.Arnou

me and my irresistibly charming irascibly naughty little brother

.barefoot

life is better experienced with the shoes off

.dusk

sun sinking indigo gold behind the freshly planted earth - a glorious
Tchadian sunset

.purple

laughing at dusk near the rice fields

.blue

Florence

.market

girls at the market trying to sell me peanuts and gateaux, they walk
around all day with platters of food, tea, and other things to sell on
their heads.

.let.it.be

i like vespers here - just being able to relax and to think and be with people in a nonstressful, nonwork related environment

and they were asking tonight, asking the people leaving - what are you experiences, insights, what changed you??  are you worried about going back home?  any regrets?  any revolutions? 

and i thought about how I would answer those questions.

but how do you answer them? 

i don't view my time here as a "year out."  Instead, i view it as my beginning - the first sentence of a gloriously blank page - i love that about the future - anything can be written there. 

some things you write yourself - some words and sentence are formed by dreams, ambitions, thoughts, things you pushed yourself towards. 

other phrases are people you met along the way, snatches of conversation, shared smiles, a look, an exchange, a hand, a flash of color -

and still others, the dashes and commas of chance, of happenstance - all of conspires to roll out the words of the book of your life -

so I don't think i can define my experience here in profound terms - i don't think i can have a neatly wrapped answer - i don't think my time here is isolated - this year so different from the year before and the year after - i think this year is a continuation - a reality of the years of dreaming and working and planning - a steppingstone towards the next year - not valuable on its own but valuable in a sequence

and they asked me what it was like to go home, how was the "transition"

and the transition wasn't so hard as it was muddy - like being in a fog and as Justin said tonight - realizing your body is in one place but it takes a bit for the soul to catch up and live there too

i hope to one day transition beautifully between cultures and continents and climates - being able to absorb it all - discard that which does not fit - and internalize that which broadens my worldview, makes me grateful, makes me kinder, makes me better

i think its an art - and the only way to acquire the delicate balance is to just go anyway - to bravely go between home and new horizons - to step out onto the blank page - whether its an unknown homecoming or an unknown part of the world - and then to value everything that is written there

to allow others to write on the book of your life while at the same time stepping out to write your own story

there is nothing as mesmerizing as a blank page - creamy and perfect and blank -

 nothing as breathtaking as marking that page with the inky footprints out your life -

nothing as invigorating as climbing a mountain, letter by letter, and then at the top spreading your hands into the air and spinning in slow circles, looking down on the clouds and up at the sun, and finally seeing those letters you trusted as you fought your way to the top merge into sentences, and paragraphs, and finally, you see looking down, your story

i don't know what my story of Tchad will be - as all who have been here agree, it is impossible to put into words, to impart every moment in a few sentences

i don't know what it will be, but i am collecting it in fragments

and one day i will have the perspective and hindsight to view its impact as a whole

and my fragments of late have been sad ones

I do the best I can to open my heart to suffering and let it impact me on a human level - i try

but i also am imperfect at letting it go - at letting it pass through me and then take its rest somewhere else

the last week at least 1 or 2 children have died in pediatrics every day -  3 of them were on my watch, on my shift

all of them i knew

 i listened to their hearts, heard their breath rush in and out of their lungs with my stethoscope

heard the heart falter, the breaths become shallow and hoarse

having no resources at my disposal to stop it

just letting them die
just letting them die
just letting them die

i don't understand life and i don't understand death

i don't understand how a heart starts beating and I don't understand how it stops

i can understand on a scientific and intellectual level, but not on the personal level

not on the level where the skin is warm and they aren't breathing well but they are breathing and then one minute late, the heart that had beating furiously just stops and the hand that was wiggling turns limp

and then you clamp the IV so the fluid isn't flowing into a dead child and thats the moment i hate the most, taking out the IV, not knowing what to say to the parents, not knowing how to comfort them so just saying nothing at all, sometimes putting a hand on their shoulder, sometimes not, and then watching them cover the face and walk out sobbing, sometimes their hands are in the air, like they are clutching at the skirts of heaven, beseeching God for a life that just moments ago was vibrant

tell me how

how does a heart stop beating?? 

how does a lung stop breathing? 

how does everything about that person, the dreams, the smile, the love they shared, the twinkle in their eye, their entire swirling cataloge of memories - how is that suddenly obsolete when their heart betrays them? 

i have seen more death than i wanted and i still don't understand it

and then you mark the roster, put a 1 under the deceased column, and then you go about your night

and you have you done something more?  maybe
you have have made mistakes?  maybe
could you have done something you didn't realize to save someone else's life?  maybe
are you doing more harm than good?  maybe
are you doing more good than harm?  maybe
for every truth, is the opposite also true?  maybe

but its not about me.  its not about if i made a mistake that lead to a death.  its not about me if i tried something that saved someone's life.  the world does not revolve around me - it is gigantic and galactic and star studded and swirling - and all these tiny moments are just part of the slow screaming slow dance of humanity as we spin further and further into madness



and we all try different things to rectify the chaos - to name it, to describe it, to stuff it into a box or package with a bow on top, to force the fluid elements of the universe into something we can work with and understand and build a life on

some people call that religion, or politics, or beliefs, or crutches

there is so much effort to explain, to explain ourselves and our worldview into a position of rightness

but if being here has taught me anything, it is that there is not a an easy answer for anything

there isn't an easy way to wrap yourself around something that is so monumentally unfair, horrendous, unjustifiable, and unexplainable

and for those that think they have the answers, i say walk a mile in the shoes of those you are trying to solve the question for

hold their hands on the way to market

eat boule from the same dish

watch them die in front of your eyes

again
and again
and
again

and then tell me you have the answers

i don't understand how a heart can start beating
i don't understand how a heart can stop beating

i don't understand how the human state is so tenacious yet so fragile

and the only thing that makes sense was written by 2 very wise gents in their time


King Solomon:  in Ecclesiastes - .....a time to be born....and a time to die..... a time to reap....and a time to sew....a time to mourn.....and a time to be comforted...... concluding with "for time and chance happen to us all" 

time and chance

time and chance

everything to its season


and the Beatles:  ......when i find myself in times of trouble.....mother mary comes to me.....speaking words of wisdom, let it be......

in my hour of darkness, she is standing right in front of me, speaking words of wisdom, let it be 

let it be

let it be
let it be

let it be

whisper words of wisdom

let it be

and when the broken hearted people. living in the world agree,

there will be an answer,

let it be

and though they may be parted, there is still a chance that they will see.....

let it be

let it be

let it be

there will be an answer

let it be

....whisper words of wisdom......

let it be 

let it be

and when the night is cloudy, there is still a light that shines on me, shine until tomorrow, let it be

let it be

let it be

let it be

there will be an answer

let it be

.0.00%

so my malaria test was negative today - that should make me happy, right?

wrong

i hate the crucial but inconvenient fact that a negative malaria test
doesn't mean you don't have malaria - in the states - you would have to
have six negatives before it was ruled out -

so i could have it
i could not

but i feel like i've been run over by an army of egyptian slaves hauling
stone up the pyramids

i feel further as if every cell in my body was hooked to a slap of pure
granite, making every minute action - such as talking, thinking, or
putting one foot in front of the other - an exhausting maneuver.

i had chills last night for the first time in my life - goosebumps in
the 90 something degree evening -

i should have checked my temperature

and i'm about due for it again - have enjoyed 3 months of fantastic
health other than being thrown off a horse and breaking bone - so
perhaps my time has come.

it was exactly 3 months last time too -

since quinine puts me into liver failure, i may start malerone sans
positive blood smear or i may wait until i either feel better or worse -

so thats my story.

great blog, right..........

.sorry4me

if anyone is inclined to feel sorry for me working all alone in
pediatrics - don't.

see what you don't know is that I have all the company i could ever want -

a rat that dashes in and out of its rabbit hole every night around dusk
a small army of giant voracious ants sniffing out spilled syrups
a bat swooping in and out of the quinine drips
a snake scurling its way across the floor of the "nurses station"
a cockroach crunching sickeningly beneath my crocks
a battalion of mosquitoes whizzing and whirring and drunk with blood
a lizard scuttling across the rafters
a fat army colored monster toad crouched menacingly on the cement floor -

so like i said, don't feel sorry for me - I'm not alone.

.correction

correction to the blog .sisters

baby sister of the girl that had retinoblastoma, not rhabdomylosis - seriously wonder where my brain has gone sometimes

.sisters

Me and my babies outside of pediatrics - the sisters of the 3 year old
with Rhabdomylosis that I posted pictures of. The little baby died the
day they were finally liberated to go home after 4 months - I still
don't understand why or how - we had treated her malaria, re-tested and
it was negative, gave antibiotics - the days before she died she was
breastfeeding and laughing and fat and happy as ever - this is what
Tchad is like.

.kindredspirit

me and my kindred spirit Liz - English teacher in Mondou with James and
Sarah - leaving Tchad tomorrow - tear - love and miss you Liz!!

.littleone - 2

so cute and so little

i wish he would have had a chance

.littleone - 1

this 2 year old died last night - see the puffy hands and tiny wrinkled
arms? I put an NGT in, we fed him regularly, and i thought he would
make it. i think i loved him

.smile

me and one of the amazing women I interviewed - we traded headscarves
and both left feeling lucky

.tea

drinking dark spicy Arabic tea with Justin, Bronwyn, and Naomi - outside
the little shop in front of the hospital - a perfect mellow grey
overcast whispery day

.drumbeats

        i followed the drumbeats tonight

i followed the chanting, the laughing, the stamping of feet, low thumping cadence of voices

        I followed the drumbeats tonight

under the clear white stars

circle dancing, the girls round and round in a slow rhythmic shuffle -

around

shoulders forward back, forward back, boom boom forward back

around

feet stamping time with the shoulders

hunched into the dance

altogether now

forward back

side to side - the hips

forward back

the shoulders

as if they were perfect wild puppets - moving as one by invisible strings

        I followed the drumbeats tonight

boys in the center - beating furiously, crescendo of bare hands and bare feet, faster and faster, slapping the drums

little children dancing frenzied

in and out

the circle breaking and merging

screaming shouting shaking laughing dancing chanting living

        i followed the drumbeats tonight

doing a strange white amerihop jitterbug shuffle

screams of laugher

nasara dancing

missing beats and spastic shoulders

shuffle

shuffle

around

        i followed the drumbeats tonight

under the clear white stars

circle dancing, the girls round and round in a slow rhythmic shuffle -

around

shoulders forward back, forward back, boom boom forward back

around

feet stamping time with the shoulders

hunched into the dance

altogether now

forward back

side to side - the hips

forward back

the shoulders

as if we were perfect wild puppets - moving as one by invisible strings


I heard the drumbeats tonight
i thought about the drumbeats tonight
I walked towards the drumbeats tonight
i followed the drumbeats tonight
i watched the drumbeats tonight
i danced to the drumbeats tonight



free
and the beatbumpumstampslapclap of the word called  go

follow your drumbeats - I know you can hear them

free

and the beatbumpumstampslapclap of the word called  go

.holocaust

I know how the Holocaust happened now


it happens when you are confronted with a group of people you have nothing in common with

               with a group of people you don't understand

it happens when you pass judgements on that group of people - as a collective - because you don't like the behavior of the individual

it happens when your too furious to even want to put yourself in your shoes

it happens when you think your shoes are better than their shoes

it happens when you think they are ignorant - and you think you are not

it happens when you think your way of life is better than theirs

it happens subconsciously -  and only later do you waken to its brutality


I know how the Holocaust happened now

because it happened in my heart



may I find kindness, patience, compassion, empathy, and love - for a group of people i do not understand - because I woke up to find myself entirely without
may my eyes be opened to what makes us human - what makes you human - what makes me human - what makes us equal



I know how the Holocaust happened now

because it happened in my heart

.moonlocked

so the rains have started and the mud is slipping against the roads and
the puddles are drawing circles in the dirt paths. the coarse rainbow
of brown is lightly dusted with a misty green, spring green, new green,
tiny sprigs of grass and weeds and millet.

and they are planting the millet, along the roads, next to the paths,
coarse furrows dotted with tiny green millet shoots, they are ploughing
in the compounds, hand-slicing weaving grooves in the crumbling mud,
whipping the oxen, walking behind. mil
let crammed into every corner, every free space of earth

they are planting the rice too, now the villagers go early in the
morning, an exodus out of town, past the steaming market, past the
thatched mud huts, out to the thousands of fields that surround the
village of Bere. if you don't have your own field, you can work the
fields of others.

you will earn 250 CFA - 50 cents for a days work

that will buy you less than a half kilo of rice

there aren't a lot of jobs here. most of the population of Bere depends
on the rice harvest. If you have a good year - you will eat that year.
If the rains came late one year - you will not eat that year.

The Arabs do a little better, almost all the shops in in the market and
surrounding the hospital are entirely Arab owned - when an Arab child is
sick, they will pay the hospital fees - they do not depend on the rains

The Fulani do a little better too, grazing vast herds of cattle across
the Sahel, driving the cattle into the towns and villages - selling the
meat if they need to as they go. Their women are fierce looking - sharp
scars knife their cheeks and foreheads, thick silver rings hang from
their arms and their ears, noses pierced with large gold rings,
tight-fitting bright colored dresses, strings of beads swing from their
necks, wooden charms wrapped in leather protect the necks, the wrists,
the ankles of the children, bright swaths of cloth are piled up on their
heads, their hair in tiny perfect rows braided back from strong
weathered faces, full lips dyed almost black - gypsies under the desert
moon

the tchadians have a legend about the moon here

on a sunday, a woman and her child went out to the bush to gather
firewood - and spent the day tying bundles of sticks,

but God was displeased, because she was working on a Sunday, out in the
bush when she should have been in church

so he punished the woman and locked her forever on the face of the moon
- the firewood still on her head

and on clear nights, they say, you can see her

in the shadows of the terrain that mottles the face of the moon

forever in exile,

never to return

most of the women gather firewood here.

at first i thought it was an exaggeration, but almost every woman here
who supports herself or her family or is searching for any income
whatsoever will go out into the bush to get firewood.

they hack off the twigs and leaves, strip the bushes, and then carry
back long bundles of straight sticks, tied with thick strong grass.

so why do they all do it? why don't they all go out of business??

because charcoal is expensive, and many people can't afford it. no one
has stoves. all cooking is done over an open fire, either in smokey
acrid cookshacks or out in front of the compound, or in slanting woven
grassmat lean-tos. So most people cook with wood. But its not like
they pop out of their houses and find sticks lying around.

They have to walk miles, 5, 10, 15 miles. they have to walk further
than everyone else doing the same thing that day. They have to search
areas already stripped over, brave poisonous snakes, scorpions, and
scratches from the thick tangle of whipping bushes, and then they have
to walk back.

almost anywhere you travel in Tchad, no matter how remote, you will see
women walking briskly along the sides of the road, balancing huge piles
of sticks on their heads - or large bowels overflowing with mangoes -
perfect rhythm, bright colors, effortless balance, swinging hips - and
you will feel happy - and charmed - and feel like you are in Africa -
and you will want to take a picture

but they probably have blisters on their feet

and are desperate to sell the mangoes, to eat that day -
or they might have 12 more Km to walk

and they take it to Market on saturdays - the livelihood of their family
resting on their heads,

heavier than it looks.

- this blog has no point really - but now you know about the millet, and
the firewood, and the shape of the shadows on the moon

.fury

I don't think I'll ever understand it - I don't know if I'll ever really be able to put myself in their shoes

I'm too busy being completely infuriated

there is a baby in bed 22, except he is not a baby - he is a 2 year old. 

He has never walked. 
He can barely hold his head up.
His teeth are rotten, broken, black

Arms a little bigger than my thumb - loose skin hanging in folds from his armpits, buttocks, inner legs, you can see all his veins spiderwebbing across his scalp - he doesn't have any hair.

I had to switch him to oral quinine last night - I didn't want him to miss a dose - and she was completely out of money.

i exchanged the malaria exam for oral quinine - he really should have had a third IV quinine perfusion, but after scolding her, hassling her, repeating everything, i finally decided she had nothing. 

her clothes are torn, she doesn't have much.

And then I saw the father.

he came for the first time in three days.  He was large and burly, thickly built with a big belly - he had on a 3 piece suit. 

he drove away on a motorcycle. 

he drove away on his motorcycle. 

he didn't leave her with any money. 

did he not know that his son was supposed to have walked by now?
did he not worry when he saw that his teeth were rotted and black
did he not look at the skinny arms, the swollen feet, and think.....

maybe my child is sick?  maybe he doesn't look like other children??

it makes me abhor the men here all the more.  and that is biased of course.  I freely admit it.  and there are individuals i love and admire - like Teskrio, and Mary Charles, and some others I know..... but in general - i just want to glare at them all. 

Wendy Roberts brought in bouille tonight - peanut butter, sugar, salt, water - its thin enough to put down NGTs.  its rich enough to keep them alive.  She is opening her nutrition center soon - maybe next month - and i can't wait.  it will be such a pleasure and such a relief to be able to refer them there.  to know that when they leave the hospital they aren't just going home to a slow death.  it will be amazing to know they will have a chance at a full recovery.

because when the kids go home, it is almost a guarantee they won't be given the medication correctly

its almost a guarantee they won't cook them nutritious foods, or even add peanut butter

its as if there is a total disconnect - but really?? how can you NOT know your child is severely malnourished?  or do you know but the circumstances are far more desperate and complicated then i can understand....

i put an NGT in tonight - a little boy in not much better shape.  feet, legs, hands, puffy and swollen, arms tiny, bones sharp, skin crinkled in loose, irregular folds

has he eaten today?

he doesn't want to eat

has he drank anything today?

he doesn't want to drink.

I hear it all the time, almost every other patient.  so why have you not given any water and its 4 PM and the child has a fever of 104 and its 110 degrees outside?  why did you think he didn't need water?? because he doesn't want it. 

hmmmm.... imagine how well a pediatrics ward would run in the US if we had to get the toddlers permission first. 

so this baby - i sat down, and i tried to carefully explain

did you know your baby has malnutrition?? 

he said he didn't know

did you know that this isn't normal? 

he didn't know.

you need to add peanut butter to his bouille.  you need to feed him 5 or 6 times a day, little amounts.  2 times at least during the night.

He spoke French.  I explained carefully, repeated myself multiple times. 

sometimes i wonder why I bother - because I know he won't do it.  I know i'll come in tomorrow and see the full bottle sitting there - the one Wendy brought

and when i ask why it wasn't given - he'll say -

he didn't want it. 

most of the time i want to grab everyone by the neck and shake them. 

i want to scream at them - your child will die if you don't listen to me.

your child will DIE if you don't change


your child is dehydrated - GIVE THEM WATER.

your child has an infection - needs IV medication, is vomiting - DON'T GO HOME AMA!!!!

i gave out 5 bottles of water mixed with Oral Rehydration Salts tonight - I explained carefully - i made them give it front of me.  but i had 17 patients...... and when i did my last round - the bottles were full. 

i don't understand

i am literally totally and completely baffled

these kids man, their fontanels are sunken - you could pitch a circus tent on their stomach and it would retain its form - lips are dry and cracked - how man times do i have to explain, how many times do i have to mix up the salts in front of you, what am I doing wrong here??

and i'll come in tomorrow = and the bottles will be full.  and I will say, WHY WASN'T THIS GIVEN.  and they will act surprised.  I was supposed to give it???

I'm not exaggerating either. 

I am fighting a losing battle every single day.

also, with the NGT - maybe the kid will get lucky and the dad will give some buille and rehydration drink - maybe

but I can tell you with complete certainty that the other nurses will not. 

I can spend all this time fixing everything - i can writing out the exact number of mililiters of bouille on the dossier as if it were a medicine - i can detail it on our poor exscuse for patient notes column - and i can leave assured that THEY WILL NOT GIVE IT. 

I prescribed IVF tonight - but i couldn't give it.  there were too many holes punched in the bottle of quinine - if i unspiked it, no matter how i taped it, they would lose all their valuable medicine.  so its in the box.  I gave Dextrose, the kids eyes were rolled back in his head - did it last night and he perked right up.  But will anyone look in the box - see a Ringers, look at the kid - see dehydration??  no.  it will be there when i come in tomorrow night. 

i don't understand.

i come in tonight - quinine perfusions e hung at SIX AM were still completely full at 3 pm.  Granted, quinine is hard work, even with the utmost vigilance its impossible - to manage 15 drips - the parents touching it, the kids kicking and screaming, the IVs positional, they almost always go in to fast, or stop constantly - i get it.  but REALLY??  full since 6 am??? 

and many of the dosages were wrong.  even of quinine.  and when i pointed it out ( i need to stop being confrontational - not good in this culture - but somehow speaking in French completely removes my filter) and they blame it on the ER  - it wasn't me who wrote that - YES, BUT YOU GAVE THE MEDICINE!!!

and then i want to grab them by the neck and shake them

i make mistakes too - ones with no excuse  - but i am still infuriated

there are 5 people on days - 3 students who pretty much give all the meds - the chief, and another nurse.  do you think any of them take a vital sign?? no.

i have, however, won one battle - now we are labeling all the quinine perfusions in increments of 8 hours - much easier to rapidly control - really great actually - and now they are all doing it

also - just have to interject this bragging point - i gave a lecture on Typhoid to the nurses in French without a translator.....they said they understood!

and then

another kid

looks horrible - impossible to get an IV on, switched him to IM artomether - his mouth is eaten up with candidiasis - lips, gums, tongue - he won't drink, he won't eat.

well, they bought Nystatin Sirop.  and the mom gave all of it in 2 doses - should have lasted a week.

Olen wrote for more today.  did they buy it?

no

why not??

because they already bought it, and it didn't work.

the father refused.  he said, "we already tried that.  it doesn't work for him." 

he says he has no money.  i don't believe him. 

his eyes were rolling back too - mixed up sugar in a glass and gave it to him - i want him inside so if he gets worse the next nurse MIGHT know.....but she takes him outside to sleep anyway

i want to shake her too. 

and then the woman, she had mastitis and her breasts were completely engorged

Marci and I and Wendy started working with her, she has excellent milk production - we thought we were making progress - she looked better, the baby looked better

he would feed for hours, violently sucking - so hungry

she had been giving him water.

we said at least 34 times, DON'T GIVE HIM WATER.

well, several days ago,

"he didn't want milk"

and so she gave water.

now he is throwing up, exhausted, has bloody diarrhea, looks 2 weeks old but is 2 months -

why did you give water??  he didn't want milk

and they give well water here - its not potable - they don't boil or bleach it - and they splash it in every babies mouth

but if its a kid of 3 years  burning up with fever?? forget it - you can see the shock on their faces when I explain how much a kid needs.

maybe if an alien came to my hospital and told me that i needed to eat toenail clippings and dye my babies hair purple or he would surely die - maybe i wouldn't do it either

i don't know

i am just completely exhausted

completely frustrated

completely infuriated

completely exasperated

and completely baffled

and tomorrow - I'll do it all over again

.baby

in Peds with a baby that hadn't eaten since birth - she gave him nothing
but water for 4 days - here with an NGT - recovering nicely

.news

Chad Famine – Mothers Breaking Apart Anthills in Search of Food

Source: ips.org

N’DJAMENA, Mar 29 (IPS) – “Only God knows what will happen to me and my children – for two months there’s been nothing to eat. We’re living like beggars,” Henriette Sanglar, a mother of four in the Moursal quarter of the Chadian capital, N’Djamena, told IPS. Oxfam International says that in Tassino, a village in Chad, women are breaking apart anthills, searching for grain stored there by ants. Credit:Irina Fuhrmann/Oxfam “The famine is gaining ground, even here in N’Djamena,” said Diane Nelmall.

________________________________________________________________________________

well, those headlines are kind of salacious, however a famine IS creeping up on tchad -

Rice is now over $80.00 a sack, millet is $50-60 dollars a sack, and I have seen more children with malnutrition this month than any of the previous months. 

and some of the malnutrition is glaring, most is not the kind that would grace the cover of TIME magazine, but more and more, you can count every rib, their skin wrinkles around them, arms to skinny, legs all jutting bones, dehydration dipping into the tops of their heads, you can run your finger along the scalp and feel the hollow

more and more they are saying they have no money, more and more they are telling me, "we haven't eaten today" 

Staple foodstuffs are scarcer this year, driving the prices higher and out of the realm of affordability for many

and we have many months to go before the harvest

and even that is no guarantee.

even though the heat is still oppressive, the rains are more frequent now and all the oxen are being mobilized to start planting the rice fields.  Oxcarts driven by ragged barefoot boys with medieval farming equipment slashed to the back rattle by

when everyone with oxen has finished planting, then they will sell their services to the people without

they are headed to the fields again, splashing through new mud, ready to begin another season

because Tchad may be short of many things

but it is never short of grit, hope, and resilience

.Review

so, for all you Adventists out there, the cover story of the May edition of the Review is written by Dr. Olen Netteburg and highlights the work done here at the Bere Adventist Hospital......

also, for all you avid readers out there, if you could recommend some stellar books on women's rights, I would be grateful.  I have interviewed ten women already and the deeper I get the more I realize I need to understand, so any recommendations would be appreciated. 

.riverstar

we layed in the river tonight, and looked at the stars

no one around

just us, and the river, and the stars

crunching handfuls of sand, letting it slip through your fingers

carried gently by the current

ears submerged

free floating

gazing up at the brightest stars I've ever seen

this, this is the God I love

skyblack, stars cold stark brilliant

lulling me into happiness

the river makes everything make sense again

mesmerized

freedom in water

in movement

in space

i can't get enough of the stars

and i want

to stay here, to be carried on the fluid arms of the river

eyes locked on the stars

scraping my toes on the sandpaper riverbed

i want to stay lost in this moment

to stay lost in the shiver of coolness

in the shiver of Africa by moonlight

to let this moment baptize me

ingrained

because it is so

vivid

and beautiful

alive

and free

.hospitalhospital

its so hard - sacrificing individual children for the good of the hospital

in fact, i don't really do it that often, being a firm believer in the individual over the collective

but.....the hospital does have to be self-supporting - if we give everything for free.....what about those thousands of babies 2 years down the road, what will they do if there IS no hospital......

i want to give everything for free. 

I want to assess a patient - make a list of their s/s - and give them everything they need

I want to give them fluid - even just maintenance fluid
I want to give them nutritious food, 3 times a day
I want to give them a bath
I want them to be laying on clean sheets, instead of puddles of urine and sweat
I want them to get a full course of antibiotics
I want them to get as many days of IV quinine it takes for them to get better
I want to test their Hemoglobin, if they look pale
I want to kick their families out and strictly enforce visiting hours
I want to give juice - when they refuse to drink
I want to give all their medicines IV - when they are throwing up
I want to give Tylenol every 4 hours, instead of every 8
I want to call a code, when their heart stops
I want to breathe for them, when they stop breathing
I want to give them epi, atropine, etc
I want to shock their heart
I want to give them oxygen
I want to hook them up to a ventilator
I want to call respiratory
I want to make them sleep under mosquito nets
I want to adjust their air conditioning
I want to get a nutrition consult
I want to give them multivitamins
I want to call hospice
I want to consult wound care
I want to draw a rainbow - and analyze the bloodwork
i want to give them dextrose - when they are hypoglycemic
I want to check their blood sugar
I want to get an EKG
I want to get an CXR

I want to give them the same thing a patient in a fully equipped hospital would have -

 a chance

a chance to live
a chance for their heart to stop beating again
a chance to come out of their coma
a chance to die peacefully
a chance to be cared for at home
a chance to battle cancer
a chance to know all their options
a chance to recover

just give me some oxygen
give me a well-stocked pixus
give me regular vital signs
give me a crash cart

tube the medicines I want up from the pharmacy
give me a stat on that order

give me a society that lets their patients pay later
give me a society where you will get the best care possible - regardless of your bank account

give us a chance
to give them a chance

it is just so unfair

another kid died tonight - i knew he didn't look good, kept assessing him, re-assessing him - they had no money  - but he went faster than i thought he would - there isn't anything we have here that could have helped.....

and then you take the IV out of a limp grey hand - and they cover the face - and walk away

and then everyone else wants to leave -

and you tell them to stay - you point out, if they go home, their kid will probably die

threaten and bribe them to stay the night -

buy the medicine they have no money for - the IV quinine the kid desperately needs

and then the others see it

they expect you to buy their medicine too.

they didn't buy the medicine today - now they really won't buy it

so by buying that kid his quinine - am I helping, or hurting

They won't go look for money

they may have it, they may not

but they will look you in the eye, and tell you they have nothing

there is no way of knowing

I made someone cry tonight - insisting she buy an IV - telling her she had too

But I made another man buy quinine - a man who had been refusing to buy all day, insisting he had no money - and then i talk to him one more time - and there he is pulling out his wallet -

its so brutal to demand someones money - to argue with them, to insist that they pay - to tell them to trade in their phone, their bike, to call their relative - to basically hassle them until they pay.  but when every single person looks at you, sees that you are white, and tells you: i have no money.  What are you supposed to do??  how are you supposed to separate the liars from the destitute - 

and when i saw that man, the man who insisted he had no money, when i watched him pull out his wallet that was falling apart - and carefully pull out his 2,000 CFA ($4.00) and buy the quinine, and the Glucose, and then walk back slowly with his shoulders hunched - my heart broke.

because why did he lie?  because I'm white??  probably not just that - he could have spent his last money - he may go hungry tomorrow - his other kids may go hungry tomorrow - he may not be able to pay his bus fair, he may not be able to take the next sick child to the hospital - and for what.....a quinine perfusion.  but whats the alternative?  letting the kid die??

but is someone else going to die so this kid can live?? 

is the whole family going to go hungry?? 

we think they don't care enough about their kids - but we may have no idea what they sacrifice

we may have no idea what its like to decide what to do with your last dollar 

knowing that either way, someone you love will suffer

the cycle of poverty generates an environment in which impossible choices must be made every day, choices that leave you sick to your stomach, choices you may never forget, choices you should never have to make

and the mother - the one who really didn't have any money, the one who looks 14..... she had walked miles today, shown up at the hospital with nothing, has not eaten all day, will probably not eat tomorrow, is sitting there with her head in her hands because she is just so exhausted. 

her baby is tiny - stick thin arms and legs covered with wrinkled skin - a smooth old face - he hadn't eaten or drank all day, I put an NGT in and now he's at least keeping something down

so should i feed her?? and if i do, will I have to feed everyone?

should i buy her the IV?  and if I do, will I have to buy for everyone??

I had IV fluid - and I didn't give it to a kid that needed it tonight, a kid who when you pinch his belly it stays in the shape of a tent, and I didn't give it because if I did, they would no longer buy any of his other medicines......

i hate the brutality of this kind of nursing

I hate utilitarianism

it works in theory not in practice

it only works when you can't see their faces

the individual that didn't get what they needed so the nameless thousands in the distant future would be okay

what am I supposed to do? 

half the patients hadn't bought their next dose of IV quinine tonight - I get report - oh, they didn't buy it. 

but I'm still an American nurse, I still take personal responsibility for the scheduled medicines on my watch - If they don't get it, if there is a full 24 hours between doses, if they miss a day - the quinine levels are not staying therapeutic in their blood, the parasites are not dying, your body is developing resistance, its just bad care on so many levels

so what am I supposed to do?? pay for everyone?  I can't.  I shouldn't.  we are not here to give handouts.  In the broader sense, where your not looking at a shrunken feverish kid, handouts are crippling - they are whats WRONG with Tchad.....at least a piece of the puzzle

and so we trade this for that, and barter and plead and threaten, and translate, and shove the carne under their face, and gesture emphatically toward the pharmacy, remind them funerals cost much more than prevention, glare and insist, and slip off to buy it for them and try to give it unseen by the others, and somehow it comes together every night.......

what am I supposed to do?? 

I hate this part of it - of stripping the poorest of the poor of their last penny -

walking around with my nice phone and nice stethoscope - there is judgement in their eyes

but their is no alternative

if it was America, would we look for the money?? would we call all our friends and relatives and surrender our car for collateral???  would we fight for life the way we are famous for, would we never give up if we payed for EVERY SINGLE THING upfront???  EVERY siringue to flush the IV.  Every single medicine - EVERY IV???? 

and if we saw someone getting something for free, would we hold out, to the detriment of the child, hoping we could get it too??

or would we, as some people do, spend our income for a year - get deeper and deeper into debt....saving a child when several others had already died????

if we were living on less than a dollar a day....what would WE do???

somehow....i don't think it would be much different -

but no matter who is in what situation.....

the hardest thing about working here is that it is grossly unfair - all of it. 

that someone has to die because they were born into the wrong country.......

because some environmentalist somewhere that never saw a malaria patient taking their dying breaths - decided to wage war on DDT

that a child has to die because the parents don't know any better

that the parents didn't know any better because their parents didn't know any better

its terribly, terribly unfair

and we shouldn't be content to let it stay this way. 

.livinthedream

warning: the following blog long and in-cohesive:

.............drumroll........

A Day in the LIfe of a Pediatrics Nurse in Tchad, Africa in the Evening:

get to work

quinines uncovered (UV light destroys quinine....) X 2

sink crawling with huge ungodly larger than life killer ants

spray enough Rambo to start a 3rd world war and killer ants slowly die

use the last compress to clean the med cart/iv cart/trash cart/mobile nurses station which is a sticky disaster

see more bugs that need killing

kill them too

get report

oh and this one - they haven't bought the next quinine

neither has this one

this one doesn't have any meds left

this one needs quinine - hasn't bought it

....this one - waiting on the father to come buy meds - next quinine long overdue

can you please tell them in Nangere?? 

oh, they already know

this one throwing up

and that one

almost everyone

has malnutrition

varying degrees

of shrunken wrinkled skinniness

patchy hair

wide large eyes

see the first patient -


baby with possibly fungal rash covering body - they didn't give her the Miconazole creme at 13.... why not?  couldn't find it

and they have a point

sort of

an old plastic bag with old bandages and a jumble of old medicines

half eaten food

dirty pieces of cloth

everything covered

in flies - the mother to week from malaria and giardia to really do anything - laying there moaning -

if you want to know which baby is the sickest - follow the flies

the flies here are tenacious suckers

pure evil

they swarm the sickest, the weakest, the dying

no soap to wash the baby - no soap to wash the clothes -

do you have food??

 a little

 -  sometimes i think she is giving up - has been here 2 months, a sick baby, a blind 3 year old - husband abandoned her - every day she looks more haggard - her eyes are glazed - she is moaning - a low moan - and moans all night long - i should give her some soap

give the creme to the baby - which is really oral gel - out of creme at the pharmacy - i figure it must work a little right

next one - l'eau la - c'est fini........

get a translator - explain the next perfusion is in a couple hours - explain that it is pas grave -

and the next - arms to thin - belly to big for the skin - legs wrinkled - new patient -

painstakingly explain they need to mix up oral rehydration drink and give it to him every 1/2 hour - say it at least 5 times - they won't do it

the next - fever, 105 - then i drop the thermometer and break it

fantastic

and the next - fever persists - 104..... i tell the mom to fan her and sponge her with cool water - i give extra tylenol - not a big deal because she'll spit half of it out anyway - the mom glares at me - assures me she has already been cooling the girl down - I re-explain - she does it only once

they are convinced the child doesn't have malaria - are convinced something is wrong with the "core"  keep pointing to the chest - get a translator - (translator means any poor soul that speaks a bit of french) re-explain

get a new patient - have to stop rounding - text book malnutrition - Wendy cooked him up some pat d'arrachide bouille- peanut butter, salt, sugar - she gave it to the mom this morning - she hasn't really given any - despite being told to give it multiple times - put in the IV - I prefer putting IVs into skinny babies - easier than fat ones

bolus of fluid - the mom looks about 14

has no food - barely any belongings - walked here - has an old morton salt looking container for water - and thats it

i want to hate her

her baby is so sick and so weak

I want to believe its her fault

but its not

more and more malnutrition coming into pediatrics lately - MSF opening a malnutrition center in the southeast - we heard there wasn't much food this year...now we are starting to see it

next baby - dehydrated - fever - explain re-hydration - tell them to cool him down - i'm a broken record - guess what - they don't do it

give water now

they just look at me

give water now

right now??

yes.

NOW

do we give it or you give it??

YOU give it!!

duck as a bat swoops next to my head

everyone laughs


a mother comes up - a little blood has backflowed into the IV tubing - we get in a fight - i end up yelling at her that it is PAS GRAVE!!!!!  she yells back that it is.  I go cry because i shouldn't have yelled -

if there is any blood even the tiniest tinge, they get so upset here - they think its the biggest deal in the world

they also think that a 500 ml bottle of glucose and quinine is enough water and they don't have to give any....... every time i say its pas suffice they are astonished - and then they don't give water

and then an IV is infiltrated

i prescribe a new one

pas l'argent -

we argue for 15 minutes - i tell them their options - i tell them quinine IV is better - they still insist they have nothing - they refuse to buy the IV - i find out the kid isn't vomiting....looks kind of perky....i prescribe oral quinine.....they find the money

am putting in an IV when i get interrupted....we have no medicine and we want to leave.... all the medicine is gone and we have no money

he is grinning as he says this

he looks 16

i tell him there is medicine - he argues with me - i argue back - i go look - a half full bottle of Tylenol Syrup, Amoxi Sirup, Metro IV.....just not another Glucose to mix the quinine in - see, look - here is medicine.  Ah Bon??  as if he didn't know.  I tell him he is lying because he just wants to leave - the kid is still vomiting - the kid looks like crap.  the mother looks 15. 

you need to buy a serum glucose ...... pas l'argent

do you have a phone?? they can hold it as collateral.......

no.  no phone.

anyone in your family??? no, no phone

we trade in his IV B vitamins and an extra quinine and a seringue - come back - hang the drip - he promises to wait until morning

he is still grinning

i am not

5 minutes later - he comes looking for me

do you have a charger for a Nokia phone????? 

Gotcha!!!

i point out to him that not only is he a liar but I have just caught him in a lie

he starts laughing hysterically

i put in an IV

the mom keeps giving me deathstares

its not my fault a baby doesn't like needles

no money no money no money

a whole line of patients - quinine late - can't buy it

we trade seringes for tylenol......

they magically unearth money

I fill out a free form for the baby i put up the picture of - still a fever - not getting better -

and I can't stand the way they give everyone one day of IV ampicillin - just one day - no one finishes their antibiotic regimen here - they can't afford it

someone asks me to buy their medicine

i say no

the wind is slamming the windows shut -

dust is flying

people run inside - dragging mats

the floor is covered

they always know when its going to rain

and then the rain is fierce

liquid bullets pounding the mettle of the roof

ricocheting into mud

and the building shakes

and the thundergod shakes her rain rattle

and you scream if you want to be heard

and the windows are still slamming

open, shut, open, shut

pediatrics used to be a chapel -

but this is not a holy night

and the stars aren't brightly shining

i look at all the quinines

none of them are perfect

fiddle with all of them

half of the IVs are positional

at least no one's dying

that's a plus

l'eau la, c'est fini

c'est pas grave

I yell at people because they don't understand my french

you can go ahead and unpack how hypocritical that is on so many levels

people will pretend to understand that don't

people will pretend not to understand that do

I am tired of being lied to

I get lied to every day - varying levels

they call me nasara - white person

all night - i hear snatches of conversation - nasara, nasara, nasara

here, you don't even have a name

racism - i don't much like it -

I didn't sit down once all night - except to put in IVs.....

i started this night with the grandest intentions - kindness, carefulness

had the grand plan to explain everything so well so that I could sleep at night knowing that now, if it doesn't get done - its the parents fault

so i could stop getting mad over things that are not in my control -

well, tonight i explained all right - no one did a single thing i said to do...... 

the tchadians say you have to yell - get in the mother's face and MAKE her give the water - demand she does it this second.......  (not that they take the time to DO that...)
 
that they won't do it otherwise

honestly, I am completely baffled

why WOULDN'T you give it?????

cultural beliefs are so strong here.....tradition -

i'm going to go ahead and be colonialist for a second -

YOUR TRADITION OF GIVING BABIES WATER AND NOT GIVING IT TO KIDS SUCKS!!!!

balance - still looking for it

I am definitely not being the person i want to be of late

am definitely learning alot of lessons about how NOT to be

how NOT to act
how NOT to re-act

am definitely needing to re-define how i deal with stress and frustration

to re define how i deal with suffering - as if that could ever be defined anyway

its a shadowy gray that darts sluggish in and out of your conciousness - spewing fire or mopping your heart with lidocaine in slow widening circles - just depends on the minute really

sometimes you find the absence of emotion strangely curious - like watching someone die in slow motion and knowing you should be crying when instead your coldly evaluating the ramifications of your lack of human response -

or sometimes you care too much, like your whole heart is bursting with perfectly ripe mangoes - and this sentiment in fact begets the former one, although there is a form of courage and strength locked in its futility

or sometimes you get it just right - but your too busy to register it

or sometimes you break down in a completely isolated moment - like if someone steals your granola bar, or you get woken up too early in the morning by incessant sweeping and clouds of dust

the only thing you can do is to try to live as deeply in each moment as possible - if its a happy moment, a sad one, an angry one, a numb one -

thats what the tchadians do - thats how they survive -

they laugh the loudest

and weep the longest

but thats the whole point right -

to open yourself up to experience

to failure

to frustration

to happiness

to numbness

its a roller coaster

it will make you clench the bar in front of you white nuckled as you stare into the abyss

you will scream and feel your stomach drop down below sea level

you will laugh hysterically and feel like you are flying

you may vomit and lose your voice

and then, at the end - your breathless and winded

and ALIVE

....and you want to go again

its imperfect - and balance eludes you - but there is no parallel

to the knowing

to the feeling

of opening up your soul to experience

and feeling life rush through your veins

and tonight -

i have to open myself up to failure

and to frustration -

so that tomorrow

I can be a little bit better

of a person

of a a nurse

of a nasara


i only have one thing going for me tonight -

and that is that I'm doing my best



its nights like this I gotta remind myself.....

Your living the dream!!! 

You dreamed of this for over 6 years.....

there was no other place you wanted to go.....

you tried, failed, and got accepted the second time around.....

you spend a huge amount of money to get here

you worked long nights every weekend to be here

you dreamed of it....

prayed for it.....

sacrificed for it......

fought for it......

so even on nights like this......

Your living the dream..............

.grandma

I want everyone in the whole wide world to know that there are 2 people I love very much:

I LOVE YOU GRANDMA YOUNGBERG!!

I LOVE YOU GRANDMA RIEDERER!

thanks to both of you for keeping in touch and for your prayers and encouragement!!!

I have the most amazing Grandmas in the world!!

....my grandma's better than your grandma.....

so there

.malnourished

this is what malnutrition looks like
this is what going to bed hungry looks like
this is what dirty water looks like
this is what parasites look like
this is what ignorance looks like

this one still has a chance

.hard

I am completely exhausted on all fronts.  Sometimes, like right now, it is just so hard to be here.  hard to be in a culture you don't understand, you don't agree with.  hard to be always misunderstood and in return misunderstand.  hard to always make someone repeat their sentence because you didn't get it the first time.  hard to repeat yourself over and over, thinking you are using proper pronunciation the whole time.  hard to always be culturally incorrect - accidentally insulting someone, disrespecting them, not being a good host, a good guest.  hard always being insulted in how our culture would perceive insult - being laughed at, lied to, not taken seriously.  hard to be going about your business, maybe daydreaming, or walking from one place to another - and gradually the realization sinks into your consciousness that there are about 50 people staring at you.  hard to be so constantly the center of attention that you begin to just create your own world so you hardly notice it anymore.  hard to keep from saying mean things to people in French - things that i wouldn't just say in English - somehow if i say it in French I don't connect with it.  hard to start IVs in the dark with a headlamp.  hard not to make a mistake when you have 15 quinine drips.  hard not to be hard on others that make the same mistakes.  hard to be nice.  hard to be kind.  hard to cry.  hard to not complain.  hard to be grateful.  hard to face each new health disaster.  hard to get along with the combustible melange of different personalities that are the bane of any mission compounds existence.  hard to get  up at 5 30 am no matter what.  like i said, sometimes its just hard. 

i had a complete melt-down on Peds tonight - my third night working on my own.  while i am not ready to recant my scathing reviews of the efficacy of the nursing staff - I am willing to concede that doing a good job and trying to give American style care and assessment is very very very hard.  but to do it, you don't sit down.  you round continuously.  you painstakingly take temperatures with a mercury thermometer.  you yell and persuade and hassle and hustle and march here and march there and exchange this and write for that. 

and you can't just do the right thing.  you can't just write for what you think they need.  you can't pump that dehydrated kid full of fluids - you can't give him all the medicine he needs.  if he has only a dollar for his medicine, how are you going to spend that dollar??  the hospital HAS to support itself.  no matter which expat comes and goes it has to keep functioning.  to do that we have to pay the staff.  we can't give everything for free.  we just can't. 

you have to argue about money.  everyone will tell you they nothing.  everyone will say pas l'argent.  everyone will look at you with those pleading eyes and shake their head mournfully.  1/3 of the time - its true..... and for the others?  well, define, argent.......

and then the ones that spent their last cent fran - the ones that used everything they possessed, the ones the bought medications that were not entirely necessary that some pen happy nurse wrote - and then the kid dies anyway.  what about them. 

who is lying and who is telling the truth. you don't want that to matter when someone's life is at it stake, but unfortunately, here, it has to.

so you get creative.  exchange this for that.  bribe someone to give blood with three ripe mangoes, profusely thank the lab staff on call for the fact that he came in on his night on call, politely agree that writing A + can only be penned in red - be nice to the pharmacist so he will be nice to you - write for things one day at a time only - threaten and beg and point and somehow get it all translated

Nangere to Arab, Arab to French - French to Gumbi - sometimes, no one even speaks French. correction: most of the time

and tonight - i didn't sit for 6 hours - there was problem after problem - put in IV after IV - adjusted drip after drip.  gave medication after medication.  did assessment after assessment - and it doesn't help that i am so exhausted.  I got up at 5 AM because its impossible to sleep after 5 30.  just doesn't happen.  there isn't such a thing as sleeping in here.  they are sweeping right next to your face, screaming, cooking, singing horrific sounding hymns, and its all like nails on the chalkboard of your exhausted brain.  i cried this morning too.  at 5 30 AM.  because now I work evenings I don't get to bed until 10 at the earliest.....  i just wanted them to stop sweeping....just....for ONE minute.... and then i went to the village in the morning, and then went back to a previous one - training the community health workers - and then went directly to work - and then at work, problem after problem.   and its truly nerve wracking because you alone are responsible for people's lives, there are too many patients, you definitely don't want to intrude on the precious family time of the doctor unless its necessary - but then here, the emergencies are often what we DON'T see them about - because we already know there isn't anything to be done....but if you can catch the problem in that in between phase....then its worth a shot.  and then tentatively prescribing.....transfusing....turn around, how did that quinine go so fast??? trying over and over and over again to get an IV on an anemic and dehydrated baby - it jerks its hand and blood starts running all over your ungloved hand..... and then the three patients that were discharged....well guess what, they didn't go anywhere.  they have 3 or 4 more days of quinine and metro left..... guess what - they think the nurse will give them their meds, the nurse has "liberated" them, assured me everything was fully explained, and then tonight they had no idea what to take, when to take it, or who it was for - and that was the weird last straw that did me in, i was kneeling outside practically yelling in French at my poor translator I apprehended, trying to teach her about her medicine, doing a job that had been neglected by someone else, the sheer ridiculousness of the fact that we "discharge" people that are still staying in our service indefinitely.....that there is no such thing as adequate discharge instructions and when pressed the parents NEVER explain i back correctly - it takes patience - but if you don't do it?  what have we been doing?  if they don't take their quinine, their antibiotics...its all for nothing...... and of course at that moment the other nurses on night shift come by and start laughing hysterically - and then my hip hurts so bad from the horse that i can hardly walk..... i must have looked like such an idiot.  and maybe I am. 

but, i maintain - IT IS STILL POSSIBLE to give good care here - there is NO EXCUSE not to give your medications, not to asses your patients - but if you actually do it.......its very VERY hard.

BUT

despite this rant, I am TRULY delighted to have the opportunity to work on my own.  I do enjoy it.  I did ask for it.  I did take the steps needed to make it happen.  So in that aspect I am grateful and happy. 

I just don't do well with no sleep. 

I don't do well at all. 

and on that note, I've been up for.......17 hours

bon nuit

.hothothot

it is hot here

steaming boiling sizzling burning searing humid sunburned broiled bare
feet on pavement at high noon hot

the kind of hot where sweat pours off your face, tears of salt rolling
stoic down your forehead and pooling in the corners of your eyes

swirling down the spine and soaking the back of your shirt within minutes

sweltering

your entire body slick with sweat - as you sit in the shade - doing
nothing - trying to breath

and some days its not so bad - some days you feel pretty proud of
yourself - functioning normally at 115 in the shade......

stepping into a sauna at 5:30 am......

and other days - it sucks the air from your lungs - tangles your
thoughts into teaming volcanoes of sludge - creeping up your arms and
legs and settling down with a horrific lethargy

maintaining delirious discussions with yourself as to whether or not you
have it in you to walk 2 yards - or to get up off the cement floor your
laying on

but you do get up

and you do go to work

and you do draw water from the well

and you do walk in the sunshine

and you do realize the greatest lesson to be learned here - that you are
always stronger than you think you are -

you experience that most precious aspect of being human - the power to
endure - the power to rise above - the power to surprise yourself

and yeah, its only heat - not starvation or genocide or paralysis or
clouds of whirring locusts eating all your crops - but I am enduring it

and i no longer have to dread it

and i am that much more ready to do the next hard thing

to picnic in the next charred and withered landscape

because once you strip away comfort

you realize you don't need it

and that

is liberation

.or

sometimes its easy to feel un-inspired here - until you remember that
the little things count

and it is the little things make up every life-changing moment

every pebble thrown into the ocean

every soft flap of a birdwing

every smile ever smiled

every meal shared

every time you decided to love someone

those things matter

or, like today -

the Community Health Worker that now has 6 people regularly coming to
his house for dressing changes - 2 people's wounds have already
completely healed

or,

the village midwife wearing her new bright pink jacket - bringing a lady
into the hospital

or,

the 4 day old baby of the Chief de Quartier not dying - they had been
giving him only water for 4 days - because they thought the mother had
no milk - now the baby is breastfeeding and her milk production has
increased

or
or
and the thousand other ors we will never know, never hear about, never see

those are the things that matter
the little things
the things that glide vanishing under the surface of the water
changing the shape of the waves
changing the tides
changing the rhythms
the shape of the splash
that one day
will rock the boat