Saturday, October 12, 2013

P.S. One Final Photo.

This is signage in the Dar airport.

Friday, October 11, 2013

Oh, sure - the Zurich pics!

Happy Friday! Enjoy the pics from Zurich.

Lake Zurich, aka, Zurichsee.

Swans all over the lake.

After that long hot shower, and podcast, my meal. A 4 ounce glass of wine, a pretzel, and a salad buffet. Beets. Arugula. Apples. Peppers. And a little pasta, a little meat.

The rivers running to the lake... a city of bridges, like my own.

One rainstorm for about 45 minutes, and the rest of the time was postcard-perfect.

Famous Grossmunster Church.

I wanted to eat at every little tucked-away place. 

Middle of the city, crossing a bridge from Hallwylplatz into the financial district.

An art installation of enormous tapestries. There was a metaphor in there for me about the laundry drying in the third world providing art in the first.

Dinner. 4 dl of wine (about 13 ounces), meat, cheese, apples, tomatoes, pickles, figs, nuts.

On a boat, on Zurichsee. 

You sort of have to. It's Swiss chocolate. 

Thursday, October 10, 2013

Tanzania: Epilogue

The last night's dinner was lovely - three of us were leaving, and eleven were staying another week. The three of going said a few words to each other volunteer, and then the eleven said something to us three.

Turns out, I was appreciated mainly for being sarcastic, and funny, and calling shit "shit" when it was needed. I was also given what I think of as a blessing... told that Meggie and I are seekers, and for seekers, the journey and the experience are often the whole purpose, not the destination. I was admired for being in a marriage that "allowed" me to travel alone, to complete my heart's calling, that it was ok it was not John's heart's calling. Meggie and I were solemnly toasted as a model of a beautiful friendship, a model others said they're going to strive to emulate.

We were up in the dark Friday morning - but Mamatony was too, with a little green onion omelette and toast for our journey. This time, we drove all the way to Dar in one push - stopping only for lunch, and for more "surprise!" experiences with public toilets. (You never know what you're going to get, but I learned one thing - check the faucet first, see if there's running water. It's just good to know before you see what the stall has to offer.)

We got to Dar in the dark, and went to one of those food-court strip-mall places that you see and read about it in the developing world. Attached or near a shopping mall, they're bad food in a safe setting, they're places the middle class socializes with itself, and shows off as members of the middle class. Meggie and I had burgers - she had beef, but I wasn't quite ready to let go of the flavors of coastal Tanzania, and had a chicken tikka masala burger. I tried to get a photo of the sign across the street - we make fun in America of "any excuse for a sale" but this was pretty well on par:

(That's "Pay only 80% during Eid!" I think 20% off is smarter than pay 80%, but there must be a learning curve up to American standards of marketing.)

We stayed at the same hotel from two weeks earlier; this time, we comfortably strolled around the market area, got an ice cream, had a glass of wine at the oceanfront restaurant and felt perfectly at ease with the currency, the people, the music. This time we knew to expect a Ramadan party all night, and put in ear plugs. And oh - the shower. The long, hot shower. To be honest, I showered first, and Meggie said, "How'd it feel!?" And I said, "Just OK. That shower was getting the grime off. Tomorrow's shower will be one I can enjoy."

(Me after 6 days without even attempting a hair wash, and just a couple half-bag half-warm sun showers from the safari in Ruaha, up through the last week. My hair was so fantastically matted, I could shape it into any style.)

The next day was Saturday, and all flights leave Dar for Europe at night - so we spent the day shopping, buying trinkets and thank you gifts for our supporters, trying some candy and Saudi Arabian dates. We learned a new tradition from a volunteer... when people leave, don't wave. Don't say goodbye. Dance them off, and then you can dance them home again when they return. So we danced off the first of us to leave (she sent this ridiculous picture later, and note I am still snug as a bug in a rug in my hiking boots:)

And then we went for an early dinner. Note the Sprite - I'm considering it medicine still, at this point.

And after a long, dusty trip to the airport, after buying Cuban cigars for John at the duty-free, we got to our waiting area at the airport - where the plane was late, there were no updates announced, and only Meggie's French managed to get us an explanation from the Swiss Air steward! We took off about an hour late, first for Nairobi and then for Zurich. One last photo at the airport....

And then we slept - sort of - but flew in relative silence. The guy in front of us puked the whole flight. The woman in the aisle over had malaria and was cutting her trip short.

Arriving in Zurich, our lateness meant Meggie had to run to catch her plane to Paris. I was to have my two nights in Zurich... and realized I had no idea how to get to my hotel, where it was in the city's districts (beyond an address), or how to use public transit. We squeezed hands and I shrugged and laughed, "I 'm sure I can figure it out!" Calmest I've ever been. I mean, there were clean toilets and drinking fountains I could use. How bad could it be? Meggie provided me with a few French phrases to use, and I wandered through customs (they thought it was very odd that I was staying in Zurich under 48 hours) and then up to an information booth. I got some Swiss Francs, I brushed my teeth, and I left the airport, determined not to take a taxi but to figure out the buses and trains, to get to Hotel St. Georges on my own, and ate my very last nutrition bar. 

It took three hours to do it - and should have taken about 40 minutes - but I got there. Zurich on a Sunday morning, with the church bells vibrating my skull, and hardly a person out, with all the shops closed, was as other-wordly as a Tanzanian dirt path. My room was miraculously ready for an early check-in. I opened my third floor window. I looked out on this:

I took a long, long shower and put on a podcast of The Splendid Table. Then I headed out to see Lake Zurich with the Sunday revelers. 

It's all in the journey. 

Wednesday, October 9, 2013

Last Night in Pommern, August 1.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

I'm sitting watching the sun set, and thinking how I wanted to feel the air and see the light in Africa - would it be so different? 

Yes and no. It reminds me of remote Montana or Canada in clarity and vividness - and yet there is something different. There's a heightened sense of isolation, of danger. Like, something bad happens out here and sister, you're on your own. That gives it excitement - but a wary edginess I can't shake, no matter what time of day, no matter whether I'm outside or in the mission house. 

Maybe Maslow's layer of security makes us soft Americans, but displaying a tender heart is what Pema counsels us to have. Is poverty different in a Buddhist society? Although, things that are part of society here are not stolen - our iPods would be, but that neither the pile outside the clinic nor the bikes, bricks or lumber we see outside the Lutheran church for days are. So perhaps this is as peaceful a place - minus teachers with sticks, of course!! - as it can get. Or is it a detente of sorts? A recognition that you don't take bread out of a hungry man's mouth, even you're starving too - even if you're starving more. 

I've also been thinking today, after the clinic experience, about my possessions - things here, like the little nail clippers I brought and just used, that work so perfectly for their one exact use - and things awaiting me at home, like the exact right clothing for a mood, for the weather, for a celebration or mourning at hand. And people told me, and I expected, to think of my possessions with awe at how much, too much, I have. But you know what? I don't think that.

I think... I'm so grateful to have what I do, and I have long been trying to value it all by only keeping things I love. I already work to implement rules. No continuing to wear something I don't feel great in. No more decor pieces I used to like, or was given as a gift and I feel too guilty to give to Salvation Army. No extras - we currently have only one set of sheets, a half dozen towels, no good china (just one set of dishes I like and use daily), no more clothes than can all fit into my closet at any one, single time (a full ban on seasonal wear that cycles in and out of storage!). 

So I look around here at people who own so little and I don't feel guilty for what I have because I'm not unconscious about it. It's not wrong to possess an item because it brings joy or beauty or function or ease to my life. It is wrong, maybe, to possess an item I don't use, like, or enjoy. 

So it hits me. I expected to discover totally new things on this trip - new realizations, thoughts, conclusions about human nature and history and spiritual life, revelations about the rest of my own life! But - that has - I think - universally not occurred.

Instead, all the revelations - the aha moments - and experiences and ideas here are connected to current ones. I see the through-lines of my own growth and spiritual maturation. What brought me here continues to be experienced here, and will continue when I get home. Everywhere I go, there I am. There's nothing new under the sun, or even inside me. All of the learning, here, is part of what I already wanted out of life, what I already seek - giving up control in order to be freer, calmer, more loving and compassionate and kind. Giving up rigidity in order to experience joy and surprise, to be present in the moment with gratitude. And, I sigh as I write this. It's so fucking hard. 

I stop short here of saying "be happier" though because I don't pursue happiness, as a general rule. I don't use happiness as a yardstick to measure much of anything. I use novelty, excitement, especially accomplishment and completion, to judge success. When those line up, happiness probably follows. But I'm a terrible judge of putting happiness first - usually, I end up overeating, over drinking, oversleeping or oversharing, and the thing that was supposed to make me happy makes me bloated, tired, embarrassed or hung over. 

Far better to use the other yardsticks, and far better to keep a continued, and ever-honed, sharp eye on my possessions as a tool to ensure this feeling of value, appreciation... real gratitude even in material things... is not at all out of place. 

Tuesday, October 8, 2013

August 1: Last full day in Pommern.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

It's CTC day - and through Meggie's excellent manipulative conversation skill with Edward, she's gotten me out and about, assigned alone to the Clinic, and herself over to the primary school - where she has wanted to volunteer since we arrived. 

CTC means Counseling and Test Centres - the HIV/AIDS clinic that serves seven villages, including Pommern. My energy is too low to do justice in describing the inefficiency with which 62 AIDS patients were seen today, at this monthly clinic. It is actually every Thursday, but each patient is on a monthly rotation - first Thursday, second Thursday, etc. They get ARVs or other drugs. And it wasn't the plain, pitiable, understandable inefficiency of no shelves, drawers, computerized lists of patients, or drug inventory. It went far beyond that and I want to do it justice when I have the patience to walk through it in each excruciating detail. 

After a long morning of work, and a late lunch, Meggie and I said our goodbyes to the tech and athletics team at the secondary school, who made Zumba possible, Adrian and Flavian. And then to Nurse Patricia. Meggie's totally hellish morning in the primary school has moved her to an interesting place - from guilt or pity to frustration that people are not helping themselves. I remember my brother being there, then in another phase of compassion, and finally he moved into a sort of Zen acceptance. Acceptance by attrition, maybe!

To try to do this description justice... first you have to imagine a cold morning, and the cement clinic. People "line up" to be "checked in". I use quotes because they sort of stand or sit around, near the door to the children's ward - no kids here today, so apparently it will be the CTC clinic. Every person has already waited outside on the far side of the clinic - the shaded, coldest area - to be tested (I can't see this happening; is it a blood test? A weight on the scale? Something else?) and given a number on a scrap of paper. Then they mill over to the yard in the sunshine, in front of the children's ward, where I sit at a table with another huge bound book in front of me. 

The nurses bark, "Next! Next!" and snap fingers at each patient to hand over their CTC card. They shuffle in, sit down, hand the nurse their card and slip of paper. (Or they don't, appearing as if they've never done this before. The nurse snaps for the scrap of paper, then, too.) A CTC card is a battered piece of card stock bearing their name, village, CTC number (it's a national registry) and instructions on when their clinic meets (what week of the month, what location).

This second line I'm helping with is to create a hard copy record of who showed up today, and whether they'll be getting ARVs or not. So I write their CTC number down, reading it from the card, and then the nurse tells me their village and their age, to fill in the next two lines. The age is asked for (why is it not on the CTC card!?) and if the person does not know, it is guessed at. Then their mystery number is written down and by science I don't understand, I'm told whether to check "ARV" or "No ARV" on the sheet of paper. 

The person is sent out, back into the yard, to mill around in a large group. No order is kept. 

We get through all 62, recorded in the book - the youngest patient is 9, the oldest is 72 - and most are female. The average patient is a woman in her 30s or 40s.

The young man diagnosed on Monday, in front of me and Meggie? He was in the line.

Then, everyone - the nurses, me, all the CTC patients - are herded to the very front part of the clinic yard. We spread out on the ground and on the few benches, sitting just in front of all the junk that's been mysterious to me since we arrived (rusted bed frames, broken old-fashioned wheelchairs, rotted boards, smashed bookshelves), not just for the content, but also because I look at it every day and wonder, in a village with so little, what is the social contract that prevents any item from being stolen? These are not useful wheelchairs or good boards - but surely someone could repurpose them and get great value. However, that sort of theft seems to be neither considered nor allowed; the village rules are clear and illustrated to me, if definitely unspoken.

What we attend, I start to understand, is a lecture on the importance of treating HIV and AIDS. Taking medicine, getting partners and family members tested, and then the longest segment on how it is possible to give birth AND breastfeed, without passing the disease to the baby. There is a young mother, who has AIDS, nursing her baby, and she seems to be telling everyone the baby is regularly tested but is negative, since she is taking her drugs and taking care of herself (she mimes eating food). The lecturers are Nurse Nema and Doctor Elton - and it's not fair that I am hard on Dr. Elton; I mean, yes, he's a dentist, and so that's an easy thing to point at and tease - but he's probably had enough clinical experience to push himself right into internal medicine, right?! 

The lecture is about 30 minutes long - and I'm glad for a seated break, I won't lie. Plus the sunshine warming me a little; it is another cold morning (though the sun is back out today, after being hidden by clouds and drizzle for both days I was home sick). 

Then, all the patients form another half-assed line, and I go back into the children's ward with the nurses. We sit at a table with boxes of drugs, and each person comes in with an old pill bottle. They show the kind they've been taking for a month, and are given a new bottle of the same kind. They also might have a scrap of paper with other prescriptions written on them - usually antibiotics, ibuprofen. 

The people getting ARVs are shit out of luck today; there are none. I'm told the government didn't supply them. No nurse appears to explain whether they should come back next week, out of their usual rotation, or what they should do for a month, being out of pills and all. In my head, I'm screaming, "Of course there is a contingent of Africans who think AIDS drugs don't work and that Americans and Brits are just poisoning their minds! The drugs DON'T work if you don't take them properly!"

A couple people don't have their old pill bottles anymore. We spend 15 or 20 minutes trying to decide what to do. We have to give them what they are used to taking - how can we possibly know if they don't have the old bottle, nor can remember? (There are two choices, friends, of pills to take. Two.)

Nurse Patricia leaves for 20 minutes by my count, with no reason, and comes back so we can pick up again with distributing. While she was out, the other nurses chatted on their phones. The line just stopped outside our door. Meggie said later she saw Patricia having a Coke and a snack at the little coke stand. 

These other drugs are available, for those not getting ARVs - getting what I think is a simpler protease inhibitor combination pill. And hey, they don't send the CTC ARV patients away empty handed... they all get vitamin B12 pills! That'll cure your AIDS.

Charting & Pill Dispensing:

I stay at the Clinic until about 1:30 PM. So in 5 hours, we've made people line up three times. Once to get their number determining ARVs or no. Another time to get registered at attending the clinic, in the big useless book. Then they attend a lecture - and all I can think is, is this something required by USAID or the Tanzanian government, and is the same lecture every week? - and we've made them line up AGAIN to get handed the right pills. When I leave, 9 of the 62 have their pills. It takes until about 4 PM to get all 62 through the lines and process here.

It appears as if this is the first time such a clinic has happened - and we know that's not true. We know this happens Every Single Thursday

Why line up three times? Why not see one patient at a time? Why not have pills counted out in a 30-day's supply, instead of waiting to count them out for each person? Why ask their age each time - why not ask them to be ready to supply it? Why record the check-in process in one large useless book, and then record who gets what drugs in a SECOND large useless book? 

And the best part? The second book records only what was prescribed. ARVs? Check. They were prescribed. The fact that they're not fucking available is not recorded anywhere. Check the books, and all looks well. This is Tanzania. 

So - I'm writing this so long after the actual day, I know I've forgotten some details of all the other tiny inefficiencies I witnessed. And as frustrating as it was - and, oh, lordy, it was! - in the middle of it, I sat there, patiently, for hours, waiting for bursts of activity, waiting to be told to record certain data, and generally not trying or wanting to tell anyone what to do. I just took it all in, and with the exception on the one mental scream above, I felt useful in recording the data - because it was something. It was freeing up a nurse's set of hands to actually chat with patients, and touch their shoulders, and look into their eyes. But for me to not want to tell someone what to do, how to do it faster, better, more efficiently... well, that's basically an African miracle! 

Monday, October 7, 2013

July 31 in Pommern.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

At breakfast, Edward tells me I'm not allowed to work today. "One more day to rest. You don't leave the mission house this morning."

I'm so disappointed. To lose a second day!? Nearly my last?! But within thirty minutes of breakfast - one plain slice of bread (so oddly sweet, I need some sourdough up in here!) and 1/3 of a banana - I find I'm ready for a nap. So perhaps Edward knows best - and perhaps he's been through this before with a previous volunteer (ha, ha, ha - that's a joke; I know he has).

So today I find stillness, whether I want it or not. And it ends up a very powerful day, connecting with fellow volunteers. 

We're finally discussing openly our frustrations with African time versus American time, and our complete inability to understand how teachers can fail to show up for class, say, as happened today - there was a prominent death in the village. Then everything stopped. And so students go without teachers and lessons, while Nurse Patricia is in a fog (tells Meggie, who has been there yesterday and today without me) and can barely work. Most volunteers were sent back to the mission house. Everyone is feeling useless. 

Rather than find this stoppage an admirable sense of community, we volunteers are mystified and frustrated. You can't stop everything, every time a person dies! Or can you?

Oh, and on another note, Dr. Elton leaves a line of eight sick patients while he watches a tree being cut down, using a rarity here - a chainsaw. It seems that every, and any, interested person has the right to be involved in any decision or event - and so we have a village, region and country possibly incapable of making forward progress. Every voice is heard, maybe, but also everyone who wants to stop working to watch how cool it is to see a tree get cut down can take a break. A break, a break, a break.

I believe in Maslow's Hierarchy of Needs and we get into a group discussion meandering around it. Is there true happiness without emotional knowledge of the full self, and are we here to help, to hurt, to be neutral observers? Can we forge personal connections with villagers when the need to manipulate us is so great? (And so justified.) 

We asked each other if we'll try another Global Volunteers trip - yes's and undecided's. 

We discussed how this is called a volunteer vacation, or voluntourism, and can that phrase take a little pressure off (of, ahem, me)? Did white, Western colonialism create a culture of dependence - and are we reaping what we've sown? 

And then my great revelation - in which I realize, truly, for the first time, that for all the talk of global natural resources and the water wars we're sure to see - only one thing seems certain to me; we in the West aren't going without our hot showers to help anyone here. We'll absolutely let them die, and the clean water and availability of oil will winnow down to being available only over America eventually, and probably zoom right down on D.C. as the last place with modern comforts. 

I didn't write this to be heartless - or inflammatory - or because I think it's OK to let people die so we can have hot showers, cars, plastic baggies in our lunch everyday. I wrote it because it smacked me hard as truth. We will absolutely watch people die if it means we get to keep our Stuff. If it means we have to give up a lot, including the comfort we're used to, for them to live lives we don't understand and don't respect, I just don't think we're gonna do it. One of the problems a volunteer wants to solve here is to get the children to eat with a spoon, not their fingers. Porridge is wasted, it's messy and dirty, she argued. Tell me we're going to give up life as we know it for them? 

In the afternoon, I convinced Edward I was feeling recovered fully, and that I was ok to go to Zumba with Meggie - her last class, and my last chance to see the high-school girls. I promise I won't dance - I've been sick, I need to rest, I know. I'll watch. Lies! All lies. I dance one song, and that's where all the YouTube videos previously posted are from - not exactly in my best form dance-wise, and it sure tuckered me out - but it felt great to get my blood flowing a bit, to dance with the girls, to watch Meggie leading them in total joy and confidence. 

Tonight Edward gives a little lecture on Tanzanian migration patterns (of the Bantu and Masai, largely, and some Indian and Arabic), and then on modern society here. Of course the most interesting part if the Q&A - yes, polygamy is common. Yes, the 1964-65 history of integrated education, that sent people all over the country to school, to learn Swahili, broke tribal loyalties and thus has prevented civil war. Yes, men here think American women are funny - they hear in our country we talk more than men. How can that be?! Men do the talking! And that women in America expect to do all the same things as men - they get it in concept, but really can't picture it.

Tomorrow: hopefully I get to go back to work!

Sunday, October 6, 2013

July 30: Recovery in Pommern.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

My day of rest. I sleep deeply for most of it - with a few little breaks, starting with chamomile tea (oh, blessings on the volunteer who brought it!), dry toast and the other two oh-my-god-I-am-beyond-glad-I-brought-it chicken noodle soup packets.

Today is the first cloudy day we've had in Pommern, and I can feel a rainy day restlessness set in - I wake off and on to hear the kids constantly nitpicking, arguing, sticking things in the fire - and then getting yelled at for it. Joann has come down with a terrible cold - later I learn she is 74!  I get up at one point to brush my teeth and it's enough effort to prompt a nap. I obsess all day, at any point I wake up, about the need to feel better soon - now - faster - there's only tomorrow and Thursday left! We leave Friday for Dar. Saturday night we fly away.

I read a little bit, finally finishing up with Paul, and I am happy to be done with him. At least I like when he says, "The best writers are scrupulous and pitiless observers." I've long known that "not much gets past me" but it is nice to hear Paul speak of that as a common trait among the writerly species.

The smell of cooking fires has already been a little gross to me - and today I can't take it. The smoke drifting in, and the oil I experience as rancid-smelling, though it's probably not - there were fried doughnuts for breakfast, more greens stewed in it for lunch. I've moved back into my little solo room which is great - but it is also closest to the cement-room kitchen, where cooking is half inside and half in the backyard. I think of Kimi and Bradley, and how tired of oil they are after two months in India each time, something I couldn't truly understand before - and now I can't imagine more of this, much less another six weeks. Every wafting wave of smoke or oil turns my stomach.

Mamatony brings in some mandazi at one point. "Eat! You need to eat." I want to scream at her - get that oil-soaked dough out of my face! I say, "Oh, no, Mamatony, I'm ok."

"No, no, you need strength. Eat - eat." She pushes it at me. I point at my dry toast and tell her I'm starting with that and soup. She looks at my powered soup very skeptically. I tell her that American stomachs always heal with that kind of soup, and I promise I will eat her food when I feel a little stronger, but I need to start here.

Marie gets me a Sprite from the little pop stand up the dirt road, and it is the best thing I've ever tasted. (She gets me a Coke too; also freaking delicious.) I manage to get up for dinner - a feat! - and thank god Mamatony has included plain white rice on the menu tonight. Although nothing is really plain - there's some margarine or cooking oil in this, I can feel a little sheen. I can't stop thinking about Shelly's Vegan Wrap from Elephants Deli in Portland - something tart and vinegary, with sweet grapes and crunchy apples. I lean against the wall during dinner and am happy to get back to bed - with high hopes for tomorrow.

And because if you're my mother, or happen to be someone else who is wondering... no, I didn't attempt a sun shower. So I've been lying in the same outfit, with the same dried sweat, since 4 PM on Monday, and it's now 9 PM on Tuesday, and I'm just going to ride it out until tomorrow.

Saturday, October 5, 2013

July 29 into 30: A long Pommern night.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

I think of John forcing me to drink water the last time I had food poisoning - so I try hard to be my own pusher, and keep hydrated. I spent the day at that clinic. I'm not putting myself in a position to have to go there!

Hour on the hour, I'm up - and it is worse each time, more violent. I may never eat peanut butter again after the taste of those noodles and weird sauce coming back up. Everyone is so thoughtful but I besieged by anxiety. How long will this last?

I don't want to be alone, and Meggie is the best nurse - we move rooms to be in one vacated by Peg and Nancy. Their room has a bathroom! Meggie puts on some music for me (precious battery life on the iPhone), gets me an extra blanket - I'm freezing - and half a case of water bottles. I want music with no words, and she makes me chuckle - the piano music she has is from an album called Dark Night of the Soul.

At one point I say, "Meggie, some day this is going to be a funny story."

The generator lights go out - must be around 10 PM - and thus I'm on the hourly puke-and-shit round. I've been able to do one, then the other, but can feel myself losing strength to walk very far, strength to carry my bucket in with me. (Thank god Meggie got me a bucket - I was so sure I wouldn't need it...)

Fluffing up a famous quote, our family friend Dennis is known for saying, "It's always darkest before it goes completely fucking black."

I sit on the throne. I am going to have just enough time to turn and flush before I have to vomit.

Pull. Pull on the chain. Pull on the chain again. Stuck, stuck. No movement. Nothing. "Meggie! Meggie!" I shout, as I realize it. "There's no water!"

"It's ok then, it'll be back on in the morning."

And standing there I look at the shower drain hole in the floor, and the unflushed toilet. Gotta do it. And so I vomit into the bowl, filling it further - a classic scream-puke, if you're familiar (second definition at that link). I'm also crying, just to add another liquid-shedding bodily function to the mess, and I stumble back to the bed - I've given up on fiddling with the mosquito net, and am just leaving it up, so let's hope that puking up the malarone is not putting me at any risk.

I'm out of breath and lay there, panting, sweating. Meggie has left - to get Joe, it turns out. He brings an unused half-bag sun shower; the water is cold now and he's going to fill the toilet tank with it (I unknowingly used the last flush an hour ago).

"Oh no, no, don't look in there," I half-call out.

"Oh, please. I'm a veterinarian," he says. "And I have four kids," he adds as he lifts the toilet seat. "Eh! It's nothing." Later I think that he looked to be sure there was nothing dangerous going on - blood or anything - since he's the closest thing we have to a doctor. I mean - it's him or Dr. Elton, the dentist at the clinic!

He fills the tank, flushes, fills it again, and comes out. "OK, you've got one more good flush in there for a bit. Need anything?" I sort of moan. Meggie tells him we're alright.

Eventually the two bodily functions merge into one, and I have to hold the bucket on my lap, and then dump it into the shower drain or toilet after using the throne - the bucket contains such clear liquid it looks like water you could drink. There is literally nothing left in me.

When I come shuffling back to bed again, and lay down, Meggie is hovering above me. "Here, drink some water!" She looks anxious. I'm out of breath from the sheer act of full expulsion and gasp, "Just give me a second!" I have to catch my breath before I can drink water - with that awful knowledge that I am providing my body with exactly what is going to be coming back up again, so painfully, soon.

A little while later, the water comes back on.

At about 1 AM, I awake but am able to ride out the urges, and I fall into something a little like sleep, a little like passing out.

Monday, September 30, 2013

Apologies. Promises.

Funny thing... writing about getting sick? Got me sick, I think! I know I owe you the story - and the end of it all, as we're in the home stretch, only about 5 more posts after that! But thanks for your patience just a little longer. I'll get it wrapped up soon, I promise.

In the meantime, the way you show a promise in Tanzania? Not with a hand up, like we might, as if swearing on a Bible, nor with a cross-my-heart-and-hope-to-die gesture like we did as children.

Instead, you draw your index finger across your throat, an exact imitation of the gangster-movie threat gesture, but faster - and then end it with a snap as your hand flies out past your neck, and back down to your side. THAT caught our attention! And it's a helluva way to say you promise!

Wednesday, September 25, 2013

Just Pictures.

Oh, we'll get to the sickness story! But a few photos I forgot to post first. Below, with Emmanuel in the safari jeep - only 18! But so mature and thoughtful, and how I hope he does get to South Africa to train to be a chef, and make his dreams come true.

Where there's no copyright, there's Obama everywhere. Yes we can chew strawberry gum, my friends! 

Everywhere, everywhere, everywhere. Women carrying the stuff of life - water, food, and firewood.

And an amazing baobab:

Tuesday, September 24, 2013

July 29, A Pommern Monday. Part 4.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

The feeling of being in the right place, at the right time, lasts all day. There were two more working events. First, a clothes-sizing and second, the latrine again. The clothes-sizing was for the 13 orphans at the other primary school (not the one near the mission house, where our fellow volunteers have been working).

I have visceral trouble, coming from the land of 25-cent BINS at Goodwill and corner sidewalk FREE BOXes and even piles of clothes strewn near homeless encampments, with this first task. How can I understand the importance of two pieces of clothing per child? We're told many of these orphans have one single outfit. These orphans live with grandparents or aunts, and a shirt might be 1,000Tsh, Edward says. It might take a month to save that up, after buying food and cooking oil and fuel and matches and salt.

So Meggie, Marie and I slapdash our way through the kid's clothes Marie tossed in a suitcase back in New York (and some very small adult clothes chipped in from the rest of us).

We hold things up to each child, lined up by size, erring on the side of "too big" so they can grow into it. I'm able to give one of the big girls, maybe 12 or 13, a training bra - a thin, grey, shelf bra, a castoff of the girls in our volunteer family, and as much as she'll let herself express emotion, her eyes light up at it.

This is also the nicer part of Pommern, I'm shocked to discover. The school grounds are really quite pretty, the homes are neater, all the grounds are kept up, fences are more common. The school was built by the Roman Catholics, and there's a big difference between it (below, in the background) and the buildings built by Global Volunteers. Interesting to find out we're in the poorer section of a poor village. And I resist making jokes about things Catholics build versus things Lutherans build.

(After giving away clothes:)

For some reason, I like the picture below of us talking after giving away the clothes; it shows the intensity of conversation among volunteers the whole two weeks. Experiencing, analyzing, discussing, stretching - a lot. Beyond comfort. 

And I wrap up the day's work with a couple hours back on the latrine - and how much progress we've made! I also find out that Thomas and Moses call me The Commander. They're busted by a bilingual person who tells me this at the construction site, and I turn to them in mock insult, eyes wide and mouth open in shock. Then I laugh and they laugh, and Moses says, "Commander njema!" But our bilingual companion says, "Oh no, not true! When you walked up they said, 'Oh no! The Commander is back and now we'll die!" And here I thought I was working slow and matching their pace. Apparently, as my pal at home Mikey says, I've been mushing their butts uphill! 

As we're wrapping up, as the mortar is running out, around 4 PM, I start to feel - a little  - off. 

I walk slowly back to the mission house alone. I hope it's that I didn't drink very much today, or that I pounded my lunch of peanut-butter-sauce-with-local-cabbage over noodles (yes, it was that weird). Maybe it's the smell of the latrine, especially pungent today. 

I come home. I pound some water. I take a half-bag-shower and then absolutely MUST lie down. I'll feel better if I just rest through this terrible weighted feeling.

I get up a couple hours later for dinner, which I don't really want to do. I take only a slice of papaya - papaya!  Good for the digestion, too, right?! And I heat up a cup of the powdered chicken noodle soup I brought from home. The packing list recommended soup packets for "homesick tastebuds" and though I was sure that would never be me, I said to John, "If someone gets sick, wouldn't it be nice to give them chicken noodle soup? I'm bringing four of these."

I have to leave dinner early and lie down.

And at 7 PM, it begins. Truly violent vomiting and top-of-the-line diarrhea.

Monday, September 23, 2013

July 29, A Pommern Monday. Part 3.

Not written in my journal, but a couple quick stories. First, stool samples. Meggie and I did not witness one. We saw the slides, and we saw the specimens. They keep a couple formaldehyde jars of examples, either to impress visitors or to illustrate to parents the importance of treatment - or both.

Also, when urinalysis was ordered by the doctor, the man or woman had to give a sample. And what are you given to collect your urine in? A now-empty insulin jar. As pictured above (small ones on the left) with worms in it. Think of the size of the opening on those little jars. Have fun peeing in that! Oh and I'm sure hands get washed...

Also during our day, one of our cases negative for malaria, negative for typhoid fever, was an old woman - oh, probably about 300 years old. To my eyes. Her grandson was with her and he was in his late teens, so that would make her in her 70s at the oldest - if he were the youngest child of her youngest child.

The woman was asked to give a stool sample and when she left, Patricia engaged in a long conversation with her grandson. As an observer with no language, I relied on body language and tone of voice. It appeared like she was lecturing him. He didn't want to argue with her, he maybe even knew she was right, and he felt ashamed, but stuck. She showed him a Bible passage. Once he left the room, she explained to me. "He has completed his secondary school and it is time for him to go teach. To go away to a new place and to have a job. But every time he has made plans and found somewhere to work, she gets very sick. But no tests come back. Sick with what? Sick to keep him home? I tell him he needs to go; he cannot cancel again his plans and his life. Again and again."

Nurse Patricia:

The rules:

Sunday, September 22, 2013

July 29, A Pommern Monday. Part 2.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

After cleaning, I move into the pharmacy with Patricia. The "pharmacy" consists of a rickety, mostly-empty shelf of cough syrup, OTC pain meds and antibiotics.

After seeing Dr. Elton, patients bring a scrap of notebook paper to the dispensary window - most today were for tooth pain or an abscess (some oral, some not); 18 aspirin and 30 cipro is the common scrip.

Patricia tells me we're to make "a Chinese envelope" out of old homework paper for each pill type - because there are no envelopes, plastic or paper, in which to give you your pills. She explains, "We say things are Chinese when they are badly made," and I lean in and tell her, "We say that in America too." She laughs and laughs, and she loves that my mother's name is Patricia too - she calls me her mtoto, her child, for this week, and tells the other nurses they can call her Mamaemmy. (I've shortened my introduced name to Emmy, with an exaggerated pronunciation like Ay-Me, as Emily is just too hard to wrap around for Swahili mouths.) The other nurses laugh at her.

Finally we move into the lab, as tests have started being ordered. It seems like people are tested for one or more of: malaria, typhoid fever, HIV/AIDS, a baseline urinalysis, a stool sample. No other possible diagnoses are discussed. We don't see any malaria; we see one typhoid fever. The tests are all prepackaged single-use, but the procedure is, simply observed and without frustration or surprise to me, just totally horrifying.

Sometimes alcohol swabs are used to clean the inner elbow site where blood is drawn - sometimes not. A new prepackaged syringe and needle is used to draw blood each time but there's no hand washing in between (there's no sink with running water in the lab, only the common one just outside the door in the public waiting room), and the drawing of blood is probably done with a skill level that I'd have after a few weeks of training. 2, 3, maybe 5 stabs with the needle into each patients arm. A little digging around to find the vein. The blood comes out slowly, thickly.

A glove serves as the tourniquet first, and then as the sterile surface to place the test and blood-filled syringe on (see the background of the above photo). Sometimes multiple blood draws are taken, put on their glove, and only then is each test run. No tests got switched around - I think - but you can imagine the potential for a blood vial to get moved, and then recorded in the little blue-book-like health record of the wrong patient. Oh, those blue books. Talk about taking charge of your health care!

It's a little terrifying to be allowed to help with this, though all I'm doing is dropping blood into a small plastic hole and adding the right solution to start the test...

Meggie wears gloves. She is smarter than me. 

This is a close-up of a malaria test, sitting on top of the blue-book health record. If that was your health record, you'd keep it with you for each doctor visit. The "back up" record kept at the clinic is a giant bound book with lists of patient names, estimated ages, date of the test and results. So unless you know what day you came for a test, there's no way the clinic records are going to be helpful. Lesson? Don't lose your blue book! 

Drop-drop-drop the solution on top of the blood sample.

Multiple tests to get going; we wait two minutes by Patricia's watch for results. Who has malaria? Who has typhoid fever? I keep thinking, what if you have cancer? What if you're depressed? What if it's Chrone's Disease or fibromyalgia? What if you've developed an allergy or esophageal damaging reflux or a urinary tract infection? 

Basically if it doesn't show up on these few tests and it's not enough describable pain for a knock-ya-out course of Ciproflaxin, then it's probably not a disease recognized in Africa. Or not in Pommern, at any rate.

The four tests we take sit out, on the gloves, on a table also strewn with empty packaging, dried alcohol swabs, partial bottles of the processing solution. The disorganization, the mess - these are not too shocking. The trash can, however, is. I don't think they've heard of sharps containers.

It all goes into the same place - blood, needles, you name it.

Then a young man, who says he is 27 and has only a primary school education recorded in his blue book, has a malaria test come back negative. He's been feeling unwell for a little over a year and was referred here by another clinic in the nearby village for this set of tests. The AIDS set of tests. With fascination and horror, Meggie and I watch Patricia get a first-test positive. SOmetimes these aer wrong though, so she puts the rest of his blood in to the second one. Count down two minutes, and watch the lines appear. Positive.

Normally the doctor delivers this news but if he is really busy, Patricia does. Which, HIPAA concepts be damned, she does with Meggie and me in the room. 

I have the same reaction as when the students were being beaten - I try to become physically small, I look at the floor and refuse to make eye contact or be seen as a voyeur; I won't watch. I breathe quietly. I think, I want him to forget I'm here. Patricia speaks calmly in Swahili. She sounds straightforward and unemotional; she doesn't touch him or appear to give words of comfort. Just the facts, ma'am. She asks often, "Sawa? Sawa?" which is, "OK? OK?". He nearly whispers in response. Sawa." She gives him a CTC information notice; that's the once-a-week AIDS clinic on Thursdays here. I think, there's no way this guy is showing up again later in the week. 

Blood draws. Single use test kits. Recording the results in patient blue books, and again in the clinic ledger. Using our own pens - no one at the clinic can ever seem to find one. Rinse and repeat. How long would this relatively simple work take Patricia if we weren't here helping? At her pace, it seems like we're cutting the time by half, helping the patients move twice as fast through the line. And it finally feels like I am being useful. I'm supporting existing work and not supplanting existing knowledge. Just a pair o' hands here. And this is exactly what I wanted to do in Africa: pitch in, not harm, experience life as it is before I was here and will be after I go, among the poorest on the planet, as one of the richest.

Thursday, September 19, 2013

July 29, A Pommern Monday. Part 1.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

If there was only one day to journal about in Africa, this would be it, hands down. I'm writing late on the 30th and you'll see why. This is going to stretch over a few blog posts, partly to prevent an epically long post that only my parents would fully read! Meggie and I were assigned to the clinic today - the first volunteers, yet again, to take on an assignment. Somebody sure trusts us.

After Dr. Elton, a dentist and also the presiding medical officer in the village (actually, in the whole area - this clinic serves seven villages and he's in charge) introduced us to the three nurses - Nema, Patricia and Farajah - I learned from my past eagerness in the secondary school, and instead sat on the bench to wait for an assignment. When Patricia began to mop, Meggie and I jumped up to do it for her. Something we can do!

I mopped the laboratory, the children's ward, the IUD insertion and sterilization room, and the delivery room. (Sterilizing of materials, not people. As far as I could tell.) It was amazing that last week, on our first day, during the brief clinic tour as part of village orientation, I was horrified at the filthy conditions. Too-small sheets on rusted frame beds with mattresses about 2 inches thick. Peeling paint. Pitted cement floors, windows so covered in red Pommern dust you can't see outside. A stained, torn and dirty curtain over the window, if you're lucky. Chipped metal bedpans back from well into the last century. Side tables with the tops smashed in but nothing to replace them, chairs missing armrests. But then...

This is where your baby is weighed and checked, immediately after delivery:

Ladies room...


Inside the men's ward...

Need an IUD? There are instructions on the wall, so don't worry. And this is the room speculums are sterilized in too (in something that looks a lot like the cooking pots, to be honest). But it smells like the Piniest Pine Sol ever.

For the gents...

This pretty room is the maternity ward, where you'll labor and recover (though to deliver, you'll be moved - only two beds, not four, in there.

Ladies' ward...

Meggie making beds.

... after I straightened everything to my beloved right angles, and tucked in corners, and mopped it carefully with the most intense-smelling disinfectant yet (and that's saying something!), I look around and think, hey! This is pretty clean! It looks decent! Ah, satisfaction.

Just like coming through Iringa Town the second time yesterday, after being in mud-hut rural villages, I thought, yeah, this is pretty modern. Fairly organized. I'd rather live here than in a hut, I see why people come to live in towns and cities. I would too.

If in only a week my perspective can shift that much, what will a second week bring? And how those Peace Corps or State Department folks must feel after two or three years away? Unimaginable. Though I can try. What else is being a writer about?