Friday, December 20, 2013


I am so happy right now.  The sky is grey but my world is rainbow.  Skipping and grinning back to the hostel - my Diploma in Tropical Nursing course is completed, exam done, and I'm off tomorrow to see the Lake District National Park in Ambleside, UK. 

Then to see the Peak District, then on to Grantham to see my dear friend Bronwyn for some spicey Christmas cheer, perfect coffee, mountains of chocolate, and long chats swimming through everything from leaving Tchad to starting over to the many memories that will glue us together forever that need only be said with a glance. 

I haven't seen this beauty in over a year, the last image I have of her is a receding beautiful shaven-head figure, waving from the dust of the air strip jutting bumpy and red from the grasses, smaller and smaller and smaller.  The night before I left taking a late night motorcycle spin, drinking one last cup of inventively whipped up coffee, curled up in the depths of the mosquito net, wishing I wasn't going, knowing nothing would ever be the same again, one last deep glance at bright clear stars, a broken mosquito lullaby.

I left her there to coax F75 into peeling lips, place NGTs through tiny nostrils, and march the daily grind of death and beauty alone.  Leaving this dearest of friends was one of the hardest things I ever did.  And now she's back home, after more than two years in Tchad, and I finally get to hug her under crisp grey sky on the other side of the world, and I simply cannot wait. 

I am going to see the one person that truly understands every aspect of what Tchad was to me.  The one person that just gets it.  All of it. 

I feel brilliantly liberated now that this course is behind me and exam passed!  Coming here to the School of Tropical Medicine was one of the best things I ever did for my career and I would highly highly recommend it to anyone who is currently working in or wants to work for an NGO, FBO, or is going to do any sort of tropical medicine nursing or community outreach in the "tropics" and/or in Sub Saharan Africa.  If anyone wants my lectures for their own knowledge - I will get together a link on drop-box in the next several weeks so just let me know. 

I will officially be in NYC Feb. 11-14 for MSF Info Days and have a ticket back to Homer Feb. 15!  Can't wait to plunge into the snow, wear plaid layers, and play with my friends.  Even though I am having the time of my life I consistently miss my beautiful Alaska.

Here's some back to school pictures - just for you mom.  Cheers and happy Christmas! 

oh the gram stain

Looking for Ascaris ova
Listening intently as usual - with the fabulous Masha.

post-test euphoria

class photo

Saturday, December 14, 2013


I am so excited for life.  I am excited to live.  I am excited to be.  I am excited to go.  I am excited to wander.  I am excited for color.  I am excited for faces, for places, for strange ocean beaches, for new ideas and concepts and flashes of oh! understanding.  I am excited for travel.  And more travel.  and more after that. 

I'm like a dog panting after a dripping bone, like a baby screaming for milk, like a horse jumping a fence, like a rocket that just launched, like a train emerging from a long deep tunnel - finally seeing the green and steep of a breathtaking mountain valley.  Being here is like finally looking through telescope at the vast universe I'd only seen sparkle vaguely, like summiting a high grey mountain and glimpsing the coast of the ocean I'd only heard crashing.  It's like seeing an apple tree bursting into blossom or a dandelion breaking and puffing into the wind.  Its like seeing detail in what once looked blocky and vague, like glancing out the window to see a rainbow that had been arching for hours. 

I want to scream and run wild up mountains and roll down heather purple hills and stumble across pockets of hidden ruins and see mountains rising jungle from mist.  I just want to go

Being here is just as much about inspiration and different kinds of knowledge as it is about my tropical medicine course.  I am not spending as much time studying as I technically should but I am too busy talking to people and being amazed.  This fervent tirade about seeing the world is coming on the heels of leaning on the wooden table in our hostel room, three of us gathered around a laptop seeing my friend Masha's amazing pictures.  Photos of Tibet and Nepal, of trekking the Himalayas, of red and yellow and blue tattered prayer flags, ripping and streaming from mountain summits, of Everest base camp, of rock climbing in Thailand, street food in Vietnam, and and and and and my mouth was open and my eyes were wide and my heart is pounding and yes yes yes I want to go there I want to be there I want to see that I want to taste that I want to touch that I want to live that.  It is amazing to see the photos of places I've never heard about and places that I have.  There is so much breathtaking beauty in the world just waiting for me to conjure up a bit of money and a good pair of hiking shoes. 

I have been on the path to realizing it, preaching it even, but at the deepest level I am wild with excitement because I finally truly know that travel is possible, true experience is possible, seeing the world and traipsing the earth is possible.  Not only is it possible it is attainable, it is within my grasp, it is practical, and I have been shown the way.  From learning from my brother who was on the road for 5 years to following the travels of my friend Dave as he hitched back and forth across America to my couchsurfers who have made it in buses or on foot or by train hitching and camping and driving across continents, stopping for a few days in Homer, Alaska.  Just all of it makes me feel like a little kid, sitting at the feet of a wonderful vivid teacher, listening to the most wondrous anti bed time story ever told. 

Every encounter, every story, every map pulled out and route traced, every photo shown is shoring up my excitement and my courage, this little bug called explore the earth is contagious and my head is spinning with imagination and I don't have words for it all. 

Some of the best magic of travel is human connection.  The people you meet that tell you a story, or sing a song, or point out a town that you just have to get you, or call up friend you could stay with.  Its magic really - and it happens all the time.  About 2 1/2 years ago I met my friend Joe in Chattanooga, TN - we met accidentally had a connection in common and
talked for less than an hour.  Now he is passing through Liverpool after hiking across Scotland and Ireland and part of England.  It just blows my mind to be exploring the city with someone I met by chance so long ago - but travel is like that, taking that risk and talking to a stranger is like that - and it represents everything that is right about the world.  I'm salivating over his pictures too - sacred abbey ruins, wild jagged coast lines, tiny tucked away Scottish towns, just the wild vast green grey windswept quality to those photos - now I want to run out and get lost in the Scottish highlands or spend weeks hiking through rolling plains and stumbling into tiny crumbling towns. 

Before I came to England I hadn't really cared much about Europe.  I craved more travel in Africa, wanted to road trip across Canada, and was starting to be more intrigued by SE Asia.  But now that I have glimpsed the beauty and the possibility here, even just England is added to my list of must see must do, have to get back.  And I'm already here.  But I am just in one city.  There is a whole country waiting to be explored!  I have 4 days after travel starting this Friday before I head to Bronwyn's for xmas and after my class ends.  I am close to the Lake district and also to Yorkshire Dales NP.  Joe sat down with me tonight and gave me some pointers, ways I could see abit in a hurried four days.  I am grateful for my four days but I wish I had four months! 

I bought my ticket from London to Nice last night and I'm scouting out couch surfing in between. I stayed with an interesting Zimbabwean guy when I first got to Liverpool and it was a fantastic experience as my first time actually doing the "surfing" bit.  There was a Polish couple there as well and I am just so in love with hearing where people came from, what they care about, what they have studied, where they are going.  Traveling is just an immense education. Its definitely like being in a really rad school where there aren't any uniforms and you don't realize you are in class.

Speaking of school I have one week left of this 3 week course.  It has been very intensive both intellectually and emotionally.  There is no way I can fully absorb all of it - we are covering a wide range of topics related to tropical illnesses, public health, foreign aid, and health systems development.  The true value to me in this course is exposure.  I have just been given an armload of resources that could take me years to read through.  But I have them.  I have MSF and WHO pdf documents telling me how to run a measles vaccination campaign or set up a refugee camp.  I have tools to develop a comprehensive and successful project.  I have handbooks for obstetric care for the nurse that just isn't familiar with it.  I have tables for treatment of TB and ARV treatment for HIV.  I have malnutrition re-feeding guidelines and recipes for ORS and weight-for-height charts.  This isn't about memorizing for me.  This is about getting a general understanding of the tools at my disposal, placing them in a box in such a way as I can easily access and utilize them when I need to.  It's about the bigger picture - realizing the impact an intervention can have - for good or for bad.  Its about being exposed to the current research and to the current challenges being faced by the international community and by resource poor countries.  I guess I feel a lot less ignorant now.  At least I'll stop and consider the complexities of my choices and behavior and projects as I prepare to have an international nursing career and hopefully go on missions with MSF. 

The main things I have drawn from this course that have hit me the hardest are mainly things I was either too busy or exhausted or lazy or ignorant of to do in Tchad.  Many of the lectures have been hard to hear because I am constantly seeing faces or drawing parallels to people, to specific patients, to friends and family and the Tchadian health care system.  It is all very real.  A talk about malaria takes me back to seizing kids, dehydration lecture brings me back to the eyes rolled back exhaustion and spiking bags of Ringers and repeatedly urging parents to give ORS.  On TB day all I could think of was one chief de quartier - the one with active pulmonary TB who just wasn't getting better - who was coughing up blood, who used all his money for a week to get a chest xray, who a prescription was hurriedly written for by a well-meaning nurse who worked full time in another department.  I can still see him under a tree, away from his family, rapidly weaving grass mats, working the fibers in and out, skinny hollow chest and wide hopeful smile.  I had his carne for a week and in the end nothing changed for him. 

I almost started crying at in at least 3 different lectures.  Tchad was a hard place.  In many was it was an impossible place.  I am struggling to not burden myself with this new knowledge I have.  To not play, "I should have known this, why didn't I google this, how dare I have done this without consulting the research, what would have happened if I had done it this way, did my project do more harm than good to the community?", these questions go on and on and I'm struggling under them.  I just cannot let myself go there.  I worked hard.  I did my best.  I asked MANY questions.  The optimal is often not possible.  Protocols often simply cannot be implemented due to resource constraints.

 The one thing I will squarely take responsibility for my lack of personal research.  I should have read more.  I should have studied more.  I should have read labels more carefully, I should have practiced in an evidence based manner.  But the good news is that now I will.  I have learned hard lessons I have a lot of experience in terrible situations where my hands were literally tied - where everyone's were - the doctor's the parents, the hospital's.  In countries such as Tchad life is just brutal and unfair.  There just isn't oxygen.  You will run out of medicine.  There will be poorly trained nurses. The poverty is simply too extreme.  Every single person doing their absolute best and it simply isn't enough.

In light of all this I am just so excited to work for an organization like MSF.  Olen and Danae were and are amazing, experienced, and knowledgeable clinicians - working and learning there was a wonderful education and experience.   But personally, when I was the white nurse working in Pediatrics and a child needs his second bottle of IV quinine to keep the parasite at bay in his bloodstream and the parent refuses to buy that second bottle because I am white and I know if I buy it the next bed over will refuse as well - what do I do? Its situations like that that shook me the deepest and that I frankly have no interest in being a part of again.  Someone stronger needs to do it because it broke me.

 Or having a child that has that almost dead look hanging about their eyes, talking to the Doctor just in case he has more insight - realizing that its just about the quinine and the IV fluid and that bag of blood and maybe a bit of diazepam for the seizure and that's it - being so angry that there isn't an ICU and that I don't know what to do and that there isn't much else to do other than count the heartbeat as it slows and monitor the drip rate, its the choosing not to do CPR because we don't do it there because there was no life support because a few cracked ribs later they would still be still and flopping - its about knowing that and being there yet still being tortured by should I have breathed for him? would he have come back?  should I have bought that extra medicine?  what if we had had some oxygen, or a ventilator even...... those questions and situations broke me too.  My hat is off to Olen and Danae and Bronwyn who do this every day and somehow stay sane.  I was reading back through my blog and I was shocked at how really imbalanced and crazy I was towards the end.  It was embarrassing really that I put that kind of thing out into the universe.  Its not normal to write about seeing skeletons wrapped around mannequins in the mall or excessive descriptions of ugly things......

but the good news is I know my breaking point.  I know what I can't handle.  I know what I am not strong enough for. 

I know how I can make a difference.  I know how I can't.

 I know I don't know anything. 

And I know that next time it will be different.  I will be working within a rigid set of protocols.  We give this medicine for this.  We have the resources for this medicine.  What I prescribe will be given.  People I train will have an actual job to do and I won't have to write my own materials. I won't have to feel like I'm playing god.  I know that working within an organization will come with its own set of complications and problems but I am ready for them.  I have decided that what I can handle is guidelines and protocol in an environment where the optimal intervention is implemented with sufficient resources.  I won't have to make haunting decisions daily (maybe just weekly....).

I don't know.

 So I have been thinking about all this and thinking about traveling and talking to Canadians and Australians, and Brazilians, and British folk and so many more in between and I feel like all of these thoughts and conversations and experience is much for important than trying to get an "A."  I have context for the past, passion for the present, and preparation for the future - and I am grateful.

Saturday, December 7, 2013


City Street
Christmas Market
Albert Dock cityview
I think I could spend my days in hostels and be extraordinarily happy.

I also think I could spend them studying parasites and public health terminology and be equally as delighted.  For the first time ever I want to look at things under a microscope, to peer into the void of squiggling worming tiny killer bugs.  I have a neon yellow high-lighter (and a pink one!), a stack of scribbled on lecture notes, and it feels criminally delicious to be back in school.

Yes.  I can be a nerd.

However!.....back to my pristine lodgings: other than braving a basement kitchen over run with black rats and "just little mice," and a bi polar roommate suffering from delusions of grandeur, I am loving it here.  Everton hostel, in addition to being the cheapest in the city, is an over 200 year old house converted into shelter extraordinaire for all sorts of wanderers, derelicts, students, and traveling workers.  It is cozy and grand and bright with lime green walls, Beatles murals and black framed posters, rooms with high ceilings and giant cracked vertical windows with sweeping cream curtains that match the ceiling trim - opening the door is like turning the pages of a forgotten novel. 

There are many people from Spain who live and work here.  I learned that Spain is experiencing a particularly high unemployment crisis and many Spaniards have immigrated to the UK to work, the workers here being no exception.  Others are here for what Liverpool is famous for - its fabulous pubs, clubs, and nightlife, birthplace of the Beatles (Beatles fans are crawling wildly through the city, coming thousands of miles to see the Cavern Club - where they first played, and to see the birthplaces of John Lennon and Paul McCartney.  You can go on multiple different Beatles tours about town), and its football team.  Last week the hostel was packed with people coming in to watch the match - sadly I don't know who it was between.  Sadly also for the Beatles fans out there....I won't be going on any tours...because although money can't buy me love it CAN buy me food.  and plane tickets.  and train tickets to the more remote parts of England so I can walk about the English Moors and pretend I'm in a Bronte novel.

Liverpool has been great really, it's sprawling and decently old and its on the coast.  In earlier times a very bustling sea port both for the slave trade and all sorts of other imports and exports.  The accent here is insane to the ear that has never heard it, "scouse," and it is a very distinct English dialect if you will.  I won't even try to attempt to imitate it either in writing or speaking but its worth a look up.  It can be very difficult for those who haven't heard it to understand, even to native English speakers.  Liverpudlians therefore are also called "scousers."  If I walk down the street I am surrounded by many different subtleties and variations of what I used to just call an "English Accent."  Another wonderful thing I discovered is that much of Europe traditionally has Christmas Markets.  These are usually in the city center and are festive and happy and fun.  There are booths and tiny assembled storefronts strung with Christmas lights (think much the vibe of a fair), people playing all sorts of instruments in the street, stalls loaded with heaping chunks of fudge, vats of beer, hot dogs and ice cream, "make your own" personalized stockings, wooden carvings and knickknacks, and all sorts of things you could possibly imagine - sweaters and oranges.....and white Christmas patterns strung across cobbled walking streets.   Many of the girls do their shopping with huge curlers in their hair - later they will be out steaming winter with perfect tiny dresses, red lipstick, legs for miles, like a ship of alien bridesmaid models descended on the city center - these girls dress it up - no Xtra Tuffs and leg warmers on a Saturday night in this city. . 

There are travelers here from France, Germany, Japan, Poland, Spain, Czechoslovakia, other parts of the UK, and many different places.  And the embarrassing thing is - every one of these blokes and wanderers speak English.  Quite good English.  It's sick how ignorant that makes me feel as I stammer about in my French and wonder what my American accent sounds like to foreign ears.  And the view most seem to have of America and particularly Alaska is embodied in one woman.  Sarah Palin.  Alaska?  US?  absurd right wing politics, the games played and wars waged on Capitol Hill and....Sarah Palin. 

I have been horribly sick, I think I had both the flu and bronchitis and its just today after a miserable 3 day sludge through congested hell and city streets I finally feel like a semi normal person.  I missed class yesterday on purpose and slept almost 17 hours straight.  So this with assist from dozens of cough drops, cold medicine, Kleenex, hot tea, a shower that sometimes works, and some Penicillin (that my roommate has conveniently been carrying across the world for 6 un-expired months!), I a have beaten the beast with many heads and am getting better slowly.  Now at least I can refocus on topics such as refugee health, emergency obstetric care, anemia, cholera, and the increasing burden of non communicable diseases in developing countries.....

I really love the Diploma in Tropical Nursing course that I am taking.  The school of Tropical Medicine here is really world renowned and we are lectured to every day by people who are involved in cutting edge research and are at the top of their fields.  There is far too much information for me to absorb but I think the real goal of this course at least for me is not just memorization.  It is just as much about gaining knowledge as it is having my mind exposed to new ideas and current thoughts and issues in the field of global health, refugee health, and foreign aid and international policy.  I will come away from this course with an amazing stack of electronic reference materials - even if I don't learn it now I will know which documents contain the information and need and where to get them. It is just a very valuable experience, the only part of which I dread being the referencing of my research paper......

I am also blessed in the random gift of a perfect roommate, the only other person in my 4 bed hostel room that not only happens to sleep in the bed above me but also is in my class.  She is a Bosnian Canadian world trekking mountaineering vegetarian yogi nurse with as great a passion to work for MSF as I do.  And she is nice.  It simply couldn't have worked out more perfectly.  It is nice to have someone to make jokes about parasitic life cycles with and who also wants to wander the streets of Liverpool on foot culminating the journey with a visit to the International Museum of Slavery (what??!!!).  Anyhow - very grateful.

Also - MSF update:

I passed the interview.
I passed the reference and background check.

There are a host of people that deserve thanks for their help advice encouragement and input in every step of the process but I will save that litany for a later date.  The truth is I am now only cautiously optimistic.  Almost every person that goes to Info Days gets into the Applicant Pool and gets to work for MSF officially and go on a mission.  But I feel that I cannot rejoice until I am done with this class, done studying French, pass my French review, and make a good impression during training.  However, it IS a big deal, at least to me, so yes.  cautiously optimistic!  Only when it is official will I celebrate full throttle screaming whoop run through public places dousing perfect strangers with champagne leaping crying dancing status.

so hmmm....that's about as newsy and informative as I feel like being for now...I actually have a host of blogs to post that I just haven't put up that I started writing since I left AK.  All in good, sweeeeeeet, time.  I'm off to study about nematodes and helminthes.  peace.