I worked the night shift last night. Going into work as everyone is going home feels like you are going against the natural current of things. Working at night is more spacious and tends to be a bit more mischievous. It feels like trespassing. I haven't worked nights in a long time until I arrived here. The same night work vibe materialized. Except it remains hot and well lit at the Ebola treatment center.
I have been reading enthusiastically about the drop in the number of new Ebola cases in Guinea, Liberia, and Sierra Leone but they don't dilute the individual cases we continue to see. They also stir a unique set of emotions for our national staff. Every single Sierra Leonean will tell you that Ebola has been a scourge and has shattered life here on every imaginable level. But getting a job working for an international relief agency has given them something often unattainable in Sierra Leone- a steady job. Even those with advanced degrees in engineering or business administration sat unemployed for years after the war, making ends meet with odd jobs here or there for which they were terribly overqualified. They are now drivers, warehouse managers, and security guards for our American-based non-governmental organization (IMC). And they get paid reliably and mostly on time. When Ebola is driven back to the jungle and the international disaster relief agencies start to withdraw from Sierra Leone, they will once again be entering into the pool of overqualified, underemployed folks akin to those who drive cabs in Bangladesh, sell used phones in Dakar, or work as nurses in Freetown in government hospitals that pay little and often sporadically.
Some will have a chance to go back to the work they did before Ebola with the money they have saved working for IMC. Michael, a driver who takes me in a Toyota van to work regularly, owned a small sporting goods store in town before Ebola shut him down and wonders if and when he may be able to open up again. He has a mouth that looks like it is always smiling when he talks. He drives safely but fast and looks at you when he is talking/driving. "The people here don't have any money. And when they start to get that money again, I don't think they are going to come buy footballs." The economy here will bounce back, like a deflated ball here, an inflated ball there, and likely end up where it was after the civil war and before Ebola- leaving its citizens on the bench. It is no wonder that so many of the brightest, or luckiest, or most connected, when given the chance, choose to leave Sierra Leone for the United States or Europe.
The national staff working in our organization, from Yusef, a talented sketch artist who never finished school because of the war and then Ebola, who works security at the front gate , to Isaac, who lost almost all of the elder men in his family to the war and then 4 of his cousins to Ebola, who works on the WASH team disinfecting the grounds and us, to all of the nurses who leave their children and homes to come work in our treatment center from far away, there is a lot vested in battling Ebola and a lot of uncertainty about what they will do for a living after Ebola. They endure with grace and humor. I am filled and affected by their spirit.
"We all require devotion to something more than ourselves for our lives to be endurable. Without it, we have only our desires to guide us, and they are fleeting, capricious, and insatiable. They provide, ultimately, only torment." So wrote a philosopher named Josiah Royce in 1908.
I read that quote in a book I am reading called Being Mortal.
(Now that would have been a good title for the instruction manual they forgot to give us at birth.)
Friday, January 30, 2015
Wednesday, January 28, 2015
Exchange Rate
The market in the center of Lunsar is about a thirty minute walk. We try to go early before the sun elevates and burns through the morning fog that is mixed with the burning of tree trunks and stumps. They light the bases of the uprooted trees on fire and cover them with dirt. They smolder and a pungent earth aroma leeches out from the smoke as it sifts into the fog to become one gaseous vapor. The burnt wood is cut up and sold in giant bags, covered with banana leaves, on the side of the road as a type of charcoal used in cooking. I ran by such a burning mound last night at dusk, just after a field was cleared by setting it on fire, the terrain blackened and sepulchral under a socketed sun whose exit was unceremonious from the day. This morning the heaped pile of dirt with the burning tree inside still emitted smoke as we walked by on our way to town.
We passed a boy carrying an oil drum horizontally on his head, wearing a faded red v-neck t-shirt that read "San Francisco Does it Better." Children came out to the road to greet us with the familiar "Ah-patto!!!" , "white man," in the local language, Temne. It remains irresistable for them. We wave and respond with a few greetings in Temne and they laugh at our pronunciation and tongue-tied and likely tone-deaf efforts. Jon is a family physician from Alabama whose wife was struck by lightning and killed 6 years ago. He was here visiting his daughter who was working as a missionary in a children's home in Freetown last year when he met his now fiancee. His daughter introduced them. He is a gentle soul who lives guided by his Menonite beliefs. He takes lessons in the local language a few times a week and plans on staying here for a long time, even after Ebola has receded back into the jungle. We passed by the creek where women using wash boards cleaned their clothes by force, wearing open back tank tops that exposed each muscle involved in the process. Children ran pushing inner-tubes with a stick that never lost speed. Everyone was doing something and a lot of it involved labor. We were walking with backpacks into the market to get some fruits and whatever else we could find.
First, I had to stop to exchange money with Kabia, an old Muslim man who owns a small hardware store. I have changed with him before. He pretends that he has just called the banks in Freetown to determine the daily exchange rate. I pretend to believe him. We have imputed his falling exchange rate to the fact that there are more of us exchanging money here in Lunsar. It is a matter of a few dollars and I prefer to exchange with him rather than the banks who give a much lower rate. So I exchanged one hundred dollars and walked down into the market. Women sat on wooden stools behind their mounds of salt they sell by the small cup that sits on its peak. They sit behind neatly arranged piles of dessicated fish that no doubt never imagined a condition in death so at odds with how they once lived. I push through and find the young woman I buy peanuts from laying down on a rough day bed made of bamboo. She perks up and doles out two cans of roasted peanuts and ties them in a plastic bag for me. Her smile is genuine and young. We find some fat cucumbers and knobby carrots and buy them all. Yusef, a teenager wearing a loud shiny necklace and sunglasses sells us popcorn in that insouciant teenage kind of way you could find anywhere in the world. Voices project and intermingle with the Zouk music blaring out of what looks like a 1970's Peavey amp sitting next to a cage full of chickens. The market is the lifeblood of a village and I was being transfused. We filled our backpacks with bananas, bread, and some rope for a bee box Jon had made and plans on suspending from a tree next to several log bee hives.
As we walked home, the same children yelled out to us "Ah-patto! Ah-patto," in their chirpy sweet voices, as they gathered on the hills and in the fields of their childhood, to watch us go by. The musical memory of them there, cheekbones and elbows and lips highlighted by the morning sun, I cut out to paste later into the Missalette, unedited, to face the page of Mohamed's song, their voices rising up above the smoke and fog to that space where the sky drifts in cool blue pools.
We passed a boy carrying an oil drum horizontally on his head, wearing a faded red v-neck t-shirt that read "San Francisco Does it Better." Children came out to the road to greet us with the familiar "Ah-patto!!!" , "white man," in the local language, Temne. It remains irresistable for them. We wave and respond with a few greetings in Temne and they laugh at our pronunciation and tongue-tied and likely tone-deaf efforts. Jon is a family physician from Alabama whose wife was struck by lightning and killed 6 years ago. He was here visiting his daughter who was working as a missionary in a children's home in Freetown last year when he met his now fiancee. His daughter introduced them. He is a gentle soul who lives guided by his Menonite beliefs. He takes lessons in the local language a few times a week and plans on staying here for a long time, even after Ebola has receded back into the jungle. We passed by the creek where women using wash boards cleaned their clothes by force, wearing open back tank tops that exposed each muscle involved in the process. Children ran pushing inner-tubes with a stick that never lost speed. Everyone was doing something and a lot of it involved labor. We were walking with backpacks into the market to get some fruits and whatever else we could find.
First, I had to stop to exchange money with Kabia, an old Muslim man who owns a small hardware store. I have changed with him before. He pretends that he has just called the banks in Freetown to determine the daily exchange rate. I pretend to believe him. We have imputed his falling exchange rate to the fact that there are more of us exchanging money here in Lunsar. It is a matter of a few dollars and I prefer to exchange with him rather than the banks who give a much lower rate. So I exchanged one hundred dollars and walked down into the market. Women sat on wooden stools behind their mounds of salt they sell by the small cup that sits on its peak. They sit behind neatly arranged piles of dessicated fish that no doubt never imagined a condition in death so at odds with how they once lived. I push through and find the young woman I buy peanuts from laying down on a rough day bed made of bamboo. She perks up and doles out two cans of roasted peanuts and ties them in a plastic bag for me. Her smile is genuine and young. We find some fat cucumbers and knobby carrots and buy them all. Yusef, a teenager wearing a loud shiny necklace and sunglasses sells us popcorn in that insouciant teenage kind of way you could find anywhere in the world. Voices project and intermingle with the Zouk music blaring out of what looks like a 1970's Peavey amp sitting next to a cage full of chickens. The market is the lifeblood of a village and I was being transfused. We filled our backpacks with bananas, bread, and some rope for a bee box Jon had made and plans on suspending from a tree next to several log bee hives.
As we walked home, the same children yelled out to us "Ah-patto! Ah-patto," in their chirpy sweet voices, as they gathered on the hills and in the fields of their childhood, to watch us go by. The musical memory of them there, cheekbones and elbows and lips highlighted by the morning sun, I cut out to paste later into the Missalette, unedited, to face the page of Mohamed's song, their voices rising up above the smoke and fog to that space where the sky drifts in cool blue pools.
Tuesday, January 27, 2015
Counting
We have a tendency to count things. We count up. We count down. We count how many of one thing make up a larger thing. A dozen eggs. A six-pack of beer. And we come to expect that number to remain true, a constant. And then we count repetitions. How many games have been won, or lost, in a row. We start to look for numerical patterns or sequences. We then start to collect, organize, analyze, interpret, and then present numbers. Statistics. Numbers are powerful. They can change the world for the better or for the worse. My children are counting the days until I get home, at least that is what my wife tells me. I have been counting my blessings. I count on the people who spray me with chlorine and help me in and out of my moon suit to keep me safe. Others may count on me to provide good medical care. Yesterday, I started counting the number of deaths in our center since I arrived 30 days ago. Twenty-five.
William Faulkner once said, "there are the facts, and then there is the truth." Many numbers are tracked in the Ebola epidemic here and reported out by several agencies on a daily basis. And they are put forth as facts. And we desperately want to believe them when the number of new cases is reported as dropping precipitously. But there are always other things at play. Recently, the Ministry of Health stopped paying the surveillance workers again. They are the teams that go out to the villages where cases have been documented and establish quarantines, and return to monitor individuals under quarantine for evolving sickness. If they are not working, we don't have a way of effectively getting people sent expeditiously to our treatment centers. So when they didn't get paid and didn't work, the number of cases referred to us dropped drastically. Now they are back working and we are seeing a spike in cases again. In the last two days, we have had at least 10 new patients admitted to our center.
One of the 10 patients came in yesterday. His name was Mohamed and he was 4 years old. He came in with his aunt Ramatu, who was 12 weeks pregnant, and his older sister, Hawanah, who was 8 years old. I didn't work yesterday so when I came in to make rounds on the patients today, the doctors on the shift before me gave me an update on those most critically ill. Mohamed was brought in from a quarantined house in a remote village. We took care of three women from his village who contracted Ebola during a burial ritual. They all died in our tents last week. There are two patient characteristics I don't want to see on our patient board when I come in to work. Children under five years old. And pregnant women. Death from Ebola comes in predictable and not so predictable patterns. We have yet to see children under five or pregnant women make it.
The air in our medical tent this morning reminded me of a roadside produce tent in a rural Tennessee town in the middle of August whose flaps had been rolled down during the rain. The air did not move and what air you took in seemed to have just come out of someone standing next to you. Bodies were fragrant and too close. The charge nurse admonished several of the arriving nurses for
being clamorous as they swelled around the main work table. Sweat dripped from under my arms. The heat has a way of making you irritable followed quickly by the shame of being affected by something so benign. So you drink water and center yourself. Transcend the transgression. And drink more water. You start to think about who needs what form of hydration in the treatment tents. Is Mohamed taking anything by mouth? Were you able to start an IV on him overnight? Reports are given on buckets filled up with bodily fluids. If you have ever carried a full plastic bucket of liquid patient waste to disinfect it and discard it into a dug out pit latrine, you will understand how the shifting sway of the bucket's weight steals your hope. You don't want to allow it to, but it does.
This morning I worked with a family practice doctor from Vermont named Jean. She has three children under the age of eight and spent time in Africa as a child and later as an adult. She couldn't answer "no" when she asked herself about coming to join in this fight. We finished the paperwork we needed to do, drank some more water, and put on our gear to go inside to round. Before we had even put on our hoods and aprons, there was a message from one of the nurses inside that Mohamed had died.
We started as we always do in the suspected cases tent, those with the lowest probability of having been infected with Ebola. Jean and I, perhaps through our young parenthood connection, seemed to both be taking an extra amount of time in the suspect ward. I examined a 44 year old man who looked like he had TB or AIDS or cancer, his body contracting and involuting, pulling itself inward through its' bony cage leaving only the surface skin and dying hair follicles visible amongst the bony outcroppings I put my hands on a 60 year old woman's muscular shoulder and told her everything was going to be okay as if I somehow could promise that. I found myself talking to patients about hope and faith and courage. And other not small things. We washed our hands and left the suspect tent and walked on the concrete passage to the probable ward, where Mohamed was. I stepped in the chlorine foot bath and took a deep breath.
Someone had wrapped Mohamed's body up in a colorful blanket. No part of his body was showing as he lay there in a long bundle the length of a doorway. I kneeled beside him. Jean and the nurses stood above me. I unwrapped the blanket slowly to find that beautiful boy laying on his side, his hands under his head in a final pillow. I didn't need to open up his blanket to know if he had died. I needed to open up that blanket because all children's deaths need to be felt. Not counted but felt. Each and every one of them, everywhere, every time, needs to count. I ran my hand over his head, over his tiny shoulder, and prayed without prayer before covering him back up.
We still had the confirmed tent patients to see.
It was probably not even noon.
William Faulkner once said, "there are the facts, and then there is the truth." Many numbers are tracked in the Ebola epidemic here and reported out by several agencies on a daily basis. And they are put forth as facts. And we desperately want to believe them when the number of new cases is reported as dropping precipitously. But there are always other things at play. Recently, the Ministry of Health stopped paying the surveillance workers again. They are the teams that go out to the villages where cases have been documented and establish quarantines, and return to monitor individuals under quarantine for evolving sickness. If they are not working, we don't have a way of effectively getting people sent expeditiously to our treatment centers. So when they didn't get paid and didn't work, the number of cases referred to us dropped drastically. Now they are back working and we are seeing a spike in cases again. In the last two days, we have had at least 10 new patients admitted to our center.
One of the 10 patients came in yesterday. His name was Mohamed and he was 4 years old. He came in with his aunt Ramatu, who was 12 weeks pregnant, and his older sister, Hawanah, who was 8 years old. I didn't work yesterday so when I came in to make rounds on the patients today, the doctors on the shift before me gave me an update on those most critically ill. Mohamed was brought in from a quarantined house in a remote village. We took care of three women from his village who contracted Ebola during a burial ritual. They all died in our tents last week. There are two patient characteristics I don't want to see on our patient board when I come in to work. Children under five years old. And pregnant women. Death from Ebola comes in predictable and not so predictable patterns. We have yet to see children under five or pregnant women make it.
The air in our medical tent this morning reminded me of a roadside produce tent in a rural Tennessee town in the middle of August whose flaps had been rolled down during the rain. The air did not move and what air you took in seemed to have just come out of someone standing next to you. Bodies were fragrant and too close. The charge nurse admonished several of the arriving nurses for
being clamorous as they swelled around the main work table. Sweat dripped from under my arms. The heat has a way of making you irritable followed quickly by the shame of being affected by something so benign. So you drink water and center yourself. Transcend the transgression. And drink more water. You start to think about who needs what form of hydration in the treatment tents. Is Mohamed taking anything by mouth? Were you able to start an IV on him overnight? Reports are given on buckets filled up with bodily fluids. If you have ever carried a full plastic bucket of liquid patient waste to disinfect it and discard it into a dug out pit latrine, you will understand how the shifting sway of the bucket's weight steals your hope. You don't want to allow it to, but it does.
This morning I worked with a family practice doctor from Vermont named Jean. She has three children under the age of eight and spent time in Africa as a child and later as an adult. She couldn't answer "no" when she asked herself about coming to join in this fight. We finished the paperwork we needed to do, drank some more water, and put on our gear to go inside to round. Before we had even put on our hoods and aprons, there was a message from one of the nurses inside that Mohamed had died.
We started as we always do in the suspected cases tent, those with the lowest probability of having been infected with Ebola. Jean and I, perhaps through our young parenthood connection, seemed to both be taking an extra amount of time in the suspect ward. I examined a 44 year old man who looked like he had TB or AIDS or cancer, his body contracting and involuting, pulling itself inward through its' bony cage leaving only the surface skin and dying hair follicles visible amongst the bony outcroppings I put my hands on a 60 year old woman's muscular shoulder and told her everything was going to be okay as if I somehow could promise that. I found myself talking to patients about hope and faith and courage. And other not small things. We washed our hands and left the suspect tent and walked on the concrete passage to the probable ward, where Mohamed was. I stepped in the chlorine foot bath and took a deep breath.
Someone had wrapped Mohamed's body up in a colorful blanket. No part of his body was showing as he lay there in a long bundle the length of a doorway. I kneeled beside him. Jean and the nurses stood above me. I unwrapped the blanket slowly to find that beautiful boy laying on his side, his hands under his head in a final pillow. I didn't need to open up his blanket to know if he had died. I needed to open up that blanket because all children's deaths need to be felt. Not counted but felt. Each and every one of them, everywhere, every time, needs to count. I ran my hand over his head, over his tiny shoulder, and prayed without prayer before covering him back up.
We still had the confirmed tent patients to see.
It was probably not even noon.
Sunday, January 25, 2015
The Road to the Mine, and back
Every son, to some extent, is the son of a preacher.
I have been reading a book called "Gilead," about a multi-generational family of preachers in American Civil War times and this popped into my head this morning, eyes closed still ,after I woke up. Maybe it is because I have been thinking about my parents a lot lately. It is their wedding anniversary today. Or perhaps it has to do with all the kids I have seen lose both parents to Ebola. Of course, family structure as it is here, the children will be raised by aunts, uncles, sisters,brothers, cousins and so on who live in the same village. Every parent is haunted by the thought of leaving their children behind or their children leaving this world before they do.
Some kids are born into families with little wilderness. Everything is provided. And controlled. Others are born into great wilderness. Parents are not involved for whatever reason from the start. Or part way through go missing. Or disappear during the crucial years. And then there are children who are born with the wilderness in them. I know how my parents would comment if posed this question. Tonight, I think of Kadiatu, who lost both her parents here with us to Ebola, and was placed in the Children Fund's temporary orphanage after testing negative to be watched the requisite 21 days to make sure she doesn't start showing signs of Ebola. She will go back to her village but has little family. I wonder how the wilderness quotient will play out for her.
I went for a run this morning on the road to the iron ore mine. It is a hard-packed red clay dirt road with occasional ribbed areas that are less than affectionately referred to as "washboards." The road is wide enough for two articulated dump trucks to pass easily. Iron ore is used to make pig iron and ultimately steel. It is arguably the world economy's second biggest player behind oil. Sadly, the mining company is owned by a Swedish firm. Lunsar, as a community, shows no overt signs of benefiting from this precious mineral harvest. At the end of the road there are box cars that are loaded up to be taken by rail for processing and then exportation to China I am told. The mine operates 24/7 and I can hear the lorries wheezing and rattling from my room as I lay in bed reading. I picked up a piece of rock that had an argent glaze on it that rubbed off into my hands like the glitter my daughter dusts onto glue to "spice up" her pictures. It looked pre-historic like it had been taken out of a formation that had been made by a drastic event that shook the earth to its core and was not witnessed by any higher functioning creatures besides bees. I stuck it in my pocket for my son and kept running. Up ahead I saw a man walking in his Sunday clothes carrying a machete in the way that a man in Detroit might carry an umbrella, tucked under his arm but still able to strut. A lorry downshifted to make it up a hill and coughed up a cloud of exhaust that drifted like a black veil off the road and was suspended briefly in the early morning air before diffusing. Banana tree leafs drooped with a thin, red dust that took away their waxy lustre. The industrial effluvium reminded me of running in medical school on the banks of the Kaw River in Kansas City, Kansas behind the Colgate-Palmolive factory. There was a sweet, synthetic scent to the air then. We called it the "Industrial Run." I suppose this one here on the road to the Sierra Leonean iron ore pit would qualify as an industrial run, the soot and the particulate dust sticking to my skin as if I were a lollipop dropped on a wood shop floor. But when the trucks all passed and the morning sun poured through the palm trees and the birds cawed from high up on ancient mango tree branches, I inhaled the landscape as a whole and it filled me with power and light and a transient equanimity that made who I was or where I was blissfully irrelevant.
Our psycho-social team often goes out to provide support to families who have lost loved ones to Ebola. Anna, an Australian, has spent the past four years working in South Sudan and Bangladesh in international relief work camps. She is quiet and has a sadness about her that is more than situational, almost a settled, habitual sadness. She flowers when she is working with families in that way that some people are better suited to weep with those who are suffering as opposed to those who are better suited to rejoice with those who are rejoicing. Today, I rode out with her to a village where an 18 year old girl, Hawa, contracted Ebola before being sent to our treatment center. You may recall her from an earlier entry. She was 24 weeks pregnant and believed up until her last breath that her baby was still kicking. I met her husband and all of her immediate and extended family from behind a small plastic green rope that was tied between the trees that surrounded their house in the village. To keep them as effectively as the wind, under quarantine. We talked about her death, expressed our sorrow and delivered the bereavement package donated by the World Food Programme which consists of 50 kilos of rice, a large sack of what looked like lentils, a sack of enriched corn meal, cooking oil, and some laundry soap. I brought along some crayons, pens and pencils for the kids. We reminded them to guard the death certificate that certifies that Hawa passed from Ebola as it will entitle them to certain small governmental benefits down the road. I watched the kids watch me as I watched them. They all came out of the house and stood quietly in flip-flops. Mothers in tank- tops hipped babies. Charred aluminum pots cooked cassava leaves and fish stew over open flame branches. We had come to talk about an eighteen year old pregnant woman's death and have some sense of dignified closure. When we finished we sprayed our boots with chlorinated water before getting back into our vehicle. We are so close but we are not out of the wilderness yet.
I have been reading a book called "Gilead," about a multi-generational family of preachers in American Civil War times and this popped into my head this morning, eyes closed still ,after I woke up. Maybe it is because I have been thinking about my parents a lot lately. It is their wedding anniversary today. Or perhaps it has to do with all the kids I have seen lose both parents to Ebola. Of course, family structure as it is here, the children will be raised by aunts, uncles, sisters,brothers, cousins and so on who live in the same village. Every parent is haunted by the thought of leaving their children behind or their children leaving this world before they do.
Some kids are born into families with little wilderness. Everything is provided. And controlled. Others are born into great wilderness. Parents are not involved for whatever reason from the start. Or part way through go missing. Or disappear during the crucial years. And then there are children who are born with the wilderness in them. I know how my parents would comment if posed this question. Tonight, I think of Kadiatu, who lost both her parents here with us to Ebola, and was placed in the Children Fund's temporary orphanage after testing negative to be watched the requisite 21 days to make sure she doesn't start showing signs of Ebola. She will go back to her village but has little family. I wonder how the wilderness quotient will play out for her.
I went for a run this morning on the road to the iron ore mine. It is a hard-packed red clay dirt road with occasional ribbed areas that are less than affectionately referred to as "washboards." The road is wide enough for two articulated dump trucks to pass easily. Iron ore is used to make pig iron and ultimately steel. It is arguably the world economy's second biggest player behind oil. Sadly, the mining company is owned by a Swedish firm. Lunsar, as a community, shows no overt signs of benefiting from this precious mineral harvest. At the end of the road there are box cars that are loaded up to be taken by rail for processing and then exportation to China I am told. The mine operates 24/7 and I can hear the lorries wheezing and rattling from my room as I lay in bed reading. I picked up a piece of rock that had an argent glaze on it that rubbed off into my hands like the glitter my daughter dusts onto glue to "spice up" her pictures. It looked pre-historic like it had been taken out of a formation that had been made by a drastic event that shook the earth to its core and was not witnessed by any higher functioning creatures besides bees. I stuck it in my pocket for my son and kept running. Up ahead I saw a man walking in his Sunday clothes carrying a machete in the way that a man in Detroit might carry an umbrella, tucked under his arm but still able to strut. A lorry downshifted to make it up a hill and coughed up a cloud of exhaust that drifted like a black veil off the road and was suspended briefly in the early morning air before diffusing. Banana tree leafs drooped with a thin, red dust that took away their waxy lustre. The industrial effluvium reminded me of running in medical school on the banks of the Kaw River in Kansas City, Kansas behind the Colgate-Palmolive factory. There was a sweet, synthetic scent to the air then. We called it the "Industrial Run." I suppose this one here on the road to the Sierra Leonean iron ore pit would qualify as an industrial run, the soot and the particulate dust sticking to my skin as if I were a lollipop dropped on a wood shop floor. But when the trucks all passed and the morning sun poured through the palm trees and the birds cawed from high up on ancient mango tree branches, I inhaled the landscape as a whole and it filled me with power and light and a transient equanimity that made who I was or where I was blissfully irrelevant.
Our psycho-social team often goes out to provide support to families who have lost loved ones to Ebola. Anna, an Australian, has spent the past four years working in South Sudan and Bangladesh in international relief work camps. She is quiet and has a sadness about her that is more than situational, almost a settled, habitual sadness. She flowers when she is working with families in that way that some people are better suited to weep with those who are suffering as opposed to those who are better suited to rejoice with those who are rejoicing. Today, I rode out with her to a village where an 18 year old girl, Hawa, contracted Ebola before being sent to our treatment center. You may recall her from an earlier entry. She was 24 weeks pregnant and believed up until her last breath that her baby was still kicking. I met her husband and all of her immediate and extended family from behind a small plastic green rope that was tied between the trees that surrounded their house in the village. To keep them as effectively as the wind, under quarantine. We talked about her death, expressed our sorrow and delivered the bereavement package donated by the World Food Programme which consists of 50 kilos of rice, a large sack of what looked like lentils, a sack of enriched corn meal, cooking oil, and some laundry soap. I brought along some crayons, pens and pencils for the kids. We reminded them to guard the death certificate that certifies that Hawa passed from Ebola as it will entitle them to certain small governmental benefits down the road. I watched the kids watch me as I watched them. They all came out of the house and stood quietly in flip-flops. Mothers in tank- tops hipped babies. Charred aluminum pots cooked cassava leaves and fish stew over open flame branches. We had come to talk about an eighteen year old pregnant woman's death and have some sense of dignified closure. When we finished we sprayed our boots with chlorinated water before getting back into our vehicle. We are so close but we are not out of the wilderness yet.
Saturday, January 24, 2015
For 3rd Graders Only
My daughter asked me to write a note for her that she could read to her 3rd grade class, so here goes...
Dear Jasmin and Ms. Griffin's 3rd grade class-
Hello from a country in West Africa called Sierra Leone! I had to take 3 airplanes and make 5 stops to get here.
We are 8 hours ahead of you. So if it is 12 noon in San Anselmo then it is 8 pm here. I get to see the sun rise and set before you do! We see the same moon and same stars too, but the stars are a little different. There are over 6 million people in the entire country here. That is like taking the population of San Francisco and multiplying it by 7. So it is not a very big country.
Everybody in Sierra Leone speaks a language called Krio, which sometimes sounds like English but most of the time does not. When I meet someone I will say "Aw yu du?" which means "How are you?" But there are a lot of other languages people speak here. It depends on where they were born and raised. We are living in a town called Lunsar and the people here talk Temne. When I meet someone who speaks Temne I say "Topeh moi?" which means "How are you?". Or I say "Endiray" which means "good morning." The languages sound a bit funny at first until you hear them a bunch. Then they start to sound like music and are beautiful. Jasmin, you already know one word in Temne- "Momo," which is the name of your friend in Portland, Oregon. It means "thank you" in Temne. Isn't that cool? I bet Momo doesn't even know that!!!
The people here are so nice. They teach me a bunch of things every day about their way of life. I have made a lot of friends. Sometimes you don't even need to speak the same language to talk!! The children here have not been able to go to school for almost 9 months now. That would be like all of you missing an entire year of school! Sounds fun at first, but the kids really want to go back to school. They listen to a teacher on the radio when they can so they don't forget how to spell or do math. All of the schools were shut down because of a really bad virus that can make people sick. You can get the virus, called Ebola, even by just touching someone who is sick. Can you imagine not being able to touch anyone for almost a year????
People here eat a lot of rice and fish. They also make chicken, yams, corn, plantains, egg sandwiches, and lots of other stuff like stews and greens (kind of like spinach). They drink juice and soda but mostly water. Most of the food is cooked outside on a fire. Like how we do when we go camping. People make their own houses in the village out of mud bricks and cut down trees. They are really good at it. It is always hot here so they don't need a heater. They like to sing and dance and have parties just like we do. People everywhere want love and happiness. We may have different stuff or talk different languages but we are all pretty much the same. You would like the kids here. They are creative and make up a lot of games and run a lot. They make a lot of their own toys out of sticks and recycled stuff like cans.
There are a lot of animals here. I see dogs and cats just about every day. There are goats, sheep, and chickens but not a lot of cows. I haven't seen any horses. They have chimpanzees and gorillas too but this virus has been getting them sick. We hope that this virus is finished soon because it has been a terrible thing for the country of Sierra Leone and other countries in Africa. Your daddy takes care of people sick with the virus. I have to wear a special suit that looks like a space suit so the virus can't get me. I am really safe here. But it is important to come to places like this to help people. It is like helping friends or brothers or sisters who are sick or sad. We live in one world and everyone is our sister or our brother. The more we help one another, the better the world will be.
I think you are old enough now to come with me next time to Africa Jasmin. Anyone else in your class ready to travel to Africa???? Awa-woo! (Good Bye in Temne)
Dear Jasmin and Ms. Griffin's 3rd grade class-
Hello from a country in West Africa called Sierra Leone! I had to take 3 airplanes and make 5 stops to get here.
We are 8 hours ahead of you. So if it is 12 noon in San Anselmo then it is 8 pm here. I get to see the sun rise and set before you do! We see the same moon and same stars too, but the stars are a little different. There are over 6 million people in the entire country here. That is like taking the population of San Francisco and multiplying it by 7. So it is not a very big country.
Everybody in Sierra Leone speaks a language called Krio, which sometimes sounds like English but most of the time does not. When I meet someone I will say "Aw yu du?" which means "How are you?" But there are a lot of other languages people speak here. It depends on where they were born and raised. We are living in a town called Lunsar and the people here talk Temne. When I meet someone who speaks Temne I say "Topeh moi?" which means "How are you?". Or I say "Endiray" which means "good morning." The languages sound a bit funny at first until you hear them a bunch. Then they start to sound like music and are beautiful. Jasmin, you already know one word in Temne- "Momo," which is the name of your friend in Portland, Oregon. It means "thank you" in Temne. Isn't that cool? I bet Momo doesn't even know that!!!
The people here are so nice. They teach me a bunch of things every day about their way of life. I have made a lot of friends. Sometimes you don't even need to speak the same language to talk!! The children here have not been able to go to school for almost 9 months now. That would be like all of you missing an entire year of school! Sounds fun at first, but the kids really want to go back to school. They listen to a teacher on the radio when they can so they don't forget how to spell or do math. All of the schools were shut down because of a really bad virus that can make people sick. You can get the virus, called Ebola, even by just touching someone who is sick. Can you imagine not being able to touch anyone for almost a year????
Me and a nurse called Mbalu
Two boys in front of their house
Me and another doctor with a nurse and her family
Every market here is a farmer's market
People here eat a lot of rice and fish. They also make chicken, yams, corn, plantains, egg sandwiches, and lots of other stuff like stews and greens (kind of like spinach). They drink juice and soda but mostly water. Most of the food is cooked outside on a fire. Like how we do when we go camping. People make their own houses in the village out of mud bricks and cut down trees. They are really good at it. It is always hot here so they don't need a heater. They like to sing and dance and have parties just like we do. People everywhere want love and happiness. We may have different stuff or talk different languages but we are all pretty much the same. You would like the kids here. They are creative and make up a lot of games and run a lot. They make a lot of their own toys out of sticks and recycled stuff like cans.
There are a lot of animals here. I see dogs and cats just about every day. There are goats, sheep, and chickens but not a lot of cows. I haven't seen any horses. They have chimpanzees and gorillas too but this virus has been getting them sick. We hope that this virus is finished soon because it has been a terrible thing for the country of Sierra Leone and other countries in Africa. Your daddy takes care of people sick with the virus. I have to wear a special suit that looks like a space suit so the virus can't get me. I am really safe here. But it is important to come to places like this to help people. It is like helping friends or brothers or sisters who are sick or sad. We live in one world and everyone is our sister or our brother. The more we help one another, the better the world will be.
Taking off the suit we wear
My laundry drying where I stay
Shakira
I think you are old enough now to come with me next time to Africa Jasmin. Anyone else in your class ready to travel to Africa???? Awa-woo! (Good Bye in Temne)
The Beach
Palm Tree Sunset
Friday, January 23, 2015
A Day Off Poem
A pressed hospital gown
hangs
in
the closet
like a thin white ghost.
The generator
convulses
on its concrete
platform
one final time,
goes silent.
You learn after a while
to keep the shades
drawn
and not open up
the refrigerator.
To keep it all from escaping,
Or breaking in.
Days off
are like uncapped syringes
on the confirmed ward floor.
Outside the Kenyan nurse's
room
a man takes a machete
to the ochre chaparral.
It crinkles
then slouches.
No different in death than life.
For now anyway.
It could have been different.
It could have been seared,
leaving ashen stalks
on red earth,
the memory
of black plumes
rising
from the funeral pyres
that once incinerated
the virus
and all the cloistered dreams
from amygdala
to spleen
in a pit lined with stones
too large to be called gravel.
The smell of singed hair
is back to the smell of molten plastic.
The sun turns a pallid eye,
and has been confused for a hot moon.
Acronyms form and then scatter
in what few night clouds remain
in neither holy nor unholy trinities-
WHO.
NGO.
IMC.
CDC.
APB.
IMF.
CNN.
NFL.
MLK.
DNA.
PCR.
CPR.
And
RIP
written
in
dry
erase
red
on
our
whiteboard
in
the
white
medical
tent
next
to
a
name
given
three
years
ago
hangs
in
the closet
like a thin white ghost.
The generator
convulses
on its concrete
platform
one final time,
goes silent.
You learn after a while
to keep the shades
drawn
and not open up
the refrigerator.
To keep it all from escaping,
Or breaking in.
Days off
are like uncapped syringes
on the confirmed ward floor.
Outside the Kenyan nurse's
room
a man takes a machete
to the ochre chaparral.
It crinkles
then slouches.
No different in death than life.
For now anyway.
It could have been different.
It could have been seared,
leaving ashen stalks
on red earth,
the memory
of black plumes
rising
from the funeral pyres
that once incinerated
the virus
and all the cloistered dreams
from amygdala
to spleen
in a pit lined with stones
too large to be called gravel.
The smell of singed hair
is back to the smell of molten plastic.
The sun turns a pallid eye,
and has been confused for a hot moon.
Acronyms form and then scatter
in what few night clouds remain
in neither holy nor unholy trinities-
WHO.
NGO.
IMC.
CDC.
APB.
IMF.
CNN.
NFL.
MLK.
DNA.
PCR.
CPR.
And
RIP
written
in
dry
erase
red
on
our
whiteboard
in
the
white
medical
tent
next
to
a
name
given
three
years
ago
Thursday, January 22, 2015
Routine Water
Much gets routinized here. In the month I have been here in Lunsar, I wake up around 5:30 as the roosters just over the fence outside my window give their throaty serenade to the sun gods. Contrary to my normal waking reflex, I am able to be awake here for several seconds, or sometimes longer, before making the conscious decision to open my eyes. It is like deciding when to press the "record" button. I have come to enjoy this form of waking and don't attempt to control what I think about there in my bed, in the dark, with my eyes closed. I often have the images of my children conjoined with the images of the children I have met and cared for here. I take quick survey of my body- no fever, no headache, no joint aches. Relief. It is with gratitude that I slowly open my eyes, put on my glasses, and reach for the day.
I brush my teeth with bottled water, cup and splash tap water onto my bearding face, wash my hands and put in my contacts, left always before right. I gather my black shorts and KC Royals t-shirt from the balustrade of my front patio, put them on, lace up my old sneakers and stretch. I grab a small flashlight my colleague from Sebastopol, Mary, gave me and enter the morning darkness that is just being infiltrated by the slow blush of the morning sun. And I run. In a zagging loop around the perimeter of our lodging compound. Past the garden Thomas has put in since I have been here. The rows of squash with their core yellow bugles announcing the largesse to come. Past the heaping rows of soya beans. Past the stalky teenage growth of pepper plants. I used to throw the flashlight over all of them to see if the goats got into them overnight. Now, with the goats gone, I illumine them to mark their growth and the passage of time. A few days ago Thomas showed me the well they dug in the middle of the field. A man stood at the bottom of a 30 foot reinforced well filling buckets of moist soil. Two men at the top used a pulley to hoist up bucket after bucket. All done by hand down to the water table to bring water in the dry season up to the fields. Later in the morning a farmer walks with a watering can up and down every row like a priest carrying an aspergillum to sprinkle holy water on his congregation.
I continue my run past the generator shed that rumbles and hums. I pass the garbage pile and the magpies fly off. I cross the wooden plank across the dry ditch and start another lap. Sometimes if the guards at the gate are awake, I leave the compound and run on the iron ore lorry route next to a large rice paddy field. But not all that often. I don't mind running in circles, really. I process what I am doing here by speeding up my heart rate, pulling it into my lungs, locomote, and pour it out in sweat and exhalation. Take it in, strip it down, and be sure to let it out. Time after time. Near the end of my run I turn off the flashlight. The sky fills with a soft, iridescent light that starts at the periphery of the horizon. And without knowing exactly when, the night has been relieved by the understated dawn.
I take off my running gear and hang them back on the balustrade in the same place I removed them from earlier. Sweat. Cold water swallowing. Morning ablutions. Continued sweat. And when the post shower sweat has slowed and my body has cooled, I get dressed and head down for hot Nescafe and white bread with butter and bananas for breakfast. Every day. Routine. Blessed routine.
I was on track this morning to start the day like every preceding day since I have been here. I woke, kept my eyes closed, and didn't hear the roosters. I kept my eyes closed. And then I heard the wind pick up velocity and write about it in the trees. Leaves shook, trees leaned. And then leaned back. I imagined. I opened my eyes, got up, and went to the door. Ink black. Rustling of leaves and the sense of movement in the dark. The world in dark is a foreign world of sensation. Not having to work today until the afternoon, I slept in. So the light came sooner than usual. I went through my routine and laced up my sneakers. As I stepped outside, Sharkira was not there to greet me. The air smelled of suspended moisture and mineral dampness. Something outside of the morning routine was being plotted. I began my run and before I even reached Thomas's vegetable fields, the rain began to fall. Drop after warm drop it fell onto the ground in front of me. And onto me. RAIN!!! In the middle of dry season, an unexpected early morning rain. The red, dusty road was tempered and lay now like a sheet of old red velvet cake. Rivulets of pink and brown ran downhill like a mixture of pink and chocolate milk. The rain came down in individual drops and never coalesced into sheets. It fell straight down and didn't slant. Nobody else was outside as I ran and ran under it. In it. With it. I thought of Father Garcia Viejo and the unopened missalettes in the darkened pews of San Juan de Dios. I thought of how kindness and faith can dilute even the most evil of assailants. Routines are routines and meant to be broken. For the sake of new, better routines. The squash bugle flowers filled with water, lap after lap. Soon the bees would come to drink from them, yellow on yellow. The whole earth was being baptized anew. For the first time, I knew Ebola was truly receding. And a new routine written in water awaits me.
I brush my teeth with bottled water, cup and splash tap water onto my bearding face, wash my hands and put in my contacts, left always before right. I gather my black shorts and KC Royals t-shirt from the balustrade of my front patio, put them on, lace up my old sneakers and stretch. I grab a small flashlight my colleague from Sebastopol, Mary, gave me and enter the morning darkness that is just being infiltrated by the slow blush of the morning sun. And I run. In a zagging loop around the perimeter of our lodging compound. Past the garden Thomas has put in since I have been here. The rows of squash with their core yellow bugles announcing the largesse to come. Past the heaping rows of soya beans. Past the stalky teenage growth of pepper plants. I used to throw the flashlight over all of them to see if the goats got into them overnight. Now, with the goats gone, I illumine them to mark their growth and the passage of time. A few days ago Thomas showed me the well they dug in the middle of the field. A man stood at the bottom of a 30 foot reinforced well filling buckets of moist soil. Two men at the top used a pulley to hoist up bucket after bucket. All done by hand down to the water table to bring water in the dry season up to the fields. Later in the morning a farmer walks with a watering can up and down every row like a priest carrying an aspergillum to sprinkle holy water on his congregation.
I continue my run past the generator shed that rumbles and hums. I pass the garbage pile and the magpies fly off. I cross the wooden plank across the dry ditch and start another lap. Sometimes if the guards at the gate are awake, I leave the compound and run on the iron ore lorry route next to a large rice paddy field. But not all that often. I don't mind running in circles, really. I process what I am doing here by speeding up my heart rate, pulling it into my lungs, locomote, and pour it out in sweat and exhalation. Take it in, strip it down, and be sure to let it out. Time after time. Near the end of my run I turn off the flashlight. The sky fills with a soft, iridescent light that starts at the periphery of the horizon. And without knowing exactly when, the night has been relieved by the understated dawn.
I take off my running gear and hang them back on the balustrade in the same place I removed them from earlier. Sweat. Cold water swallowing. Morning ablutions. Continued sweat. And when the post shower sweat has slowed and my body has cooled, I get dressed and head down for hot Nescafe and white bread with butter and bananas for breakfast. Every day. Routine. Blessed routine.
I was on track this morning to start the day like every preceding day since I have been here. I woke, kept my eyes closed, and didn't hear the roosters. I kept my eyes closed. And then I heard the wind pick up velocity and write about it in the trees. Leaves shook, trees leaned. And then leaned back. I imagined. I opened my eyes, got up, and went to the door. Ink black. Rustling of leaves and the sense of movement in the dark. The world in dark is a foreign world of sensation. Not having to work today until the afternoon, I slept in. So the light came sooner than usual. I went through my routine and laced up my sneakers. As I stepped outside, Sharkira was not there to greet me. The air smelled of suspended moisture and mineral dampness. Something outside of the morning routine was being plotted. I began my run and before I even reached Thomas's vegetable fields, the rain began to fall. Drop after warm drop it fell onto the ground in front of me. And onto me. RAIN!!! In the middle of dry season, an unexpected early morning rain. The red, dusty road was tempered and lay now like a sheet of old red velvet cake. Rivulets of pink and brown ran downhill like a mixture of pink and chocolate milk. The rain came down in individual drops and never coalesced into sheets. It fell straight down and didn't slant. Nobody else was outside as I ran and ran under it. In it. With it. I thought of Father Garcia Viejo and the unopened missalettes in the darkened pews of San Juan de Dios. I thought of how kindness and faith can dilute even the most evil of assailants. Routines are routines and meant to be broken. For the sake of new, better routines. The squash bugle flowers filled with water, lap after lap. Soon the bees would come to drink from them, yellow on yellow. The whole earth was being baptized anew. For the first time, I knew Ebola was truly receding. And a new routine written in water awaits me.
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