.who are you

here, you have nothing. Stripped down, facial nudity. No where to hide
and no where to break down.

here, there is no makeup to look out from. There is no media,
entertainment, or music to distract you from what you are and who you are.

here, there is no mirror to look in, yet here is the harshest of mirrors.

Who are you, when you are hungry?

Who are you, when hunger is all around you?

Who are you, when you are covered in bugbites and nondescript rashes and
are always caked in dirt no matter how many times you bath?

Who are you, when you feel your body breaking down? when you have fungus
between your toes and dirt in your eyes?

Who are you, when your chest and face are covered with oozing breaky
open fly bites?

Who are you, when with one hand you are eating and the other waving away
insects?

Who are you, when cockroaches are your co-inhabitants every night?

Who are you, when everyone asks you for your water bottle, your
headscarf, your headlamp.

Who are you, when you say no.

Who are you, when you see a boy covered with 3rd degree burns because
his mother poured boiling water all over him?

Who are you, when you shake that mother's hand.

Who are you, when you assess a child on rounds and he dies 5 minutes later.

Who are you, to think you should come here.

Who are you, to be in Chad?

Who are you, if you don't stay......

.Inshallah

The Christians here say it is up to God whether someone lives or dies.
In fact, almost everyone here does. Why did the baby die in the middle
of the night. Inshalla. Its God's will. They will shake a mother and
say sternly, "stop crying. it is God's will."

Why did the Arab man die after the prostectomy? It was God's will.
Why did 4 children and 2 babies die in one night? It was God's will.

Why, why why? it was God's will.

Is it God's will that you don't give your medicines?
Is it God's will that you don't assess you patients?
Is it God's will that you feel like sleeping and not taking vital signs?
Is it God's will that you don't check on your patients?

I don't think it's Gods will.
I think you didn't do your job.

Stop crying. Your baby died because it was God's will.

....

Nothing is an emergency here. One thing I value about American medicine
is that everything is an emergency. Anything that is either affecting
or endangering someone's life is an emergency. Although many times
futile and expensive, we aid, abet, prolong, and fight for life.

Who can put a value on life? Is it better to live for 10 minutes than
to never live at all? Is it better to open your eyes and blink them and
look at the world and feel your mother's skin and experience the
sensation of air filling your lungs, to see the colors and the faces, or
to never have opened and blinked and looked and felt and experienced and
seen at all?

Is it easier for a mother to lose her baby after 5 minutes or after 14
hours? Is it easier to have had that time, or is it harder?

Its easy to judge here. Its easy to think no one cares. Its easy to
say the nurses don't care. Its easy to say the families don't care.
Its hard to be culturally competent when this culture seems so incompetent.

You have to get people to give blood here. Even if their relative,
husband, child is dying. They still have to be begged, cajoled,
threatened. Even then, sometimes they don't. Its easy to think they
don't care.

Mother's often don't hold their babies here. After birth, they often
hand it to the grandmother, then turn and face the wall. Its easy to
think they don't care.

Someone may be brought in hemorrhaging, or may have been in labor 20
hours. Then, right after they get here, their families may take them
away. They will die if they leave, and they leave anyway. Its easy to
say they don't care.

The nurses don't assess their patients here. There is little energy
spent on those who are dying. Its easy to say they don't care.

and i know that they must care. I know they must cry. I know they must
love their babies. I know they must love their families. I know they
must want the best for their patients.

I will be the first to day I absolutely don't understand this culture.
I am not being impartial. I am being judgmental. Do I have a right to be?

.....

its not up to God and its not up to Allah.

Its up to me and its up to you.

its up to you to get oxygen in this hospital. Its up to you to get
better nurses. its up to me to be better. Its up to me to care even
when no one around me seems to. Its up to me to work harder. Its up to
you to work harder.

and maybe they would have died anyway. but why did they have to die
here, in t chad, with nobody to fight for them.

America, don't ever stop fighting for life.

.....(a few days ago, in the delivery room....waiting and breathing,
waiting and writing)

"This baby is dying right now. I've revived it 5 or 6 times. By
revival I mean CPR. Because I'm an expert in infant cpr.....It was born
4 1/2 hours ago. 2 months premature. 1.7 kg. She is so cute. Her
heart keeps stopping. I am doing CPR and someone is moving my operation
over, looking for a lost pen. A door slams, nurses walk in and out,
laughing, talking, watching. She came in 3 cm dilated already. By the
time the family bought the cefedipine (*** wrong spelling, desole, we
don't give Salbutamol here because the nurses can't be trusted to take
BP's), she was 4. She delivered 45 minutes later. She didn't make a
sound. No epidural. No nothing.

I should be breathing for it right now, but its against the skin and
they are laying down, the baby and the mother, facing each other, and I
think that's more important.

I don't want her to have 5 hours, i want her to have a lifetime. Its
not fair. Its not fair that this is her 4rth premature infant. Its not
fair that all the others died. Its not fair that she has never had a
baby except in utero. It is not fair there isn't a NICU team swarming
her right now. Its not fair that there isn't any oxygen. Its not fair
that if she was born almost anywhere other than here, she would have
made it.

There is a difference between seeing suffering and seeing preventable
suffering. Preventable suffering stabs a little more. Its the kind
that keeps you up at night and gets you up in the morning. The very
word preventable denotes personal involvement, responsibility. If
something is preventable, it can be prevented. If it can be prevented,
why isn't anyone preventing it? If no one is preventing it, why aren't you?

She is holding it skin to skin like I taught her. She loves it. I see
a tear on her cheek. I wonder how much babies know. I wonder how much
they see with their wise little eyes. I know its going to die, but I
keep hoping it will live. Maybe she just needs one more breath. What
if I stop before that one more? Maybe just one more round of CPR.
that's all. maybe. maybe. maybe. Live. LIve. LIve.

The infant mortality rate in Chad isn't just a number. It isn't just 1
in 8 births and 1 in 5 children. Its a real baby. with perfect blue
eyes that's try to cry. that's fighting for every single breath. its a
baby that would live anywhere else."

14 hours later, she died.

I wonder if the power to be incensed by injustice and suffering belongs
mostly to the young. To the ones who are freshly exposed to it. To
view horror for what it really is. Maybe we are the ones who should be
taken seriously after all. Age and sage and ad finem jade. That
doesn't change anything.

It is the tragedy of this life that vision is given to the young, but
power to the wise. Why can't the dreamers be 58 year old portly balding
hedge funders with more than enough money to buy the will of God.

Inshallah. I don't think so.

+++ Inshallah is my very poorly writ and most likely improperly spelled
version of the Arabic expression, If God wills it.

.boring but relevant

so i realized i haven't written anything too informative. so here
is some information.

I live in a small room on the end of a mud house. In Chad, most
families have compounds. Most compounds including mine contain a well,
hopefully a tree, clotheslines, a place to cook, a place to dump trash,
and maybe another house. The houses are mostly constructed out of mud
bricks. Most compounds also have a multitude of ducks, chickens, dogs,
and goats always scratching and running around.

My compound is about 15-20 minutes walk from the hospital. I walk down
a narrow packed earth path that winds through other compounds, corn
fields, cows, pigs, children, and trash. Once I enter my coumpound,
there is a lovely mango tree on the left. to the right is the 3 room
family's house (hut) with a metal roof and adjoining that at a 90 degree
angle is my room. I have a metal roof and metal doors and it is usually
15-20 degrees hotter inside and my glasses fog up when I enter. they
did however, give me the best room (i recently found this out) because
there's doesn't have cement floors and they have rats. (hence the
reason we are moving soon)) there is a kitchen outside in front of the
house opposite my room and there are woven mats held upright by sticks
that shelter the kitchen area.

there are these woven metal basket things that they fill with coal and
cook on. or 3 rocks placed at angles with sticks underneath and a pot
on top. I cooked soup once and it took me 2 hours and i was so
exhausted at the end. but they still magicaly always have hot food for
me no matter when i get home.

the family eats boule (spelling incorrect i'm sure) which is made of
rice and millet and it is like a thick cuttable pudding consistency.
when its fresh it is actually really good. they wash their hands and
just dip into it with the fingers of your right hand and then dip in
into a communal pot of sauce. the sauce is usually fish or goat meat or
chicken or tomoto or made of a green leaf called legume?? i actually
like boule but since i'm vegetarian they have decided to cook macaroni.
For almost every meal. the macaroni is exactly what you would imagine
macaroni to be and it is seasoned with tomatoe powder and copious
copious amounts of oil. I try to eat it but its getting difficult.

for breakfast...breakfast is my favorite. I usually get beans and rice
(beans = blackeyed peas) (also drenched in oil) or a starchy sweat
potato boiled and served with tomato sauce. Sometimes I get rice also
with scrambled eyes on top.

I am definately not starving but entirely grateful for the multivitamins
I brought. they also serve me heaping heaping portions of everything.
literally enough to feed a family of 4. so i usually eat for 2 and
leave 2 in the bowel. i try very hard. they said because i am big my
stomach is also so i need more food than everyone else. when i say our
stomach is the same size they laugh as if its the funniest thing they
have ever heard. so, so much for coming back from Chad skinny and
wonderful looking......

there are 6 kids in the family, ranging from 2 to 12, a 14 year old
niece that lives with us. 2 grandmothers, Bikaou, the mother, is a
midwife or "sage femme" in French. Teskrio works in
"urgence" the tchadian emergency room. they are lovely and intelligent
people and i am so glad to live with them. there is also the neighbor
that lives next to the grandmothers with 3 kids also.

i'm tired of writing about my surroundings but perhaps will add more
later.......

.beautiful things

.there are beautiful things here

like the way the wind moves over the rice fields and the shimmer of
the black and the green and the warm mud oozing between barefoot toes.

like the way the moon is brighter here. more luminous, milky,
ferocious. like the way the shadows move and the drums beat low in
your eardrums and how your headlamp illuminates a flash of pig and a
stalk of corn or the white eyes of strolling lovers. like the way the
mango leaves are dark and cut circles around the brightest stars i have
ever seen.

like the way the children dance. beneath the tiger moon. the way they
love reggae and we have mini raves on the woven mats after the work is
done. how we blink my light and wave it and dip and flash flash and
noodle arms and pounding feet and chanting "stop, can you hear the
sound...a little bit of riddim makes the world go round." (Michael
Franti and Spearhead - they LOVE it)

like the way they fall asleep on the mats. one by one, the littlest
first and then like falling dominoes, they all curl up and sleep until
we drag them inside. like the way there are 2 grandmere's and they tell
stories in the night and fan themselves topless under the naked moon.
and how we drinking steaming tea by moonscape and add heaping powdery
spoons of milk powder and how i have never tasted anything better in my
whole life.

like riding a moto and throwing your arms out like your flying and your
face cracks from the wind and from smiling and how they are laughing as
i pass but i don't care because i'm in Chad and i'm flying.

like sitting under the mango trees with Teskreo (my Chadian father)
having our language lessons. and how he can't stop laughing when i
speak really fast. or the look on his face when he understands what I
said. like the brightest whitest face crunching smile i have ever seen
when he says, "now that you are here, i can speak, i can learn to speak
the English." and how he carefully carries his "compact" (laptop) to
the hospital every day to charge it and how excited he is about learning
to hook up his external drive. like how he has shortened "how are you"
to "how." so i wake up in the morning, or I pass him in the hospital
and he says, "Janna, How?"

like how at breakfast he started singing, humming low, "the answer, my
friend, is blowing in the wind, the answer is blowing in the wind." and
how I almost teared up because it was Bob Dylan, because it was Africa,
because he knew it, because here, it could not to more relevant. and
how i ran and got my IPOD and we spent the rest of breakfast jamming to
Blowing in the Wind, Forever Young, Shelter from the storm. and how we
couldn't stop smiling and how he said, "Bob Dylan, he is my friend."
there is something so sacred about hearing music like that in a place
like this.

like how the 2 year old, Arnou, finally knows my name. and how he will
say, "Anna, I dive! Anna, I dive! (translation, Janna, High Five!) and
how all the kids are all high fiving now. and how we read french Dr.
Suess at night and the giving tree and how we all love to read.

and how the sky is grey and wild and the trees will whip and twist
before the rain and how you can feel the rain in your bones before it
dashes against your skin and how the chickens scatter and the leaves
slap your cheeks and how the bright colored clothes are snatched from
the line and the mats dragged in with the speed of light and how the
rain kisses the earth in giant splatters and how the air is cool and
fresh and breathable and alive. and how it sounds at night, on my tin
room, and how I love to just listen to the rain.

like how a baby is born, and it lives.

or someone gets better.

like how the spices are heaped up in huge wooden bowls and how they are
orange and brown and the black green of the tea and the red of the
millet and the white of the maize and the greens and yellow of the
pepper and the fresh gatos sizzling in shallow vats of oil and how the
fabric is everywhere, hanging and purples and pinks and sunset and
rainbow and garden of colors and how the fabric is on the head and on
the hips and on the racks and on the children and how the flies are
buzzing around the meat and the purple rods of sugarcane and buying a
fanta from the only frigerator in the market and tripping over sheep and
the stacks of candle colored soap squares and the peanuts, the heaps and
heaps of peanuts, (arachides) and the little plastic bags of peanut
butter and the coiled brown dried fish and the plastic flip flops and
strings of blue and red beads and the harsh and the sweet of the
languages bouncing off your eardrums and how the market........

like how there are beautiful things here.

. strictly nursing

Imagine a hospital in which......

there are no saline flushes

there is no tegaderm

there are no caps for the IV tubing.

there are no gloves to start IVs

the same tournaquit is used over and over

and it is a glove.

in which....

the medicines are in a box under the bed

the patients have to buy their own medicines

and the IV tubing

and each syringe for each medication

the IV pole is whatever you can find.

where medication administration is encouraged, but not enforced

and you have to look for your patient, to give them the medicine.

where if they have no IV, to spare expense, you inject it straight into
the vein

in which....

IVF, maintenance or otherwise, is not given unless in an emergency, or
the family can pay for it.....or they REALLY need it.

where there really aren't many emergencies

where people die during the night...and no one knows why

where night shift is 16-18 hours.

by headlamp

2 sets of vitals

double the patients

and double the meds.

in which.....

vitals are only taken Q12, if at all

where no initial assessments are performed

where report is a sentence or two

where no one knows a thorough baseline for their patient.

where there are no curtains

and little privacy

in which.....

everything is in French.

imagine you are a nurse at....Bere.

*** disclaimer**** this hospital does a vast amt. of good, i have only
observed for 3 weeks, prenatal care here is improving, many lives are
saved through surgery, the hospital itself is a blessing to the
community.....the doctors do an excellent job.....the nursing
however....is just....different.

.here!!....

so. not much time. sketch to no internet access.

chad.

today i saw a baby who fell in the fire. his arm and hand was twisted
and contracted and his fingers arched back.

last night I spent about an hour sitting rigid tense upright as i
watched a cockroach crawl all over my bug net tent and then slowly die
from the permethrin.

i keep a cockroach stick in my room, have everything sealed, and scream
regularly.

My family feeds me delicious beans and rice for breakfast and then
pasta every other meal. they are treating me special because no one
else gets pasta. I try to finish it.

when i am late coming home, my tchadian grandmere looks for me.

it is nice to nap under the mango trees.

i have finally learned the names of the kids in my family.

i taught them leapfrog.

and they now have a thing for Dr. seuss in french.

my feet have 4+ pitting edema most days.

I am priviledged to be here.