.Mali update

It has been 2 weeks since I left Alaska and the north countree feels like it was another age, an ancient lifetime ago. 

I would like to have an MSF blog so I can freely talk about the project but in the meantime I am going to cautiously blog here.

I flew to Paris from Alaska for my briefings and stayed 2 days. 

The first day I got lost in the city, was the epitomy of a foolish tourist, tried to see the Louvre, which was closed because it was Tuesday, and ended up walking probably about 4 miles through the city to the Eiffel Tower. 

I saw the tower from a prudent distance because my feet were tired and I saw the Arc de Triumph in the same manner.  Mobbed through some sweet gardens with old statues etc, had coffee at an outdoor cafe and sat for a spell by La Seine, that grand old river flowing through the heart of the city. 

I tried to ride the bus, succeeded of course but the bus driver was lost in conversation with some beauty and I couldn't pay and he kept driving.  So i hopped off when i got to the river and tried to pay for my previous bus ride on the next bus which caused some hilarity and i wasn't allowed to pay.  Oh well.  I dropped something in the river by accident which was of course karma for the stolen bus ride and that's just the way it goes sometimes.

I told the universe I didn't mean to steal the bus ride. 

I went to bakeries and bought some good wine and other french delicacies for the Pediatric team already stationed in Koutiala and had an interesting time trying to buy a permanent marker and thumb tacs. 

After spending the second day at the Paris office I flew from Paris to Bamako the next day.  I was met by one of the drivers and spent the next several day in Bamako, the capital getting more briefings, and the beginning of a gradual clarity that is still continuing regarding what I will be actually doing day to day.

Last Saturday we left Bamako and had a long 8 hour truck ride to Koutiala.  We stopped and had rice with tomato sauce and lean sauteed chicken for lunch and continued on until we got to our compound.

I have my own room here and the first week was almost unbearably hot.  I woke up every morning between 4 and 6 am because of the heat but finally we have AC installed and which works some of the time. 

My accomadations here are very comfortable, very different from a mud hut and even better than my dry cabin life in Alaska so no complaints there.  We live on the second floor, the third floor opens on to the roof and in fact is the roof, and the first floor we have our offices.

My team consists of 3 other people and we all speak French.  Or should I say they speak French and I try not to cry.

Day by day, second by second, every time i figure something out or understand a document or a conversation is a small victory.  At the end of every night my brain is mush goo and i get a glazed deer in the headlights type of look and then wake up in the morning and try and try again.

My job seems like it will consist of major supervision and administration as we roll out the CPS (SMC - Seasonal Malaria Chemoprevention) which is in its third year in the district of Koutiala in the Sikasso region of south eastern Mali.  The target is about 170,000 kids under 5 who will receive anti malarial medication for four months at the beginning of each month.  It is a combo of Amodiaquine and Fansidar.

This gives them about 28 days of protection from malaria while of course needing to still use standard prevention methods such as insecticide treated mosquito nets and the like.  When taken correctly this method has been proven to decrease the cases of simple malaria and the reported cases of acute malaria by 75% and is really a phenomenal endeavor that translates to large amounts of real lives saved. 

I don't think I can discuss the exact breakdown or exactly what I will be doing but right now I am working on modifying the paperwork so it current for this year's distribution and so it can be easily used by the Ministry of Health when it is passed to them next year. 

Tchad was hard because of the up close and personal suffering we all worked with in the hospital and also because of the extremes of village life but this job is hard in a different way.  I will be pretty sheltered and spend most of my time in the office so I won't really have much to deal with psychologically.  The hard part for me is somehow trying to get my French better asap, to understand what is going on around me and a hard job is made that much
harder by the fact that it is in a language I don't feel fluent in.  It takes me probably 6 times longer to read a document in French than in English.   But I am happy about it in theory because this was my goal - to go on a French mission partly because I want to work for MSF France and partly because I just want so badly to be bi lingual and to be fluent and I guess there is no other way than this
insane immersion that I asked for.  I have only been here a week.  5 months and 2 weeks to go and I expect by then I will have vastly improved linguistically.  But oh. my. lawd. I don't think I have ever ever EVER been this mentally challenged.

Other than work I have managed to buy some mangoes and bananas so I can have fresh fruit smoothies and have watched the rains rolling in from the porch.  There is nothing like instant brilliant deep grey sky and lightening cracking on the left while blue sky and white clouds are quickly being overtaken on my right. 

I wanted to have a good blog again now that I guess I have something to write about but in reality I don't think I'll have much that I can say and somehow I have a block that prevents me from writing quality pieces.  My Africa this time is the compoud and while I am in Mali it feels like I could be anywhere. 

One day I'd like to get to the point where I have something real to say no matter what, not just a reaction to certain poingnant experiences but I'm not there yet so I may keep writing from time to time when the mood strikes me. 

I have great internet here (except its not working right now) so you can call me on FaceTime if you have an iphone or send me an email at janna.e.wagner@gmail.com.  Also I have skype so send me an email if you'd like to skype.  Once again thanks again for the faithful few that follow this blog, sorry I don't have more for ya.

I'm just a lonely American trying to find her way and I'll try to blog every now and again if I can think up anything prudent or interesting to say. 

Much love from west Africa and thanks to everyone for their words of encouragement through email and facebook and the like - if only i could have the confidence in myself that everyone else seems to have in me.... but that is life huh people tell you they have utmost faith in you and you laugh and say ha! and then looking back somehow you pull through but when you are walking through that mire or lost in the grey of another language or in the fray
of a new experience...it doesn't seem like you can do it.  And you just have to trust that even though it doesn't seem like it, you are on the right path, that you haven't strayed, that if you just try a little harder, keep going a little longer, you will break through to the light or at least get to hang out by a tiny candle or stick of insence for awhile. 

So tomorrow is a new day of work a new week of work and i'm just going to keep marching through the linguistic darkness and keep looking for ways to pull my weight despite the language barrier. 

Its been years since I've cried this much.  But I kind of like crying.  In the middle of it you can stop and smile and be like, I'm already crying.  This is as bad as it gets.  And this isn't so bad. 


and it isn't so bad. 


It really is quite wonderful.  This opportunity and the stage I am at in my life and the fact that I am young and alive and free.  Life is good.  And I don't take it for granted.  Not for one second.  So once again, despite the mental panic and the heat and the tears, I am grateful. 


I guess this is what it's like to live yer dream.  


It's rain and heat and thunder on the rooftop and the struggle to be just be just be just be here.




PS.

Grandma Y if you get to read this, I love ya.  Ever so much. 

.ice&sand

Leaving maggots are once again crawling and squirming through the flesh of my toes, burrowing under dirt and nailbed and wriggling pulsing up down the arches of my feet and dancing their way into my heels. 

This is the song of a reluctant traveler.  Of a humanitarian baby.  Of a person stepping across the ocean one bare foot in the spring mud and ice, the other in the burning sand of the Sahel.  Of a heart torn.

I got it.  And I didn't know it would feel like this.

I officially work for MSF.  Approx. May 15-Nov.15 I will be working in a pediatric project in Koutiala, Mali.  I will be the nurse on the SMC project - Seasonal Malaria Chemoprevention - a very exciting continuation of a pilot program started in Tchad and Mali that have shown stunning decreases in inpatient hospitalizations and reported cases of malaria in the target population that received preventative anti-malarial medications at intervals during the rainy season. 

I am over the moon [and howled under it] , under the sun, have danced in the kitchen [jerky shaky bluegrass hops], laughed on the beach, scrawled furiously and depressingly in my journal, started unfinished "Mali, bring" lists, and have struggled through my job description/project description documents that are in French.

How does it feel to have everything you have ever wanted? 

I'll get back to you on that. 

What is it like to have achieved the ultimate dream?

Pure terror. 

Celebration a couple shots in crumbles to anxiety and what what no, yes, no I just got back here. 

Back to the land of blowing snow and ice shards in my extra tuffs and trying to dig the car out with a broom on back mountain driveway.

Back to slowing down for moose bopping scrawn and brown in the other lane, to jogging and driving in a clear crystalline paradise, blue ocean and white mountains leaning into aqua and harbor and sunshine and peacock sunsets, catching your breath with invisible rawhide nets and forming a thousand throaty plumes into wild grey clouds. 

Back to cars breaking down and the friends that  never leave you stranded and offer whiskey and beach walks and steaming home cooking as a precursor to more sane solutions. 

Back to conversations that go like this (in regards to a birthday dinner), 

"Well, we could have it at our house but we don't have electricity and the mattress takes up most of the room and with 2 dogs...."

"Or it could be at my house, but I'm out of water and honestly I don't feel like doing all those dishes and I don't want to haul all that water up in the sled..."

"I guess it could be at mine, but I don't have a kitchen or a stove...."

"Then your house is the only option, but its at the end of the road on the top of a mountain and its a little too far for all of us to come."

Back to friends such as these, struggling and toiling and loving and working and stoking the woodstoves and leaving to work on boats or at hatcheries or buying land or moving back or growing garden starts and feeling the creeping mania of summer light floating in to permeate it all. 

Back to smelling deeply that fresh ground coffee in the morning and standing on the deck surrounded by silent falling snow and wooded stillness, odd snaps from moving animal feet and heaps of languid snow on the deck and in my heart. 

Coming back was everything I knew it would be and more.  Homer is in my heart like a plague, like a disease of beauty and knowing that has taken firm residence.  It was hard to leave and go to Europe, as I said in earlier blogs.  And its even harder for me to think about going to Mali.

Of course I want to go.  Duh.   Of course I'm excited and dreamy and filled with anticipation jitters and solemn personal promises of high quality performance.  But really, on the daily, I just want to be here.  I crave it.  I am slowing down and enjoying it.  I am living as much as possible in the moment.

I guess that is the strategy.  To this month just be here.  For the next few weeks I won't think about Mali if I can help it.  I won't research the country, the stats, the projects, the political situation, and I won't even study French.  I am instead going to ground myself by sinking into Alaska.  By breaking my bare feet in and jamming my toes into hard dirt until I feel dug in.  I am going to walk on the beach and listen to my breath and the crashing of the waves.  I am going to marvel when I see eagles and continue my wild breathless love affair with the far off mountains and their ever changing backdrop of sky.  I am going to cook slowly the most beautiful food I can find, peppers green red and yellow, purple onions and potatoes, orange yams and sizzling yellow eggs.  I am going to make bubbling curries and berry smoothies and slice creamy dust green avocadoes.  I am going to laugh with my friends and work as little as possible and read books I've been meaning to get to and call the people that bounce like shadows in the back of my heart. 

And maybe, once I've found my spiritual rock, maybe then I will stand on it.  And stand taller.  And square my shoulders.  And take a deep breath.  And then I will power forward with courage and intention and do the physical and mental preparation required to be gone another 6 months. 

I am so grateful I get this amazing opportunity.  I intend to do my absolute best.  I know that I will come back a stronger and more well-rounded woman, rougher and more polished, a better French speaker and a better nurse and with eyes that have seen and hands that have felt and a heart that may either be redeemed or sink further into stone. 

I think I have an understandable mental reticence because this is frankly going to be very hard.  I am starting from the bottom in a new organization.  I don't have the faintest idea what to expect really.  I can barely decipher the French documents.  I will be working in French completely (which is what I wanted.....!!!).  I will have to hit the ground running.  And I will have to bring it.  And no one has the slightest sympathy for me because they think I can do it.  And I do too.  But I am acutely aware that the stakes are so much higher.  I am working for the best and I need to be the best.  There isn't a wide margin of error or a cushion when I fall down.  I am there to do a job that I have stated I am capable of.  I am there at the end of the day because I believe that kids shouldn't die if they don't have to.  I am there because I want to fight the beast of malaria and I know that when I am in that space I will be able to access and channel my passion for it again. 

But right now, the light is streaming white gold through my window, my second cup of coffee is calling me, music is grooving out the radio, the cat is purring and snuggling with the damnest tenacity and the ice is slowly melting from the porch.  I'm reading Love in the Time of Cholera, studying for PALS provider course online under fake names (characters such as Fermina Daza), had homemade pancakes with apple butter for breakfast and am wearing pants with singing bells when I climb into bed.  I am happy.  And here and only here is where I want to be right now. 

Blessings to each of you from the end of the road. 

Love, Alaska.



***My blog will continue (haphazardly) until I leave and then my hope is to switch it to an MSF blog as I will have to go through that channel to write about the project. 

The beautiful Rachael at sunset, Bishops Beach

Back porch stillness

Cloudy day walkabout

that time of night

Happy Birthday to Nalani

.je sens

Mmmmmmm France

Good bread crust bread french bread for breakfast, creamy salted butter, slather of jam, raspberry, strawberry oranges falling off the trees fresh lemon le chocolat croissants thick cuts of cheese molded hyphae branching delicate arches tiny trees, green and blue through yellowed sagittal slices.

Le vin wine wine red wine white wine sweet wine dry wine old wine new wine rows and rows names I can’t pronounce but are oh so delicious rolling arching off the tongue fresh salad crisp salad green salad perfect crunching circles of onion round juicing spurting tomatoes red red oil serous oil huil d’olive sauces and crèmes and rainbows of vegetables á le dejouner

J’adore

Avec plaisir, pleasure pleasure oui, avec plaisir, madame slow down, an hour for lunch, for the French, sometimes two.  Savor it enjoy it roll it around your tongue like cool firm summer cherry enjoy life taste life touch life feel alive

Quality food, fresh ingredients, local produce, take two hours to cook dinner be starving ah! first bite, two hours to eat dinner, slow down slow down vivre!

La vie est belle!

J’ai tombé en amour avec France. 

I could live here, I can be here, I can breath here. 

It’s about taking time for the beautiful things in life, for the things that make you happy, for the tiny moments that slap and caress and lull if you stop for them. 

Let the sunshine fall on your face, let your ears ecouter la mer let your eyes linger on the mountains on the ocean on the on the trees groaning with citrus let your toes curl in warm crust of sand let the sound of the ocean roll over you let the flakes of a steaming fresh croissant melt like buttered snow in your mouth

and be

be

be alive

be aware

be here

open your pores your mind fling out the tendrils of all your senses and absorb absorb

slow down

embrace

let your eyes and your ears and your mouth dance and sway and smile and twist

with pleasure

pleasure

pleasure

avec plaisir

stop

just stop

Aretez!

and let your surroundings overwhelm you

overcome you

transport you

the way the lace falls in the gentle billow of curtain

the way the wind lingers over your cheeks

the way the music tingles and thums in the deep of the ears and winds swaying down the spine and into the belly

the way an orange peel waxes and curls ragged in your palm the spurt of each tiny citric burst on your lips the way you no longer crave sugar when your tongue swims in cream

the way a chocolate smears dark and silken into the crevices of your fingertips and spreads like heady lava through your teeth the way steam rises phantom grey from the aroma, aroma the coffee, the heat, hands curled hot cupping mug of groan fresh morning

the way a cigarette burns slow and curling into the zesty musk of your wineglass at dusk sunset stain pink and tint orange faint to the stark kiss of red lipsticked rim

the way the city glimmers and burns in the wild eye of the full plump moon the way the night hums wild lullabye and forgotten shadows come out to play

sentir: to smell, to feel

je sens, I feel, I smell

I you he she it we they fell, smell, touch

the forgotten sensuality of life of life of ordinary life the way there is no longer any such thing as ordinary when you live in awareness of the vibration that surrounds you when the five senses are no longer a definition but are the breath the crux the eyes the skin

you – no longer IN contest but ARE context

when you realize the senses, that they are porous that you are porous when you slow down when you stop when those five magic creature friends are allowed to be sponges yes sponges and you howl yowl growl to the heavens to LET IT RAIN and suddenly you are filled you are bursting with the fat the gristle the moan the opera the clap the perfume the tang the fire the prick the bruise the sneeze the of swollen fruit and golden glory and thunder thunder thunderstorm vibration of not five elements but the energy, the awareness, the BEING of six.

 

you are arched by a rainbow

allow your eyes to marvel, to open, to blink, to tear

 

you are saturated by the waft of humanity

allow your nostrils to flare, to inhale, to ingest

 

you are nourished by what you eat

allow your tongue to zing and savor, your teeth to crunch and gnaw

 

you are ever in a melody

allow your ears to perk and tune to the frequency the chirp the opera

 

you are living in an earthquake

allow your core to quiver to tremble to crumble

 

you are permeated by a spirit

allow your soul awareness, existence, radiance

 

you are alive

allow yourself to be.

 

.odetotheairport

London Gatwick Airport. 

Once again in the twilight zone of moving trains planes buses blurring faces clicking shoes thunking bags accents and languages and people streaming and teeming and swirling. 

I love airports.  I really do.  They are a comfort zone.  I know where I can sling my back pack down and lean against it, I know where I can pull out my sleeping bag and crash out, I like waiting for flights or spending the night or people watching.  Being in an airport is like being in a lost pocket of time, being in no man’s land, neutral ground everyone a stranger with only travel in common.  It is a unique space in time, a world that belongs to no one and everyone at the same time.

There is love in an airport, sopping goodbye’s and devil-may-care-who-sees-me kisses hello – couples bumping heavy bags and careening towards parked cars and buses, stopping in the middle of nowhere tile laughing and locking eyes and lips and smiles in the moment of you you you-again.

There is the trepidation that often comes with any journey, the when do I check in and where and is my flight on time and who will meet me on the other side and am I really doing this and will my world change when I get back will I get back if I get back.  Of maybe it is leaping and there is no back at all.  There are the ones that never flew before, that circle anxiously studying departure boards, ask everyone with a name tag the same questions, hold up the line in front of you.  I hope to never be angry with that person.  Doing anything for the first time should be applauded, respected, admired.  They might not move with the same finesse but they are moving, they are seeking, they are going.  And compared to the way I handle subway navigation they look like seasoned champions.

There is the man in the Stetson and snakeskin boots holding a dozen red roses. The young one in the black business suit holding a neat white black lettered sign – who is he meeting, where have they come from? is he wishing with starched posture that he is curled up in bed, away from the world of suits and ties and smooth glass tables and men that sit in circles?  How do the pressed suits walking towards him stay so…wrinkle free?  I wonder who they are in their free time, what do you drink? are you a whiskey man, do you prefer scotch?  where would you go if you had a week to be anywhere?  who would you take?

There is the couple with the bright colors and odd instruments, squatting against the wall with their backpacks, the girl with wild hair and billowing powder blue genie pants.  There are the mothers with sensible haircuts and rolling bags pulling packs of cheese crackers and juice bottles from thin plastic shopping bags, the sleepers with back to the milieu shirts slung over eyes spooning luggage.  There is a garish smooth trimmed mammoth of a Christmas tree, angel-less tip almost touching ceiling style, silky red and dull golden bulbs and lights locked in a slow jerking mandala of twinkle.  I like it.  I hope for the tree’s sake it’s a fake; trees should be wild and tangled and windblown and sunlight, cloud dreamers with root fingers twisting gentle opened deep in the belly of the earth. 

There is relief in an airport.  Relief to be back.  To be home.  To be off the flight.  To be finally here, to be at the beginning of the first sentence in a new book, to wander a new chapter, to buy a different ticket and change how the story ends.  Relief: to walk back into air conditioning or come home from a war or a mission or a trek, to re-enter a world you weren’t sure you would live to see again.  There is culmination of long and impossible journeys of suffering, strips of sacred smooth tarmac a universal Statue of Liberty. Or relief to enter these doors, following signs to “departure,” to have crossed out that list and tied up and buttoned down and passed on all those things that bound you just moments before.  In the airport you can take a deep breath, it can finally be real. You can allow yourself to be excited, to be scared, to meditate or wrap your head around what it means to change your life.  It can finally be just YOU – whoever you want or need to be.  Relief that whatever it is – it is finally happening.  There is magic in beginnings. 

 

I have met life-long friends in airports, or strangers I still keep in touch with, people that are in my life because of a simple "hello."  Hikers, writers, dreamers, madmen - passionate humans that went where they wanted to go.  People that long to see the world - and are seeing it.  Backpackers that summited Kilimanjaro, a couple from San Francisco that stayed in a tent in the Kenyan bush, booted up and on Safari, tourists that traveled travel will travel.  Awe and respect. For them, for anyone, that in any way, stepped outside of their world, and moved towards a dream.  These are my greatest teachers. This is the shiver of alive.

So now I’m sitting in a great room with a winking cone of a Christmas tree surrounded by sleepers and families and readers, cleaners dragging clattering/chugging thump rolling yellow carts, strange fingers tapping laptop lullaby, crinkle of sandwich wrapping, murmured French and the floor is looking goooood.  mmmmm sleeping bag and voila bed.  It’s the middle of the night and in the morning I’ll be on a plane to Nice, couchsurfing all weekend and school at the Institute de Francais on Monday morning......

 

 

.thatwhichmatters

It is getting hard for me to write this blog. 

The numbers show people are still reading - who, I do not know.  And it is because of that that I keep trying to post things, keep trying to haphazardly keep this journey alive in the space I have created for it. 

But I feel like it isn't what I want it to be.  I am the only one that can make it better, do better, spend more time, write more often.  But the crux of the problem is that the writing I did in Africa was fervent.  It was passionate, words flew like raging mud from my fingers, everything was exotic, most things were hard, many were unconscionable.  I miss that raw flow of honesty, that exploration of a harsh and different world and how I tried to find my way in it.  I am missing that now.

I could be much more forthcoming here of course.  But I can't.  I have to find a balance, to try to write something that won't shock my grandmother and that the wildest of my friends can dig and identify with.  It seems like an impossible task.  I have thought many times about quitting it, frankly because I am tired of putting what I consider to be rubbish waxy plastic writing out into the universe. 

I guess right now I am taking a small jab at honesty. 

Within the next 6 months I will probably be some place hot again.  I will probably work long hours, feel entirely unequal to my tasks, will be in completely new environments and again be faced with situations that make it impossible to suppress what I have to say.  I will be exhausted and invigorated and will be able to document what it is really like. 

I think in some ways my blog has worked because I showed what it was like to take a risk.  I talk probably too much about this main theme of terror and loneliness, how I don't really want to do any of it, how I am so scared to go to new places, to start over, again and again.  And how I keep proving to myself over and over again that its the only way for me to live a vibrant life.  I don't make it rosy because I want that one person who is just as nervous and scared as I am for radical change to know that they can do it to.  That maybe they don't need comfort.  That there are always more choices.  But even this sounds like total bull**** to me at this point because really, what do I know about a hard life?  about discomfort?  honestly, not that much.

The new undisclosed chapter is exciting and sobering.  My life is about to change because I fought for something.  Now, facing everything I ever wanted, the initial excitement has worn off.  Of course I'm going to do it, I'm going to go.  But the weight of what I'm about to jump in to is weighing on me.  I am about to embark on a lifestyle from which there is no turning back from, at least for me.

It is the simple things that bother me the most, that hold the gravest personal consequences for me.  It's also things I whine about here ad nauseum.  It is hard to maintain close friendships when you are gone for 3-9 months out of every year. It is nearly impossible to find a life partner. That unknown person I wish on every pummeling star for just in case.  But I have decided to take the consequences with eyes wide open.  Life is bitter sweet.  You have to pick your poison.  I have picked mine, it is amber and liquid gold and I'll tip it back with the greatest of knowing, firmly cementing my place on the glorious fringes. 

I know, I KNOW  that MSF will be different than volunteering in Tchad.  Of course it will be. But I only have my first experience to draw on, so still I am asking, do you really want to get malaria again?  Do you really want to crawl around on the dust, puking up the lining of your stomach?  Do you really want the culture shock, the relationship forming with national staff, the leaving of the place you've come to love, the reverse culture shock and impossibility of true re-integration?  Do you really want to be sweating in 110 degree heat, do you really want to be the white minority? Do you really want to look into the living breathing human faces of injustice?    

not really.....

...... I guess

yes.....

.....yes really, I do.  

but there will be ground rules this time.  I am different now, I have a radically different perspective.  I have completely flipped from caring about he individual to wanting to maximize the greater good.  I would rather bring my education to training national staff in a country and participating in research and data collection than having my own patient load.  I hope to be conscientious and careful of not having a negative impact. 

I don't want to make any promises to the people I meet.  Because I will not keep them. 

I don't want to form close relationships with kids, with women, with families.  Because I will not see them again. 

I don't want to go the hardest place I can possibly find on the earth anymore.  I want to go to any place where the capacity I have to make a difference with my particular skill set is maximized.

I don't want to spend time living out in the community anymore.  I want to be behind high walls in the evening, I want a gate to cross through, I want to be able to "get away."

When I went to Tchad it was with the explicit purpose of opening my eyes, my ears, my heart, my soul, my every fiber to the suffering and experiences and colors and beauty around me.  I wanted to live like that.  And you may find this horrible - but once was enough.  I still want empathy.  I still want passion.  I still want to be loving.  But it will not be at the price of myself. 

And I apologize to no one for the hardening of my heart.

 It is so I can still have one. 

But as always, I am ever grateful for the opportunity march this great path, to have this great journey, to walk in the footsteps of the great and stand on the shoulders of giants, to leave a few dust particles and ripples in my wake. 

I am just trying to figure out what it means to be human. 

to be human.  the awareness of a collective longing. 

longing for food, for success, for fame, for survival, for adventure, for wanderlust, for romance, for roots, for connection, for the sacred, for spirituality, for belonging, and most of all, for meaning. 

We all package our meaning in different wrapping.  We all climb in and out of different boxes, gaze up at different stained cathedral ceilings or towering redwoods, try on different crutches and shoes for size, kneel on numbed knees or position our after the great yogis or Buddhists to move from the carnal into a higher state of enlightenment or worship.   

at the end of this life, when we are wasted and waning, when tattoos and lips and cheeks have faded, when skin hangs loose and cells betray us, when the last touch we feel is from a stethoscope, we all want to look back and think that it mattered.  That the moments meant something.  That something, a love, a memory, a life, will survive us.  be it a spiritual, a written, a breathing legacy - we all want to leave something behind to make sense of why we were here. 

for some the answer lies clearly in an omnipotent, omnipresent, loving God.  For some, their legacy is not of the world but of the "next."  For others, the answer lies in connectedness in the now to other beings and to themselves, in awareness of individual impact on the collective.  There are millions of thoughts and prayers and paths and beliefs that surround the crux of this longing for meaning, that make try to make sense of the need to make sense of it all.  For some, simply being alive and returning to dust is all the beauty that they need to exist. 

For me, meaning lies in social justice.  Meaning lies in fighting to reduce suffering.  Meaning lies in human connection and global awareness.  Meaning lies in never forgetting tiny old man faces and fading heartbeats and the hope that maybe more children survived than died because of me.  I don't think for a second that this is unselfish.  It is the opposite.  But it is what it is.  It has taken the place of religion or G*d and become the sacred. 

And so in my little life I'm going to go out again.  I'm going to cement my feet to this path, I'm going to squinch my eyes and dive into this great river of knowing and serving and traveling and seeing and fighting from which there is no turning back.  I knew from the moment I worked my first solo shift in the pediatrics ward in Bere that I was eternally damned by the horrid need to be amidst great suffering, touch great evil, and wrap my arms around exquisite fragility. 

In Tchad I both found and lost humanity.  It was a dark and shadowy line.  And I need to walk it again.  I don't pretend this is healthy.  So I need a rigid structure and perspective and balance this time .  And so I'm going to work for MSF.  And it will be hard.  But I will be back in the primal grind of chaos and survival and a life that is stripped down to that which matters most.  And I can't wait to be back.  I'm ready.  I'm going. 

And no matter what happens or who I become may I always remember to cherish.  May I always try to love.  And may I never, ever forget the faces of the forgotten.  And may their memory fuel a knowledge and passion that results in one person, somewhere, living to see another day, another week, another year, or perhaps even a lifetime.

to live.  because it is life, not my privileged quest for meaning, that matters most.

.donebabydone

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

 

 

LSTM

Looking for Ascaris ova

Listening intently as usual - with the fabulous Masha.

post-test euphoria



class photo

.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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