What Makes a Day Great?

Today was a typical day for me here at Lalmba.  I set out early to go on outreach to the village of Angela, a newer site for us, which was a two hour drive from Chiri.  Turnout was good and we gave over 200 hundred vaccines.  We were there most of the day and returned to the health center around 3pm.  I was sitting in my office when Faith told me that one of my favorite malnutrition patients, a little girl named Mizrat, had returned with her father for her follow-up appointment.  As I have mentioned in other posts, I spend a lot of time in the malnutrition room playing with the kids and interacting with the parents.  They are here from one to two weeks, depending on how bad their case is, so it gives me a god opportunity to get to know them.  There was something really special about Mizrat and instantly I just adored her.  When she first came to Lalmba she could barely walk, I should mention she is two and a half, and was in such bad shape that she basically couldn’t do anything but sit in her bed all day. Slowly but surely her health improved was and she became more active, walking all around the clinic with me (my version of physical therapy I guess) and began to actually interact with the world around her.  When her time here ended I sadly said goodbye to her father and her, hoping they would return for follow-up so that I could see them again.  Patients can live very far away, theirs is a six-hour walk, so it’s not a sure thing that they return. 

I was glad to hear that they came back for their appointment but was a bit said to have missed them.  Faith said they waited a bit but must have left.  Bummer…..I was wondering how she was doing and if she would remember me, but I would have to be satisfied with just reading her follow-up paper work. 

As I was imputing data from today’s outreach one of the clinic guards came into my office to say that my friend was here.  I looked and up and wouldn’t you know—it was Mizrat!!  Her father said that he really wanted to see me so they spent the afternoon in town (not sure what they could have done since there isn’t much to do here).  Literally in a matter in seconds my day went from fine, to amazing.  I really can’t tell you how happy it made me to see them and to be able to give her a hug and see them for a bit. I must have had the biggest smile on my face and I think I yelped with delight when I saw it was them.   There happened to be another patient and her father here for malnutrition follow-up, so the four of us chatted for a bit. Something new I am starting here is to give patients who return for follow-up seeds to plant vegetables in their gardens.  People here mainly grow and eat cocho and teff, plants that don’t provide enough protein or calories which causes malnutrition.  While patients are here we counsel them on different foods, show them our demonstration garden and have them attend a cooking class all in hopes of teaching them about the different foods that can be grown here--carrots, beets, spinach, etc. (Unlike in the US where people often know how to prevent diseases, here surprisingly people have no idea that their diet can cause malnutrition.) I gave the fathers some seeds and tried to pick their brains on how to make the program better.  While they didn’t have any criticisms of the program Mizrat’s father did have a lot to say about why it was good.

            

             Before coming people in his town said he was crazy to bring Mizrat to Chiri as it was obvious she was going to die.  No one thought she would make it and the journey would be for nothing.  He came anyway and sure enough she was not only alive but doing better.  When he returned home everyone was so happy and excited to see that she was in fact alive and well.  He went on to describe how he learned here how to change their eating to make sure this doesn’t happen again and about other health issues that can cause illnesses such as poor sanitation, cleanliness, etc. Clearly, the health center had done a lot for Mizrat and he was tremendously grateful as he came with only 35 birr (about $3) and Lalmba paid for all of her treatment and his food while they were here. He thanked us and promised to be back for his last check-up in a few weeks.

             There are moments when I wonder if the work I am doing here really matters.  I can’t help but question if the communities I go to on outreach would be any different if I (or any other ex-pat) wasn’t here….and if there is any real change from the work we are doing.  But then there are times like this afternoon when the sight of Mizrat and her father just made my day.  Knowing that they stayed to see me makes me think that the little itty bity part I play here might just matter after all. 

             

Being Poor Sucks

As the day was ending at the clinic I noticed Daniel and Richard, the other ex-pat doctor, walking into an office with their last patient.  Seeing as I had just finished up with my work I thought I would sit in.  The young man looked pretty healthy but as it turns out he had TB.  This is a pretty common illness here, one which is treated with two months of daily medications given at the clinic followed by six months of medication taken at home.  The key to treating TB effectively is that the patient cannot miss a dose of their medication and if he or she does the infection can become drug resistant which is really bad-- therefore we initially require patients to stay in town and come to the clinic each morning to take their meds.  If you have read Tracy Kidder’s book about Paul Farmer, Mountains Beyond Mountains (which I highly recommend) this probably rings a bell. 

Anyway, the patient was about 17 years old and from a village very far away.  When it was explained to him that he had TB and what the treatment protocol involved, he got a very sad look on his face.  While you might guess this was due to the new information about having TB, the truth was that he was more stressed about how much it would cost for him to be able to stay in town to be treated.  He explained to us that last year his family and he had been moved from another area of the country and resettled to our zone because of the limited amount of  land where he is from.  We sat there listening to him as he told the story of his family’s finances, they used to have more money but now are quite poor, and how he now only has 50 birr to his name (about $4).  He quickly calculated how much it would cost him to rent a room for the two months and to buy food, less then $15 a month, and immediately his head sunk.  This was too large an amount, impossible for him to come up with.  Could he go home and borrow money from family and friends we asked?  He did not seem too optimistic about this.  Could he start treatment today he wondered?     He clearly understood the danger of TB and wanted to start medication as soon as possible. 

Normally we require a 75 birr deposit, but all he had was 30 birr.  Lalmba does have a special fund for people who truly cannot afford their treatment, but I had a feeling he might not qualify.  This may sound crazy but since he had shoes and new(ish) pants and a shirt I had a feeling the committee that decides these cases wouldn’t believe him.  Now whether he can come up with the money or if the committee will find him needy enough to pay for both his treatment and living costs, I don’t know.  I don’t think Lalmba would ever let a person go without being treated, especially for something as serious as TB, but the situation still pains me just to think about it.  If that were me or probably any one of you reading this blog this would never be our reality.  TB is almost nonexistent in the US in the general public largely due to our higher standards of living and better health care, when we need to get from point A to point B it usually doesn’t involve walking for hours or days, most teenagers wouldn’t have to travel and be on their own when seeking health care in a different city, and most obvious--- if we were facing a potentially deadly illness that would cost less than $50 to treat, it would not cause us an unbelievable amount of stress. 

Daniel and the other doc, Richard, sent him home to collect his stuff and bring back as much money as he can come up with.  TIme will tell what the outcome will be for him as he said he could be back by Thursday (it’s about a day’s walk from Chiri to his town).   

Everyday we see patients like this and the same thoughts run through my head.  Whether it’s a child who is so severely malnourished they look as if they just left a concentration camp, or a woman who was burned after having an epileptic seizure and fell into the fire they use for cooking, it all just seems so unfair.  So much of the illness and injury we see is completely avoidable it really makes you wonder if life is playing a mean joke on so many billions of people whose reality is like this patient.

Man's Search for Meaning

I am not sure if this post will make any sense, but I have a few different thoughts running through my head that I wanted to try and share with you....so bare with me on this one.

Last year one of my favorite graduate school professors (Sallie Foley for all of my U of M people out there) recommended to our Grief and Mourning class that we read Viktor Frankl's book, Man's Search for Meaning.  Frankl was both a Holocaust survivor and a well respected psychiatrist. In his book he argues that "life is potentially meaningful under any conditions, even those that are most miserable" and that "people have enough to live by but nothing to live for; they have the means but no meaning." Frankl credits his surviving the Holocaust to the fact that he was in the middle of writing a book when placed in a concentration camp. His strong desire to survive in order to finish and publish it kept him going in even when he was the sickest.  Even in the bleakest of human situations, he was able to find meaning and it was this meaning that made life bearable. 

While I am in no way comparing my life here to living through the Holocaust, it's quite the opposite really-- our life here is pretty amazing....this morning I ate breakfast with Daniel while watching the monkeys play, I spent the day training community leaders from four villages in public health programing, and I sit here on my porch drinking a beer, listening to the birds and looking at  beautiful sunset over the mountains.  Yet, I feel like I am beginning to understand what Frankl writes about in his book.  Yesterday I drove to a meeting in and on the way saw a patient who was beginning his journey home, nothing less then a four hour walk mind you, even though he is missing a foot and on crutches.  He happened to be going to the same village I was and so I was able to give him a lift.  It actually made my day to be able to give him a ride as I knew the walk would have been long, hot and brutal. 

In the end, the meeting I was going to didn't happen as not enough people showed up. Even though I had spent all morning getting there and hiked half an hour in and out of to the meeting place, I still felt the day was a success because of giving the man a ride.  That made me think about Frankl's book and his argument about our ability to be happy in life, no matter what our circumstances.  It really is all in the way you look at things.  One might think that there is no way a CTA bus driver could be happy with his job or find meaning in driving in traffic all day, stopping every block to let passengers on and off, having to give directions to tourists all day long on how to get to Michigan Ave. or the zoo, but now I see how it is all in their point of view.  Without the driver people wouldn't be able to get to work,  to a necessary doctor's appointment, to see the friend they are visiting in town... yup, his job can in fact provide endless amounts of meaning.  And when we see the meaning in life, this makes us content.  It doesn't matter what kind of car we might drive or the vacations we can afford to go on, its these little things. 

Everyday here I am given these opportunities and I feel so blessed that this is the case.  Whether it's playing with a patient in the malnutrition room and getting them to smile or holding someone's hand while Daniel stitches up their arm, these moments provide me with what Frankl describes in his book as opportunities to find meaning in life.  Something I struggle with in my own life is being appreciate of what I have and living in the moment.  I hope that throughout this year I am able to curb my negativity and find the meaning in each day, to which Frankl suggests allows us to be happy and fulfilled.   Hmmm......here's to trying.