Two weeks after the two weeks.

Oh, the two weeks were glorious. The things I dined upon! Pizza, breadsticks, ice cream, frozen yogurt, a bagel, a biscuit, a slice of sour cherry pie a la mode. Potatoes - french fried, mashed, and fingerlings a-roasted. The kati roll from Bollywood Theater, a polenta soufflé, a chocolate brioche and lemon tart from Maurice. (Bill, if you're reading, the polenta soufflé was worth writing home about.) Bread, bread and more bread. With butter, and jam. A slice of so-chocolatey-it-was-almost-black cake.

And then there were the things I forgot to eat. Pasta. I didn't think of it, not once! And no Frank's noodles, and no sweet potatoes. No oatmeal!? Indeed, no oatmeal. I didn't bake because I didn't want to restock any flour, sugar, or chocolate for just one recipe.

And then there were the things I ate that were not good. No surprises here: a Chips Ahoy cookie, a granola bar, a Fig Newton (that was ok, but not great). Anything processed tasted like nothing; like cardboard and sugar. If my eyes were closed, I'd never have known it was a Chips Ahoy. It could have been shortbread.

But alas, even two glorious weeks come to an end. There were exactly three things I think about still. One, the biscuit and two, the cherry pie from Lauretta Jean's. I mean, if this Captain of Team Cake is thinking about a slice of pie, you know it's out of this world. And the biscuits. Oh, the biscuits. They are worth every calorie of butter, worth every bit of gluten. And Three, ice cream.

Look, there's nothing like ice cream when you've not had sugar in 9 weeks, and neither dairy beyond hard cheese, butter or kefir. Ice cream is amazing. Ice cream is everything Anne of Green Gables thought it would be at her first picnic, it's everything you waited for at the beach as a kid. Ice cream is the miracle at your grandmother's World's Fair and I take back any time I didn't appreciate ice cream for the glory that it is. I work with a group of folks who have ice cream every day at 3 PM - it's one of the engineering groups' rituals - and I'm not precisely accusing them of not appreciating ice cream, but I am saying that generic Safeway brand creamsicles can't, just can't, hold a candle to real Rocky Road. Or a premium vanilla-bean-flecked vanilla. Or Salt and Straw honey strawberry balsamic with cracked black pepper. Or a Ruby Jewel sammie.

But I digress. I had a bit of ice cream, it's true.

Then the two weeks ended. And I had to strictly go back on the SIBO-approved diet. Which I've been on for two more weeks. And in about two MORE weeks, I'll get to take the bacteria test again.

Much like last time, where I thought it would show I made progress but was not healed, this time, I feel it's going to show that I beat it. The bacteria will be gone. And what comes after that? I haven't asked yet. This whole process only works if you stay in the day you're in, and not think too far ahead - I mean, I never could have said I'd eat meat, eggs, fat, veggies and some fruit for months. So I can't say what will happen and how I'll do, but I'll tough it out another couple weeks and then test, and then tough it out a week while the results get analyzed, and in the meantime, I'll share some of my infinite variations on meat-and-sauerkraut with you!

(I actually won't because that would be terrifically boring. But I will post some regular updates on life and health, and to the four people who still read along - thanks for sticking with me and my microbiome!)

The results are in.

The time has come - my SIBO test results are in!

I picked up the phone with great nervousness, and heard, "Hi Emily! It's Dr. M!" She was excited and smiling, I could hear it.

"Hi! How are you?" I said in a big rush, as I locked myself into a conference room at work.

"I'm great, I have your test results and it is so exciting!"

Ohmygodwhatisit!?

So my bacteria indicators are down 80% or more. I still have it - and I knew I did - but it's going away, and it's going away fast. I'm not at all disappointed. I knew it would still be there, and my only fear was that it would be, like, 10% gone or something. But 80% gone! Miracle of miracles! Every single bite of food I passed up was worth it!

However.

It gets weirder.

The latest drug regimen, which Dr. M. wants to see me undergo, would be a choice of either herbal or pharmaceutical antibiotics. Herbals are $200 out of pocket and take 40 days. Pharmaceuticals are $850 out of pocket and take 14 days. She wasn't strongly advocating either way, but the pharmaceutical route - as evidenced by the cost - is a pretty incredible drug. It does not build up a resistance, so it should be as effective this time as it was last time. And it's non-systemic, so it does not cross into the blood and body; it stays right there in the digestive tract. If it does as well as it did in January, and I do as well with the diet as I did the last 8.5 weeks, I could be free of bacterial overgrowth and back on a path of healthy well-rounded eating. And so, yes, I'm a Western science girl at heart - I'm gulping on paying the bill and going for it. Round two shall be more pharmaceuticals.

But this is where it gets weird.

The second drug regimen comes with a new instruction. If choosing the pharmaceuticals over the herbals, one should, for 14 days - and not sooner, nor later - be eating, at one or two meals a day, something(s) from the list of "NO" foods. 

!!!

The highly fermentable foods list, aka everything delicious, will become my friend for 14 glorious days - and on day 15, it is cold turkey back to the SIBO diet. The theory here is that you want to feed the bugs while killing them… draw them out and knock 'em down; don't let them hide in dormancy while you take the pills.

As the calendar would have it, I am headed to Florida to see my mom and aunt next week, and frankly, this couldn't be better timing. I have not started the regimen yet, for two reasons. One, I am afraid I will get sick, like I did last time. It was the flu; I know it was. But what if - what if - what if it was a die-off reaction from slaying bacteria? And secondly, because I am making a list of Portland things I want to fit into my 14 day schedule. Any other suggestions? So far I have what is below, and it may well be two more months before I can have anything this tasty again.

• a slice of berry pie from Lauretta Jean's
• a kati roll from Bollywood Theater
• something from Maurice (brand new sweet shop near my office)
• half a pizza from Firehouse
• ice cream with hot fudge from Salt and Straw
• chocolate blackout cake from Sugar Cube (I've never had it!) 
• Frank's noodles 
• bread from Fleur de Lys 
• a bagel from Tastebud, now at food carts near my office

Cheater.

So today, I cheated.

Tomorrow marks eight weeks - two fucking months - of living grain- and refined-sugar- free.

And I have not cheated, not once. And if you don't know, I work in a literal candy store. Yes, it's a software firm, but it's all the tales you've heard about these insane, hedonistic, childlike Googlesque workplaces? They're true.

Snack plates are put out once or twice a day in the three most high-trafficked areas. Perhaps brie and summer sausage, perhaps guacamole and chips, perhaps almond mini croissants and a bowl of coconut whipped cream, perhaps peanut butter-filled celery sticks. And that's just those three areas. Then each kitchen (there are also three) is stocked: a cereal cabinet with 15+ kinds. A candy cabinet, a cracker drawer, all the bagels, bread, and muffins you could want (cinnamon raisin, plain, vegan, wheat, etc.). There is a sweets cabinet - Oreos, Petit Ecoliers, Nutter Butters. There are at least ten kinds of granola bars: Kind, Kashi, Nature Valley, PowerBar, Clif. There is, ok, a nod to health, with a fruit bowl. But there is a soda cooler, there is beer and wine, there is endless tea and coffee with your choice of soy, coconut, almond, regular, skim, whole and lactose free milk - half and half. (One guy eats two bowls of cereal a day, with half and half as the backdrop.)

This is meant for us to enjoy, every day, all day, for free, day in and day out. Since the second I have worked there. There is also at least one company lunch each week from the nearby food carts (variety makes it impossible to prepare your defenses against the deliciousness), and I've yet to work a week there when there is not also another pile of leftovers for lunch or at about 3 PM, everyone's best time to avoid high-cal snacks - it is often Voodoo Doughnuts, or Elephants Deli sandwiches, or Pizzicato pizza of six or seven varieties.

Oh, and we have a monthly food holiday - National Milkshake Day was one. Just come order up! The soda jerk is ready to help you out.

And so it is that in the face of this, I have not cheated once. Not one time. I have not eaten half a broken Chips Ahoy as I filled the cookie jar. I have not licked the spoon after slicing up chicken enchiladas. I have not had a Twizzler. Not a Dove chocolate square. Not the edge of a pizza slice. Not a quarter of a doughnut. And yet it's all staring me in the face, for the eight to ten hours a day, sometimes more, that I spend in the office.

But today, friends, I broke.

I came to work to help set up a breakfast buffet for visiting colleagues from the remote offices. French Toast. And pancakes. And look; I love pancakes like Phillip Seymour Hoffman loved speed balls. One is never, ever, ever enough. There were mountains of butter pats and maple syrup. But no, I set it up - and I walked away.

Then I attended a lunch event on behalf of the company. We were served a chicken sandwich on fluffy ciabatta. And if I can't get heroin but I can get oxycontin, to continue the inappropriate and gross metaphor, then bread is the very best next thing after a pancake.

But I didn't eat it. I ate the chicken out of the sandwich. I declined the basket of rolls (yes, rolls, with a sandwich, good sweet Jesus) and I declined the cookie assortment after that. It's true that I love cake more than cookies, but don't get me wrong - I love a cookie, even a bad one, too.

I made it back the office, still slightly hungry. I decided to heat up my almost-cooked-into-baby-food-texture carrots and a little beef short rib. And what is waiting in the kitchen?

A Thai buffet. With a giant hotel pan of fluffy, steamed white rice.

My doctor told me that if I'm melting down, and freaking out, the very best cheat on this diet is white rice. It has no nutrition - it has no fiber to feed the SIBO bacteria - and it goes right through you.

And willpower, as scientists are learning, is a muscle. Like any muscle, it can get fatigued. It needs rest to get strong again. I think - side note - this is why I am averaging 8.5 hours a night of sleep right now. I need to replenish the willpower reserves! And by the way, people with kids, plug your ears: that is 8.5 hours of sleep. I measure it with my UP band. I'm actually IN bed a good 9 hours or more. That's the pure, sweet sleep of someone not actively consuming peanut butter by the gallon, hoping to stop thinking about bread and pancakes.

So the willpower muscle was tapped out, and I added about a third of a cup of fluffy white rice to my dish. And Oh. My. Lordy. It tasted like sugar. No. It tasted like nectar. It was like some kind of divine manna. And I am talking white rice, I know. But it was almost funny, I almost laughed - how good it tasted.

And then, about twenty minutes later, I felt like I was on speed myself. I was hyper alert. Vigilantly awake. I was giddy, smiling. I had more energy than I have had in weeks. I was giggly, bright, amazed. What a world! What a day! What a gorgeous life! I'm going to the gym, to my crazy-tough fusion workout class!

Which I promptly did. And I set a new (self) pushup record, which my teacher noticed and was impressed by.

Powered by the blandest thing in the world. I may be a cheater, but I'm definitely a rice rocket today.

A Whole Lotta Nothin' Goin' On

I'm stuck in neutral over here - in the next couple days, I'll get the SIBO Test #2 results. As I've said, I'm certain it's not gone - but I'm dying to know what the reduction is. In half? Less? More? How much bacteria do we think is still in there, wreaking havoc?

But in the meantime, there's a whole lotta nothing going in, dietarily. I've admitted that almond flour and me don't get along. Things seem to be better with coconut flour, but I have more experimenting to do this week. It really is like the universe is trying to take away ALL my food joys. At least I still have peanut butter, and I'll be giving that up with cold, dead fingers, trust me.

I haven't added in many new foods; I'm still figuring out what amounts of the existing list of 25 or so are good, and which cause belly aches or bad poops. And it's getting depressing. I don't get to participate. At work, I ordered ice cream sandwiches - even gluten free ones, and vegan ones. But no makes a grain free, refined sugar free ice cream sandwich. I order lunch for the whole company every Friday, but I never get to eat it. I put out the snack jars a couple times a week, but there are no snacks for me. It's boring. It's isolating. It's frustrating and at some point, if I don't start getting healthier, the depression is going to outweigh the striving for health, and I'll go back to the SAD. (Standard American Diet.)

But know this, friends. Maranatha nut butters? They all contain cane sugar of some sort! Those little liars. Give me Justin's every day of the week.

Hit It Hard

Well, the plan at the outset was to be on this diet for 3 months, and then re-test for SIBO.

But upon a detailed report of my poops - and oh, how I can talk about poop! I could write a cover story for Poop Magazine at this point. I could ID a healthy poop a mile away. The greatest part of my day is checkin' out my poop and seeing how what I'm eating is affecting me, and being able to pinpoint foods and quantities and their effects.

But I digress. Ahem.

Upon this detailed report, and when taking into consideration my extremely high levels of SIBO indicators (hydrogen, especially), my doctor has me taking the test again now! Tomorrow! She thinks I probably still have it… and so do I. I can't imagine, in fact, that I don't.

But seeing where the levels are will be really helpful, and if they are indeed positive, then we can discuss a second round of pharmaceutical antibiotics, or a round of herbal antibiotics. I'm not sure which route I'd choose actually; there is little study on the herbals but the study that is out there says they're equally effective. But my little scientific heart belongs to Western medicine, and so I lean toward the pharmaceutical.

So stay tuned! In the meantime, I get to repeat the prep diet today. It is:

• any meat or seafood
• olive oil
• butter
• eggs
• weak tea
• salt
• pepper

Yup, that's what I am eating all day today, then fasting for 12 hours overnight, and then taking the crazy-ass breath test on Saturday morning. Wish me luck! 

Grapes of Wrath

So after rolling back in health, I spent two solid days eating nothing but broth, fatty meat, olive oil, and various kim chis and sauerkrauts. It was amazing how fast it put me back on track - a nice silent belly, consistently feeling sated but not bloated.

And then I ate some grapes.

I had tried them previously, and they seemed to go fine. But this time it was either the amount of grapes or a still-slightly-al-dente portion of bok choy. But I was up three times in the night, wakened only by stomach pain, with nothing to do but wait out the waves of pain.

I figured I better see what it was, so I repeated all the things I had for dinner throughout the next day, and the timing of the grapes to another stomachache led me to point my finger at that vined culprit.

Grapes! I mean - grapes! C'mon. They'd been in the fridge for a week or so, and were starting to shrivel the tiniest bit - maybe it was this concentration of the sugars that did me in.

But if these grapes are anything like what will happen when I try to drink some wine (yes, I am eventually allowed dry wine, vodka, and gin), I will be one unhappy camper. I haven't had anything alcoholic in well over a month, but I like knowing I CAN and WILL soon. Maybe it's better to keep waiting on it, rather than finding out bad news.

In the meantime, I probably say this at least once a day: thank god I like sauerkraut and always have! I'd be one sad puppy without it.

Two steps forward...

It was, it turns out, too many foods introduced too closely together. And though if I see you in person I will happily share TMI about my digestive tales, should you be interested, I think sharing in writing with the wider internet world is not a wise thing for my future run at the U.S. Senate. Suffice to say I did not feel 100% this week. I took quite a few steps back. 

I'm back on a diet of mostly meat stews, with carrots and celery in them, and a little bit of pureed fruit. There is one problem: I had started grain-free baking. And I probably need to dial that to Zero for a week or two. But among the four or five failure recipes - like the almond flour 'bread' - I've hit on two good ones so far! A banana bread that tasted like banana bread - and not like 'pretty good for almond flour banana bread' and then… ahh, for the Super Bowl party today… peanut butter cookies!

Grain free, refined sugar free. Just peanut butter, butter, almond flour, salt, honey and a pinch of baking soda. I don't know if I am allowed baking soda; I am not asking about it. Head in the sand on that one, I fully admit. But I've baked up a storm for the Super Bowl party and like any good plan it is starts tomorrow. I am going to take all the baked goods out next week to see if I can't start more steps forward again. 

And in related taking-steps-back news, I have never been a hot bath person. This is because I am a clean freak. And almost everywhere I've lived since the age of 21 has been a rental, and no matter how much I clean that tub, it still (emotionally) feels dirty and used to me. (I know. I know. Psychological field day.) 

And so it just became a habit to always shower. Even after a long day or when enduring a sickness, I'll take a nice long hot shower - not bath.

Well, this week broke me. I've taken a bath every night. I just needed to be surrounded, immersed; held.  And you know what? Baths are really nurturing! (Yes, you did know that.) This year's word of the year for me, if you recall, is Nourish. These baths have been quite nourishing to this slowly repairing body and fragile spirit. So that's something. 

Go Sports Team! Happy Super Bowl! An American holiday especially treasured by this fantasy football league winner right here.

(Photos of all the baked goods to come.)

Climbing uphill

Health-wise, I'm walking uphill, getting better, back to normal, my usual peak - but I'm walking extremely slowly. I have a three-day weekend and my biggest ambition for it is to catch up on laundry, and try to see Philomena. I'm not pretending I'll feel 100% come Tuesday; I'm being realistic. Maybe this is what happens when you've been eating mostly simmered meat for seven days.

But today! No more simmered meat! I sautéed it in ghee! And finished it in a hot oven. With some spaghetti squash mixed with sauerkraut, and half an avocado, it was the greatest meal of my life. Well, not quite. That was probably here. But it looked like a real meal - colors! textures! And it tasted like a real meal - flavors! Different from each other!

I forgot that yesterday I ate two boiled shrimp with my bone broth and simmered meat. Today, I ate three. Sweet as sugar.

Tomorrow, I will add a little bit of carrot juice! And cold olive oil, and by late in the day or Sunday, I'll try baking almond meal bread.

It's hard to describe both why I'm committed to this, and how I'm actually able to stick with it. It's very unlike me. That I've completed seven days, and am planning to keep going, is about as unlike me as a weeklong backpacking trip, or a weeklong vacation without any email.

But somehow - I'm doing it. Maybe it is taking the antibiotics each day, five times a day, that make me think that a Chips Ahoy, a tortilla chip in bean dip, a Twizzler, or any other of the million snacks that sit out at work, in beautiful glass jars, aren't worth it. Maybe it's my theory that sleep begets more sleep; discipline begets more discipline, on and on. So in this case, each day that passes successfully in turn strengthens my resolve to stick to the diet's rules, with even more commitment. Maybe it's that despite physical exhaustion, I feel an incredible mental clarity without sugar or grains or, sigh, chocolate. Maybe it's that somewhere in the soft, quiet, deep self, I know that this will heal my gut and I'll be able to enjoy a renewed healthy relationship with all kinds of food.

As I embark on a weekend of sweet, sweet rest - here's to hoping!

Like a three day weekend… except nothing like it.

But, a three day review instead!

Tuesday: no new foods added. I made it through work only because of forward momentum. An object in motion tends to stay in motion, and it was a 'hafta' be there day so once I got up, I was going. I fevered, sweated, panted and phlegm-couughed through the day.

Wednesday: I could only recognize what feeling like 50% was like today, in comparison to realizing yesterday was a 25% day. And best of all: avocado! And real sauerkraut! Both went great during the day, so I took the big leap and make pancakes.

These are not pancakes.

They are a puree of eggs, raw zucchini, and nut butter of your choice. (Respond to the next thing you're asked with, "Nut butter of my choice," and you will get a laugh.)

They LOOKED a lot like pancakes. They did not taste like pancakes. But they tasted a little like nut butter, and between that and avocado, my palate is doing cartwheels of joy at all these exciting flavors. I bet you never thought that avocado was sweet - but it is to me!

Thursday: Only new food added was a different type of nut butter. Cashew. What?! Have you had this? It tasted so sweet I couldn't finish the tablespoon. I know that sounds crazy. But it truly happened. And as I write this, I wouldn't quite call my health 75% - that would be a leap too optimistic for this couch-happy West-Wing watcher, but 55% - I'm solidly confident about that.

Death on a Triscuit

That's a West Wing line and a good description of how I woke up this morning. And so despite being absolutely vital to the work day - I could not get up. A 102 degree fever, exhaustion, coughing, congestion, weakness - I have been laying around all day. It is harder for me to NOT go to work, than to go, when I am sick. There were a lot of tears this morning.

I added ghee and eggs to the menu today - not just the egg yolks as prescribed. I really felt I needed the whole thing. I increased my tablespoons of fermented juice (aka sauerkraut juice). I tried raw ginger tea. I still can't taste a thing! And I still can't decide if I have the flu or if these are so-called die-off symptoms. Which apparently can look exactly like flu, complete with mucous buildup.

Because let's get real here, people. If you're reading this blog, you know me. And so yes - for sure - a good 47% of me thinks this whole thing is total junk science and absolute bunk. It's like fluoride being a brain poison. It's like a cayenne-lemon detox diet that shockingly helps you lose weight by not eating for 7 to 10 days (duh)!

But then, I have long followed the emerging science on gut bacteria. And I read articles like this one, from no-bullshit Michael Pollan (who also published a pate de choux recipe of ease this week, that torturer!). That is a long article but if you want to come up to speed on the gut biome, it is worth your time. It includes the sentence, and evidence to support:

• Medical science may be on the trail of a Grand Unified Theory of Chronic Disease, at the very heart of which we will find the gut microbiome.

Crazy! So I guess 53% of me, albeit skeptically, is willing to keep pushing through this, and see what can happen. Can one do a hard reset on their gut biome? Can I?

Cold, flu, or SIBO?

Yesterday I woke up with a weird hacking cough. I've been off-and-on sick since the 12th of December with the cold that won't die, so I just thought this new cough was a slooooowly-fading-away form of the old cough, in a new form. And I was determined to start this SIBO Journey. So I did.

Today I have a fever and chills, the cough is definitely established in this new intense iteration, and I'm blowing my nose like crazy.

Is this an antibiotic side effect? Is this my body rebelling against the removal of anything resembling a traditional 'carb'? Is this just another cold? Is it the flu? (And I got a flu shot, dammit!) All I know is, I am basically miserable. (And I have a hellish week of work ahead where physical presence is required. Of course.)

But once you start an antibiotic, you have to stay the course. And if I'm taking these big-guns-drugs, I might as well keep on with the intense food restriction. And neither of those things are going to make me break this fever any faster. So that's where we are today - if yesterday was Tender, then today is Broken. And yet oddly committed to riding this out.

The menu is not an exciting one… more of all the same foods, plus a chicken stew with zucchini coins (cooked to mush). John told me it "smelled like death" but luckily I am so congested I couldn't even taste it! Small blessings?

Tomorrow and the next day I am due to add raw egg yolks and ghee to the menu. In the final piece of honesty, I learned this weekend that I can't give up coffee. I drink one or two cups every single morning, and apparently, have an addiction to it. I went without it twice in the last ten days (including yesterday) and by 3 PM, had a brutal headache that lasted until I had coffee the following morning. The lesson here is that from the get-go I'm not perfect on this process (though I am drinking it watered down, as suggested).

I excitedly found a couple SIBO Journey blogs… only to discover most of them were one or two intro posts, and then they stopped writing. So I hope to keep this SIBO one up, and begin adding more of my usual writing once again - it can't be all poop talk, all the time.

Can it?

(I'm kidding. It won't be.)

The Next Journey

This blog started five years ago with a long (three month) work trip to Central America.

Most recently, it documented every thought (that I wrote down) while on a short (three week) volunteer trip and spiritual journey to Africa.

And now, dear reader (I think there are about three of you left)… you may want to go on your merry way. For this blog is about to turn inside. Way inside. Like inside my digestive tract. Inside the very walls of my small intestine.

This fall, my health insurance began accepting Naturopathic Doctors as Primary Care Physicians. And my sneaking interest in alternative care then combined with the fact that I have not had a regular doctor since I had a pediatrician, and the end of the equation was = I have a new ND! (There was a false start here worth noting; the first ND I met with made me feel unhealthy and skeptical and mean. The second one was - and is - amazing.)

So as me and my ND made our way through everything about my health, everything I'm concerned about or interested by, everything I've been through and want to achieve, we kept coming back to my digestive health. Which is … not great.

Don't say I didn't warn you; this is the journey, like it or not. Feel free to look away.

And my digestion (which, yeah, ok, is a nice word for bowel movements) has been worse and worse over the last 18 months or so, and been pretty atrocious in the last six. Just never regular. Just never satisfying. Just daily meh. So I took this totally crazy breath test (that turns out not to be crazy at all), and have the classic result of SIBO: small intestine bacterial overgrowth.

At first, I thought SIBO was crazy. I thought it was in the league of non-medically-accepted diagnoses, like adrenal fatigue or vertebral subluxation. This could not be a thing. Could it? Well, it is.

I went to a shiny, high end, solidly Western medicine, practically concierge-care type gastroenterologist - and he not only assured me the test for SIBO is very real, but that my results were indeed classic SIBO. His treatment plan, as a second opinion, was extraordinarily similar to my ND's plan.

And that plan starts tomorrow.

It is no easy plan. It is 10 days of very intense antibiotics, while starting a diet that should last from 3 to 12 (or more) MONTHS.

If you know the GAPS Diet - that's what it is. If you don't know it, all you need to know is what I won't be having, for 3 to 12 (or more) months:

• Flour, wheat, barley, rice, corn, oats, cous cous, quinoa, rye, parsnips, white, red and sweet potatoes and everything made of them: tortillas, pasta, bread, cake, cookies, chips, crackers, chips, risotto, pizza.
• Garbanzo beans, kidney beans, fava beans, black eyed peas, butter beans, cannellini beans. 
• Ham, hot dogs, smoked or preserved or processed meat.
• Ketchup! Chocolate! Cocoa! 
• Maple syrup, molasses, sugar.
• Chèvre, gruyere, feta, cottage cheese, mozzarella. 
• Beer (but I don't care about that).

So when I come to your house, or we go out, what can I eat?

• Beef. Lamb. Chicken. Wild Game.
• Eggs.
• Nuts (raw only).
• Ghee, butter, olive oil, avocados, coconut oil.
• Sauerkraut, kimchi, kefir, fermented sour cream and yogurt.

And ok, to be fair, I will be able to eat lots of vegetables and some fruits, too, eventually - and hard cheeses. Eggplant, squashes, onions, garlic, lettuces, carrots, cauliflower, capers, beets, asparagus, pineapple, pears, cherries, and more. But when you look at a list of things you can eat, and things you can't eat - it's hard to stop your imagination. 

So filled with anxiety, and total dread, I've been eating like a madwoman for the last month, since the diagnosis. I've put on another ten pounds. I've been thinking, if I just eat everything I want NOW, I'll be OK on this restrictive diet - which starts out literally with fat, meat and eggs for days before letting other things trickle in (first avocados, then nut butters, then soft lettuces, cucumber, etc, over the weeks that follow).

But I know that's not true. And so tomorrow it all starts. And I ate five pieces of sourdough toast for dinner, and then made a cherry-chocolate cake at 9 PM and ate three big squares. I'm gonna give that bacteria a big ol' feeding frenzy before I boot them out.

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! 

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!

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.

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.

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:

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.

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?

July 25/26, Before the break, Part 1.

Before our two nights away, this is part one of my last evening of journaling in Pommern - after the first full week. I may be repeating myself a bit here, but it's as-written, knowing the next day I'd work a half day on the septic and then go... on a safari! 

I find that having secure shelter, safe food, clean water and English speaking friends means I can remain in a heightened state of observation more often than not. There's nothing rote here; there's no single unconscious action, from food to sleep.

Also: the showers that Joe and Marie and their family brought might be the greatest possession ever and I vaguely feel like I OUGHT to be ashamed of the daily 3 minutes of waist-height better-than-lukewarm water. But it's one thing I'm not embarrassed about. it's too powerfully restorative to feel guilty.

So during my peek into Lutheran choir practice today, and then hearing "Hey Ho" on Mamatony's battery-powered tinny kitchen radio - both bring me to tears. It's that heightened state, and I write this after working, after showering, feeling reborn. The tears come for scope of Africa's problems that I can't help - like how these women, their girls, and their girls' girls will live almost this exact life. I know I won't be able to fix anything of consequence for them, the ones right in front of me, even. Tears for the health, their hopes, for how they get smitten and fall in love but it probably does not make life much better. Again and again the beauty continues to pain me - more literally at times when I see this gorgeous place, with vibrant life humming in the very air, as also the source of their pain - geographically isolated from the power, but rich in natural resources ripe for the thieving.

And it becomes, over these days, apparent how we'll each divvy up the personal resources when they get scarce. Fellow volunteer Joe is wildly generous - having brought not just the sun showers for us all to use, but thousand (truly) of dollars in medical supplies. But when they are sorted and divided to take half to the clinic near us, and half to the Roman Catholic clinic across the village, he comes back harshly certain it was not only done wrong - ah, our attachment to literally giving the gift, to seeing the joy or appreciation or the reverence for the plenty we bring, the plenty we think we innately are - but that even more importantly, his personal medications were accidentally given away.

Now, look, I don't want to lose my Ciproflaxin either! But the pure possessiveness is both funny and part of the constant state of high alert I'm in, this constant open wound I am.

I see suddenly, my God, exactly what you would do with two servings of porridge and three kids.

And perhaps, at some point, what you would do with those two servings when one child becomes ill. And then gravely ill.

How Joe - and all of us - love our little things, things, things - and how our fresh-showered good humor and ability to poke fun at ourselves is there - until a very genuine threat arises. Someone gave away my pills, vitamins, medications. Then the entitlement to OUR items flares like Bilbo Baggins clutching after his ring, baring his fangs at a dear nephew.

And with that - Mamatony says dinner is served. I peel myself off the back deck and away from my rumination, away from my imagining of scarce, scarce food and what it would do - to me.