout, ou à cause de la pluie retardée ça ira quand-même.

30 October 2017

The more things change



All views represented here are mine alone and do not represent Médecins Sans Frontières.

Democratic Republic of Congo

Version française

 

"AFYA!"                     "KWA WOTE!"
"AFYA!"                     "KWA WOTE!"


I wanted to write about life this week. So I'll start with my favorite thing about health in Congo. Every health-related meeting I've been to, every support group, every time someone speaks they start and end with "AFYA!" (health) to which the group responds "KWA WOTE!" (for everyone). There's an incredible energy within it. It makes it easy to feel like an insider. And it adds to my very rudimentary Kiswahili (without it...there is no speaking with patients. Not much beyond "Bonjour." At all). This includes the group of PVV (Personnes Vivant avec le VIH, or People Living with AIDS) who actually search for patients who are "lost-to-follow-up" (have missed appointments for over two months). For patients who are newly diagnosed, they accompany them home. So many meanings in that word. We've been discussing plans for World AIDS Day (December 1st), and they're creating plays, songs, there will be dancing...apparently, "karaoke" just means a band with instruments. I have to admit I was very disappointed by the (to my ears) misnomer. (There's at least one Congolese song I could do, at this point...the lyrics are mainly "Sawa Sawa," which means "okay, okay").

There's life, here.

I don't need to mention the 3-month-old who died during my consultation (in obvious respiratory distress, complications from likely AIDS). Or how pediatric AIDS was the first thing I learned to diagnose in 2005, eight years before I was officially a doctor.

Le plus que ça change



Toutes les opinions représentées ci-dessous sont les miennes et ne représentent pas Médecins Sans Frontières.

République Démocratique du Congo

"AFYA!"                     "KWA WOTE!"
"AFYA!"                     "KWA WOTE!"

Cette semaine, je voulais écrire de la vie. Alors je commence avec ma chose préférée liée à la santé au Congo. Chaque réunion dans le cadre de la santé à laquelle j'ai assisté, chaque groupe de support, chaque fois que quelqu'un parle il commence et termine avec "AFYA!" (santé), et le groupe répond "KWA WOTE!" (pour tout le monde). Il y a une énergie incroyable dedans. C'est facile de se sentir membre du group, impliqué. Et cela ajoute à mon Kiswahili très rudimentaire (sans le Kiswhaili...c'est impossible à parler aux patients. Peu après "Bonjour" et "Comment ça va?"). Y inclus le groupe des PVV (Personnes Vivant avec le VIH) qui font la recherche sur le terrain des patients qui sont "perdus de vue" (ont manqué les rendez-vous pour plus de deux mois). Pour les patients qui sont nouvellement diagnostiqués avec le VIH, ils les accompagnent chez eux. Quel mot complexe. Nous sommes en train de discuter les plans pour la Journée Mondiale du SIDA (le 1er décembre) et ils créent des pièces de théâtre, écrivent des chansons, il y aura de la danse...apparemment, "karaoke" veut dire simplement un groupe de musiciens avec instruments. Je dois admettre que j'étais très décçue par la (à mes oreilles) fausse cognate. (Il y a au moins une chanson congolaise que je pourrais faire, déjà...la plupart des paroles sont "Sawa Sawa", ou, "Ça va, Ça va").

Il y a de la vie, ici.

Je n'ai pas besoin de mentionner le bébé de trois mois qui est décédée pendant ma consultation (en détresse respiratoire très apparente, des complication du SIDA probable). Ou comment le SIDA pédiatrique est la première chose que j'ai appris à diagnostiquer en 2005, huit ans avant que je ne devienne officiellement médecin.

22 October 2017

Not enough blood or water

Version francaise

Democratic Republic of Congo


There's one example I use whenever I talk about grief. How I came to understand grief in medicine. Grieving in Africa. Grieving when children die. And how people keep going.

It was 10 years ago. A Sunday, late morning. I was awake enough, outside on my porch, maybe reading, maybe walking down to the hospital to see friends. I saw Doc running. Yvonne running. Cecile running. Julie running. So I went. And in the salle de consultation was a disheveled mother, listless child on her lap, Cecile connecting an IV from her arm to the child's arm, there wasn't time for a real transfusion. I was there for minutes or hours, or seconds, standing back, watching them work, not knowing how valiant it was in the face of most likely futility. And the child died. And I forget at which point or who noticed it first. There weren't any chest compressions that I remember or anything else done for resuscitation. But we didn't have oxygen, I don't think, and I know we didn't have anything else.

I remember the mother throwing herself on the ground, screaming, outside la salle, where we'd have 100s lined up for vaccinations. Banshee-wailing. It went on. I don't remember where the child was at that time. It was the first time I had seen death happen, and I don't know at what point it happened, and in the events of attempted, urgent resuscitation, and I had wanted so badly to be in it.
I remember going back (500 ft) to my house, lying on my bed, staring up at the ceiling through the mosquito net canopy. I remember wandering into town that afternoon and finding bananas, which I hadn't seen in weeks, I remember talking to a friend after that (no power, but the landline in town was working that day! 1/100 occurrence) and when they asked me how my day was, I said, "Great! I found bananas!" And I meant it.

Severe anemia. From malaria. Died from not enough blood. It's a common story for malaria in kids.

Insuffisance de sang et d'eau

République Démocratique du Congo

Il y a un exemple que j'utilise quand je parle du chagrin. Comment j'ai commencé à le comprendre, dans la médecine. Vivre les décès, faire le deuil en Afrique. Vivre les décès des enfants. Et comment les gens continuent.
           
Il y a dix ans. C'était un dimanche, tard dans la matinée. J'étais assez réveillée, dehors sur ma véranda, peut-être lisant, peut-être allant à l'hôpital voire les amis. J'ai vu Doc en train de courir. Yvonne courrait. Cécile courrait. Julie courrait. Alors je suis allée. Et dans la salle de consulte, il y avait une femme désespérée, débraillée, avec un enfant léthargique sur ses genoux, Cécile en train de connecter une voie intraveineuse entre son bras et le bras de son enfant, il n'y avait pas le temps pour une vraie transfusion. Le sang coulait. J'étais là pendant des minutes ou des heures, ou quelques secondes, un peu à l'écart, les regardant travailler, pas comprenant à quel niveau c'était vaillant de leur part dans la face de, plus probablement, la futilité. 
Et l'enfant est décédée. Elle a donné l'âme, aux termes de l'expression. Pendant qu'on la regardait, pendant que mes collègues, mes chers amis, faisaient de leur mieux. J'oublie à quel point ou qui s'en est aperçu en premier. Dans mes souvenirs, il n'y a pas de compressions thoraciques, ou rien d'autre fait pour la réanimation. Mais je ne crois pas qu'on avait même de l'oxygène, et je sais qu'on avait rien d'autre qu'il aurait fallu.

Je me souviens de la mère qui s'est jetée sur l'herbe dehors de la salle, hurlant, où parfois on aurait une centaine des personnes attendant les vaccins. Je me souviens de ses gémissements, comme une banshie. Ça continuait. Je ne me souviens pas d'où était sa fille, décédée à l'âge de trois ans.  C'était la première fois que j'ai vu la mort, active, devant mes yeux, le passage, et je ne sais pas quand ça s'est passé. Et pendant les actes urgentes pour la réanimation, je voulais tant être parmi ceux qui agissait. (Voilà pourquoi j'ai quitté le Cameroun, pour devenir médecin).

Je me souviens de rentrer chez moi (500 pieds), de m'étendre sur mon lit, de fixer sur le plafond de ma chambre à travers la canopée de la moustiquaire. Je me souviens de me promener au centre ville, cet après-midi et de trouver des bananes, que je n'avais pas vu depuis plusieurs semaines, je me souviens de parler avec une amie après cette grande découverte (il n'y avait pas de courant, mais le téléphone fixe pour tout Mvangan fonctionnait ce jour-ci ! Evènement d'un jour sur cent), et quand elle m'a demandé comment j'avais passé la journée, je lui ai dit, "C'était fantastique J'ai trouvé des bananes !" Et j'étais sincère. Je n'avais oubliée la petite fille, morte à l'âge de trois ans. Je l'avais pleuré. Je la vois, je pense à elle, dix ans plus tard.

Morte à cause d'une anémie aigue. Du paludisme. Morte à cause de manque de sang. C'est une histoire très courante pour le paludisme chez les enfants. Ici.

06 March 2016

The Poet-Doctor Returns to Africa

Disclaimer: This was written Feb 29-March 2, but I'm posting it on March 6th, from Uganda. I am currently in Kisoro, I've been in the hospital since Thursday, and there will be more regarding that, soon. There will be/are real time delays, as with internet.

*****

le 29 fevrier ->2 mars 2016

It’s been almost three years. And this is the first plane ticket I have personally paid for. Then again, it’s the first time going that I have a job. Then again, it’s the first time I’m going as a doctor. My (nascent) career trajectory has spanned this. Next time, I’ll be on my own, maybe with Peace Corps, maybe MSF. A friend in med school commented once, it was hard to imagine there was a time when I hadn’t been to Africa. It’s true. Now 1/3 of my life since that first moment. In first grade, so enamored of geography before I’d seen anything other than the country of my birth, my most native tongue, France, snd the country that has claimed most of my years and words. I named Africa my second-favorite continent (Europe was first), and Ouagadougou was my favorite capital (Burkina Faso). My favorite movie was Cheetah—a Disney movie in the 80s, two kids and their Maasai friend trekking across the Serengeti in search of a cheetah (duma) they had rescued from the poacher that killed its mother, taking this one for greyhound racing. And in 2008, before going to Kenya, I downloaded “Jambo Bwana,” from the movie’s soundtrack. I named the kitten who came with my house in Migori (as did hundreds of of bats under the eaves) Duma. I went on safari, overland, in Maasai Mara (the Kenyan side of the Serengeti). I saw a cheetah.

I wrote about this almost three years ago. What it feels like to return to Africa. The light. The Equatorial light, existing in the back of my eyes like uncapturable jungle greens, makes me ache. The Constant Gardener has it right. Paris has a light. So does Equatorial Africa.

I wonder if, in this direction, I´ll see the Sahara in the same way. I wonder if, descending, I’ll feel the rush of warm air into the plane. I wonder if, in landing, the plane will erupt into applause. Flying to Cameroon is that way.

*****

I wept the first time I flew away from Africa. I kissed my fingertips and touched the tarmac in Douala (…and our Kenya Airways plane turned around soon after take-off, we landed in Douala, and, 26 hours later, I left again). When I returned to Africa (Kenya) six months later, I kissed my fingertips and pressed them to the earth. A year after that, I was back in Cameroon. You can go home again. I have. But in the between times—Africa makes me ache. Everyone, everything I know there, wondering who will be alive, the next time. Or have died of what. It’s funny to think of it as a continent, in so many ways (though the country I consider home is called “Africa in miniature.”) Or anything unified, really, when even within countries borders are arbitrary, so being from one nationality means many divergent cultures, traditions.

It’s been almost three years. I’ve traveled to the developing/Southern/non-Western (not true, for Central America), Global South three times on vacation in the past three years. But the first time I went to Africa, first time I went anywhere but the US or Europe, I moved in. Comfortable, stubborn, familiar in a plaster and stone house in the equatorial rainforest, with mostly walls, five rooms, and in the annual migratory path of the biting ants that can kill a child (a swarm of hundreds of thousands acting as one organism, in through a living room window, out through the kitchen at the other end).

       In Cameroon in April 2013, my last time anywhere in Africa, I was such an almost-doctor that all I had left of med school upon my return was graduation. This time, I’m such an almost (terrifyingly so) – attending that upon my return, I have 2.5 months left of residency. But now. Now I refuse to tell my patients I’m leaving. Not yet. There’s a minuscule “maybe” in there. But really I wonder if they’ll forgive me, if they’ll believe I didn’t say it, couldn’t say it yet, I nodded dumbly to “few months follow-up,” because, well, maybe. I wonder if they’ll believe I didn’t say it because it hurt too much. And now. Now I tell my patients I’m going to Uganda, they tell me to be careful, they tell me to come back.

     In the years before personal TVs in seat-backs and interactive maps, I used to think that flying over the North Atlantic—icebergs visible, sometimes—was the most exciting thing. I’d look for the maps of the flight path, posted somewhere near the galley, back bathrooms. Now I’m breathless, flying over the Sahara. It defines and divides the continent—North, or Sub-Saharan. The anticipation of crossing it, majestic, immense, impossible so, is of what lies south. The scattered clouds. Most of the time, I fly to Africa during the day. It’s not my second-favorite continent anymore.

******

      In Brussels. Two hours until I leave for Africa. One hour before boarding the plane to Kigali. I’m not wearing pagne, not this time (on the way to Cameroon, I generally wear Eto'o Fils), but there is some pagne packed in a bag of mostly medical supplies. That bag, as I am, is en route to its 9th African country. Walking around the gates of this terminal closed off by customs, I chance upon one scheduled for Yaounde. It is Wednesday—I think the one from Brussels is the MWF flight. My heart, to be both blandly general and exquisitely specific—aches. Maybe it’s a mistake to not be going. Not this time. East Africa isn’t home, it isn’t as loud and chaotic and colorful and full of spice (literal and figurative). Even considering my friends in Kenya, where I too, promised I would be back to Migori, and hoped to mean it. But there is a sense of belonging in Africa. Both appearing so starkly Other...mzungu (ntangen…white…foreign) and feeling like I belong. One of the most difficult parts of reentry and readjustment after Peace Corps. But, as I’ve learned, you can go home.

From what I’ve heard and seen in pictures, this hospital, this town (Kisoro, Uganda, and also a district hospital like Mvangan was) is much more developed than Mvangan—thus also busier. And there is no French or Bulu to fall onto, but constant translation. I’ve been called “dokita” (Bulu) and “docteur” and “doctor” many times before in Africa. For this first time, it’s true. I wrote my applications to medical school from Cameroon, about Cameroon, I worked (though mostly in public health) in the hospital there. I returned to the US briefly, then on to Kenya to start tentative steps in medicine, the summer before I started school. Then again to Cameroon in 2009, summer between 1st and 2nd years of medical school, both doing research and doing consultations (precepted!) in the hospital in Yaounde. And then 4th year of med school, back to Cameroon, both in the ER and medicine wards in Yaounde and doing surgeries out en brousse. And now. At every step of my career, I've been back. This only guarantees that I will work in Africa...and in Cameroon...again.

******

I’m on the plane now, watching the countdown of minutes, miles on the screen. I can see the Sahara, though it’s unfortunately cloudy. You can just make out the color underneath.

       The temperature is warmer than it was, maybe, but it’s really in landing that I’ll be able to tell. Or not. There isn’t the same portentous humidity on the East side, though, as I’m going very close to the Equator in Uganda, and I lived at 2 degrees north in Mvangan, there are certain similarities. But as I saw in Kenya, there were some trees that were the same, patches, looked like vestiges of what is still rainforest on the other side and in the middle of the continent. But the light will be right. It’s rainy season, and the rain on the tin roof at night will be right. The clouds are lifting. I can see more of the Sahara. And now it’s the Nile, I’m on the East side of the plane. Few oases along the banks; the map notes Khartoum, and I can just make out a larger cluster. It grows dark before we reach the southern edge of the desert, the Sahel, the transitions.

It’s a tradition I learned in African dance. The drums speak. Dance is about doing what the drums tell you, listening, and then not listening but becoming part of the music. Your body being inside the music. If the drummers keep going, you do. If they switch abruptly, you do. They direct everything. It’s one of the things I love best about it. The complete abandon that is necessary. And becoming rhythm, music, speech. At the end, the dancers go in front of each drummer, pressing both hands together as if in prayer, lowering your head to kiss your fingertips, and pressing them to the ground in front of each drum. Each drummer. They are above human, they are to be respected and revered. They create you. That’s where I learned. Malian dance class. 2002. It’s an amazingly, incredibly diverse continent, with >200 languages and ethnicities in Cameroon alone, with every landscape imaginable and history from prior to it. I recognize it, but still, there is something intangible and specific about returning to the diverse, heterogenous continent.

I hope we land on the tarmac, I hope there is an external stair, I hope we descend immediately into African air and African soil.
Regardless, I know what to do. I know what I will do. It’s been almost three years.
Reverence.

~j
Disclaimer: This was written Feb 29-March 2, but I'm posting it on March 6th, from Uganda. I am currently in Kisoro, I've been in the hospital since Thursday, and there will be more regarding that, soon. There will be/are real time delays, as with internet.

*****

le 29 fevrier ->2 mars 2016

It’s been almost three years. And this is the first plane ticket I have personally paid for. Then again, it’s the first time going that I have a job. Then again, it’s the first time I’m going as a doctor. My (nascent) career trajectory has spanned this. Next time, I’ll be on my own, maybe with Peace Corps, maybe MSF. A friend in med school commented once, it was hard to imagine there was a time when I hadn’t been to Africa. It’s true. Now 1/3 of my life since that first moment. In first grade, so enamored of geography before I’d seen anything other than the country of my birth, my most native tongue, France, snd the country that has claimed most of my years and words. I named Africa my second-favorite continent (Europe was first), and Ouagadougou was my favorite capital (Burkina Faso). My favorite movie was Cheetah—a Disney movie in the 80s, two kids and their Maasai friend trekking across the Serengeti in search of a cheetah (duma) they had rescued from the poacher that killed its mother, taking this one for greyhound racing. And in 2008, before going to Kenya, I downloaded “Jambo Bwana,” from the movie’s soundtrack. I named the kitten who came with my house in Migori (as did hundreds of of bats under the eaves) Duma. I went on safari, overland, in Maasai Mara (the Kenyan side of the Serengeti). I saw a cheetah.

I wrote about this almost three years ago. What it feels like to return to Africa. The light. The Equatorial light, existing in the back of my eyes like uncapturable jungle greens, makes me ache. The Constant Gardener has it right. Paris has a light. So does Equatorial Africa.

I wonder if, in this direction, I´ll see the Sahara in the same way. I wonder if, descending, I’ll feel the rush of warm air into the plane. I wonder if, in landing, the plane will erupt into applause. Flying to Cameroon is that way.

*****

I wept the first time I flew away from Africa. I kissed my fingertips and touched the tarmac in Douala (…and our Kenya Airways plane turned around soon after take-off, we landed in Douala, and, 26 hours later, I left again). When I returned to Africa (Kenya) six months later, I kissed my fingertips and pressed them to the earth. A year after that, I was back in Cameroon. You can go home again. I have. But in the between times—Africa makes me ache. Everyone, everything I know there, wondering who will be alive, the next time. Or have died of what. It’s funny to think of it as a continent, in so many ways (though the country I consider home is called “Africa in miniature.”) Or anything unified, really, when even within countries borders are arbitrary, so being from one nationality means many divergent cultures, traditions.

It’s been almost three years. I’ve traveled to the developing/Southern/non-Western (not true, for Central America), Global South three times on vacation in the past three years. But the first time I went to Africa, first time I went anywhere but the US or Europe, I moved in. Comfortable, stubborn, familiar in a plaster and stone house in the equatorial rainforest, with mostly walls, five rooms, and in the annual migratory path of the biting ants that can kill a child (a swarm of hundreds of thousands acting as one organism, in through a living room window, out through the kitchen at the other end).

       In Cameroon in April 2013, my last time anywhere in Africa, I was such an almost-doctor that all I had left of med school upon my return was graduation. This time, I’m such an almost (terrifyingly so) – attending that upon my return, I have 2.5 months left of residency. But now. Now I refuse to tell my patients I’m leaving. Not yet. There’s a minuscule “maybe” in there. But really I wonder if they’ll forgive me, if they’ll believe I didn’t say it, couldn’t say it yet, I nodded dumbly to “few months follow-up,” because, well, maybe. I wonder if they’ll believe I didn’t say it because it hurt too much. And now. Now I tell my patients I’m going to Uganda, they tell me to be careful, they tell me to come back.

     In the years before personal TVs in seat-backs and interactive maps, I used to think that flying over the North Atlantic—icebergs visible, sometimes—was the most exciting thing. I’d look for the maps of the flight path, posted somewhere near the galley, back bathrooms. Now I’m breathless, flying over the Sahara. It defines and divides the continent—North, or Sub-Saharan. The anticipation of crossing it, majestic, immense, impossible so, is of what lies south. The scattered clouds. Most of the time, I fly to Africa during the day. It’s not my second-favorite continent anymore.

******

      In Brussels. Two hours until I leave for Africa. One hour before boarding the plane to Kigali. I’m not wearing pagne, not this time (on the way to Cameroon, I generally wear Eto'o Fils), but there is some pagne packed in a bag of mostly medical supplies. That bag, as I am, is en route to its 9th African country. Walking around the gates of this terminal closed off by customs, I chance upon one scheduled for Yaounde. It is Wednesday—I think the one from Brussels is the MWF flight. My heart, to be both blandly general and exquisitely specific—aches. Maybe it’s a mistake to not be going. Not this time. East Africa isn’t home, it isn’t as loud and chaotic and colorful and full of spice (literal and figurative). Even considering my friends in Kenya, where I too, promised I would be back to Migori, and hoped to mean it. But there is a sense of belonging in Africa. Both appearing so starkly Other...mzungu (ntangen…white…foreign) and feeling like I belong. One of the most difficult parts of reentry and readjustment after Peace Corps. But, as I’ve learned, you can go home.

From what I’ve heard and seen in pictures, this hospital, this town (Kisoro, Uganda, and also a district hospital like Mvangan was) is much more developed than Mvangan—thus also busier. And there is no French or Bulu to fall onto, but constant translation. I’ve been called “dokita” (Bulu) and “docteur” and “doctor” many times before in Africa. For this first time, it’s true. I wrote my applications to medical school from Cameroon, about Cameroon, I worked (though mostly in public health) in the hospital there. I returned to the US briefly, then on to Kenya to start tentative steps in medicine, the summer before I started school. Then again to Cameroon in 2009, summer between 1st and 2nd years of medical school, both doing research and doing consultations (precepted!) in the hospital in Yaounde. And then 4th year of med school, back to Cameroon, both in the ER and medicine wards in Yaounde and doing surgeries out en brousse. And now. At every step of my career, I've been back. This only guarantees that I will work in Africa...and in Cameroon...again.

******

I’m on the plane now, watching the countdown of minutes, miles on the screen. I can see the Sahara, though it’s unfortunately cloudy. You can just make out the color underneath.

       The temperature is warmer than it was, maybe, but it’s really in landing that I’ll be able to tell. Or not. There isn’t the same portentous humidity on the East side, though, as I’m going very close to the Equator in Uganda, and I lived at 2 degrees north in Mvangan, there are certain similarities. But as I saw in Kenya, there were some trees that were the same, patches, looked like vestiges of what is still rainforest on the other side and in the middle of the continent. But the light will be right. It’s rainy season, and the rain on the tin roof at night will be right. The clouds are lifting. I can see more of the Sahara. And now it’s the Nile, I’m on the East side of the plane. Few oases along the banks; the map notes Khartoum, and I can just make out a larger cluster. It grows dark before we reach the southern edge of the desert, the Sahel, the transitions.

It’s a tradition I learned in African dance. The drums speak. Dance is about doing what the drums tell you, listening, and then not listening but becoming part of the music. Your body being inside the music. If the drummers keep going, you do. If they switch abruptly, you do. They direct everything. It’s one of the things I love best about it. The complete abandon that is necessary. And becoming rhythm, music, speech. At the end, the dancers go in front of each drummer, pressing both hands together as if in prayer, lowering your head to kiss your fingertips, and pressing them to the ground in front of each drum. Each drummer. They are above human, they are to be respected and revered. They create you. That’s where I learned. Malian dance class. 2002. It’s an amazingly, incredibly diverse continent, with >200 languages and ethnicities in Cameroon alone, with every landscape imaginable and history from prior to it. I recognize it, but still, there is something intangible and specific about returning to the diverse, heterogenous continent.

I hope we land on the tarmac, I hope there is an external stair, I hope we descend immediately into African air and African soil.
Regardless, I know what to do. I know what I will do. It’s been almost three years.
Reverence.

~j

14 November 2015

# Porte Ouverte


le 14 novembre 2015
  

It was ten months ago that I wrote about freedom of speech, of words, of the privilege of pens, and of those were killed, in some ways, for that. #Je Suis Charlie. Today, yesterday, it’s freedom of assembly. A concert (could “death metal” become more ironic?). A soccer game. Restaurants. Freedom of movement, of passage. The borders are close to closed. Famously, in the 1830s (as also depicted in Les Misérables), Paris was barricaded, fighting from the inside. Seventy years ago, there was the Maginot line, there was “Free France” and my grandparents fighting in the Resistance, there was my old favorite movie, La Grande Vadrouille, with the propeller plane landing just over an invisible frontier and then escaping back to England.

I still don’t know how much we should take for granted. There is a UN declaration. But not even every country is counted in that.

I commented to a friend that this—ISIS, all of it—is like a terrible, blockbuster movie for July 4 weekend. Except I don’t know who the hero is. There isn’t one. In another friend’s village in Cameroon, he discovered that people believed that in action movies, those who die, die. Ebola was that. I have trouble truly conceiving of so much destruction I have not experienced except in fiction. I know personal tragic and tragedies. I’ve seen babies, so many babies (and so many adults) die of AIDS. And TB. And malaria. And diarrhea. And malnutrition. And tetanus (the most banal-sounding shot I give my patients to check off the 10-year mark) : a five-day old with lockjaw who died because he couldn’t feed. And there was nothing else to do. I’ve seen that. I’ve been in shantytowns. I was in Kenya six months after buildings and people were burned in the 2007 elections. I saw the burn marks. But I’ve never been in it.



10 January 2015

All the dangerous things we do with our hands

le 10 janvier 2015


Wielding pens. Waving swords. Stopping traffic.
                                                                                                                                  
I’ve believed that for a long time, not just in the old adage that “the pen is mightier than the sword.” As a writer and a doctor, one of my greatest hopes and exultations in earning my MD was the power and respect the degree bestows, for better or for worse, deserved or not, to be a spoken/outspoken advocate, and to be published for it.
I use writer in the sense of “someone for whom the act of writing is not an option; someone for whom writing is as necessary to existence as is oxygen.” I use doctor in the sense of not just the traditional physician and caretaker for a body and a person, but in the Latin derivation of “doceo, docere – to teach.”

Almost every sentence and every paragraph here starts with I. There is, too, now, “Je suis Charlie/ I am Charlie,” for what it’s worth, for belief in and disbelief against the recent attacks in Paris of freedom of speech.

I have recently felt ill, paralyzed, galvanized by moment and by turn by the deaths of Ebola, inequalities in Africa and health systems in Africa, prejudice, hatred, and fear of those of African descent living in the United States, focus on a few individuals sick in a country where they can be taken care of versus thousands upon thousands in countries whose fragile infrastructures are being destroyed; by injustices perpetrated by institutional racism across the country and most poignantly, most close to home in New York, a system in which I, physicians in general, anyone in a hierarchical position of power is complicit, where I weakly, as a primary care physician, offer flu shots and preventative measures to my patients who, in the South Bronx, are more likely to go to prison than to college, who could be stopped and frisked on the basis of nothing, who fear and are injustly feared on a daily basis.

Toutes les choses dangereuses qu'on fait avec nos mains

le 10 janvier 2015

Manier le stylo. Brandir l’épée. Arrêter les voitures.

J’y ai cru pour longtemps, pas seulement dans le vieil adage que « le stylo est plus puissant que l’épée. » Ecrivain et médecin,  un de mes plus grands espoirs et joies dans l’acquisition de mon doctorat était la foie dans le pouvoir et le respect qui vient avec, pour le meilleur ou pour le pire, méritée ou pas, d’être défenseur a haute voix, et d’avoir mes écrits publiés.

J’utilise « écrivain » dans le sens de « quelqu’un pour qui l’acte d’écrire n’est pan une option ; quelqu’un pour qui l’écriture est aussi nécessaire a la vie que l’oxygène. » J’utilise « médecin » non seulement dans le sens du médecin traditionnel, celui qui s’occupe du corps et de l’humain, mais dans le signifiant originel en Latin, « doceo, docere » - enseigner. »

Pratiquement chaque phrase et chaque paragraphe ici commence avec « je. » Il y’a aussi, maintenant, « Je suis Charlie, » dans tout ce que cela représente, pour la croyance et l’incrédulité envers les attentats récents a Paris contre la liberté de l’expression.

Récemment, je me suis sentie malade, paralysée, pousse a agir par moment et par tour autour des morts d’Ebola, les inégalités en Afrique et dans les systèmes de sante en Afrique, la préjudice, la haine, et la peur de ceux d’origine Africaine vivant aux Etats-Unis, la focalisation sur quelques malades dans un pays où on peut s’occuper d’eux, contre mille et des milliers dans des pays où les infrastructures neuves et fragiles sont en train d’être détruites ; par les injustices perpétrées par le racisme institutionnel à travers le pays et, plus poignant pour moi, à New York, dans un système dans lequel je, et les médecins en général, tout le monde qui fait partie de l’hiérarchie est impliqué, où je impuissante, comme médecin généraliste/des soins primaires, offre des vaccins contre la grippe et d’autres mesures préventifs à mes patients qui, dans le sud du Bronx, ont plus de chance d’aller en prison que d’aller à l’université, qui pourraient être arrêtés dans la rue sur la base de rien, qui ont peur et qui font peur, injustement, chaque jour.




14 December 2014

The Whiter Coat

14 December 2014

The Whiter Coat

            I hadn’t worn it in a year.  Halfway through internal medicine residency, I’ve lost two of my allotted four. But yesterday, for the Millions March in NYC, I donned my white coat under the banner of “White Coats for Black Lives,” over jeans, under scarf and knit hat. Doctors worldwide wear stethoscopes—a necessary tool, used for heart-lungs-belly-neck. A patient feels taken care of if you’ve listened to her heart and lungs. We have the laying on of hands and the laying on of stethoscope diaphragm and bell. Doctors worldwide wear white coats, a tool of nothing but repository for tools, a signifier of identification, power, an instrument of implementing hierarchy, and whatever else (including the positive) that is associated with the profession. With power comes implied responsibility, a mandate to earn the given trust.
            Before even my first day of medical school, we received our white coats in a ceremony, parents came and took pictures, and we solemnly recited the Hippocratic oath, months before touching our first patients. A symbol of induction into the lifelong guild. For students, the white coat is short, still symbolizing power to patients perhaps oblivious to the length, but clearly showing the lowest rank to other doctors. It takes so many years to arrive at medical school. We had made it. Quickly, I learned to hate the coat, resent it, except for its many practical pockets, and I relished the rotations—pediatrics and psychiatry—that didn’t require and even discouraged its use. In my social medicine program, there is something vaguely uncool about the white coat, the long white coat we worked so hard to achieve. I wore it for the protest, yesterday, faint ink marks still visible after hospital dry cleaning, in a contingent of many others---to show we know We are an institution, We are implicit and complicit, and We, in positions of power, are here in solidarity because, among other things, racism is bad for health.
            But to reject the whiteness of the coat requires whiteness, no need for cloth that soon shows sweat stains to confer that final privilege.

17 February 2014

Let there be equatorial light


le 27 mars 2013

I used to think of writing (or doing anything inside) by headlamp as spelunking. It was certainly more practical than my first year PCV strategy of candles and kerosene lamp propped on various books and papers—before I had a table—and sitting hunched over to the in the right part of the penumbra.

It’s a funny thing about light.

The Constant Gardener came out weeks before I left for Peace Corps in Cameroon. Without mention anything else I love about the movie (which was great for terrifying many parents of about-to-be PCVs about to move to Africa), the light struck me. The quality of it. I’d noticed years before that Paris has its own quality of light. Some photos, movies capture it (Amélie does). I don’t think you can successfully pretend that something is filmed in Paris.
This light, though, the Kenya-in-the-movie light, was unlike anything I’d ever seen.
And then I moved to Cameroon.

It’s the same light. Gazing across the city at very familiar views this morning (Yaoundé, like Rome or San Francisco, is a city of hills), I remembered it. I have photos of the same view, and in the US they look—faded. Light-stained. But that’s how things actually look.
The forest almost never comes out, either. I think it’s more greens than the human eye can discern (we can see sixteen shades of gray, I recently learned, on CT scans).

19 December 2013

On Love and Medicine

Part old, part new. The first part was originally posted November 15, 2010, about halfway through my third year of medical school (edited for length). It takes place during my anesthesia and integrated medicine/neuro/psych rotations. Rereading, though I have changed many descriptors and diseases, I can picture the patients again. Still. What remains is what matters. Then, I had many fewer patients and many fewer responsibilities; in some ways, it was easier to really care. There was more space and time.

And the second part was written tonight.

********
November 15, 2010
Fresno and San Francisco, California
MSIII

I think a lot about “for better or for worse” these days. In medicine, you see a lot of “worse” and “worse”, and I see a lot of partners who are there for both. For anything. Siblings, children, grandchildren, nieces, nephews, friends. I guess these would be the ‘chicken soup’ or whatever stories (are they even still publishing those?) But it’s true – rushing around, where so many things are difficult and sad – it’s something to stop and think about. Or try to remember to stop and think about. With the sickest patients, it’s their loved ones that I know. The ICU patients, the altered mental status patients, dementia, kids…whatever. I’ve spoken with a lot of family members. In anesthesia, wheeling people into surgery, you leave Loved Ones at the corner. (They call it the ‘kissing corner.’ Really). And you see them into the waiting room, point it out, say go get coffee or whatever, we’ll be ____ hours, and don’t worry, we’ll take really good care of X. Your X. I’ve seen the wide eyes when we push through the doors again, X is barely waking up from surgery, likely has an oxygen mask over her face, and we’re rushing into the PACU. It doesn’t mean anything’s wrong. It’s normal, and it means the surgery’s over, and if people don’t look like they’re freaking out (The doctors), everything is probably fine. It’s a vulnerable position to see someone in. And in the OR, they’re alone.

There’s the couple who came in with the wife’s entire medical history typed out – each had their own version – with a list of questions. She suddenly went blind, no one has any idea why, no one has any idea if it’s part of something more progressive – probably. So they’re searching. And with each doctor, they get more frustrated at not having answers. But the other point, to me, is that it’s always both, it’s really about their health, and the patient is – almost – both. Making sure you do speak to both.

09 September 2013

Communion

Yaoundé, Cameroun
Centre Hospitalière Universitaire (CHU)
April 2013

Last day at CHU
                              

I flipped open my patient’s blue cardboard folder. Groupe sanguin. Blood type. ---

***


The day before, I'd gone to the blood bank at CHU.


It was the first time I'd ever donated – my more than 6 months straight in Western Europe since 1980 disqualify me by Red Cross standards (mad cow disease/CJD). And even if that ever changes, after living in Africa, there's no way I'll ever be able to donate blood in the States.

The irony. I can donate in Cameroun. I explained to the phlebotomist that I can't donate blood in the US, trying hard to make my explanation make sense, without the questionable undertones of the Red Cross rules rejecting African or "African-ized" blood. It was my last day at CHU. In a month, I had watched people die, and I had maybe, minutely, helped. I had spent a night on call learning about how overstaffed the hospital really is, when compared to the resources they have for patients. Compared on that alone. The nursing censuses are lower. The doctor censuses, even, are lower. There were so many eager med students (their education, not mine), working zealously on med student-thorough, handwritten H&Ps in French or in English, that they sent me to the resident call room for an hour or two of sleep. The GI fellow was in there, and she woke up enough to kick off her shoes, move over, and give me part of the twin bed. I felt hesitant and unnerved; they were treating me like a doctor (and four months later, firmly enmeshed in my intern year, I finally don’t jump to attention at the appellation “med student”).

The transition from dark to dawn is the same in every hospital. There are the early evenings hours. There are the middle ones that stretch forever—nothing good happens, then. Either people are asleep. Or they are very sick. It's the slight undertone to complacency on a quiet night. In the US, we have pagers; if you lie down, you will be awoken. In Cameroon, there are cell phones, of course, but there is almost no reception in the hospital. And no one knows who is there.

25 August 2013

Peripheral

NYC


I look idly at the hand grasping the laundry basket. “That’s a beautiful vein,” I think. “Someone would be lucky to get to slip an IV into that.” And like everything that gets accidentally carried back from the hospital—venipuncture kits, 4cm x 4cm gauze (think: measures I am learning), alcohol swabs, tape, fecal occult blood cards and guiac solution, gloves—I have the materials to do it. But I’m not the one I would need practice on. It’s the patients with scarred veins  (drugs, fistulas, too many hospital visits) or overloaded with fluid—the “vasculopaths”— that take skill. A patient with good veins is a good patient. Ones that don’t roll or slip away from you. Ones that leap to attention under tourniquets and alcohol.

We are vampires not only at night.

It’s using your hands (not trusting your head), taking ownership of each step of the process, delegating tasks (most) that don’t take a medical degree to yourself.
I’ve caught myself thinking “I wish I had a med student for this.” To get patients’ weights while standing (find the heavy scale, wheel and weave it through the hallway, support the hesitant frame). To get orthostatic vital signs (vital. Life. Here, to check the difference in how fast and how hard the heart beats, how much the veins and arteries contract and relax, when equilibrating between lying down and standing up). It takes minutes. Five. Or more. I picture third year of med school, two hours per patients, an afternoon to sit and talk…

Or carry blood.

30 June 2013

And now introducing

I'm starting residency. Tomorrow is the first day I will introduce myself as "Doctor" to patients.

I'm in the Primary Care/ Social Internal Medicine program at Montefiore Medical Center, in the Bronx. More on that later. In essense, public health + internal medicine + primary care.

Two years ago, I was taking a leave of absence from medical school to pursue an MFA in poetry at Brooklyn College. I had started my fourth year prior to leaving, and had thus spent close to three months in the "sub" intern role, with a greater degree of autonomy and individual work with patients than during my third year.

Prior to leaving, I wrote a blog post called "The Luckiest," referring to (at the time) medical students, poised on the path of an incredible career. (Reposted below)

This is something to recall, and something that, even on the bad days, is still true.

Today, tomorrow is the first day, but it's also the nth day of a path I've been on for a long time. Steep learning curve, steps you learn how to barely jump or grasp with determined fingertips. I'm still convinced--and I hope to remain convinced, most of the time--that, for me, this is one of the best things, and it is absolutely the right thing. Right now.


The Luckiest

I wrote this in the middle of my fourth year of medical school, before taking a year off to go to New York for an MFA in poetry.

August 2011


It’s said in many ways.
Absence makes the heart grow fonder.
Nostalgia in looking back.
Selective memory.
And, per Ben Folds, “The Luckiest.”

This usually refers to, I think, people/place/thing. Certainly people. Certainly place. Time period. Self at a different stage of life.

It’s not usually used in reference to career.

It’s now been three days since I was an active medical student.
And I miss it. A significant lot.

I can’t wait to be a doctor.


Before I started med school, I couldn’t believe how lucky I was to get to go to medical school. I’ve had a lot of privilege in my life. This is one of the greatest, most amazing, most incredulous ones.
What I’ve done, what I’m doing, what I will be doing.
I was let into this hallowed profession – in some places, hallowed, darkened halls – in which I get to learn all about the body. Get to. And I get to interact with people in the most intimate way, at their most vulnerable – they trust me, let me in. I have to earn that trust.
Starting, and before starting, I didn’t understand that sacred trust. It’s something I continue to learn, every day. And I am amazed.