.going home

I am going back on Feb. 19 - probably.

liver enzymes on the decline and trying to remember to take my 30 days of steroids.

have discovered I have an affinity for non compliance to treatment regimens and that I am in fact a far better nurse than patient.

I am excited to go back and be a nurse again.

on the other hand, i feel like I am missing out on alot. One of my best friends, Abbie, is a nurse on the Critical Care Unit at Memorial hospital. she keeps my mind up to date with tales of running to codes covered in blood, the same patient that coded six times during her shift, of writing orders and managing 10 maxed out drips at a time.

when i am in tchad I am always begging for stories of "real nursing" and wonderfully petty things like writing a co-worker up for ignoring the order to hang 6 bags of FFP or the frustrations of techs that won't do their job even though you already did half of it for them.

stories about leaping onto a coding patient in an elevator on the way back from CT and straddling them, giving CPR and while the bed is carreened through the halls on the way back to CCU.

and I guess its fair to say I'm jealous. I'm jealous I am not a super nurse. I am jealous I don't work in and ICU. I'm jealous I don't get to learn CRRT machines and how to manage patients with balloon pumps. I'm jealous that I've only gotten to help with 2 codes. I'm jealous of all the experience she is getting.

and its not like I'm not getting experience in Bere. I am. but not the glamorous, high pressure, live fast life of the ICU nurse. I am getting experience in differentiating rashes and what stage of malaria the kid is in based on the lung sounds.

I am getting experience starting IVs not Art lines. and I don't know what it is. but part of me wants to stay here - in America, to apply for my dream job until I get it. But tchad was/is my dream job too.

So i'm going back. I'm going to plunge back into malaria and arguing in french until fond memories of ventilators and peg tubes is distant haze.

I'm going back to the heat. to not being able to sleep at night because its so hot.

I'm going back to the mosquitos. to the daily battle of minimizing bites and staving off malaria a few more weeks.

I'm going back to the latrines. to showering right next to them.

I'm going back to the inevitable weird skin rashes - the steady stream of sunburns, heat rashes, bruising, flesh eating rashes that have struck one after another as soon as the previous one cleared up.

I'm going back to the frustrations of hospital work. Of putting forth extraordinary effort to make a small change that may or may not be important anyway.

I'm going back to learning french. To try to make myself read Le Petit Prince for an hour a day. well, dream on. maybe this time i will work toward half hour instead.

I'm going back to exhaustion.

I'm going back to loneliness and the studied avoidance of interpersonal conflict.

I am going back to rats.

I am going back to cockroaches.

I am going back to food I can barely eat anymore ( but with TONS of food in my suitcase)

but

I'm going back because I said I was going to

I'm going back because I promised

I'm going back to help with my part in Project 21 (the community health project Marci Anderson is launching - I am teaching lectures on HIV, AIDS, Malaria and training the CHW for each village)

I am going back to give the Pediatrics ward an extra pair or hands and eyes

I am going back to learn tropical medicine

I am going back to somehow try to help Olen and Danae

I am going back because I love my tchadian family, because i stocked up at the thrift store on new looking American outfits

I am going back because I am going to buy Bob, my horse, from Sarah. and then i will ride him and be so happy.

I'm going back because I miss the rivers and the rice fields and the flat lukewarm fanta in the market. because i miss the sunsets streaking over the villages and the chant of the drums at night. because I miss lying on the mat next to the grandmothers - looking at the stars as they tell stories in languages I don't understand.

because I miss the screaming two year old and the fighting laughing wonderful children in my family. because i miss helping shell peanuts for market and the sugary amber of the breakfast tea.

because I miss Bikaou, my tchadian mother, how hard she works, how she always makes time to take care of me when i'm sick, making me tea with milk and rice gruel, always listening as I try to convey my bad day in french.

I'm going back because my family and my co-workers need to believe they are important enough for someone to come back for them. so they know that I appreciate that they let me into their hearts and lives, that i wasn't just a tourist, breezing into their world, melting awy

I am going back because this was my dream. to go to Tchad. and you can't give up on your dreams. not ever.

and in the daily haze and grunge of survival that is tchad, i need to remember why I am there.

1. to learn tropical medicine - to build a platform for future endeavors
2. to learn french
3. to fight for a basic human right - the right to live


so, i guess even though i wish i was learning where things are in the crashcart and what size gloves dr. so and so requires, instead i will get on that plane, and go back to try to become the person I wanted this experience to make me, and go back to accomplish the goals i set out to finish.

air conditioning, ice cubes, winter - how i shall miss you.

.??how.was.africa

So, how was Africa?

How. Was. Africa.

How was Africa?

and I’m using kind of a revolving platter of three responses:

Well, it was very African.

It was good.

It was an experience.

When I am walking down the path through the village to my hut I am always being greeted by the children.

They like to come bursting out of their compounds, hop up onto rock piles and low tree branches and start screaming,

“I am fine!!! I AM FINE!!! I AM FINE!!!!! I am fine!!!!!”

They think it’s a salutation instead of a secondary response.

I am fine

And I want to just go up to people and start screaming at them,

I am fine! I am fine!

I want to scream it in a mall, or stand up and pronounce it in a movie theater.

I want to shout it into a canyon until my voice is scratched and raw and the echoes reverberate and bounce like cannonball into my eardrums until the words explode into a million pieces, I want to be deaf but I can’t stop hearing

I AM FINE.

I AM FINE.

I am fine

But I’m not fine.

And its funny. And a little silly. And it’s a cute little breach of etiquette.

But how many times do we do that?

When absolutely everything in our day is wrong, how often do we smile and say,

I am fine.

I am fine.

Most of us are never just “fine.” Sometimes, we feel like dancing. We wish we could run around and hug everyone because life is so beautiful. Sometimes, we have just experienced small devastations or everything has gone wrong. We really want someone to ask us about it – to just tell them the whole story – bit we don’t. we say,

I am fine.

I wonder what life would be like if we all told the truth?

I think there would be more friendships, less suicides, fewer TVs sold, more writers.

It is strange to be back here.

And strange is a mild word for the almost mental haze

I cannot seem to slice through it.

I am more discontent about the fact that all the foods I dreamed of eating – crust less white bread sandwiches with Worthington smoked turkey and mild cheddar cheese, cut into beautiful perfectly sliced triangles, that soft perfect first bite – and I want crunchy saltines and real ice cream and giant genetically modified strawberries.

I want fresh yellow pineapple and a salad that is lush and green and rich and rainbow

And I want kettle korn and mango sorbet and perogies slathered in butter and onion and fresh garlic.

And somehow, I haven’t eaten any of those things

Things I have been desperately dreaming of the last four months

And I want to snap myself out of this smogbog and systematically start eating my way through the list – I feel like I will be so upset once I go back if I don’t.

But instead, what do I do? I make purple mush soup.

In case you want to make purple mush soup, well, just ask.

But purple cabbage and whole milk make a surprisingly buttery lavender.

I am fine.

It is somewhat my tendency to victimize myself when I think of all the “things I went through” in Africa.

In Tchad.

It is easy to slip into this rut of feeling sorry for myself because of all the things I have seen.

It is easy to make this about me.

But I went, purposely, for the expressed intent of wanting to see.

To see to see to see and never look away

Its easy to construct my own little self-imposed tale of woe

But its not me who is dying in tchad.

It is me that got medi-vac and took a jet back to the US

It is not me who had to wait 6 hours to see a doctor,

It is me that saw one 20 minutes after I stepped off the plane.

It is not me that runs around with chronic jaundice and fatigue,

It is me that had an acute and now receding condition

When I first thought about coming back, I was so torn. I literally couldn’t figure out whether I was genuinely concerned for my health or whether I was just so hungry. Yes I had no appetite but all I could think about was food……..

And I also didn’t want to go because I felt so keenly the injustice of it all – the fact that the hospital is filled with people far sicker than I, people that need a more advanced level of care – people that don’t get to anywhere on an airplane with insurance paying the bill. People that will never have that option – people that are dying without that option.

But it was sternly pointed out to me that that was silly too. There was no sense to die because of some misguided sense of martyred solidarity. Oh please, they said. And they were right.

And yes, the suffering I have seen is not about me. But everything you see does in fact affect you. Whether you want to do mental gymnastics around that fact or not.

I can’t turn my brain off. They keep marching past my eyes. Sometimes they turn and look at me. And I remember all of them. All the ones I was brave enough to truly see anyway. The ones that got better, the ones that got worse, they are all there. Flashes of the living, playing with the dead. Soundtrack of screams.

I can’t go a single minute without having this movie playing in my mind. And it is only in a corner of my mind. And I am happy. And enjoying time with friends. And enjoying watching the Batchelorette and leisurely peeling perfect orange clementines. But they are still there. Kind of like a merry band of pranksters marching in and out of my thoughts, stopping to terrorize, stopping to laugh, mostly just stomping and jingling.

Why is it that we always romanticize the places that we are not? Every person has of course had this very epiphany a thousand times applying to a thousand scenarios, but just because its cliché doesn’t mean it isn’t true.

When I was in Africa, I was dreaming of this moment – here.

Now I am here, and I am dreaming of other moments – there.

And if you have never experienced this, cross your heart, drop to your knees, and thank your God he made you content and simple – and then don’t go looking for greener grass, in fact, move to a city where that isn’t even an issue.

Basically, I am fine.

I’m just sour and dour and sleepless

And I want to go back to where the road is clear, where right and wrong is brutally stark, where no matter the motive I have a purpose, and where I don’t have to hear about the antics of that decadent and evil bafoon, Mit Romney.

But this needs to stop being about me,

Because really, now that I have finished writing this – I am fine.

.to the wanderer

Location. Experience. Geography.

who would I be if I'd never went?

who will you be if you never go?

....................................................................................

All i want is for you to be happy

all i pray is that you will be free

all i dream is that wonder will guide you

that in closing your eyes you will see

but i fear that time may find you lonely

that your heartbeat will dull in your fist

and i fear that the hunger which drives you

will fade and dissolve like the mist

Do not slake the wander which bore you

forsake not the call of the wind

remember the soul that is aching

to taste whats around the next bend

oh bitter the road, but the sweetness

the pungent perfume of the free

the tumbleweeds rocking your footsteps

roll on for eternity

i'm closing my eyes just to see you

the light in your eyes flaming beams

your soul beating fierce as you whispered

to strangers the stuff of your dreams

so let not your heart be so troubled

and let not routine shroud your soul

and turn to the dusty highway

and there you shall be made whole

.Update#2

hey friends and family!

Thanks everyone for your concern and support.

just a small update - I am in Chattanooga, TN staying with friends.

I didn't end up going to the hospital. The doctor got me in right away
and did a ton of blood-work, a CXR, and abdominal ultrasound.

Then i got referred to a Hepatologist who has taken over my care.

the good news is that I don't have Hep A,B,C,D etc. so that is so exciting,

they have done more blood-work and I have a follow-up apt. this Thurs.
with the Hepatologist.

He is thinking it may be a toxic hepatitis from medications I have taken
for malaria or possibly an auto-immune hepatitis.

So, I am feeling better, am less fatigued, and eating more.

I am planning to go back to Tchad as soon as I can buy a ticket/get my
visa situation straightened out.

I would LOVE to hear from anyone and everyone and catch up while I am here.

i am literally carless and entirely free so if anyone wants to call me,
please do!!

my temporary phone number for a month is:

423-987-0708

I would love to hear from you!!

.you hate

.dirty south

Quote of the day:

"hey so do they still have that AIDS problem thing going on over there in Africa?"

~ TN resident

.Update#1

So, as you may or may not have heard, I am finally back in the US.

On Friday of last week, my liver enzymes, ALT and AST were very high still - I had over 15 bags of IVF pumped into me and then on Sunday repeated the tests - slightly down but still ten times the norm.

on Sunday night about 8 pm, we decided to start pursuing medical evacuation.  Now,  after 3 days of travel, fatigue, red tape, bureaucratic incompetence, insurance-related ineptitudes, missed flights, and airport vigils, I am sitting in the Charlotte, NC airport waiting for my flight to Chattanooga (see attached picture of bliss and strength)

I am unsure what course I will pursue this evening, whether it be going to the hospital or trying to see a physician tomorrow.  I have some great resources in TN so I am sure that I can soon begin learning what is causing my symptoms.

I still have jaundice, icterus, fatigue, loss of appetite, easy bruising of my skin, etc - all of which point to liver involvement but is impossible to diagnose in Tchad.  While for most liver issues supportive care is the only option, it will still be good to have a clearer idea of what is going on so I am glad that I am back.

that being said, I am surprised to fine myself completely unexcited about being in America.  I was so focused on my life in Tchad and my personal and professional goals there that this is like a weird-dream alternate reality thing going on in my head right now.  I can already tell that after being there, my life will never be the same again.  I already view the world differently and I'm not even out of the airport.

thank you to everyone for expressing your concern, support, and encouragement and placing my name on prayer lists.  I feel grateful to have such an amazing support system of family and friends so thank you.

I would also like to publically (well, as public as family, several friends, and a handful of baby boomers who keep up with this thing gets!) thank Drs. Olen and Danae Netteburg for their role in helping me to get out of Tchad.  There were numerous appalling frustrations that occurred while we were trying to initiate the medivac process.  for almost 24 hours straight, Olen and Danae worked from their phones and their computers using limited resources and even more precious time to do everything it took to get me out safely.

They were with me every step of the way, answering every question, arranging everything, checking up on me and my health, and in reality fighting for me.


Since I have arrived in Tchad, my respect for them has grown almost daily.  They have made a 7 year committment to this country, are juggling being the dedicated parents of 2 small children with running an entire hospital.  During the time I was sick, I stayed with them and I was able to see firsthand the sacrifices that they make every day.  Almost every night they are woken up several times a night by the tchadian nurses.  sometimes they just answer questions and other times they get up to see patients and do surgeries.  They are literally on call night and day and during the day time often there will be a knock on their door every 15 minutes.  They never turn anyone away.  Ever.

 They see EVERY patient, make time for EVERY question and every issue that arises with the hospital.  Every day I see them go above and beyond the call of duty under conditions that would cause a lesser person to break.  And they do all of this without complaint and often cheerfully.

They also genuinely care about the health and safety of their volunteers.  No matter how tired they are, they are always here to answer questions and teach medicine.  Danae spends time with each woman on maternity, learning their stories, encouraging them, fighting for them.  In a country that was ranked as number one for ignoring women's rights, she is making a difference and in many cases giving these women a reason to live.


Anyhow, I am so grateful.  Without them going far beyond the extra mile, i would not be sitting in Charlotte right now.

so I will update more when I know more.  hopefully its nothing, right?? right.

right??

right.

.clison

Burkitt Lymphoma. A mature B cell neoplasm. Characterized by rapid
grown and most commonly maxillo-facial envolvement - it is the most
common pediatric cancer in Africa. Caused by the Epstein Barr Virus
and augmented in malarial-endemic zones of sub-saharan Africa, untreated
Burkitt Lymphoma is aggressive and devastating.

According to a study by the French-African Pediatric Oncology Group
(GFAOP) published in 2011, median age of diagnosis is 7 years old with a
male to female ratio of 2:1.

The article focuses on improvement of patient outcomes using
Cyclophosamide Monotheraphy. In a nut-shell - Cyclophosamide is a
cyto-toxic chemotherapy agent most commonly used to treat Burkitt
Lymphoma. Used in conjunction with methotrexate, prednisone,
dexamethasone etc to prevent tumor necrosis syndrome and subsequent
renal failure it has resulted in complete remission in roughly 50% of
cases studied.

blah blah blah

I have seen 2 cases of Burkitt Lymphoma since I have been working in
Pediatrics here. The one I will never forget is Clison.

Male. check.

7 years old. check.

Sub-Saharan Africa. check.

geographically malarial-endemic zone. check.

He originally came before I got here. He had a massive tumor on his jaw
on the left side of his face. Through the gracious efforts of American
Donors, the doctor initiated the cyclophosamide therepy.

And by a tumor I mean it engulfed his face. Difficult to talk,
difficult to eat, to smell, to see.

here, due to a variety of contributing factors, this is how we do
cyclophosamide. We initiate it with 1 gram of cyclophosamide in a
bolus. Then we follow that with 5 days of mandatory hospitalization and
dexamethasone 4 grams every 6 hours. The interesting and often exciting
thing about treating this tumor is that when the therapy is effective we
will see a noticeable decrease in the tumor. it is possible to see
measurable diminishment on a day to day basis.

I don't know how many weeks of theraphy he received, but i think it was
5 or 6. and then he went home. the tumor looked like it was gone.

several weeks later, he was back.

the tumor swallowing up the left side of his face again. he was here
for 7 more weeks. malnutrion, anemia, malaria. stick thin arms and
legs. and then his body started reacting to the dexa. he developed
absesses all over his body. his old IV site was a tunneling pussy wound
that streaked all the way up his arm.

he developed a super-infection. he developed an absess in the tumor.
the tumor receded somewhat, but not drastically. not nearly enough.

he went home for several weeks. because every day he cried because he
wanted to see his brother. i didn't think he would come back.

but he did.

and the tumor was even worse. this time affecting both sides of his
face. unable to open his left eye. difficult to speak, almost
impossible to chew.

another round of cyclophosamide. to do or not to do. what do we want
to get him in the end.....the tumor....or the infection.

they decided to do it. one more week.

the tumor remained the same.

see the picture. thats him. thats Clison. that is a person. that is
a person I should never have gotten close to. that is a person i
couldn't help getting close to.

i don't even technically like children

a child that perfectly fits the description of Burkitt Lymphoma. A
child that went home today and is not coming back.

I played disney movies for him every day. brought him bananas and
candy. and he would sit up so straight and so still. and shake my hand
very gravely. and then he told his parents he wanted to go home to live
with me.

he started equating me with candy. but I didn't care.

and we had a rather serious discussion in which he insisted I leave the
hospital that very minute and walk the 20 minutes to my hut to get him
juice, explaining in Gumbi why that was an absolute necessity.

and he loves to color.

and loves to draw.

little orange mud huts

and loves juice.

and loves his brothers.

and he is going home today. and soon he won't be able to eat anymore.
or talk anymore. and the wrist that is the size of my thumb is going to
get even skinnier. and then his right eye is going to close. and it is
going to be slow. and it is going to hurt. and he is only seven.

he never got to go to disney world. or college.

he never got to get married or grow old.

we did absolutely everything we could for him. every medicine in the
book. every medicine out of the book.

and there isn't anything we should have done differently.

and there isn't any point to this story.

other than sometimes life is horribly, horribly unfair.

and this isn't very well written, and sounds rather plastic, but thats
all i got.

.bruler

you don't want kids like this to have names.
you don't want to look at them too long, not at the burns, and
especially not in the eyes.
3rd. 4rth. degree burn.
its easier to think in terms of the Parkland Formula. wt. in kg X 4 X
BSA burned. replace fluid accordingly.
% burned? roughly 55% body surface area burned.
both arms. all the way around. palms of hands
entire torso. all the way around
both buttocks.
both outer thighs.
so now we have our percentage.
so now we should give fluid....right?
and we should keep him from getting hypothermic....right?
and we should prevent infection....right?
and he should be in a heated burn unit. and everything touching him
should be sterile. and he should have a central line. and.... and...
and....
Monday:
he is lying on the cracked black pediatrics mattress, the same one that
doesn't get washed between patients, the same one that has absorbed
countless forms of childhood secretions over the last few years. nothing
is under him. he covered in by a thin dirty sheet. he is shivering.
no one has applied any Silver Sulfadine (creme that can be used for
burns, prevents infection as well as keeping the burned skin moist to
allow for healing and prevent severe contracture). there are flies all
over him. no IV. no one has given him water. no one has bathed his
remaining skin.
so we ( me and another lovely medical student volunteer named Mayline)
go on the warpath. First we find a tchadian nurse to translate, not an
easy task. When is the last time you gave him water? last night?
here, here is a cup for water. tell them to give 90 ml every hour (3
little cups). We filled up the basin. They said they would do it.
Then we got clothes sheets from the OR, scrubbed the mattress down with
bleach, put clean sheets on, carefully bathed him, covered him in
creme. okay. better.
no money for an IV, the feet are so swollen none of the other nurses are
willing to try. so we will push the liquid.
in the US, when you tell a parent to give the child a certain amount of
liquid, every so often. they set their alarms. they will give it every
hour on the hour. they will worry if one drop spills from the glass.
not here. when I say, "give your child water" I get a blank stare.
and then a yes. and then noncompliance. I pass by an hour later. the
cup is untouched. I get someone to translate. they didn't give it. I
repeat myself. you need to give your child water because..........
2 hours later....no one gave him water........
at the end of the day, neither of the parents have give him water once.

.......1 week later......
than
we are out of burn creme. like, no silver sulfadine, no zine oxide in
the country of Tchad. We are a hospital with a pediatrics ward that is
OUT of burn creme. with now 3 burned patients. words like
unacceptable, reprehensible, unfathonable, rediculous, come to mind.
and the worst part is, a week ago, THE DAY the child got here, i went
to the pharmacy. I asked them, how many tubs do you have left? how
many are in storage? do we need to order more? and he laughed at me.
and said "beaucoup" ( = many, many, many) and I kept asking for an
exact count, and he kept saying "beaucoup"
okay. well, we ran out the next day. called around to all the major
cities in tchad (all, well, 3 of them) and we asked if they had
anymore. they were out too.
thankfully, some of the volunteers here had Shea Butter and donated that
to the cause, buying us another week or two. I talked to the
administration - are you ordering more creme? they had forgotten.
and then we are back to the same old song and dance in pediatrics. the
have you washed the clothes he has laying on? no? why not? get a
nurse to translate. get the husband to make the wife do it. get her to
do it. have you given him water today? no? why not? re-explain the
importance of fluids. Have you bathed this child today? washed the
skin that isn't burned? no? why not? explain the importance of hygiene.
and then we scrub down the kid with bleach water (not the burned parts)
and we scrub down the bed and 2 hours of argueing and fighting later he
is semi - fixed up again.
and then we run out of shea butter.
has anyone ordered more burn creme? of course not.
so, we make our own.
Amanda (another volunteer, med student and bible teacher) and I decide
to make burn creme. because we are so highly qualified for such a task.
first, we walk to the tchadien bar and in a slightly shady transaction
fill our water bottles up with millet wine.
then, we get to raid Tammy Parker's medicine cabinet. among other
delights found there was a bottle of vitamin E capsules, barrier creme,
colloidal silver, and vaseline. sweet.
then, we pick Alum and Neem leaves from friendly trees ( leaves known to
have mysterious "healing" properties....).....
also donated was some precious olive oil and honey.
so, in case any of you are about to travel to a third world country and
work in a pediatrics ward with burned patients and no appropriate products, here is the recipe for


"New and Improved Burn Creme"
20,000 IU Vitamin E
1 cup Millet Wine
I cup Olive Oli ( with Neem and Alum Extract) chilled
2 Tbs vaseline
60 ml colloidal silver
1 cup honey
chill and whip and whip and blend and chill and whip.
the final product was surprisingly, creamy.
so we have been using this with good results the last week and finally,
yesterday, zinc oxide arrived.
and felix, his name is felix, he is still alive. he is eating and
drinking and recovering from malaria. he has an IV now and parts of his
skin are healing.
he has a long road left but we will keep fighting for him.
and in the meantime we need a public health broadcast on the local radio
detailing the dangers of carrying pots of boiling water on your head
with children strapped to your back...........

.my soapbox

this is what happens. this is the end of the road. the end of a long
line of public health terms and politically correct statistics.

this is where babies with faces of old men die because they are tired.

here.

now.

the place where problems of poverty ignorance bad water corruption and
not enough food collide.

it started six months ago, although it really began centuries before
with fat cats in powdered wigs who promoted colonialism over a glass of
port.

6 months ago, a mother was pregnant again and her first baby was only a
few months old

she was pregnant and she was tired.

she stopped breastfeeding the first baby thinking she could not support
both of them.

here we can interject words like family planning and child spacing and
other such terms that could have made our mother less tired

so suddenly our baby isn't getting milk anymore.

and then he is drinking unboiled water from the village well.

and then he has parasites

and then hes just not that hungry anymore.

and mabye his belly swells and they think he is fat. and he gets more
and more tired.

he plays less and starts having diarhea.

about the time we can start counting the ribs from ten yards away the
parents realize something is wrong.

they borrow money from family and friends and take him to the nearest
health center.

but he can't keep down the medicines they buy. and maybe while they
were away from home he is not sleeping under a mosquito net anymore.

or maybe he never was.

and now our baby has malaria and they finally get on the bus and bring
him here.

and we start on in IV quinine and tell the family to give him small
glasses of water and bui made with rice and peaunut butter and bananas
every hour.

they nod their heads and don't do it. maybe they don't understand.

they don't know how sick he is.

and now the center of the chest is sunken and concave and each
individual rib is sharp and splayed like a dish rack.

and he isn't drinking what little they are giving him

and they think that because he is on IV quinine he is getting enough
fluid but it is only 7 drops per minute and only serum glucose at that.

(many parents will not give their children anything to eat or drink
while they are on IV quinine because they somehow think that is what the
perfusion is for)

and finally we buy him IVF because there is no way they could afford it.

he is unconcious now but we give him dextrose and several IVF boluses
and he revives and even drinks something.

he looks better and sounds better and I think we can save him.

I think we have given him what he needs in that fragile moment between
just in time and too late.

and its like the skin is stretched so taut across his chest just so it
can be bunched and wrinkled all over the rest of his body

he cries and his face creases and crinkles in all the wrong places and
the only way to describe it is that he looks old

a one year old with the face of the aged

a one year old with eyes that have perhaps seen more suffering than many
see in a lifetime

and we think he is anemic but his hemoglobin is nine

they give him more bui and he revives even more

but then he starts convulsing

and thats not right, he isn't supposed to still be having convulsions on
day four of IV quinine.

and then he isn't breathing well

and five minutes later he is dead

and we don't do CPR because we have no oxygen

we don't do CPR because even if his heart started beating again all the
factors that led up to this death, right here, right now, those won't go
away.

and they cover his face and close his eyes and leave to face a funeral
that will be far more expensive than proper food would have been in the
first place.

so was it the malaria that finally got him in the end?

was it the malnutrition?

or was it perhaps that he was born in the wrong country in the wrong
village and in the wrong world.

he had everything against him the moment he opened those wise luminous
other-wordly eyes.

he was born into a world in which nothing is fair and no one is equal

he was born and he has died and I no one will remember his name

no one will see his face

a nameless shadow that lived and died in a country where parents
deliberately have as many children as possible because they know that
they are going to lose some of them.

and I am not an economist or a historian.

I don't have a single answer for how we can make this better.

for how we can bridge the gap between rich and poor, between right and
wrong, between justice and rhetoric.

but I do know that it must be bridged

I do know that this is not right.

I do know that it is the cruelest of injustices

I do know that we cannot be comfortable with this as our status quo

and I do know that there will come a day of reckoning in which this
child is remembered.

and really, is there ever going to come a day when things are fair? no.

and is there every really going to come a day in which peace can be
experienced? no.

and is there ever going to come a day that isn't saturated with
thousands of senseless deaths? no.

but that doesn't mean we can't fight for it anyway.

that doesn't mean we can't dream the impossible dreams anyway.

that doesn't mean we can't give of our wealth anyway.

that doesn't mean we can't help that one person anyway.

and maybe you can't go to Africa. and maybe you aren't a doctor. and
maybe you don't have a degree in public health or work for some
fashionable NGO. that is okay. you don't have to be that person. but
you DO have to remember the forgotten. you DO have to involve yourself
in some cause which does not let you be indifferent. you DO have to
find a way to touch someone's life. you DO have to get out of your
comfort zone. you DO have to give something that you have to someone
who has less than you.

it is your responsibilty as a human being.

to protect life - that most inalienable of human rights.

how will we be remembered?

in this, the first global society.

How will history be written?

how will our generation be defined?

we must fight to uphold all human life as sacred. we must fight for the
forgotten. for those that have long since been given back to the
earth. for those that have not yet been born. we cannot live
comfortably in a world in which one side of the continent is drowning in
an orgy of excess while the other side is dying from scarcity and neglect.

we can be the generation that dreamed the impossible dream.

60 years ago the world was shaken with a a holocaust. with a society in
which it was in fact possible to murder 11 million people. and 60
years ago we said never again.

but when my eyes roll over the ribs of this child, i wonder if we meant it.

.jaundice

so. i am sitting here typing with an IV in my hand and a box full of
fluids beside me.

After I got malaria and subsequently went through the hell that is
quinine, I haven't been feeling well.

I have been fatigued and haven't really been eating anything but rice
gruel for a couple of weeks.

then, like 10 days ago, i developed jaundice.

so i walked around like that for about a week before I or anyone really
noticed anything was abnormal.

here, malaria is like the common cold, fatigue is part of life, and not
eating is easily chalked up to the many palatable options that are
available anyway.

so, just to be safe, we checked my transaminase, liver fuction tests.
My ALT and AST were about 10 times the normal value.

and the sclera of my eyes were yellow.

so then yesterday they thought about sending me home. and that idea was
tossed around just enough for all the mental fortitude that i have been
building up to completely crumble.

and so now this weekend I am getting tons of IVF, taking cipro, metro (
In fact i have giardia as well, who knew) and parasite medications.
then, tomorrow, after the detoxifying regimen I will retake the liver
function tests and if they are worse then I am coming home.

so now I find myself desperately hoping for liver failure so I can spend
a few weeks on American soil which is of course absolutely ridiculous.

but what is going to happen is because I have am getting so much fluid,
they are automatically getting better anyway......so i'm not going.

so the whole thing is just a cruel joke on my sanity.

anyhow, please pray for my health, mental status, and unhappy liver.

and come visit me in this the most amazing place on earth, tchad.