Every Tuesday, I do home visits for children who have recently been discharged from the hospital for acute malnutrition. We want to make sure they're still doing OK. This is a typical home I see.
Monday, May 29, 2006
Monday, May 22, 2006
Rwanda Health Journal May 22, 2006
As another entry onto this blog, I would like to first discuss what Rwanda is not so far. It is not a war torn country where you feel your safety is constantly at jeopardy. It is not a military state where innumerable armed guards walk the streets with large guns and intimidating stares. It is not a place where when you arrive, all you feel is despair.
To the contrary, I have been here almost three weeks and so far, the articles and movies I saw about Rwanda did not do justice to the beauty of this country. Prior to coming here I read about genocide and war. Battles between factions that are difficult to fathom. Names of different groups that depending on who wrote the article, seemed either quite specific about who was who, or quite arbitrary. When I told people I was coming here, although I heard it was safe here now, there were many people in the U.S. who looked at me as if I was crazy to really believe that. That I better have my escape bag ready. But then people I knew working here said that the government is stable, that they are working about as transparently as a government can work, and that the organization I am working with in particular, Partners In Health, was impressed by the sincere dedication, commitment, and progressive education of the ministry of health. Meanwhile, most of the people I knew in the U.S. who knew much less about the specific accomplishments of Rwanda today expected danger for me.
Although there is a poverty here that is still shocking to me and that most U.S. citizens will probably never live or witness, no one I knew prior to coming here ever discussed the recent advances and successes of this country like a goal to provide healthcare for all via mutuelles, and to improve education for the whole country; no one discussed the graceful gentle mist that nuzzles into the bushes and mountains most mornings (makes you understand why the movie about Jane Goodall, who did her research in this country, was called Gorillas in the Mist); only one person who had spent much time here spoke of the near perfect climate of about 70-80F everyday, and perhaps most importantly, no one told me about the positive energy and dedication of many inspiring and motivated Rwandans working within the government and for many other organizations and firms to make Rwanda a better country.
And I hesitate to even write this next sentence because it feels not politically correct to even mention such a thing here at this point in Rwandan success, no one I have met at all has ever mentioned the words Hutu or Tutsi ever and when I asked one PIH staff member, she told me that it is taboo to really even use the words in conversation. You really do see many determined, dedicated, involved people at all levels, ministers of health to women’s associations in villages to farmers working together to move forward as a unified whole (Indeed, the only place I saw a definition drawn about the 2 aforementioned groups was at the Genocide memorial this past weekend discussing the historical context of that delineation, and how it was made awfully segregationist by the Belgiums who came here at the turn of the century and decided that if you owned greater than 10 cows you were of one category and if you owned less than 10 cows you were of another category. And as colonials were known to do, the Belgiums created further embarrassing and shameful distinctions, incentives for those they liked and favored, and divisions from there).
But most importantly and very palpable in the air now, at least at Rwinkwavu Hospital, is a unity and a hope I did not expect.
And although the peace here is apparent, more than what many U.S. people might think, the poverty is also great. I did not expect almost all the children I work with in extremely tattered clothes and no shoes. I walk the streets of this rural area and the children yell from far away in the distance, “Mazungo! Mazungo!” which is about the Rwandan equivalent of “Gringo” but said with so much excitement by the kids (although depending on what prefixes you tack on to the word it has the potential to be very insulting). Then children yell “Aga chupa, aga chupa!” which means “Plastic bottle! Plastic bottle!” – because us Mazungos have become associated with plastic bottles and these are very valuable to them. And children also run up to me regularly and ask my name and when I tell them, they most often repeat it as “Roose! Roose!” or “Roosy!” since l’s sound like r’s here. If I try and give them a high five, they put their hand up and we high five, and then more children run up to give a high five too and pretty soon, I am high five-ing a dozen children. Sometimes I put my fist out like a Wonder-Twin cartoon character, and they too will Wonder-Twin power back. And playing with them, even though I do not speak Kinyrwanda, is great fun. I brought my Frisbee and it has been a great success too.
In addition to so many extremely poor children without enough food, clothing or adequate shelter, I did not expect so many children to not be enrolled in school, roaming the roads and fields during the day, using a piece of what some would call garbage to play a game. Even though there are public schools, you still have to be able to afford uniforms, pencils and notebooks, and in the community I live, in Rwinkwavu, the poorest of the poor do not have these things. They have nothing in a way no U.S. citizen lives. The government in Rwanda here, although doing well and advancing as much as possible, is not yet able to pay for consistent electricity or paved roads let alone provide for the social welfare of the poor.
And yet, there is no question that President Kagame aims to improve the status of those living in poverty from many different angles, but income is needed to help others, and this country doesn’t have a huge amount yet. But all this said, as I write, I am sitting on the front patio of where I live at about 6:30AM, looking out onto a gravel driveway with grass and flowering bushes surrounding the driveway. Mist settled around the fence. Beyond this are many banana trees, individually cultivated fields and temperate jungle. All of this stretching in square patches up and down rolling hills like you would see in a Cezanne landscape. I have eaten many tropical fruits which don’t exist in the U.S. from as sweet as a jolly rancher to something like a sour cantaloupe. And so far, if you can afford to grow vegetables, rice, corn and beans, buy sugar and oil, and a family has both a husband and a wife to cultivate their small plots of land, a cement house versus a mud one, a decent latrine, not too many children, and little to no illness, with some means to earn a little bit of money in the markets or some form of employment, then these things combined would allow you to not be poverty stricken anymore. And although there are a seemingly infinite amount of people and patients here who do not have such fortune, for those people who do have this or more, everything is, at least this rich rainy season, flourishing.
As another entry onto this blog, I would like to first discuss what Rwanda is not so far. It is not a war torn country where you feel your safety is constantly at jeopardy. It is not a military state where innumerable armed guards walk the streets with large guns and intimidating stares. It is not a place where when you arrive, all you feel is despair.
To the contrary, I have been here almost three weeks and so far, the articles and movies I saw about Rwanda did not do justice to the beauty of this country. Prior to coming here I read about genocide and war. Battles between factions that are difficult to fathom. Names of different groups that depending on who wrote the article, seemed either quite specific about who was who, or quite arbitrary. When I told people I was coming here, although I heard it was safe here now, there were many people in the U.S. who looked at me as if I was crazy to really believe that. That I better have my escape bag ready. But then people I knew working here said that the government is stable, that they are working about as transparently as a government can work, and that the organization I am working with in particular, Partners In Health, was impressed by the sincere dedication, commitment, and progressive education of the ministry of health. Meanwhile, most of the people I knew in the U.S. who knew much less about the specific accomplishments of Rwanda today expected danger for me.
Although there is a poverty here that is still shocking to me and that most U.S. citizens will probably never live or witness, no one I knew prior to coming here ever discussed the recent advances and successes of this country like a goal to provide healthcare for all via mutuelles, and to improve education for the whole country; no one discussed the graceful gentle mist that nuzzles into the bushes and mountains most mornings (makes you understand why the movie about Jane Goodall, who did her research in this country, was called Gorillas in the Mist); only one person who had spent much time here spoke of the near perfect climate of about 70-80F everyday, and perhaps most importantly, no one told me about the positive energy and dedication of many inspiring and motivated Rwandans working within the government and for many other organizations and firms to make Rwanda a better country.
And I hesitate to even write this next sentence because it feels not politically correct to even mention such a thing here at this point in Rwandan success, no one I have met at all has ever mentioned the words Hutu or Tutsi ever and when I asked one PIH staff member, she told me that it is taboo to really even use the words in conversation. You really do see many determined, dedicated, involved people at all levels, ministers of health to women’s associations in villages to farmers working together to move forward as a unified whole (Indeed, the only place I saw a definition drawn about the 2 aforementioned groups was at the Genocide memorial this past weekend discussing the historical context of that delineation, and how it was made awfully segregationist by the Belgiums who came here at the turn of the century and decided that if you owned greater than 10 cows you were of one category and if you owned less than 10 cows you were of another category. And as colonials were known to do, the Belgiums created further embarrassing and shameful distinctions, incentives for those they liked and favored, and divisions from there).
But most importantly and very palpable in the air now, at least at Rwinkwavu Hospital, is a unity and a hope I did not expect.
And although the peace here is apparent, more than what many U.S. people might think, the poverty is also great. I did not expect almost all the children I work with in extremely tattered clothes and no shoes. I walk the streets of this rural area and the children yell from far away in the distance, “Mazungo! Mazungo!” which is about the Rwandan equivalent of “Gringo” but said with so much excitement by the kids (although depending on what prefixes you tack on to the word it has the potential to be very insulting). Then children yell “Aga chupa, aga chupa!” which means “Plastic bottle! Plastic bottle!” – because us Mazungos have become associated with plastic bottles and these are very valuable to them. And children also run up to me regularly and ask my name and when I tell them, they most often repeat it as “Roose! Roose!” or “Roosy!” since l’s sound like r’s here. If I try and give them a high five, they put their hand up and we high five, and then more children run up to give a high five too and pretty soon, I am high five-ing a dozen children. Sometimes I put my fist out like a Wonder-Twin cartoon character, and they too will Wonder-Twin power back. And playing with them, even though I do not speak Kinyrwanda, is great fun. I brought my Frisbee and it has been a great success too.
In addition to so many extremely poor children without enough food, clothing or adequate shelter, I did not expect so many children to not be enrolled in school, roaming the roads and fields during the day, using a piece of what some would call garbage to play a game. Even though there are public schools, you still have to be able to afford uniforms, pencils and notebooks, and in the community I live, in Rwinkwavu, the poorest of the poor do not have these things. They have nothing in a way no U.S. citizen lives. The government in Rwanda here, although doing well and advancing as much as possible, is not yet able to pay for consistent electricity or paved roads let alone provide for the social welfare of the poor.
And yet, there is no question that President Kagame aims to improve the status of those living in poverty from many different angles, but income is needed to help others, and this country doesn’t have a huge amount yet. But all this said, as I write, I am sitting on the front patio of where I live at about 6:30AM, looking out onto a gravel driveway with grass and flowering bushes surrounding the driveway. Mist settled around the fence. Beyond this are many banana trees, individually cultivated fields and temperate jungle. All of this stretching in square patches up and down rolling hills like you would see in a Cezanne landscape. I have eaten many tropical fruits which don’t exist in the U.S. from as sweet as a jolly rancher to something like a sour cantaloupe. And so far, if you can afford to grow vegetables, rice, corn and beans, buy sugar and oil, and a family has both a husband and a wife to cultivate their small plots of land, a cement house versus a mud one, a decent latrine, not too many children, and little to no illness, with some means to earn a little bit of money in the markets or some form of employment, then these things combined would allow you to not be poverty stricken anymore. And although there are a seemingly infinite amount of people and patients here who do not have such fortune, for those people who do have this or more, everything is, at least this rich rainy season, flourishing.
Sunday, May 21, 2006
Monday, May 15, 2006
Pediatrics at MGH vs. Rwinkwavu Hospital
Saturday, May 13.
I know a little about the Partners in Health mission which is in PIH parlance to provide a preferential option for the poor. I also feel like I know what they mean by this: that in terms of looking at who to serve first with the best of what the world has to offer, it should be provided to the poorest of the poor first because of the innumerable amount of forces working against them. This would include refugees, prisoners, people living in slums etc. That it shouldn’t be that the not-served and rarely represented receive the least last, but that they should get the most first. It is a noble vision. But the reality is this: I go into the Rwinkwavu hospital, and all the certifying bodies in the United States like OSHA would never allow a hospital like this to exist. There are flies everywhere – on the children, on their heads, on their eyes, on me (although a person who just came this past weekend to visit from a refugee camp saw the hospital and feels it’s “not third world, not even a second world hospital.” Coming from a refugee camp she just worked in with little to no resources I’m sure it does look great, so it depends on what your comparison group is I guess. I really believe your comparison and your goal should be the best though, not “its much better than some of the worst.” I don’t think anyone really benefits when you hold a lower bar of achievement for others). But to continue, the staff is not wearing gloves most of the time, I haven’t seen anyone wearing a mask and think they are probably in short supply, people aren’t using any sort of airborne precautions or private isolation with a negative pressure room for children with TB because that just doesn’t exist here. The nurses work with kids who have HIV, TB, malaria or some cocktail of these in seemingly most of the beds and everyone is in the same room together side by side and sometimes 2 to a bed because we just don’t have enough room sometimes.
All of this I had anticipated actually; I really think I had a good idea of what and who I would be working with and for, but part of why I write this is for all the nurses I know back at MGH, who may have no idea about what an area like this does or does not have.
On Thursday I followed the head nurse around to administer meds and there was nothing with which to give the meds. All the moms just pull out their own metal spoons, whatever size they happen to have, and you poor the child’s antibiotic into the spoon from a medicine cart that gets pushed around. If it’s 2.5mL order you pour a half a spoonful into the mom’s spoon, you’re just supposed to eyeball it. And then some of these children protest and wiggle away as should be expected in a child and the antibiotic syrup ends up spilling all over their face and you eyeball how much was spilled and pour out that much onto the spoon again. Then for some reason the most unbelievable to me, was that there was nothing to wipe up the children’s mouths. No napkins, no towels, no nothing to clean a patients face or wipe off a dirty child or wipe off your own hands. When I asked the nurse for something to wipe the child’s mouth she handed me cotton balls. Seemed so basic to at least have a towel, even a reused towel that could soak in Clorox or detergent or something, and I got some gauze and wet it under the one faucet that works and barely dribbles water for the entire pediatric ward of ~40 patients and went to go wipe up the child’s mouth. I could go on and on. Intake and output is not tracked or charted anywhere. There is no such thing as a diaper so diapers are not weighed or counted. No such things as keeping track of voids. They don’t keep track of stool/diarrhea/constipation. Food is not written down. A full set of vital signs aren’t really done as standard part of hourly/regular care. I’ve only seen them take a blood pressure once and they were all working with the cuff with a difficulty that I read as if the cuff wasn’t working right and I thought I could show the nurses how to use a blood pressure cuff the way we do it in the U.S. It’s pretty quick, it doesn’t take that long. And then when I tried it myself, there was no sound coming through the blood pressure cuff so I couldn’t get a blood pressure either. There are no stethoscopes for the nurses. There is no such things as STAT, the method to contact a doctor is to leave the ward and walk to another building and try to find them on your own. And as far as I can see there seems to be a deficit in perhaps a combination of education, understanding or interest if a patient’s status changes (a change in consciousness or increased respirations). As for meds and doctor’s orders, the exact time meds are given is not charted, they just do 6AM, 2PM, 8PM. So tid is the max a med is going to be given and the system seems to not be charted well and not done that accurately. Bed sheets are not changed regularly and although they told me they are changed between patients, the one time I saw sheets changed was after a child had died in it. When I asked how often the blankets are washed, I think they felt they had to answer me with some amount so they said about once a month. Again, I haven’t seen blankets come off yet. They are stained with saliva and hardened liquids of who knows what. Parents take their kids out to latrines to go to the bathroom, and they wash their children outside under the well water. Although some of the Rwandan doctors say that this pediatric ward is cleaner than the other wards, it would be unacceptable for a U.S. hospital. I think about the nurses at MGH on Ellison 18 and how there are many of them who upon seeing this place would refuse to work here because of a) the lack of equipment, IV fluids, meds b) the different standard of hygiene and cleanliness and c) many of these women and children have a severity of diseases that we don’t see in the U.S. and we don’t have the proper equipment to serve them. Syringes and meds are limited, records are not kept of IV intake of fluids on the children, I’ve asked if they would give morphine for certain kids who are screaming and moaning in pain, and they don’t want to give morphine because they think of it as bad since it’s a narcotic and I don’t think they’re used to using it, so kids basically only get ibuprofen for pain. No such thing as low wall suction or cardiac monitors. Oxygen comes from a large tank. Then there is a level of disease children would be in an intensive care unit with the way they sometimes present here. Many come in with electrolyte imbalances and dehydration. Days of vomiting and diarrhea. Some arrive comatose, again flies on the eyes, flies on me. And it is just so bad to me I don’t even know where to start. What is most important in terms of saving a life? Probably patient status changes: change in consciousness, fever >101.5, increased or labored respirations. ABC’s. Airway, breathing, circulation. And then I think about the PIH mission: care just as good for these people as you would want for your own child and all I can think is, “Well then this is absolutely unacceptable. Because my own child wouldn’t stay in this place ever. It would be an “over my dead body” kind of place. And I think, well then, it’s got to get to a level where I would want my child to stay here. And THAT is a FAR FAR vision from the state of things now. It makes me both angry and frustrated - like handing someone an ocean to fill up with a spoon. And yet, somehow the U.S. doctors seem to be managing well. Yeah, the locals are at a disadvantage, yeah it’s a far cry from a U.S hospital, but amazingly, they do what they can. And all the docs here, actually all the PIH staff work incredibly hard. But the poverty is upsetting. And I wonder if I need to get used to it in order to move forward. Right now, I just keep all this to myself. I think after working here awhile, you just acclimate. One of the docs told me she doesn’t even notice the flies anymore. The thing is, I also don’t want to get used to it. Like PIH’s mission, if anything, these people should be getting the best care possible, that needs to be the goal. And right now, this is not it. Not that there aren’t positive things happening, there are. They have a great educational program for kids with HIV, they have a great program to prevent moms from transmitting HIV to their children, and there are other advances. Successes. I love the home visits. Going out into the community and meeting the moms in their homes and talking with them about their children’s well-being is exactly what I enjoy. I have always liked this, in the U.S. and here. The hospital is more well run and well built with a beautiful grounds and better than anything around by far. But the successes seem like just a rain drop into the vast ocean of maladies and I guess if you constantly think about what this place is not, you would just give up, so you just have to work with what you have and see what you do have rather than what you do not. Day 12 and I am still figuring out and finding my place.
I know a little about the Partners in Health mission which is in PIH parlance to provide a preferential option for the poor. I also feel like I know what they mean by this: that in terms of looking at who to serve first with the best of what the world has to offer, it should be provided to the poorest of the poor first because of the innumerable amount of forces working against them. This would include refugees, prisoners, people living in slums etc. That it shouldn’t be that the not-served and rarely represented receive the least last, but that they should get the most first. It is a noble vision. But the reality is this: I go into the Rwinkwavu hospital, and all the certifying bodies in the United States like OSHA would never allow a hospital like this to exist. There are flies everywhere – on the children, on their heads, on their eyes, on me (although a person who just came this past weekend to visit from a refugee camp saw the hospital and feels it’s “not third world, not even a second world hospital.” Coming from a refugee camp she just worked in with little to no resources I’m sure it does look great, so it depends on what your comparison group is I guess. I really believe your comparison and your goal should be the best though, not “its much better than some of the worst.” I don’t think anyone really benefits when you hold a lower bar of achievement for others). But to continue, the staff is not wearing gloves most of the time, I haven’t seen anyone wearing a mask and think they are probably in short supply, people aren’t using any sort of airborne precautions or private isolation with a negative pressure room for children with TB because that just doesn’t exist here. The nurses work with kids who have HIV, TB, malaria or some cocktail of these in seemingly most of the beds and everyone is in the same room together side by side and sometimes 2 to a bed because we just don’t have enough room sometimes.
All of this I had anticipated actually; I really think I had a good idea of what and who I would be working with and for, but part of why I write this is for all the nurses I know back at MGH, who may have no idea about what an area like this does or does not have.
On Thursday I followed the head nurse around to administer meds and there was nothing with which to give the meds. All the moms just pull out their own metal spoons, whatever size they happen to have, and you poor the child’s antibiotic into the spoon from a medicine cart that gets pushed around. If it’s 2.5mL order you pour a half a spoonful into the mom’s spoon, you’re just supposed to eyeball it. And then some of these children protest and wiggle away as should be expected in a child and the antibiotic syrup ends up spilling all over their face and you eyeball how much was spilled and pour out that much onto the spoon again. Then for some reason the most unbelievable to me, was that there was nothing to wipe up the children’s mouths. No napkins, no towels, no nothing to clean a patients face or wipe off a dirty child or wipe off your own hands. When I asked the nurse for something to wipe the child’s mouth she handed me cotton balls. Seemed so basic to at least have a towel, even a reused towel that could soak in Clorox or detergent or something, and I got some gauze and wet it under the one faucet that works and barely dribbles water for the entire pediatric ward of ~40 patients and went to go wipe up the child’s mouth. I could go on and on. Intake and output is not tracked or charted anywhere. There is no such thing as a diaper so diapers are not weighed or counted. No such things as keeping track of voids. They don’t keep track of stool/diarrhea/constipation. Food is not written down. A full set of vital signs aren’t really done as standard part of hourly/regular care. I’ve only seen them take a blood pressure once and they were all working with the cuff with a difficulty that I read as if the cuff wasn’t working right and I thought I could show the nurses how to use a blood pressure cuff the way we do it in the U.S. It’s pretty quick, it doesn’t take that long. And then when I tried it myself, there was no sound coming through the blood pressure cuff so I couldn’t get a blood pressure either. There are no stethoscopes for the nurses. There is no such things as STAT, the method to contact a doctor is to leave the ward and walk to another building and try to find them on your own. And as far as I can see there seems to be a deficit in perhaps a combination of education, understanding or interest if a patient’s status changes (a change in consciousness or increased respirations). As for meds and doctor’s orders, the exact time meds are given is not charted, they just do 6AM, 2PM, 8PM. So tid is the max a med is going to be given and the system seems to not be charted well and not done that accurately. Bed sheets are not changed regularly and although they told me they are changed between patients, the one time I saw sheets changed was after a child had died in it. When I asked how often the blankets are washed, I think they felt they had to answer me with some amount so they said about once a month. Again, I haven’t seen blankets come off yet. They are stained with saliva and hardened liquids of who knows what. Parents take their kids out to latrines to go to the bathroom, and they wash their children outside under the well water. Although some of the Rwandan doctors say that this pediatric ward is cleaner than the other wards, it would be unacceptable for a U.S. hospital. I think about the nurses at MGH on Ellison 18 and how there are many of them who upon seeing this place would refuse to work here because of a) the lack of equipment, IV fluids, meds b) the different standard of hygiene and cleanliness and c) many of these women and children have a severity of diseases that we don’t see in the U.S. and we don’t have the proper equipment to serve them. Syringes and meds are limited, records are not kept of IV intake of fluids on the children, I’ve asked if they would give morphine for certain kids who are screaming and moaning in pain, and they don’t want to give morphine because they think of it as bad since it’s a narcotic and I don’t think they’re used to using it, so kids basically only get ibuprofen for pain. No such thing as low wall suction or cardiac monitors. Oxygen comes from a large tank. Then there is a level of disease children would be in an intensive care unit with the way they sometimes present here. Many come in with electrolyte imbalances and dehydration. Days of vomiting and diarrhea. Some arrive comatose, again flies on the eyes, flies on me. And it is just so bad to me I don’t even know where to start. What is most important in terms of saving a life? Probably patient status changes: change in consciousness, fever >101.5, increased or labored respirations. ABC’s. Airway, breathing, circulation. And then I think about the PIH mission: care just as good for these people as you would want for your own child and all I can think is, “Well then this is absolutely unacceptable. Because my own child wouldn’t stay in this place ever. It would be an “over my dead body” kind of place. And I think, well then, it’s got to get to a level where I would want my child to stay here. And THAT is a FAR FAR vision from the state of things now. It makes me both angry and frustrated - like handing someone an ocean to fill up with a spoon. And yet, somehow the U.S. doctors seem to be managing well. Yeah, the locals are at a disadvantage, yeah it’s a far cry from a U.S hospital, but amazingly, they do what they can. And all the docs here, actually all the PIH staff work incredibly hard. But the poverty is upsetting. And I wonder if I need to get used to it in order to move forward. Right now, I just keep all this to myself. I think after working here awhile, you just acclimate. One of the docs told me she doesn’t even notice the flies anymore. The thing is, I also don’t want to get used to it. Like PIH’s mission, if anything, these people should be getting the best care possible, that needs to be the goal. And right now, this is not it. Not that there aren’t positive things happening, there are. They have a great educational program for kids with HIV, they have a great program to prevent moms from transmitting HIV to their children, and there are other advances. Successes. I love the home visits. Going out into the community and meeting the moms in their homes and talking with them about their children’s well-being is exactly what I enjoy. I have always liked this, in the U.S. and here. The hospital is more well run and well built with a beautiful grounds and better than anything around by far. But the successes seem like just a rain drop into the vast ocean of maladies and I guess if you constantly think about what this place is not, you would just give up, so you just have to work with what you have and see what you do have rather than what you do not. Day 12 and I am still figuring out and finding my place.
Preliminary Thoughts
April 17, 2006
“Are you nervous?” is what I’m asked most often when telling people that I am going to Rwanda to work as a nurse. This much I know. I know that I don’t know what I’m about to get myself into. I know that the job needed to be done will be beyond my skill and capacity. I know I will probably feel that I need more skills: Education wise, capacity wise, resources wise, money wise, human people wise, inner strength wise, humor wise, love wise, wisdom wise. What I don’t know is if I will be happy doing this kind of project, although I think this is the kind of work that I am meant to be doing. I do not know how big or little the resources available to me will be. I do not know whether I will like any of the people where I’m going, or if they will like me. Of course I hope both. I also don’t know how much I will be able to keep in touch with Claudine, and I don’t know how much time I will have to really make sure her situation is all taken care of, although I feel responsibility for her, as well as to MGH and PIH. Sometimes we take on responsibilities larger than ourselves and although I realized this at the time, that taking her back to Rwanda would be a useful purpose to my travels besides just traveling on my own, I didn’t start to think about the long term until just recently. That she is going to need to be helped out at least for the rest of her highschool, perhaps some help at the beginning of college, without parents or much family, and if there is one person here or there who is related to her, in a country that is post civil war and largely unemployed, destitute, with huge sections still starving, if she is to be educated properly, educated at least somewhat to how I was educated, there is going to have to be a long term plan involved. A ten year plan. For her and her siblings. That will bring her to about 25 years old and her littlest sibling to end of high school years. This is a long time. Will I be able to finagle resources other than my own to help educate her and her siblings for the next 10 years? Yes, I can get a few handfuls of people to donate large chunks one time, but what about consistently? Several years in a row? 10 years. There is one woman in particular who has said she would help this whole time, but I guess you don’t know who will follow through, until that person follows through. And if I do manage getting her and all her siblings into an excellent boarding school, can I get Claudine to realize that this isn’t just a hand-out. That she has responsibilities too. That being given so much means that you have to give at least that much in return. Or else you end up being one of those people who takes away more from this world than they provide. You are a user rather than a contributor. It’s like coming to someone’s house and visiting for 2 weeks: do you leave it messier than when you came, neutral or do you leave it cleaner than when you arrived? I’d like to think that in the some total of the end of my life, whenever that day comes, that if tallied up, whoever does that, God, or Allah, or karmic laws, that I will have given more than I have received. That I will have cleaned up more than I have destroyed. Whatever avenue that may be: as a nurse, doctor, engineer, mother, computer analyst, singer, dancer, artist. I don’t know how many young people get this message or are moved by it. I hope some. For without that message, this world will just become a more selfish and miserable place. The house we were given, this world, will be left messier than cleaner.
But for now, I’m thinking about this: my to do list sent to me by PIH, Kwashiokor and how to run a malnutrition program, I am thinking about planting gardens and contacting my Dad to talk about growing beans and potatoes and corn, like he does. I’m thinking about hearty animals, and if I know enough people in Oklahoma to help supply livestock and better yet, who can come over and help teach people how to raise this livestock, take care of it, with people who only have the bare minimum of tools, food maybe water to take care of these animals. At least for the next few years. I’m thinking about dying children, and how many will I see who die from dehydration and electrolyte imbalance and malnutrition? Simple issues that don’t need to be happening. I’m thinking about people’s judgement, about how people wonder why certain countries “can’t get their act together” and how they’re “hopeless” and how they’re “just going to fall to hell” with unsolvable problems. And once you really start thinking about things, I then have to think about the effects of colonization and war, and genocide, and old people dying, and hundreds of years of structural inequality because everything has been in such chaos and no one seems to have much land of their own. What do you do when these skills have been buried multiple times by colonization, power take-overs, civil war, destruction, sickness and death. You rebuild.
That is the only answer to me. You rebuild. It’s a Sisyphean task. And you can be on the side of the profit margin capitalist and say to hell with it, survival of the fittest, they aren’t meant to survive, it’s a tough world out there, why work on a helpless cause…or you can actually work with some of these people, like I did with Claudine, just one night, take care of her at the hospital and all I could think, “All these people who just want to write Africa off as a hopeless place…” these are the same people that say “Africa” and don’t separate the successful from the unsuccessful places on this continent, the working projects and countries that can be proud of their achievements like Senegal, Cameroon or Kenya, verses those countries that are still in the midst of much fighting, like Sudan or Niger or the Congo. It’s like tying in Texas with Massachusetts. We are the same country, but some would say we are like different continents. Others of course would find similarities. But in the end, back to “Are you nervous?” I would have to say “Yes and no.” “Yes” because I am aware that there is rampant malaria, typhoid and meningitis and that I need to take precautions and be mindful of this. I am, at this point, prior to any exposure to Rwanda, worried about being bitten by mosquitos and getting malaria. Mosquitoes love me. Especially my ankles and wrists. At least in the U.S. they do. And Europe. And Nepal. And Thailand. So I imagine that mosquitoes will like me in Rwanda too. I am worried about this a bit. And I am worried about other illnesses and infectious diseases I may get. Not the ones I recognize and will bring medicine for, but the ones I don’t. I do worry about safety to a degree. Not so much while I am with PIH at our headquarters or working in the hospital, but when I’m not. When I’m out in an unfamiliar village at night. Even if I’m in a room by myself at night, with the door locked. That kind of scenario is worrisome for me. I am aware that there is debate about why the HIV/AIDS rate is so high, and now among children too since HIV+ moms pass it on to their children. I of course worry about my own safety. Being amidst death and poverty, that worries me…will I be able to be as loving and caring as I try to be at my job at MGH, will I be too afraid to relate to people’s hearts because people are so destitute and from such a different background than my own, will it be a lot less than expected, will I start rationalizing deaths away, well 5 more lost this week, nothing we could do about it.
We will see. But these are all some of the preliminary thoughts going through my head. But of all these fears, I have always believed it is important to plow ahead, fears in breast pocket, continue on your mission. The mission is to do something I see as worthy…and as making a difference in life. I know that this is different for everyone. Some people feed the homeless; some people advocate for legislation that will support the environment, some people are staff nurses. Some people sing and hope to move people emotionally so that the audience can feel more sincerely and powerfully than they do in the often numbing job of a cubicle worker; some people dedicate their life to their family and raising their children to the best of their ability. All worthy and the most noble of causes. But for me, this is my way. As I told my nurse manager, Judy Newell when she discussed with me the Durant Fellowship and how we each have our own purpose in life I could not have agreed more. Life is a varied path with innumerable choices to be more giving or to play it safe. May these next 8 months be more fruitful for the lives of people around me than I can ever imagine, may I alleviate the suffering of others, however few, may I piss off the least amount of people possible while being able to get the most amount of work done, no matter how small I feel the difference I am making is…and may those I work with, also want to in return continue to work for the benefit of others, no matter what obstacles get in their way. And may we all do this with great love and compassion, and always wisdom with even at times, humor and joy.
“Are you nervous?” is what I’m asked most often when telling people that I am going to Rwanda to work as a nurse. This much I know. I know that I don’t know what I’m about to get myself into. I know that the job needed to be done will be beyond my skill and capacity. I know I will probably feel that I need more skills: Education wise, capacity wise, resources wise, money wise, human people wise, inner strength wise, humor wise, love wise, wisdom wise. What I don’t know is if I will be happy doing this kind of project, although I think this is the kind of work that I am meant to be doing. I do not know how big or little the resources available to me will be. I do not know whether I will like any of the people where I’m going, or if they will like me. Of course I hope both. I also don’t know how much I will be able to keep in touch with Claudine, and I don’t know how much time I will have to really make sure her situation is all taken care of, although I feel responsibility for her, as well as to MGH and PIH. Sometimes we take on responsibilities larger than ourselves and although I realized this at the time, that taking her back to Rwanda would be a useful purpose to my travels besides just traveling on my own, I didn’t start to think about the long term until just recently. That she is going to need to be helped out at least for the rest of her highschool, perhaps some help at the beginning of college, without parents or much family, and if there is one person here or there who is related to her, in a country that is post civil war and largely unemployed, destitute, with huge sections still starving, if she is to be educated properly, educated at least somewhat to how I was educated, there is going to have to be a long term plan involved. A ten year plan. For her and her siblings. That will bring her to about 25 years old and her littlest sibling to end of high school years. This is a long time. Will I be able to finagle resources other than my own to help educate her and her siblings for the next 10 years? Yes, I can get a few handfuls of people to donate large chunks one time, but what about consistently? Several years in a row? 10 years. There is one woman in particular who has said she would help this whole time, but I guess you don’t know who will follow through, until that person follows through. And if I do manage getting her and all her siblings into an excellent boarding school, can I get Claudine to realize that this isn’t just a hand-out. That she has responsibilities too. That being given so much means that you have to give at least that much in return. Or else you end up being one of those people who takes away more from this world than they provide. You are a user rather than a contributor. It’s like coming to someone’s house and visiting for 2 weeks: do you leave it messier than when you came, neutral or do you leave it cleaner than when you arrived? I’d like to think that in the some total of the end of my life, whenever that day comes, that if tallied up, whoever does that, God, or Allah, or karmic laws, that I will have given more than I have received. That I will have cleaned up more than I have destroyed. Whatever avenue that may be: as a nurse, doctor, engineer, mother, computer analyst, singer, dancer, artist. I don’t know how many young people get this message or are moved by it. I hope some. For without that message, this world will just become a more selfish and miserable place. The house we were given, this world, will be left messier than cleaner.
But for now, I’m thinking about this: my to do list sent to me by PIH, Kwashiokor and how to run a malnutrition program, I am thinking about planting gardens and contacting my Dad to talk about growing beans and potatoes and corn, like he does. I’m thinking about hearty animals, and if I know enough people in Oklahoma to help supply livestock and better yet, who can come over and help teach people how to raise this livestock, take care of it, with people who only have the bare minimum of tools, food maybe water to take care of these animals. At least for the next few years. I’m thinking about dying children, and how many will I see who die from dehydration and electrolyte imbalance and malnutrition? Simple issues that don’t need to be happening. I’m thinking about people’s judgement, about how people wonder why certain countries “can’t get their act together” and how they’re “hopeless” and how they’re “just going to fall to hell” with unsolvable problems. And once you really start thinking about things, I then have to think about the effects of colonization and war, and genocide, and old people dying, and hundreds of years of structural inequality because everything has been in such chaos and no one seems to have much land of their own. What do you do when these skills have been buried multiple times by colonization, power take-overs, civil war, destruction, sickness and death. You rebuild.
That is the only answer to me. You rebuild. It’s a Sisyphean task. And you can be on the side of the profit margin capitalist and say to hell with it, survival of the fittest, they aren’t meant to survive, it’s a tough world out there, why work on a helpless cause…or you can actually work with some of these people, like I did with Claudine, just one night, take care of her at the hospital and all I could think, “All these people who just want to write Africa off as a hopeless place…” these are the same people that say “Africa” and don’t separate the successful from the unsuccessful places on this continent, the working projects and countries that can be proud of their achievements like Senegal, Cameroon or Kenya, verses those countries that are still in the midst of much fighting, like Sudan or Niger or the Congo. It’s like tying in Texas with Massachusetts. We are the same country, but some would say we are like different continents. Others of course would find similarities. But in the end, back to “Are you nervous?” I would have to say “Yes and no.” “Yes” because I am aware that there is rampant malaria, typhoid and meningitis and that I need to take precautions and be mindful of this. I am, at this point, prior to any exposure to Rwanda, worried about being bitten by mosquitos and getting malaria. Mosquitoes love me. Especially my ankles and wrists. At least in the U.S. they do. And Europe. And Nepal. And Thailand. So I imagine that mosquitoes will like me in Rwanda too. I am worried about this a bit. And I am worried about other illnesses and infectious diseases I may get. Not the ones I recognize and will bring medicine for, but the ones I don’t. I do worry about safety to a degree. Not so much while I am with PIH at our headquarters or working in the hospital, but when I’m not. When I’m out in an unfamiliar village at night. Even if I’m in a room by myself at night, with the door locked. That kind of scenario is worrisome for me. I am aware that there is debate about why the HIV/AIDS rate is so high, and now among children too since HIV+ moms pass it on to their children. I of course worry about my own safety. Being amidst death and poverty, that worries me…will I be able to be as loving and caring as I try to be at my job at MGH, will I be too afraid to relate to people’s hearts because people are so destitute and from such a different background than my own, will it be a lot less than expected, will I start rationalizing deaths away, well 5 more lost this week, nothing we could do about it.
We will see. But these are all some of the preliminary thoughts going through my head. But of all these fears, I have always believed it is important to plow ahead, fears in breast pocket, continue on your mission. The mission is to do something I see as worthy…and as making a difference in life. I know that this is different for everyone. Some people feed the homeless; some people advocate for legislation that will support the environment, some people are staff nurses. Some people sing and hope to move people emotionally so that the audience can feel more sincerely and powerfully than they do in the often numbing job of a cubicle worker; some people dedicate their life to their family and raising their children to the best of their ability. All worthy and the most noble of causes. But for me, this is my way. As I told my nurse manager, Judy Newell when she discussed with me the Durant Fellowship and how we each have our own purpose in life I could not have agreed more. Life is a varied path with innumerable choices to be more giving or to play it safe. May these next 8 months be more fruitful for the lives of people around me than I can ever imagine, may I alleviate the suffering of others, however few, may I piss off the least amount of people possible while being able to get the most amount of work done, no matter how small I feel the difference I am making is…and may those I work with, also want to in return continue to work for the benefit of others, no matter what obstacles get in their way. And may we all do this with great love and compassion, and always wisdom with even at times, humor and joy.
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