.yes!

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.
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