Monday, April 23, 2012


Florence is beautiful.  She is tall and strong, big boned with muscular arms and a perfect figure.  Her smile is wide kind genuine.  Her skin is a perfect smooth creamy black. 

She is only 17.  One year away from being able to take the bac – something we might think of as equivalent to getting your high school diploma.  Except that here, people have to take it over and over.  It’s a huge accomplishment – it is very hard – and there are no text books to study from.  No review book.  Nothing. 

But she is committed.  She walks 14 Kilometers every day to school, and then back again.  She leaves at 4 AM.  She doesn’t come back until 5 at night.  And then its cooking for the family – walking to get water – only at 10 or 11 at night can she find time to read her notebooks…..

She is exhausted

She came over tonight.  Waited for me for 2 hours.  I didn’t know she was here.  And she didn’t really say much.  We ate together, drank tea. 

Talked about the weather

So the rain.

Her house doesn’t have a roof on it. 

There was a rainstorm last night.  They couldn’t sleep.  They were cold, and wet.  And then she got up to go to school. 

And she needs money for school fees or she will have to stop going.

Their mother and father both abandoned them.

She started crying.  She said she was going to go too.  She said she couldn’t do it anymore.  That she wanted to abandon them too. 

The weight of her entire world is on her shoulders.  Her family is hungry.  They don’t have a roof.  They don’t have a well. 

They have no income, they are all stubbornly still in school.

She says she is too tired to go on.

She says she is going to die.

She says the road is dangerous – walking alone in the early hours of the morning.  She has already been harassed multiple times.  She says if she keeps walking the road she will die. 

She doesn’t understand how brave she is. 

How rare she is. 

In this culture where most girls drop out of school when they are teenagers – get married young, try to improve their situations (often ending up in far worse ones)

Everyone would expect her to just get married.  Or stop studying to work.  But she still goes to school.  Walking 4 hours a day. 

Working every waking hour. 

When I write it it doesn’t even sound real.  That people I know could be in this kind of situation.  That people I know are crying in front of me, telling me they are too exhausted, telling me they want to leave too, showing me their breaking point. 

Somehow, we expect more resilience out of the poor – we know they are poor – but somehow they manage – somehow they live. 

But imagine if you had a crumbling mud hut that didn’t have any roof.  Imagine if you had 6 brothers and sisters all depending on you for food.  Imagine if for months all you ate was a little rice and green mangoes.  Imagine walking 28 Km a day, just to go to school, imagine having a mother who was never coming back, a father who was dead, a family that looked the other way.  Imagine that your well is the color of green scum, you have no potable water.  Imagine that everything you own is muddy and drenched by the rain – that you are surrounded by danger – surrounded by societal and cultural pressures to just give in, quit school, find a man to take care of you. 

And imagine that despite it all, you get up every morning and face a new day anyway.  You leave the house at 4 am anyway.  You cook whatever food you can find anyway.  You walk to find water anyway.  You take care of your family anyway.

I don’t think many of us understand the kind of courage that that takes. 

How rare it is. 

What kind of courage do you have?

Do you have the courage to do the hard thing anyway?

To walk 28 km in search of a better life?

To do it every day?

To take the road less traveled by?  The road only you believe in?

Do you have that kind of courage?    

That kind of grit?

How would your life change if you did?

Courage is something that cannot be bought or sold, planted or cultivated, harvested or used up.  Courage is something you were born with.  Something that beats in the soul like a heartbeat.  Every time you challenge yourself, it takes courage.  Every time you take tiny steps towards the person you want to be, steps no one will ever see, that takes courage.  Every time you talk to a stranger, speak in public, try something new - that takes courage.

but the ultimate courage - that is the courage to believe in yourself.  That is the courage to tell yourself you can do something - the courage that is the wings of risk - the courage that propells you forward to take that first step, whatever it might be.  The courage that tells you you can take another.  The courage that faces a hard dark road - because you know in your soul there is freedom on the other side -

courage - we all have it. 

and when we summon it, it will never abandon us - every courageous act has meaning within itself - brings freedom within itself. 


what kind of courage do you have?

I challenge you to do something courageous today.  something hard.  something you don't want to do.  something that brings you one step closer the dreams that are deepest in your soul.

I challenge you to drag those dreams into the sunlight.

to look them in the eye.

to tell them you are going to fight for them

and then fight for them

like your life depended on it -

because it does.

......there are only 2 mistakes one can make in this life.....not starting and not finishing........ (buddha - or some equally wise gent)



I have rarely seen anyone so pale.  Lips grey brown, tongue white with only a hint of pink – like he had stuck out his tongue to catch the snowflakes.  White fingernails.  White conjunctiva.    Tachypnea.  Pulmonary edema.  Tachycardia. 

He’s dead now. 

After getting a pouch of whole blood from his father – after they went out to the village to try and find the money for a quinine perfusion that he should have received earlier. 

When I got to peds this morning, I was cleaning off the supply cart when I this labored dyspnea slowly sank into my consciousness.  I followed the sound and there he was.  Bed 16.  Looking horrible.

He is better now, the nurse on guard shift said.  Better?  I wondered what he was like before. 

Look at how pale he is. 


Oh yeah, I guess he is pale.  Okay, bon travaille!

And then she leaves

And maybe he would have died anyway.  Maybe so.  Maybe all the appropriate interventions in the world wouldn’t have worked for him. 

But he was only 4

But we should have started IV quinine as soon as he came in.  He should have been transfused earlier. 

And its easy to diagnose in retrospect. 

But there is no excuse not to assess the patients.  None. 

You don’t even have to be smart. 


And yeah, I think I’m pretty rock and roll.  Sometimes.  I think that oh, if I was there, this, this, this, wouldn’t have happened.

And that’s not really true.  Pretty much, here, you either die or get better, and I make mistakes every day.  all the time.  I just don't love admitting it.

And an hour before he died

They asked how much should they feed him.

A little bit of bouille?? How often??

People always fixate on something.  Someone can be pretty much coding and the family member will be all torn up about whether or not his tube feeding is at the correct rate or if he received his glucerna shake. 

Or how the patient has slid down in the bed or how the pillow is wrinkled.  And usually the things they desperately grab onto have nothing to do with how they really are doing. 

When my grandpa died, my family did it too.  We must have been the nightmare family.  5 nurses in one room.  The rest doctors.  And what did they do??  Did he get his beneprotein in his tube feeding?? He needs his protein……

We have had 15 kids die this month.  I’ve seen more death this month than in a long time.

But I’m either getting jaded or will completely lose my mind over something very simple frivolous and non related.  I suspect the latter will happen soon. 

In fact, I’m bothered by the fact that I’m not that bothered.  Or maybe I am, or I wouldn’t be writing this. 

It is just hard.  To see the tears streaming down the parents faces.  To see the hope. Hope until the very last minute.  Spending all their money.  Trying.  The next kid, will they take him to the hospital??

And they close the eyes.  And cover the face.  And I take the IV out.  And the mother, she just crumples.  And then they walk out.  And then we go eat. 

And I think I have a lot of misdirected anger at the nurses here.  And I may have taken a bit a self-righteous stance.  I am expecting the other nurses to view nursing through my eyes, to have my same world view.  They have less education.  They have no experience in an American hospital.  They were not trained in their departments – no six weeks of following someone that knows what they are doing – no formal orientation – just thrown in, sink or swim. 

And they do a little of both.  There isn’t a lot of admitting you are wrong here.  Do you know how to put in Pediatric IVs?? Oh yes.  Yes.  You have done it before?  Yes, I know how.  Okay, you can do this one.  And his hands are shaking.  And he cracks the needle.  And it’s obvious he’s never done it in his life. 

Do you know how to give this medicine?  Yes.  And then drawing it up wrong.  And giving the wrong dose.  I don’t know what that’s all about. 

But, when I was a student, if I was just thrown out there, I wouldn’t have done well either.  If no one had explained things to me, been patient with me, and watched my hands shake as I did everything for the first time, how would I have learned??

But we put these people by themselves right away – and then we expect high quality work when they never had the opportunity to learn??? 

But everything is complicated here.  This hospital has been in very competent hands the last 8 years.  Change comes slowly here.  I think I have the answers.  But I don’t.  Not even a little bit. 

The wretched part is just how preventable it all is.  No oxygen. No life support of any kind.  When they die, they die.  Now, it’s laughable that I printed out ACLS and PALS to take with me and had a special notebook to put it in.  I had every protocol for every scenario. 

It is just terrible to see children die on your watch when you know that ANYWHERE else…..they would have had a fighting chance. 

And they would have had people that fought harder for them. 

And then they might have made it. 



Sunday, April 22, 2012


being here is kind of like camping. its pretty neat. pretty swift, as
me and kimmy used to say in high school. except the campground is
pretty permanent. and the tent is made of mosquito netting. and there
aren't any showers. and the other campers are camping for life. its
kind of like hotel california. it sucks you in and you might never
leave. you play in the dirt, read on a woven mat, sleep outside, cook
over an open fire, watch the coals spitting and popping in the fading
purple light. you draw your water from a well, throwing the bucket
down, it bounces off the damp mossy sides, and splashes into the cloudy
water below, pulling it up swiftly, hand over hand, the rope raw and
rough between your fingers, feeling your arms growing stronger.
honestly, some days, i really dig it. I could be happy never living in
a house, i could be happy always waking up to the sun in my face and the
birdtwang in my ears. i could be happy stretching on my backpacking mat
and rolling over, trying to block high pitched rooster rasp. i could be
happy washing all my clothes by hand, fingers red and stinging, twisting
and ringing and scrubbing, slinging them in dripping rows to dry in the
gaze of the sun. I could be happy walking to work every day, wandering
past mango trees and sleepy cattle and sheep hopping sideways down the
path like wooly grasshoppers. I could be happy putting in IVs outside,
auscultating lung sounds in the shade of a tree, hanging perfusions on
the chainlink fence. I could be happy learning languages that are not
my own, always a little out of my element, realizing that is indeed my
element. I could be happy burying my face in juicy fleshy mangoes,
sucking the sweat juice and tearing the tangy pulp clinging like velcro
to the stringy white mango seed, letting nectar drip off my chin and
down my cheeks like golden tears. I could be happy crunching into green
and pink guavas, the chalky thick rind giving way to ruby silken
deliciousness. I could be happy here. The only thing missing is
someone to share it with.


Welcome to the place of indescribable beauty and unspeakable pain.  Welcome to the edge of the world, where heaven and hell and the dark forces in between collide.  Welcome to warm handshakes, real smiles, face melting laughter.  Welcome to quiet, stoic, stories of horror.  Welcome to the place where everyone wants everything you have.  Welcome to the place you want to give everything you have.  Welcome to the place that makes you re-define that hazy medium in between.  Welcome to a pudgy laughing baby you swing on your back, tie with a cloth, as it goes to sleep against you.  Welcome to a tiny wrinkled baby, open sores, swarming with flies, dying in front of you.  Welcome to a nurse that is eager to learn, that asks you so many questions.  Welcome to the same nurse that won’t even take vital signs.  Welcome to the place they don’t take the pulse because they have no watches.  Welcome to the place where you are your own cheerlead, your own psychologist, your own best friend.  Welcome to the place where success is measured in the tiniest of increments.  Where trying to make changes is met by a solid, seemingly impenetrable cultural barrier.  Welcome to the place where you are exhausted.  Welcome to the place where you are exhilarated.  Welcome to the place where you are always sick, always in discomfort, always sweating.  Welcome to the place where you feel profoundly grateful to be alive.  Welcome to the place that brings out the worst in you.  Welcome to the place you can cultivate the best in you.  Welcome to nights that surround you with stars, where the buzzing chirp of crickets lull you zinging to sleep.  Welcome to nights where your family snores all around you, where you would give anything for a moment to be truly alone.  Welcome to a vibrancy you’ve always been missing.  Welcome to a suffering you never wanted to see.  Welcome to an experience as organic as the earth you’re sleeping on.  Welcome to a wanderlust that creeps like delicious poison through your blood.  Welcome to the tears screams hugs laughs fights dust sun and mosquitos.  Welcome to being alive

Tuesday, April 17, 2012


the rains have finally come and the heat is steaming from the cracked musty earth and the air is thick and sweet and teasingly cool. 

and when it rains, it rains

rains in waterfalls, buckets, hugs splashing drops, thousands of teaspoons of rain turned upside down

tears of the sky

happy tears

I am always mixing up the pluie (rain) with pleurer (to cry) ,  the dark electric sky - spitting tears of rain

 the sky is crying over africa

and like all things here

it is ferocious

and the earth is opening its arms to receive it

and the lightening and the thunder here

cracking and rolling over the houses

flash in the dark

flash and flash and flash the horse and flash the house and flash the rain, tearing through the sky in shimmering sheets, flash the neighbors bulls chewing sodden hay

flash the mud

the mud the mud its cold and spongy beneath my toes

and i'm dancing in the rain and i can't help it, Scorpions and Rock you Like a Hurricane blasting from my phone and doing a jerky crutchless hop hands in the sky

flash the faces

the children are laughing

flash we laugh here

its okay to laugh at other people

its okay to laugh at yourself

streaming wet sopping dripping finally cool finally the hint of a shiver finally the rain the rain the rain the rain

and the tiny muddy arms of the earth are dancing with me

the leaves are awoken in the twigs the spiders begin to crawl

the earth is alive and breathing and moving and rolling

the tiny creatures are on the move

and the rain is pouring down

where is Noah i don't need his ark i could swim through the sky in this rain forever

flash and flash and the thunder is screaming


hot and cold

dust and mud

dry and wet

here, the land where opposites collide


the fierce grey compromise


the color

the water

the beat of life

dashing into the hut, tracking muddy footprints, the product when rain and earth and foot collide

swept way tomorrow but elemental tonight

and bullets and pellets and pings and faster and harder and the roof is buzzing with the brash cacophony of rain drops

back with a vengeance

a force

no denying

the power of  the rain

no stopping

the power of the rain

no repelling

the power of the rain

only dancing

to the music of the rain