Out of Africa

It’s 4:23 in the morning, and I’m wide awake, ready to go. Sigh. Damn jet lag. I spent some time petting my cat, tried to fall back to sleep, took a bath, counted my bug bites (21), and am now creeping around our kitchen in Benicia, making myself a bowl of Cocoa Krispies, deciding to give up and just be awake. I have to write a bit, anyway.

Observation #1:
There are many things that are great about our country. Cocoa Krispies is one of them.

Oh I miss Africa. In a way I never have missed a place before. I spent time going through my photos yesterday, and was struck by how darned happy I look in just about all of them. This is a new phenomenon for me – my father always bugs me about my travel photos, “do you have to look so miserable in all of them?” It’s true – in Mexico, I looked sick; in Thailand, I looked sweaty; in Ecuador, I looked scared; in Europe, I looked tired. But not Uganda.

In so many ways, this trip was harder than any I’ve taken before – this was my first experience with clinical medicine in a developing country, and it delivered all of the challenges expected. The heaviness of the morbidity caught up with me over and over again, and I would struggle to put on a happy face for pleasantries as the days wore on. But it seemed that Uganda always redeemed itself in some dramatic, beautiful way. A breathtaking sunset as I walked home from the sobering death of a 2-year-old from malaria. The ancient echo of the salat call to prayer when I awake in the morning before another day in the dismal emergency room. The warmth of the sun, the smell of the jasmine, the primal songs from the nearby church, resonating in my bones, strangely feeling more like home than California ever has. I have a handful of theories to explain aspects of my experience in Uganda, and one of them is this: it is no wonder that we evolved in this land. Everything grows here. This is a land of life. Humans, giraffes, jacarandas, viruses, parasites, cobras, lions, warthogs…. Africa nourishes us all, which helps me grasp its seeming contrasts with a bit of forgiveness for what otherwise often seems a cruel, ironic place. Home feels good, to be sure, but honestly a bit antiseptic. I miss Africa.

Thank you so much to you, my friends and family, for your love and support this past month. Without a doubt, one of the highlights of my month was reading your emails and responses to my blog entries – you helped me through some low times, and brought me some valued perspective and appreciation for my trip. I am lucky enough to have the next 6 weeks off from any clinical duties as I launch into taking my boards exam (on Wednesday, gulp) and then my residency interviews, and I so look forward to seeing you all individually on my days off. I’m facing a big decision in the next couple of months re: Seattle vs. San Francisco for the next three years, and will need all the advice I can get. I can’t yet say whether this past month has pushed me in one direction or another (though I have a hunch); what I can say is that it unequivocally made me even more passionate about the kind of work I have long envisioned pursuing – given how much more developed we are in the US than so many countries, it is absolutely unacceptable that so many Americans are living without health care. I want to fix this. I feel conflicted about the fact that my international work always primarily leaves me with a clearer view of how I want to provide care back home – sometimes, it feels like I’m taking advantage of these hosting countries. But the thing is, I don’t really believe that. I believe that the change in Uganda needs to come from Ugandans, and that my presence there was part of a larger solution, a more complex kind of aid.

One final story, before I wrap up. For my last weekend in Uganda, I went on a 3-day safari through Murchison Falls National Park. On the last night, after a long day filled with giraffes and hippos, I was sitting around a campfire with my safari-mates, Wes and Alex. Wes is a Peace Corps volunteer working in eastern Uganda, now 18 months into his project. Alex is his buddy from Seattle, who came out with 2 other friends to visit Wes. Good friends, huh? Anyway, we were drinking some local beer, looking out onto the savannah lit by the harvest moon, falling into the rhythm of watching fireflies blink, when our conversation rather naturally turned to religion. There had been a horrific bus crash outside of Kampala just a few days before I arrived in October, and one of the victims had been from Wes’ village. Wes shared an impression, along the lines of, “You know, I think that’s why Ugandans are so religious. They have so little control in their lives, everything could be taken away at any point. You need God to get make sense of it all.” I think Wes is right. Well, I think Wes is half-right. Yes, Ugandans live with more uncertainty and instability than most of us Americans can imagine. Bus accidents, AIDS, military coups, malaria, sleeping sickness, the list goes on. Yet I think there’s another side to this, that makes it all even harder to explain or grasp: Uganda is filled with true, unparalleled beauty. And it’s everywhere – in the sky, the people, the rivers, the music, the flowers, it’s even in the dirt. There is such suffering. There is such beauty. Maybe you need God to make sense of it all.

What a month. Happy Thanksgiving to you, my friends and family! I am thankful for you all, and for the incredible privilege of travel. Please send me an email, give me a call – I can’t wait to see you all soon.

Obligatory Election Reflection

Is anyone else experiencing severe writer’s block whenever you try to write about the election? I realize that my blogging hit a major wall last week on precisely November 5th – it felt wrong to post anything without mentioning the election, but whenever I try to write about that night, words just fail me, time and again. I wish I were a good enough writer to capture and share the energy of that night, the echoing cries of celebrating Ugandans upon the early morning announcement of Obama’s victory, the bittersweet tears upon listening to our new president’s victory speech as he acknowledged the importance of his election to those abroad, “huddled around radios,” just as we were. The world has never felt so small, so connected, so good. So maybe I don’t need to describe that night – I know I will always remember it. I can already picture telling my children about the night Barack Obama became our president, and how proud I was to be an American. And so I choose to just submit to the experience, allowing myself to enjoy these days, and appreciating the irreplaceable experience of being in Africa the day that America elected a black man as our new president.

I know this seems crazy, but ever since last Tuesday, I feel markedly safer here. This is largely ridiculous – first of all, for some still-unexplained reason, most Ugandans assume I’m Finnish (insert confused look here), or British, but rarely American. Yet I’ve noticed that many more people now ask me where I’m from, and upon hearing my response, promptly break into huge smiles, and quickly respond with one clear loving word – “Obama….” I meet eyes with people on the bus, and they smile, holding up newspapers with Obama headlines. I also have changed my own reply when asked where I’m from – long ago, I learned to answer “California”, which previously received a warmer reaction than “USA”. But now I’m eager for someone to ask me, as I respond with a proud smile, “I’m American.” Damn skippy.

(photo of me and Dana from post-election celebration party at local bar)

You Win Some...

I got mugged yesterday.

Let’s just say that it was a very negative experience. I’m ok – just short one sentimentally-important-but-otherwise-not-particularly-valuable necklace (dude ripped it off my neck while I was walking down the street in downtown Kampala in broad daylight, surrounded by business-folk).

It really scared me.

I think the hardest part has actually been the fact that I’m fairly bruised and sore around my neck where he grabbed me, which is making it harder to distract myself and forget about it, which is just making me feel more scared and vulnerable, which is making me pissed off. Blech. It’s actually the first time in my life that another human being has hurt me, which of course is evidence of just how blessed I am. Anyway, I left work early to come home this afternoon, nesting and trying to simmer down. Most of all, it’s helping me to think about something my mom said when I called her last night, breaking down as I told her what happened – after recovering from the news, she quietly said, “Wow, that person must have been so desperate.”

My parents are so amazing. I know how much this has scared them, and that they must be reliving some pretty terrible times from 10 years ago when I was exposed to rabies while living in Ecuador, and they couldn’t contact me or get any information about how or even if I was receiving prophylaxis for what is a 100% fatal disease. I know them well, and I know that all they want right now is for me to get my butt on a plane and come home, sit at the dinner table, and eat meatloaf. But instead, they cheer me on. And not only that, they remind me of why I’m here. I’m here because they raised me to try to see the good in people, to forgive their weaknesses, and to protect the vulnerable. I am humbled and inspired by mother’s ability to empathize with the man who assaulted her daughter on the other side of the planet. It would be easy for me to get pissed and leave; I’d be lying if I didn’t say that it crossed my mind yesterday. But it feels better to thank God I’m ok, take a deep breath, give myself some time, eat some cookies, watch the election, and go back to work. All of this became much easier this morning, when I started my first day on the pediatric ward here. I caught myself for a second, in the midst of making fish-faces at a 2 year old with AIDS in an attempt to keep her quiet while I listened to her infected lungs – this is why I’m here, to learn, to serve, and to teach myself to be brave, even when things get scary. Because there is work to be done, and one of these days, I’m going to be trained enough to actually make a difference.

Happy Election Day, my loved ones. These are the days.

Compartmentalizing

Wow, and I thought I relished my weekends last year. These past two weeks working in Mulago Hospital have been hugely rewarding and unforgettable, but I’m consistently panting for air by the time I reach Friday afternoon. I certainly feel a bit guilty as I practically run out of the hospital, looking forward to drinks with friends and not having to think about AIDS or death or orphans for two whole days – my patients don’t get to run out of there. But if there’s one thing I’ve learned in medical school, it’s that you have to find a way to leave work at work, or else you’ll go nuts. At least that’s how I have to play it. Compartmentalizing. Some smart people taught me that.

And I’ve succeeded entirely this weekend – properly absorbed in the predominant themes of my non-hospital time in Uganda: (1) obsessing over the US election, (2) reflecting on nuances of life as an ex-pat, and (3) marveling over the fact that I’m still alive despite the unrelenting risks inherent to living in Uganda.

Like most days in Uganda, I’m thanking God I’m alive today. I heard it articulated beautifully the other day: “Life in Uganda is just a series of risks.” The streets are a nightmare – there are more per capita motor vehicle accident deaths in Uganda than almost any other country in the world, and it takes about two seconds on a Kampala street to see why. I think I’ve prayed more in the past two weeks than in the previous two decades of my life. I could share specific stories, but my mother is reading this. Suffice to say, I count my blessings to be alive every day. Even today, Dana and I chose to keep it low-key by opting to take a boat to a chimpanzee reserve rather than go whitewater rafting. We woke up early to take a bus to Entebbe, where we boarded a speedboat to be taken to the Ngamba Chimpanzee Reserve on an island in the middle of Lake Victoria (largest lake in the world, remember?)……we were about 15 minutes into our idyllic boat ride when we realized that the “horizon” was actually a massive storm cloud. Thus began the single most terrifying and exhilarating 45 minutes of my life. It would be impossible to describe what it was like to be stuck on a tiny speedboat in a massive thunderstorm, lightning everywhere, being pelted with rain, tossed around by black waves, clinging to the arms of strangers, and frantically scanning the horizon for signs of land. I shit you not. This really happened to us. The fear was so consuming that I shook for hours afterwards, high as a kite out of sheer amazement that we made it to the dock alive.

Oh - and the chimps were awesome, by the way.