Tuesday, December 23, 2014

Serenity for a Non-Gentle Soul

Serenity.
Courage.
Wisdom.
These are the three traits that I have been attempting to center my life around...well, recently. These three simple words come from a prayer that has brought me much understanding and belonging in a life journey with many rockie roads. Serenity is defined as the state or quality of being serene, calm, or tranquil. When you hear those words, you do not think of me. I have never been called calm and certainly never tranquil. But finding serenity, finding an inner stillness and accepting calmness in a raging world has revealed a great amount to me. In the book of Colossians, Paul tells the people of new faith to let go of their old ways and take up new characteristics that resemble a spiritual life. One of these qualities is gentleness. When I first started studying this scripture it made me really mad. I am NOT a gentle soul. I think the most common describer people give me is blunt, which is very much so the opposite of gentle. How can I become a more gentle person? But in asking for serenity, I have also found gentleness. When I am at peace and actively seeking a tranquil mindset, it is so flippin easy to be gentle. I think about my words before I speak them. I consider the feelings of others before I act. I become gentle by trying to extend my serenity to others. But when I get wound up in things that shouldn't matter, stuff I can't control, work I don't have time to finish, and all the things that hinder me, gentleness and serenity seem far off.
I have spent a lot of my life playing a blame-game, but in searching for the serenity to accept the things I cannot change I remind myself that blame has no place in a tranquil mind and pursuing control will always end in a state of bluntness instead of gentleness.

Friday, July 12, 2013

Saying Goodbyes

The taxi pulled up at 1am. I gathered my belongings and turned to hug my family goodbye.
As I pulled away from this small house that I had grown to call home, I began to reflect on these past two months. Over the course of two months I began to take root in Tanzania. Streets that once use to overwhelm me, now felt so calm. People use to stare at me and call out "Mzungu," now speak swahili to me with a friendly smile. The hospital staff know me by name and assign me jobs like one of their own. This country that was once just a mystery to my imagination has become a part of my soul.

Through my work at the hospital I have learned by the "See one, do one, teach one" motto. As I became one of the "old volunteers," it brought me joy to show the new volunteers the ropes at the hospital and watch there nerves slowly break down just as mine had. Saying goodbye to the various hospital staff that I became very close to was one of the saddest moments of the day. As I went from ward to ward taking pictures and saying my goodbyes, I felt genuine joy for the people who had touched my life. Without the work of these people, the poorest of the poor would go without medical care in Tanzania. They could be working at a private hospital, they could be making more money and working with more supplies and better conditions. But instead they work at a government hospital and treat people who seem to have all the odds fighting against them. I know one day I will return here and work side-by-side these men and women.

Through my host family, I have learned the real heart of Tanzanian culture. There were days when I felt like a zoo animal and was so fed up with the way people on the street treated me. But then my host mom, grandma, niece, and sisters would show me how the real heart of Tanzania is made up of people who genuinely care for one another through thick and thin. The night before I left was probably one of my favorite nights at home because the 3 TV channels were all out. So instead we all sat in the living room just talking and laughing. As my sister Carol started to fall asleep, her older sister began switching off all the lights. Then Mama Agata threw a sheet over herself and pretended to be a ghost. Carol awoke screaming and running around the house while we all laughed. It was just simple, pure fun. It was nights doing homework with them, drawing pictures, playing balloon tennis, and tickle fights that I loved the most. It was my Grandma(Bibi) learning how to say Hello and Goodbye in English. It was Mama Agata's chipati and homemade juice. These were the memories I will cherish forever.

My 2nd to last day in Dar was spent with my Young Life family, the Larmeys. They invited me to join their Young Life Africa Committee retreat for the day. My friends Paige, Morgan and Jake from Tallahassee were a part of this committee and it was a real treat to get to see them. We put on an All City Club right across the street from where I live and over 150 kids came. Club was truly astonishing to watch as all of the kids sang and danced to the songs, with no lyrics or sound system or microphone to lead them. They were so full of joy and excitement, it rubbed off on all of us. As I said goodbye to my friends and headed to walk home, many of the committee people asked me if I felt safe walking. This is one of those moments I hope to never forget how I felt exactly right then. I turned and said proudly "Its fine, I'm just walking home." Though I have left Tanzania, it has not left me. A piece of me will always feel at home there. Even through the upsets and  frustrations with the vast differences in culture, I became a little more Tanzanian each and every day. Tanzania will be with me always.

Tuesday, July 2, 2013

Holding Hands

As I watched in horror, a seventeen year old boy with cellulitis covering all of his legs screamed in pain as the nurses cleaned the infection destroying his body. He reached out and I held his hand as he whimpered. His arms and face are one giant karposi's sarcoma. The nurse turned to me and took his hand from mine while whispering to me, "he is positive." Flipping through his chart I was overwhelmed. He has basically lived in the hospital over the last month, as his cellulitis has taken over his ability to walk. His lips are cracked, raw from ulcers consuming his mouth. The opportunistic infections have hit him one after another. As I held his hand and helped the nursing student wrap his legs with bandages that offer no protection, I am hit with the reality of living with HIV. Many of the patients I have seen over the last 8 weeks were positive, but most did not suffer from such visible symptoms such as these. Daniel will probably not see his eighteenth birthday. I quickly excused myself to chai break in the nurses room and let a few tears trickle down.

Before I came to Dar I did my share of research on HIV and in particular how the epidemic hit america in the late 80's. I recently watched a documentary called "How to Survive a Plague" and was shocked to learn so much about how Americans struggled to find care for HIV during this time. Twenty years ago Americans protested to fight HIV, get government funding to do research and provide medicine to those who could not afford it. Seen as a disease brought upon by themselves, many people had little compassion for the largely homosexual population fighting for the cause. It was more shocking to me that twenty years later, much of Africans are fighting the same fight still. Education and research on HIV/AIDS is almost twenty years behind here. When asking my host sisters if they learned about the disease in school they told me they were told to never touch someone with HIV/AIDs because they could contract the disease. This country is still stuck on the toilet seat contamination idea. You could pass out a million condoms to everyone in this city and it wouldn't lessen the pace of this deadly disease. I don't have the answer to this problem.
 
On sunday I attended the Vineyard church again, taking a few other volunteers and another friend from the hospital. It was awesome to get to listen to Steve Larmey give the sermon. He and his wife are the regional directors of Tanzania. Listening to Steve's message reminded me of a big question I have let linger in my life recently. What is holding me back from an intimate relationship with god? In the old testiment the story of Abraham sacrificing his son Isaac. Isaac was an image of everything earthly to Abraham, he would carry on the family name and create a great nation. Abraham had spent years and years waiting for the promise of his beloved son. And when God finally granted it to him, he asked him to sacrifice his son on an alter, to give up everything he has waited for. Steve put this in perspective by asking us this question, what is God asking me to sacrifice and why? What means the world to me? I think this question has always been pretty hard for me to answer. When I was younger I came to understand my relationships with guys was the answer. Then later I thought it might be my personal image of myself. As I get older, the more I realize the most important thing to me is my success. Grades, my relationship status, how the world perceives me, money, etc. It all sums up to my success. My friend mel put it this way, "what if after four years of studying for medical school, taking the MCAT, getting into the best school in the country, God told you he wanted you to do something else with your life, would you?" That is one scary question.

To bring these two topics together, I have realized that my career goal of working as a doctor and my spiritual mindset can be very contradicting. I want to help the world, but only after I help myself. I want to be established and have my career inline, and then help. No! God is tells me to live EVERYDAY for his glory, not every tomorrow. So maybe I don't have the answer to HIV/AIDS epidemic right now. So I don't have the money to give to the thousands suffering due to their lack of money today. So I am not a physician yet. SO WHAT?! All I have is a hand that can give comfort, clean wounds, and administer antibiotics. SO that is what I will do today. And realizing that this is good enough for god, doing this work in his name, that is the greatest realization of this trip. Instead of focusing on how insignificant my work is.Instead of focusing on the years of learning I have left before I can practice medicine and "make a real impact." Instead of focusing on MY success. I want to focus on the right now, right here that is happening every single second.

Saturday, June 22, 2013

A culture with 1000 greetings

I finally feel comfortable here in Dar. I know the streets, the shortcuts, the bus routes. I know how much I should pay for a candy bar and where the locals buy the best fruit. I know where its safe to go on a run and how to politely tell people I don't want to purchase any of their products.
Sometimes in Dar I feel like an animal at the zoo. As we walk to work in the morning, the air is filled with people yelling "Mzungu" and asking in very high pitched english "how are you my baby?" "where are you going my baby" "can I take you to my house my baby"
People who I have passed every single day, twice a day, for five weeks still seemed shock to see me. But when I get the chance, I stop and answer their questions and take a few moments to get to know the people around me. A man on the corner sells oranges, he also owns rents a taxi everyday to pick up some more money. However, his three kids that sit with the large orange mound while he is driving the taxi, seem to wear the same clothes everyday and eat very little. The woman who works at the small shop closest to the hospital, she smiles and doesn't call out. I buy my phone minutes from her and she always calls me dr.mzungu (as I am usually wearing the white coat when I pass by).

Inside the hospital, I have met some of the nicest people in Dar. The nursing students are so excited to get to know us and so modest when we ask questions back. This week I spent my time in the woman's medical ward. I have come to feel almost at home in this ward, as the head nurse has started to assign me specific jobs everyday when I arrive. Shamim is a nursing student who was assigned investigations with me on Tuesday. She is nineteen years old and in her 2nd semester of her first year of nursing school. She is very sweet and was very excited to teach me the responsibilities of investigation. This entails drawing blood and urine samples and taking them to the lab. At first I was slightly scared to have this responsibility as I had yet to draw blood on my own. Shamim talked me through the whole process and with my first try I successfully drew blood!
This patient has severe malaria, hyperglycemia, and swelling in her legs due to a muscle infection. I got to see through out the week as her legs began to return to normal size, her blood glucose lower, and her parasite count go down below 100. It was very rewarding to check her vital signs everyday and see,slowly but surely, as she returned to good health.

I started off this blog with intentions to talk about the culture here in Dar, but I have such a hard time summarizing what it looks like here. The streets are filled with trash, the air is so thick with pollution, and the people are so full of life. The city is like the new york city of Africa. There are roughly 6 million people living in Dar, which is only 614 square miles. Skipped by most tourist, the attention that the color of my skin gets is something I like to call backwards racism. People push us to the front of lines. Taxi drivers see us and try to push us into their cars. When they see me opt to walk or ride a bus, they laugh and are confused.

I miss the comforts of home, the simplicity of getting into my own car and driving it wherever I want with very little traffic and other silly things. But I will miss the greetings, the handshakes, the warmth of the people here. I have perfected the Tanzanian handshake. Unlike american greetings that are usually stiff and last a few moments, Tanzanians shake hands and then continue to hold hands for the rest of the conversation. At first this felt awkward to me, now I love the closeness I feel just holding a simple conversation with one of the doctors. A culture with 1000 ways to say hello and no way to say goodbye.

Monday, June 17, 2013

Halfway

I can't grasp that I have been there for a month already and that I only have less than 4 weeks left.
Every day here brings new surprises.
But for this blog post I will focus on my working experience thus far in greater detail.

As I have mentioned before, I am assigned a weekly rotation that says I should be "working" in a certain ward each week. It also says a doctors name that is suppose to be supervising me. This, however, is not true. I have met only 1 of my supervising doctors since I have been here, in five different wards. The wards I have been assigned to so far were surgical, labor, and pediatrics. I learned very early on that there is no one to check in with or to report to at any of the wards. So if I go to a different ward, it doesn't matter. This might sound odd, why wouldn't I want to go to a certain ward? Well read my post about the labor ward...I have yet to return to it and was suppose to stay there for 2 weeks. The other thing effected by the lack of authority is how the nurses view the volunteers. They seem to see us as annoyances that are in the way of them doing their work. However, most of the time the nurses are sitting at a desk shouting out to the student nurses to be doing the things they should be doing. Basically, in order to be of any help or learn anything I have to walk up to a student nurse in the ward, introduce myself and tell them about projects abroad and why I am there. Then I follow them around for a little bit, asking questions and reading files to fill in the unknowns. If I am lucky, they are super excited to show me stuff and have me assist in whatever they are doing. If I am unlucky, they speak no english. The doctors are, in general, willing to take the time to show us what we should do, but only after we ask and assert ourselves.

Though I have only been assigned to spend time in three wards, I have spent a good amount of time in the mens and womens internal medical wards. As I have mentioned a few times before, these wards are mainly patients suffering from malaria, TB, and other infectious diseases. The days spent in these wards I was shadowing my friend Ben, a nurse volunteering from sweden. Since Ben is already a registered nurse he knows so much more than the student nurses here and sometimes even the registered nurses. He is so great! He has showed me and talked me through placing IVs and giving medications, reading patient files, and placing catheters. I am scheduled to spend a week in internal medicine at the end of my stay but this is Ben's last week here so I will spend this week in internal medicine instead.

Another ward I have spent a few days in, is the minor theatre. This is where people come as outpatients to get wounds dressed or redressed and cleaned, stitches, and the most shocking, circumcision. This is where I did my first stitches as I described previously. This ward is usually where you feel like you are actually doing the most. TO explain the conditions of this small room would never paint the right picture. Patients have to bring all of their own supplies, the only supply the hospital provides is the stitches and the iodine solution. So patients come in with unsterilized gauze and cotton and it is placed in a sterilizer for less than a few minutes, so its not actually sterile. Its just very overwhelming to wrap my head around the inability for a hospital to provide proper supplies for something so simple as cleaning and wrapping a burn wound.

Regardless of which ward I am assigned to, each wednesday I have gone to major theatre (surgery). This week, I watched a man's last three toes get amputated down to his tarsal bones. It was absolutely horrendous. They don't have bone cutters so they were literally using surgical blades that kept breaking inside his foot. The man has gangrene from diabetes and as we left the surgery, the surgeon explained that they would most likely have to come back and amputate his entire foot....so then why didn't they just do that this time...I have no clue. The same day I got to assist in a removal of a hernia. Assisting means I got to hold the tools that were clamped to the skin and to cut the sutures. Afterwards the head surgeon dictated as I wrote in the patient file what happened in the surgery. I came to Tanzania with a few goals, and one of them was to figure out what I might want to specialize in. I think it has become more and more clear that I thoroughly enjoy surgery.

I wish I could explain things much better, but words don't explain the smell, or the constant film of dirt on everything, the yellow of the patients eyes that are dying from cerebral malaria, or the sound of a mother crying for her child. 

Monday, June 3, 2013

LIONS AND ZEBRAS AND ELEPHANTS OH MY!

The sun is beginning to set. The ten foot grass reaches above the car as it whips into my face. The bright clay has begun to plaster on my arm. The car jumps up and down, up and down, as we go through the rough terrain. Then suddenly, as if out of midair, a lion crosses the Safari car. We stop dead in our tracks and watch as it disappears into the grass.

This weekend I went on a 3 day safari to the Mikumi national Park along with 9 other volunteers. It was a 5 hour drive from Dar to Mikumi and well worth every penny. The first day we went on a game drive and saw Zebras, Giraffes, Elephants, Impala, Wildebeest, and Hippos. The best was when were about five feet from a group of elephants.
Elephants in Mikumi National Park
After a five hour drive through the park, the sun began to set and we drove a few miles down the road to our hotel. Woke up early and returned to the park, this time with our hearts set on seeing a lion. However, this is very hard since they are probably one of the most stealth animals and blend in perfectly with the African grass. After driving for another five hours around the park looking at everything, we had given up. When all of a sudden, like I described above, a lion crossed the road! After this one we saw 3 more, getting within 10 feet of them!

We left and drove 2 hours to Udzungu national park. We checked in to our hotel and met our guide from the park, he took us to a small waterfall about 1/4 of a mile into the park. Then we walked 20 minutes down the road from the park entrance to visit the local village. This was so different from Dar. The people saw us and stared but no one tried to sell us anything or put us into their taxi. Instead the locals shouted "Mumbo!" and smiled as we toured. Small children ran through the streets behind us and the smell of roasting chicken filled the air. Now this is the Africa I envisioned. We returned to the hotel to have dinner. Our guide bought us a round of wine and Konyagi, a locally stilled gin that is very inexpensive but pleasant to drink. The wine was also from a local winery called Dudoma. It was nice treat to sit and enjoy the company of the 9 other volunteers. Our conversation always turns into comparing the different countries we represent, on this trip we had Denmark, United States, United Kingdom, Sweden, and Australia. We laughed and talked until we were all too exhausted.
The next morning we woke up early again to begin our day of hiking. We climbed 3.2 km to the top of the 500 foot Sanje Waterfall inside the national park. It felt truly amazing to stand and look out on the beauty of this country. I loved this hike especially because after spending the last three weeks feeling fairly distant and lost in the crowd, it was so amazing to feel at one with God and his beautiful creation.
We then hiked back down to the base of the waterfall and did some swimming and jumping off rocks. It was absolutely the best weekend of the summer so far.

I have experienced so much at the hospital these last two weeks as well. I wish everyday was spent as happy as I was standing on top of that waterfall but the reality is, work the last week was especially saddening. I was scheduled to work in the labor ward this past week. On monday I reported to the ward and dawned on my scrubs to prepare to help with the miracle of birth. My expectations were soon crushed when I realized the majority of the time in labor is spent sitting around waiting for the women to be ready. You would be sitting or checking dilation stages, feeling somewhat bored, and then the next five or six woman would all have their babies at once! But the standards of the hospital don't allow for all the woman to have ultrasounds, as they pay for them out of pocket. In the five hours I was in the labor ward, two babies were born with their cords wrapped around their head and were unable to breathe for too long. I have never been so sad so quickly. In america, they would have had an emergency Cesarian section birth and the babies would have been born completely health. As well another baby was born a month premature and his lungs were not developed enough. He entered the world only for a few moments before returning to our creator. As if this was heartbreaking enough, after the babies passed away, they were wrapped in their blankets and simply placed in a container that was kept under the weight station while their mothers recovered. I couldn't stand working there knowing this. I left the ward and excused myself to an early lunch. The next day was a lot of the same. By Wednesday I was too sad and couldn't face another day of labor. So I returned to the major theatre, surgical ward. I watched and helped assist in six surgeries. Right before we left for lunch though, a pregnant woman came to the surgical ward to have a Cesarian section birth after being in labor for 3 days.When the baby was pulled out, it was wrapped in its cord as well. After 2 of the longest moments of my life I watched as he took his first breathes and began to breathe on his own. I realized that this was something I could not run from or hide. Death is a natural part of this world and it hurts us who remain here after. But laying in bed that night I realized how amazing it was that these babies would never known the pain, sin, and evil that is in this world, they will only know the glory of God and the beauty of heaven.

To contrast all of this, I had the great pleasure to miss work on thursday to do a volunteer outreach day with the other Projects Abroad volunteers. One of the girls, Kiera, works at an orphanage about 30 minutes outside of Dar. We took her orphanage to the beach and it was the most rewarding experience I have had thus far. The kids didn't want anything from us other than our attention. They clung to me and were happy just being held. So we swam, ran, jumped, ate lunch, and basked in the sun. No language barrier could keep us from sharing joy together. This was the perfect way to start my long weekend on Safari and a great reminder as to why I came to here.

Saturday, May 25, 2013

Mumbo!!!

Hello world
I am sorry it has taken me so long to be able to post but I have very limited Internet access. I'm typing this from my roommate's iPad. I'm working on getting a portable modem to use with my laptop in the next week.
Let me paint a picture for you: you are walking down a road that is made of potholes and as you pass people they're eyes are locked on you the entire time. They mumble and sometimes shout "mazungo" which translates to "white person" or "European" and they're eyes do not leave you even when you are out of sight. The main road is full of busy busses that are old 12 passenger vans turned into public transportation filled with 50 plus people at all times. As you walk out to signal you wish to get on, the  people are shocked. A few stops down you yell out "shosha" (stop) and suddenly the stairs triple because no one expects you to know a word of Kiswahili.
This is called 8am.
The hospital I work is called mwanayamala. Translated this means "baby don't cry" ironically as it is always filled with crying babies. The level of sanitation is probably the most concerning aspect of the hospital. There is only a few air conditioned areas so the rest of the hospital is cooled by open windows, which allows the many flies to contaminate the wounds that are left open between nurses caring for the hundred or so patients in each ward

In the last week and a half I have learned so much. On my first day at the hospital I did rounds with the surgery medical students. There is roughly 30 of them that are completing a part of their rotations at the hospital. During rounds we go to each patient in the surgery ward and go over there condition and treatment. However this means undressing their wounds and leaving it undressed for up to a hour. The patients are cleaned and redressed after all of rounds are completed.
During this I met two UK doctors that are here doing an elective. During lunch break we decided to go down to the minor theatre, which is where patients with minor wounds and issues are seen. The nurse working had a list of over 100 patients he was suppose to see that day, which didn't include the emergency patients that came through. After the qualified UK doctors were willing to assist the nurse, he left us to run the ward ourselves. We went through all 100 patients and 5 or 6 emergency patients. The one patient that remains in my memory is a man that came in at noon with open gashes covering his head. He had a gash on his lip that was so deep, the septum under his nasal cavity was open. All three of us worked on him for over a hour. I did my first stitches on his head, directed by the UK doctors.  He was drunk and couldn't afford to buy a syringe for us to inject some local lidocaine, so I was literally pinning him down to prevent him from moving everywhere.

On Wednesday and Thursdays they do major surgeries. So clad in my scrubs and crocs, I watched surgeries for 6 hours each day. Many removals of hernias and Caesarian sections, and two thyroid removals. The surgeons are very willing to teach during the surgeries and let us scrub in to assist whenever we want. The atmosphere is light and happy, many of the surgeons wanted to know a lot about me as we worked.  The anesthesiologist first told me I was old and should be married already. But the next day he told me we were getting married and now calls me "my baby" every time I see him! But I think his true intentions is for me to give him my scrubs when I leave, as they were all auctioning them off.

Next week I am working in the labor ward which should be very exciting and apparently very hands on.

My family is AMAZING. My sisters are Careen (age 10) and Carol (age 6). The speak very good English. Which is very fortunate because the grandmother who takes care of the hours doesn't speak any English. When I first got here my house mother wasn't here because she is a doctor at a hospital very far away. But she came home about 6 days ago and has really been the most welcoming person I've ever met. Her food is really good compared to the food many of the other volunteers. I have struggled with being a picky eater my whole life and I made a promise to myself I would eat any thing in front of me. As I've done that, I've eaten eggs for breakfast most days which I've struggled my whole life to like. Three days later and I woke up craving them! Lunch is mostly rice, beans, a meat, and vegetables. Dinner is similar. The fruit is amazing though because it is always so fresh. I eat fish off the bones most meals which I would normally never wold have eaten in America.
We now have 3 volunteers staying here and l am so thankful for them because traveling and doing all of this with someone else is much better.

Today I went to the beach all day. Just a little taste of home. The other volunteers range from places all over, many from Denmark and England. I'm one of the older people here because many of them are on gap years after high school.

There is still so much to say but I'm hogging the little Internet we have. Next weekend I'm going on safari and will for sure have a post after that. Hope everyone is well in America and soaking up their summer. Oh by the way, I had a woman tell me I looked like I had lived in Africa for much longer than two weeks because I was much tanner than most "mazungos"....best compliment ever.