Curious Misadventures & Orchestrated Opportunities

Shut up and run

2012-01-30T17:50:00.001Z

Something clicked for me this morning while running. I've always loved running, but something about running in Mali makes it a much different experience. The heat and the dust make it downright uncomfortable. Competition is completely absent (unless I'm feeling spunky and decide to race a little kid on a bike). After running any decent distance, I often suffer from headaches (due to the heat?). The gawkers at the side of the road and the crowds of children that scream "tubabu", steal away any semblance of serenity. And Mali lacks the quiet, treed hills of northeastern Ohio, the mountain views of North Carolina and Utah, and the still, early morning grandeur of old town Montpellier, France (these are a few of my favorite things…).

Yet somehow, from my earliest days here in Mali, I've known running to be one of my few, thin lines to sanity. When I cannot run because of an injury or a busy schedule, I feel a bit lost. Under the blazing sun as my feet roll across the red dirt and sand, I'm strangely calmed. I don't spend a lot of time considering the unpleasant conditions; mainly, with a strange mix of resignation and pleasure, I just shut up and run.

This morning, I realized that it is perhaps because of, and not in spite of, the difficulty of these runs that I enjoy them. I don't have to run very far to see several sights that remind me that life here in Mali is hard. Hard for people, hard for animals, hard for vegetation. There is the woman laboring to peddle her loaded bicycle into market, the herd of thin cows being driven out to pasture ("where?" one might fairly ask), and browns of shrubs and trees awaiting rain. These are visual signposts that also point to the emotional, financial, and spiritual difficulties that lie underneath the surface.

As with good worship, which brings the body, mind, emotions, and spirit into whole worship before the Lord, so these runs seem to put my body on the combat line, allied with my whole self against the difficulties that would threaten my well-being.

Before leaving France, I was involved in a study of the book of Job, and since, I've been ruminating on what I would call the strange-comforts of the book. In general, I find the book troubling, and I have no easy answers on how to make it more palatable. I don't easily reconcile the image of "the God of all comfort" seen so often elsewhere and the rather cold, hard non-explanation given Job at the end of the book. I've wrestled with His severity—simultaneously understanding (and desiring to obey) His severe call on our lives (holiness, it turns out, is not as optional as we'd like to make it) and puzzling over why He has driven me to a seemingly desolate, sheer-sided mountain and told me to climb. Despite the numerous "beefs" I have against the book, I've found myself drawing strange comfort from certain angles of the story during these last few months.

Now, I neither consider myself as righteous or long-suffering as Job, nor do I pretend my current life situation is parallel to Job's (far from it!). Yet, in the past months, I've identified with certain aspects of his story. Like Job and his friends, I've seen that while it doesn't give me license to ignore counsel from others, the story does show that even well-meaning people can make the wrong judgment call on my life and my present difficulties. At moments of clarity, I'm also able to see that the Lord "assigns me my portion and cup," and that He considers me worthy (and capable) of such trials. And then, though I see it still as through a haze, I'm beginning to see the joy of His strong, if severe, leadership through difficulty.

In our Western, individualized society, we don't take kindly to being told what to do, without at very least being told why it must be done. This is perhaps one of the biggest reasons we avoid Job—precisely because God doesn't explain the why. Yet, often crises call for a severe leadership. I imagine this is very true in combat. I have no combat experience, so I will speak of what I know. In the case of a medical emergency, chaos often breaks out as people run in all directions trying to accomplish a million things at once, resembling a room of headless chickens. The best thing that can happen at that moment is for someone—someone with great knowledge and experience—to step in and, in essence, say, "Everyone shut up and do as I say." It seems severe (and perhaps downright disrespectful of our individual worth and liberty), but for the good of the patient, someone has to take charge and organize the chaos.

Could it be the strange grace and love of God that in moments of difficulty, instead of indulging our pity parties and temper tantrums, He points severely to what He has commanded? Could it be that "shut up and run" might be the kindest thing He can say in moments when we are ready to crumble; that in doing so, He brings me, body and soul, to face the difficulties so that I might overcome?

I'm not totally sure why I post this, since I clearly see that if I was the reader, I would find it something akin to chewing cardboard—largely distasteful and perhaps a bit wrong-headed. However, since I'm not in the middle of any crises right now, (which allows me to see things a bit more clearly), maybe this will serve as a good reminder in moments of deeper difficulty. I am, after all, saying that sometimes (both physically and metaphorically) we just need to shut up and run.

Asking for and Expecting Justice

2011-12-03T15:00:00.001Z

Several months ago, a baby was kidnapped at our hospital. It was one of the darker moments for our hospital community. The day it happened felt absolutely surreal. Not here. Not like this. And precisely because those had always been our thoughts ("it wouldn't happen here") or perhaps because it never even crossed our minds, we were incredibly susceptible to this crime.

The woman who stole the child infiltrated our rather non-existent security measures (which have since been revised), and over a course of three days earned the trust of the new mothers in our post-partum ward by convincing them she was a family member of someone else (the moms were the real security for the babies), she learned the layout of the hospital perfectly, and at the opportune moment, she struck. It was in the afternoon, when almost all the moms were outside eating lunch or napping and our nurses were out of the room. She slipped into the ward, took a baby that she had probably spent time choosing, and exited by a back door. Once outside, she smiled her way past the guard, took her belongings, which she had asked someone to hold outside, rounded a corner of the hospital wall where she got on a moto and disappeared before anyone could ask questions.

The aftermath was a tumultuous mix of emotions—horror, sadness, shame, anger—and a lot of questioning. The sinister possibilities were also unsettling—did she steal it just to have a baby because she was unable? Would she raise it and traffic it? Or was it to become the victim of a human sacrifice in a spiritual power-play by someone hoping to win the presidential election? (The latter, evidently, not being without precedent.)

For my part, I was convinced that she would never get away with it. We immediately alerted the authorities and made announcements on the radio, so by the end of the day, the whole town was abuzz with the news. I counted on the fact that Malian communities are so tight-knit that very little happens without someone knowing. I figured it was only a matter of time. Sadly, I was wrong. Perhaps worse, a few weeks later, when that became clear, I just wanted to brush the whole matter under the rug and forget it, pausing only long enough make the needed corrections to prevent it from ever happening again.

So when, from time to time, someone would bring up the stolen baby as a prayer request, I would nod exteriorly, all the while thinking, "it isn't coming back, just give it up." Instead of dying down and out, however, this concern continued to ferment in the heart of several of our Malian administrators. At our annual conference the first week of November, our hospital chaplain shared with a great deal of passion his conviction that we needed to pray in faith until the baby was returned. It was enough to move me to start praying about the matter again, though more in the sense that God would protect us from setting ourselves up for disappoint and humiliation by making such bold, "misguided" claims. I had just enough faith to pray that God would at least glorify Himself in this terrible situation.

Over Thanksgiving, I found out that the whole Christian community in Koutiala was going to set aside time during the first few days of December to pray and fast for this baby. I was immediately skeptical. Are we trying to force God's hand? Do we think through an ardent display of self-deprivation, we will somehow convince God to act in a way that our simple prayers did not? Skeptic that I am, I just don't think God is susceptible to manipulation. I was happy that I would be away during that time, so I didn't have to struggle with the whole thing.

Ironically, it was while eating Thanksgiving dinner (I believe I was on my second plate) that this discussion came up, and for some reason I was prompted to start talking about the book "Fasting" by Scot McKnight that I had read a couple years ago. Someone asked me to sum up his punch line. I don't know if I did it justice, but what I remember standing out most vividly was his emphasis on the fact that Christianity is a full-orbed faith. We live, believe, and worship not just in our minds or spirits, but in mind, spirit, soul, and body, and fasting is one of the things we do to incorporate our body into worship. There are times of mourning and times of joy, in which it is very consistent (even natural) to forego food with our bodies, to express the state our spirit in an act of worship to God. (The book merits a read.)

Admittedly in the moment, I said all that in more of an intellectual mode than in conviction (though I have always tried to approach fasting from that angle since reading the book), but that idea really began to work on me. I decided that I would indeed participate in the fasting and prayer, not in an attempt to manipulate God, but rather as full-orbed worship. (And when it comes to fasting, my body is a poor worshipper, so I figured the practice couldn't hurt anyway.)

At first, I tried to enter into a time of mourning for the loss of this baby, without conjuring up trite emotions. I just wanted to authentically acknowledge before the Lord that the kidnapping of this baby was a serious and sad thing—for the baby, for the family, for our hospital community. As a part of this mourning, I was also crying out to the Lord for justice, in the spirit of Isaiah 58: "Is not this the fast that I choose: to loose the bonds of wickedness, to undo the straps of the yoke, to let the oppressedgo free, and to break every yoke? Is it not to share your bread with the hungry and bring the homeless poor into your house; when you see the naked, to cover him, and not to hide yourself from your own flesh?"

However, something unexpected has happened as I've been crying out for this justice. My fasting out of a sense of mourning has changed to a fast in joyful expectation. I don't know what will happen. Perhaps the baby will be brought back (May the Lord make it so), maybe the perpetrators will be brought to justice, maybe the Christian community will be renewed in its sense of passion and commitment. Regardless, I'm convinced that the Lord will act through this time in a powerful way, and not because we moved Him to act, but because we have been worshipping Him, and when the Church worships God, He draws near. His approach never leaves things the same. Also, because in our worship we are crying out for justice, for His intervention in our wicked world—issues very much on the Lord's heart—and when the Church identifies with God's heart, we cannot remain unchanged.

"Then shall your light break forth like the dawn, and your healing shall spring up speedily; your righteousness shall go before you; the glory of the Lord shall be your rear guard." (Isaiah 58:8)

Picking your seasons

2011-10-13T19:26:00.001Z

Fatigue doesn't usually get the best of me, especially when it comes to "mere" walking. However, I've done some serious hiking and walking in the past couple days, so this afternoon after lunch with a friend and a few hours of walking around the city, I found myself in the middle of Paris, just outside the Louvre, with a serious need to sit down. Happily, I found a park bench in the middle of a tree covered area and away from the crowds. Sitting there, I finally realized it was autumn. I love this season, and I haven't had a real autumn for a couple years. The smells, the sights of browns and oranges, and the sound of crunching leaves all came rushing in, accompanied by a flood of happy fall memories. I really wish we had "designer-climates".

I'd like summer to start around the 10^th of April and autumn to gradually edge-in near the end of September. It would stay warm during the day and cool off at night until about December 12^th. Between the 12^th and 15^th it could transition to winter; the 15^th should be the first snow, and this should promptly end with the coming of spring on January 1^st. Also, I'd like my summers hot but with no humidity, my autumns dry and sunny, my winters with plenty of snow but without interrupting my travel plans, and my springs with rainy mornings followed by bright sun in the afternoon. If that isn't too much to ask…

It is also nice when the weather matches your mood—like raining when you are depressed, or being sunny when you feel energetic. Being that I find myself in the middle of yet another transition, it is nice to be surrounded by the signs of a transitional season. Somehow, seeing the trees get ready for winter also makes it easier to ready my heart for this upcoming shift. I'm not headed into a winter by any means (especially not temperature speaking), but I do feel a sense of loss as I leave France.

On the train up this morning, I felt tempted toward a line of thinking that I already knew to be faulty—a comparison of ease of ministry and perceived effectiveness in ministry. In such a short time I grew so attached to people here and had so many opportunities for ministry that I really enjoyed. I also feel my heart pulled by the fact that I'm leaving some people right in the middle of their trials. All of this tugs toward wanting to think that I'm more effective in this environment, that I'm more equipped for ministry in this context, or that my ministry gifts would show so much more naturally here than in Mali.

However, though far from a seasoned veteran, I've weathered enough to recognize this as the resistance of the heart in the face of painful transition—in the face of goodbyes and uncertain "see-you-agains." These are, of course, not the moments to make decisions, but rather to coax the heart into its autumn, to allow some things to fall to the ground, and to tie the sights, sounds, and smells to cherished memories made along the way. To insist that it remain summer is to try to play God, and then ministry becomes a worship of self and ability instead of the One we set out to serve. We are not, after all, the Designer of our seasons.

I’m a conspiracy theorist

2011-10-13T19:25:00.001Z

(A repost from my update letter)

I was very well-behaved; I bit my tongue and didn't laugh, but as she started decrying the fifth conspiracy represented by the protest buttons on her backpack, it dawned on me that she was just an inner voice or two away from being genuinely paranoid. Though tempted to laugh, I left class that day with a feeling of pity for her, since it was evident she was very stressed and anxious about these things.

It all started when I asked one my French professors to explain a button she had pinned to her backpack. After a half-hour and a very vocabulary-expanding speech (on topics such as genetically modified grains, mineral mining, the construction of a new airport, etc), she finished recounting all the things she was protesting. I had to admire her spunk, but it was her deep conviction that all these things were being perpetrated by malevolent forces in corporations and the government that pushed it beyond what I would consider a normal concern for the environment or society to a genuine conspiracy theory.

I've certainly encountered several people here in France who seem convinced of major schemes in the world, and I've noticed an increase in such thinking in the States as well. In fact, in some ways it has become a mark of courage and intelligence to have a pet conspiracy theory. After a little internet-research, people are ready to rail against greedy capitalists, corrupt government, the medical establishment, the illuminati, the liberal media, Muslims, oil companies, banks, Mormons, aliens and the list goes on. And I'm pretty sure that I've heard conjectures of the Antichrist's existence in each one of these groups (well, maybe not among the aliens).

Certainly some of these things are concerning, but I find more disconcerting the power that many ascribed to these groups and the resulting fearful reactions to them. To listen to some, they have the power to suppress all information, to manipulate world events, and control us like mindless pawns. Again, the Bible is clear that we live in a fallen world and that the heart of man is deceitfully wicked, so I'm not saying there aren't causes for concern out there, just that we've perhaps taken it too far.

However, hearing all of this lately has given me fresh inspiration. So, here before you all, I'd like to confess to being a conspiracy theorist. Trust me; THEY do not want you to know about this. No event in history has ever been subjected to more numerous and vigorous cover-ups. They've hired historians to rewrite the books, scientists to produce studies to the contrary, and armies to chase down anyone professing the truth. Time to pin a Jesus-fish to your backpack because our Lord's crucifixion and resurrection is the conspiracy of conspiracies, the scandal of scandals, and our world still trembles under its impact. We are all too apt to forget this.

We obsess over and fear those things that we think might secretly control us, when all the while we've had this assurance: "Fear not, I am the first and the last, and the living one. I died, and behold I am alive forevermore, and I have the keys of Death and Hades." (Rev. 1:17,18) We WERE mindless pawns being controlled by forces bigger than ourselves. The plot WAS well laid-out, the trap WAS SET, and we WERE lemmings marching to our deaths, but He's got the keys!

In Luke chapter 12, Jesus talks extensively about fear. He starts by talking about the Pharisees—a group that certainly held enormous power and who were actively involved in secret plotting. He says: "Nothing is covered up that will not be revealed, or hidden that will not be known. Therefore whatever you have said in the dark shall be heard in the light, and what you have whispered in private rooms shall be proclaimed on the housetops." (v. 2,3) He follows immediately with: "I tell you, my friends, do not fear those who kill the body, and after that have nothing more that they can do." (v.4) Their gig is up—they have been and will be exposed—and we are not to fear them.

A few lines later we are assured that the very hairs on our heads are numbered, and therefore we should not fear because He knows us. (v.7) He knows what we need, so we need not worry about what we will eat or drink. (v. 29) Instead, we are completely liberated to pursue the Kingdom. (v.31)

Let's live in that liberty and, as faithful servants, diligently tend to His Kingdom until His Return. Let's not participate in the fear mongering of the world or get so caught up in our own pet-theories that we lose sight of the very important work he has called us to here and now.

I am not ashamed

2011-09-01T17:53:00.001Z

I might be embarrassed by the times we’ve acted in hate, bias, and ignorance, instead of in love, compassion, and mercy—but I’m not ashamed of the Gospel.

I might grit my teeth when I think of all the times we’ve made war before even trying to make peace, and I can’t help but shake my head when I think of all we’ve invested in making empires and kingdoms (personal and political) instead of taking care of orphans and widows—but I’m not ashamed of the Gospel.

I might desire to slip quietly out the back when I see some of us being anti-intellectual, domineering, or hypocritical instead of loving God with our whole being—mind, strength, and soul; and I’ll admitting to taking a couple steps back when I see some of us selling our most prized possession like it was a used car, instead of a gift to be given in profound love—but I’m not ashamed of the Gospel.

I might want to call us to corporate repentance for things like “God hates fags (or mormons, or…)” signs, or for ruining our prophetic voice by blindly accepting political agendas—but I promise you, I am NOT ashamed of the Gospel.

Unfortunately, we’ve put so much baggage onto the Gospel that it becomes unrecognizable. And yet, the Gospel weathers the storms of our abuses and always emerges as sharp and transformative as ever. We must continually call ourselves back to clear, whole-Gospel living—lives transformed by Christ, overflowing with faith, hope, and love, practiced by the individual living in community. In doing so we avoid shaming ourselves and we proclaim the Gospel in bold and compelling terms.

These have been my thoughts as I spent this first month here in Europe—a hotbed of antagonistic atheism and feelings of antipathy towards the Church. Sadly, we’ve done a great deal to contribute to this phenomenon, so we cannot write it off with mere contempt. Neither can we shrink back in shame.

This week in class, we listened to a song (in French of course) that topped the charts in Europe for several months last summer, titled “And so we dance.” The basic premise is that we see all the problems in our lives, personal and global, and to escape them we go out dancing. While dancing, they come back to mind, so we plug our ears and we sing. And we dance some more. Very catchy.

But really, that’s the best ya got? Plug your ears, dance and sing?? Now who is doling out opiates for the masses? I’ll see you singing-and-dancing and raise you some serious eschatological hope.

Laughable, and yet desperately sad. The very next day, I did a 10 minute speech on the hospital—the Gospel in full action. The contrast wasn’t lost on anyone (despite my poor French accent).

I’m not ashamed of the Gospel. Why? Because it is the power of God for the salvation of all who believe! Because all the world has to offer is, “Eat, drink, and try to be merry.” Because we have a treasure of faith, hope, and love…and so we dance.

Confessions of the Un-Neighborly

2011-06-23T09:46:00.001Z

During my first several months in Mali, the neighborhood carpenter had a shop along one wall of the house I was living in. We'll call him Joe, since his name currently escapes me. Monday through Saturday, sunrise until past sunset, invariably, Joe was at the shop—sometimes working, most times just sitting. In those early days, I spent a lot of time devising ways to avoid Joe. Not that Joe was a bad guy or mean or even particularly annoying, it's just that he was so friendly, or perhaps you'd say "neighborly".

In order to go just about anywhere, I had to exit my front gate and immediately go around the side of house, passing right by Joe's shop. Joe, in typical Malian fashion, would ALWAYS greet me. This was his fatal flaw, his unpardonably sin. If every other day he could just have pretended I didn't exist, we would have gotten along just fine. However, unable to sense my irritation and clueless to my American idiosyncrasies, Joe would call out the same familiar set of questions about my health, my family, and my work, EVERY time he saw me—three, four, even five times a day.

So being the mature adult that I am, I began avoiding him. I'd act like I was being called in for an emergency and didn't have time to greet. I'd try to leave at times when his back was turned or he wasn't there (rare). When I couldn't escape, I pasted on my best smile and greeted Joe with great gusto, as if I really liked talking with my neighbor first thing in the morning. Then I discovered that with just enough courage and skill, I could navigate the tiny path that led around the other side of the block. I was deeply annoyed the day Joe informed me that my sudden increase in flat tires was due to the fact that I was taking that little path. No doubt he was right, because it was a terrible path, full of sharp rocks and trash, but I was sure he knew I was avoiding him and he was trying to suck me back into greeting him 10 times per day. The two-hundred francs (40 cents) to repair my tire was worth it, and I continued taking that path every other day.

I'm not sure I could have properly expressed the reason for my annoyance at the time. In fact, it was today on my way home, while lost in a separate but connected train of thought, that it struck me clearly. I was passing by a small, roadside gas stand owned by the uncle of one of my friends. I threw up my hand in greeting but felt immediately that I should probably stop and spend a moment talking with the guy. Something inside me resisted, and instead of slowing to a stop, I pulled harder on the throttle, in a hurry to arrive…nowhere. In that moment, the reasoning of what I was doing—of what I had done to Joe—became so clear. If I stop today, I'll be obligated to stop again in the future, and that means that this guy has some claim on my time, however small. As there is only one road to the hospital, there would be no depriving him of that claim. Time is more than money to me, and I don't just go around handing it out, because after all, it is MINE.

Don't think me unaware of how ridiculous this all is. In the case of the gas-stand owner, we are talking about 5 minutes every couple days. Absurdity notwithstanding, I'm still selfish of my time and I'd prefer not to give it. I'm almost brought to laughter when I see the extremes to which I'm willing to go to enable my selfishness. I'm a man wanting to mock his moral short-fallings, and yet still strangely afflicted by them.

This was precisely my reflection at the moment I arrived at the gas-stand today. Despite being deeply convinced that a life of loving God and loving others is the only life worth leading, I find myself strangely, but markedly better equipped to do the opposite. Refusing to be neighborly is just the semi-comical tip-of-the-iceberg, I'm afraid. Deep down, I'm more capable of starting war than making peace, more apt at being fickle than faithful, more suited for force than gentleness, and more competent in greed, lust, hatred, and indifference than in love, charity, and generosity. And I'd like to think that I'm one of the good guys.

Thus, in the middle of working hard to correct injustices in this world, I pause again to confess that I am part of the problem, that I am a partaker of a human-race deeply in need of redemption and renewal. I am a man in need of grace and pardon only the God of the universe could offer. I'm deeply in need of His love, and to even begin to live up to my convictions, I need the empowerment of His Spirit.

Happily, if I will but give a moment of time and quell the tide of resistance within, these and abundantly more are mine for the… receiving.

Grace and Peace.

2011-06-03T19:45:00.001Z

Bless the Lord, O my soul

2011-04-17T09:08:00.003Z

“Bless the Lord, O my soul, and forget not all his benefits, who forgives all your iniquity, who heals all your diseases, who redeems your life from the pits, who crowns you with steadfast love and mercy, who satisfies you with good so that your youth is renewed like the eagle’s.” Psalm 103:2-5

Providing advanced medical care in Mali is an adventure in frequent frustrations and heartbreak, contrasted—in cases when available supplies and care meet huge needs—by moments of unmatched gratification. Our lives here are not unadulterated strings of humanitarian ecstasy, but the Lord in His goodness allows us much to smile about. Today I’m pleased to offer you these smiles.

KADI

Kadi has been a frequent visitor to our outpatient clinic, as her mom takes extremely good care of her. So when she fell into hot porridge, burning both of her hands, her mom brought her in quickly. The burns seemed quite deep at the time, and because burns on the hands are difficult no matter how deep, I was dreading her treatment course. To add to all of this, Kadi has mental handicaps, so I wasn’t sure how she would do with all the dressing changes. After several days of using sedatives during dressing changes, I noticed that her burns were actually significantly better and probably would not need surgery. Because sedatives carry risks and side-effects, I felt we should try to do the changes without them, if she could tolerate them.

So, I proceeded with lots of candy and a very nice stuffed animal that I named Baby Jacob. With her mom at her side, and Paul, a Malian nurse and good friend, helping me, we removed the bandages and began to gently clean the burns. She did amazingly well through all of this, but when we started putting a new dressing on—usually a painless process—she started screaming. Not catching what she was saying, I stepped back a bit alarmed, only to hear her mom and Paul break out into laughter. Paul informed me that she was yelling at me because I wasn’t going fast enough and she wanted to be done. With all haste, we finished the dressing and sent her on her way.

The next appointment, I asked her if she brought Baby Jacob back with her. She promptly informed me that she’d given him away to her older sister, but that she’d like another. I went to the office and found a rather homely little doll (I think it was supposed to be Glenda from Wizard of Oz). Presenting this “lesser” gift to her, I named it Baby Paul. To my chagrin, Baby Jacob never made another showing, but Baby Paul, much loved, made it to all future appointments.

Her wounds healed rapidly under the careful supervision of her mom. The only problem was that the smaller her dressings became, the more impatient she was to have it done and over with it—so I got yelled at quite frequently. Two and a half weeks after she was burned, we removed her last dressing. She went home with full mobility in her hands, a smile on her face, and of course, Baby Paul in her arms.

CHATOU

We “found” Chatou in the village of Fizankoro, while there visiting Samuel, a church-planting pastor. We were in his courtyard after church, and several people came by to be prayed for. There were a number of people with wounds, but Chatou’s story was the most capturing. She had had large leg ulcers for 20 years (since the age of 18), and her family, having tried everything to get them to heal, sent her to the pastor, believing the ulcers to be an act of sorcery. We prayed for her and Samuel asked if I wanted to see the ulcers. Not having the supplies to do a proper redressing, I encouraged him to simply bring her by the hospital. He informed us that the family was not taking responsibility for her care anymore and wouldn’t pay for things at the hospital. We struck a deal that if she could find someone to stay with in Koutiala, we would cover her bill.

When she arrived several days later, I opened the dressing to find a hugely infected wound on her leg and another smaller one on the other leg. We did several lab tests, put her on antibiotics, and started daily dressing changes. The labs all came back negative, so we were not really sure what we were dealing with. However, a little more than two weeks later, the wounds looked clean enough to be skin grafted (a surgery where we take a thin layer of skin from the thigh and transplant it to the wound—both sites heal very quickly with skin instead of scar tissue). We began to prepare her for this.

But that is only half the story. Most of Western medicine wants to deal only with rational, biological sources of problems; however, in recent years there has been an increasing recognition that we cannot separate a person into neat, tidy biologic, emotional, and spiritual boxes. These domains are certainly connected. As a Christian, I absolutely believe this, and though I want to treat physical problems with the best care that we find through our study of the physical sciences, I also believe the emotional and spiritual domains need to be treated. And in this case, Chatou was living under the assumption that her problem was spiritual—that she had been cursed by some ill-intentioned sorcerer. The weight of living under such a curse was causing her much pain and she had searched everywhere—in Islam, in every traditional religion—to find a cure. We had the opportunity to pray with and for her every day, asking the Lord to bring healing to her. We witnessed to the Love and Goodness of Jesus and that He brings about healing to all areas of our life.

In the end, the skin graft took wonderfully, and a little more than a month after she came to us, she went home, healed from an ordeal that had lasted more than 20 years. Two weeks after she arrived home, she came to the pastor’s home with her husband and brother-in-law. Overjoyed at this new found freedom, she expressed her desire to follow Jesus. Her husband and brother-in-law actually asked the pastor to “make” her a Christian. Chatou is now a follower of Jesus. (The two men are “observing” for a time before they make any decisions).

I truly believe that our physical care, our emotional love, and our prayers worked together to bring whole healing to her whole person, in a process that can neither be described as completely miraculous nor completely natural. But Chatou knows, much like the blind man in Acts, that she was wounded and now she is healed. And today she smiles.

SEYTOU

Frequently in wound care, a case arrives that makes my heart sink. I think it has something to do with knowing that it will take weeks (often months) to get the wound to heal, and that means countless difficult dressing changes for both the patient and caregiver, and lots of pain, despite our best effort, for the patient. When Seytou came in with her arms charred from a cooking fire, my first question was, “will this girl even really survive?”

She had been kneeling for a long time to stoke the fire, and when she stood up she became light headed and fell into the fire, spilling a pot of boiling porridge onto herself. Her face, chest, both hands, and right arm were extensively burned. We did the initial debridement, and it seemed a good possibility that she would lose the right arm.

In the weeks that followed, we did our routine dressing changes, praying the Lord would give us wisdom and work a miracle in this situation. I watched her stoically endure the pain of the burns all day long. Though she never cried, the pain was evident on her face. We gave her the best pain medications we could, but what we have here wouldn’t even be considered sufficient treatment for minor burns in the States.

About two weeks in, the transformation began. First the wounds on her face and chest closed. Then her left hand healed. Her face bore fewer creases, and she began to walk around. Then she started to crack the occasional smile. She began visiting Jessica in the office to get coloring books, crayons, and Bible stories in Bambara. She would sit for hours watching the Jesus Film, the story of Moses and Joseph and other movies that we play in our waiting area. (Her grandmother who was staying with her also became an expert color-er and loved watching the movies as well! Lots of firsts in her old life.) She gained strength by the day, and became an absolute joy to see every morning.

We did a skin graft to cover the deepest burns on her right arm. Two weeks later, (an amazingly short 6 weeks after coming to us), we sent her home. She was full of smiles, diminished only slightly because I think she is going to miss all the coloring and movies!

Please continue to pray for her and her family. There are a couple of Christians in the family, but Seytou and her immediate family, as they told us, “have not yet made the decision” to follow the Lord.

Rejoicing and Weeping

2011-04-10T21:07:00.002Z

A repost of my Feb/March update.

One of my flaws as a nurse, or in relationships—ok, really just as a human being—is that I continually slip toward the tendency to "do people." I've been aware of this tendency since my college days, when a wise mentor pointed out that in my role as an RA, I tended to consider relationships to be another task on my to-do list. While this at times worked out, often times it made relationships a bit sterile and cold.

I have further noticed that the busier I become, the more I want to relegate people to my to-do list—visited him, check; saw her today, check; wrote them an email, check.

The same feeling of relief and accomplishment that comes from crossing off items on the to-do list gets applied to your relationships. This system is almost encouraged by American culture. Unfortunately, this surface level gratification covers over the widening gap that actually threatens to destroy the very relationships you think you are "accomplishing."

The problem is that friendships/relationships—or really any human connections—are incredibly messy, and not easily confined to the tidiness of a to-do list. They are not projects that can be finished, and they know no time bounds. They demand great deals of emotional energy and a great deal of self-sacrifice. There is a reason Paul uses the phrase "bear with one another" in his encouragement in Ephesians 4. Relationships are anything but an easy check box, and frankly, all their requirements are rapidly falling out of favor.

Nursing is one of those weird fields that pay you to be emotionally invested in other people to one degree or another. However, there are options that are light on such necessities—ER nursing and adult intensive care (which is, of course, where I worked before coming here). So I've always really admired some of my classmates who graduated and went into areas of nursing that require a high level of emotional involvement—pediatrics, oncology, and hospice.

Yet, in God's not-so-subtle way of remaking me, He has brought me to Africa, where relationships reign supreme, and He has plunged me into the middle of a hospital where my work demands high levels of relational involvement. Wound care, oncology, pediatrics, and even hospice are all daily experiences. (Obviously, not a solo job… my coworkers are also heavily involved, and often I'm playing a lesser role in certain of these areas.)

Furthermore, my office sits in the middle of the pediatric wing of the hospital, so we've got a constant stream of kids coming in to visit, to get coloring books, or just to be held. One such patient is 4-year-old Alou. He has been at our hospital for a couple months now being treated for childhood leukemia (ALL). I've been less involved in his treatment, but he is a frequent visitor in my office. It started back when he was first under treatment and was doing well. I found out that he had a great laugh, so I would often go visit him, to toss him in the air or to tickle him. If I happened to pass by while he was eating, he often held a handful of slimy sauce toward me, encouraging me to come take a bite.

Unfortunately, Alou's treatment course has not been going well. His cancer is not responding well. His mouth has filled with huge, painful sores—the result of chemotherapy and subsequent infections. He has lost significant weight and has very little energy. Most of the time, he just wants to sleep or be held. Last week, I came back to my office after surgery. I saw him sitting on the ground a few doors down, so I said his name and waved, but entered my office and sat down at my desk. A few minutes later, he came through the door, half-crawling, half-dragging himself. Exhausted from the effort, he sat in the door way, and put his hands up. How could you resist that?

So I'm learning to enter into his little world and to offer comfort that comes only with time and messy emotional connection—trying to pretend that I'd rather be doing my other, "more pressing" projects. I'm learning to artfully dodge his copious drool, and I've got ideas of how to avoid being pooped on again. (Oh that diarrhea, it'll get you every time) And most importantly, I'm trying to learn what Paul meant in Romans when he says, "Rejoice with those who rejoice, weep with those who weep."

Please pray for Alou and his family. We'll continue his treatment until his infections clear up. Then we have to test his bone marrow one last time. If no significant improvement has taken place, he will be placed on hospice. Brett, Sheri, Jessica, and I will be walking with the family through this difficult time. Pray that the Lord grants us great wisdom and compassion. Pray that I—that we—rejoice and weep well, in all that we do here.

Adventures in Wound Care

2011-04-10T17:37:00.003Z

This is a repost of my update letter in January.

I've been a nurse for close to 5 years now, and in the past month, I've come to a realization. I like being a nurse…I REALLY like being a nurse. I mean, from the day I entered college, I had my little list of reasons why I wanted to be a nurse; and the list was true. I enjoyed my work, and being a nurse has shaped my very person. But I can't always say that I was gut-level sure that I loved being a nurse.

One of God's little gifts to me lately has been finding this deep joy in what I'm doing. It may be ridiculous and a bit shameful to admit that I always said that I enjoyed taking care of people, but have never experienced the joy of doing so like I have this past month. I've been doing a lot of pediatric wound-care (which I'm sure seems, to most of you, like something only Dr. Frankenstein could enjoy) over the past several weeks, and it has been great taking care of these kids and being invested in their lives. So this month's update is dedicated to just two of them.

CHAKA

There is something about a hard-earned smile that just makes your day. And when you are trying to elicit that smile from a sick kid, hard-earned is an understatement. I've been after Chaka's smile for a couple weeks now.

Chaka came at a bad moment for me. I was at the wedding of two of our nurses when the pediatric team called me to the hospital to look at him. I'll admit to grumpily leaving the wedding and heading into the hospital. But as soon as I saw him, I was moved with pity. Each of his ten fingers, and both of his feet to his ankles, were completely black and dead. As the family told the story of how he had gotten sick 12 days earlier and then in the hospital his hands and feet started turning black, my heart despaired of what would become of this little, one year-old boy. They had left the other hospital, coming to us as their last hope. It was either us, or they would take him home to the village to die. (Which may sound like a pat on the back for us, but really, we all felt like it was a horrible responsibility to have thrown in our laps.)

Working with Brett, Dan, and Saskia, we came to the conclusion that the problem was caused as a secondary effect of either malaria or a severe bacterial infection that caused his body to abnormally form blood clots in his hands and feet, cutting off the blood supply to those areas, and eventually killing them. The ONLY positive in the situation was that because it was a secondary effect of a disease that had been treated and was not being caused directly by an infection, it wasn't necessary to operate right away.

Instead we were able to wait for the arrival of a surgeon who came the first week of January. During the week, Dr. Steve Myers was able to amputate his fingers, but was able to keep the first knuckle of all the fingers and almost the whole thumb on both hands. This means that he should still be able to do a great deal with his hands. His feet, however, were very bad, and we were forced to do his amputations below the knee on both legs.

Luckily, both Brett and I know people who work with prosthetics and should be able to help us out with finding prosthetic lower legs and feet for him.

Chaka was a fussy, miserable kid from the day he arrived; he mostly just cried, slept, or lied listlessly in his mother's arms. His parents were stoic, like the typical Malian parent. Every time I passed by, I would always say "Chaka, Chaka" and try to get him to look at him and stop crying. He usually just cried harder (which I'm sure his mom appreciated). He would occasionally allow me to hold him, but not for long. But the crying got worse the day after his surgery. Finally, three days after surgery, his mom looked like she was falling to pieces. He had been crying all night, and in addition to the fatigue, I'm sure she was grappling with the new reality of her little boy's much-altered body.

We changed his pain medication, and out of pity for his mother, I started picking him up and walking around with him. If you kept moving, he'd stay calm, so I decided the boy needed some toys. I pulled out a toy that had big, wooden beads that move around on big twisted wires. I flicked the beads around, and much to my surprise he got very calm. His eyes followed every movement of those colorful beads as I moved them around on the wires.

A full 10 minutes later, he reached out his little disfigured hand, resting his palm on a round, yellow bead. Nothing earth-shattering, but a smile broke out on his mom's face. Her eyes lit up and her face shed a deep weariness. His hand quivered there on the bead for a couple seconds and then he pulled it back. It took him another minute to reach out and try again. This time he made little pushing movements with his hand, in an effort to move the bead up on the wire.

Then he decided he wanted the whole thing closer to him, so he reached out both hands and pulled on the wire. His mom looked like she might cry with joy.

Picture perfect moment, followed by getting peed on.

This morning, I came in after being away for the weekend. I saw Chaka sitting calmly with his mother, so I walked up to him, saying "Chaka, Chaka" and reached out and tickled his neck. To my great surprise, he smiled and even started to laugh. My day was made.

Continue to pray for Chaka. He was a long road ahead of him. I'm so happy to see him better and happier, but his life will not be easy. We will be here to help him as much as we can, but ultimately the Lord preserved his life, and it will have to be the Lord who gives him the strength and courage to thrive in this life despite the obstacles.

SALIF

Medical personnel are extremely caring people, but we also happen to be sickly fascinated with very strange, bodily things. Extreme and abnormal pathology calls to us irresistibly. We have great abnormal pathology here in Mali. So when someone says to me, for example, "You've got to go check out what's in Brett's office," compassion isn't my first response, but rather an excited desire to see what crazy thing has come in now. This may also explain why I often refer to people by their diagnosis (a common practice); and so, for several days, I referred to Salif as "femur-boy."

Two years prior to coming to our hospital, Salif was in an accident which broke his femur (the big bone in your leg that makes up your thigh). He went to the hospital where they casted the leg. His femur healed and he began to walk again… with just one small problem—they left a piece of his femur sticking through his skin! (That, and they had forbidden him to bend his knee, so he lost all mobility in that joint!) So for over two years, he had an open wound that had a large piece of bone sticking out of it. The wound was chronically infected, and the smell was always wafting off the wound, just barely contained by a dressing and his pants. Because of the accident and the subsequent wound, he had to drop out of school.

With the visiting surgeon, we were able to remove the dead fragment of bone and close the wound. Salif is still at the hospital, healing from all the surgery, but it seems like the closure of that wound will succeed, and he will have a new lease on life.

In the weeks leading up to his surgery, I got to know Salif, as he came each day so I could do his dressing. But during his stay at the hospital, I've had the joy of getting to know him as the funny kid he really is. When I get a free minute, I enjoy passing by his room to hang out a bit.

At one point right after his initial surgery, I gave illustrated children's books to Salif's two roommates—both significantly younger boys who also had surgery. He found me a bit later and asked if he, too, could have a book. So I caved and gave him one, but insisted that he read the book to the other two boys. After reading the books, he began to ask many questions about my faith. I had the joy of responding. Fortunately, the dad of one of his roommates is also a mature Christian and they continued the conversation over the next several days.

After his next surgery, Salif woke up quoting lines from the Jesus movie that shows in the patient waiting room every morning (he watches most mornings). He would go on and on about how much he loved that "long-haired Jesus" and how he liked Christians. I figured this to be nothing more than an attempt to butter me up, until one morning when he told me that he had asked his father for permission to convert. Surprisingly, his dad gave him permission. (They are a Muslim family.)

Salif is still at the hospital but should be going home soon. He has not yet made a decision to follow the Lord, but continues to talk about his desire to become a Christian. Pray for his complete healing and for a true understanding of what it means to follow Jesus.

(special thanks to Sara Donaldson for the pictures found in this post)

2 Year Reflections

2011-02-09T00:21:00.001Z

In a couple short months, I will be celebrating two years here in Mali. I'm sure that much of the learning and change has happened below the conscious surface, but lately I've been thinking a lot about these things. So, I've decided to jot them down—partly for fun and your reading pleasure, partly to remember, and partly to process. In a stream-of-conscience order, I present the ways I've changed, the things I've learned, and other random reflections: (something like the fortune-cookies of my life at present)

FOOD: "Bones are our friends." Why you ask? Because meat sticks to bones. Organs float on their own, fat is attached to skin, and blood vessels are found in fat. If you prefer not to eat any of these things, bones become your friend.

FOOD: In the world of food textures, crunchy is really not a bad option. Sure, ligaments, bones, and cartilage are crunchy, but that is as bad as it gets. Other things, much grosser things, are mushy, or slimy, or stringy.

FASHION: Wearing the same pants and t-shirt you've worn for the last four evening? Yes, totally acceptable. (As long as you won't be seeing the same group of American colleagues on any of those three nights.)

FASHION: Sandals with dress pants/khakis? OF COURSE!

SOCIAL: Your best friend cannot sit with his wife in church nor can he hold her hand in public, but you are welcome to do both (with her…not your own).

CULTURE: We often talk about cultural differences as "seeing things DIFFERENTLY." I'm beginning to wonder if it is not "seeing DIFFERENT things." At times, there seems to be that much of a gulf in understanding. AND…unfortunately, it is easy to trample all over the things you do not see.

FOOD: I've eaten more than my weight in peanuts in the past two years.

FAITH/SOCIAL: For whatever reason, it is extremely easy to slip into a mode of thinking that you are the one making sacrifices and enduring hardships. You stagger away with shame, humility, and profound gratitude when the Lord allows you see the sacrifice your friends make for you.

SOCIAL: Once you figure out how to quell the feelings of awkwardness, sitting in silence with a friend becomes more enjoyable than a lengthy and easy conversation with a stranger.

ME: I desperately want to have rhythm, but I don't. Africans do, and it almost feels contagious. However, I'm afraid that at 27 years of age, it is too late to develop said ability—contagious or not.

MORE TO COME…

A Christmas Reflection

2010-12-05T20:48:00.006Z

Snow and "It's a wonderful life" are not my things. Ok, I don't mind snow for a limited time frame around Christmas; I just don't really miss it. The movie "It's a wonderful life" on the other hand, I find painful to watch. This was apparent grounds for one of my colleagues to ask me, "Do you even like Christmas?" (To her credit, I may have overstated my case with "It's a wonderful life" saying that it made me "suicidal".) In response, I told her that I'd soon be stealing Christmas trees.

It's not every day that I have to defend my love for Christmas, but it made for a good laugh and made me a bit reflective about what I DO miss about Christmas in the States. This December will be my third Christmas in another country (not successive), and though I miss family and all the holiday traditions greatly, there is something about "remaking" Christmas that I really enjoy.

The distance that Mali provides from my typical Christmas celebrations, enables me to reflect better on the earth-shaking reality of what happened that day 2000 years ago. In the sadness that comes from being away, I'm forced to celebrate, not in the happiness of all the accessories we've added to Christmas, but in the joy of His birth.

His birth shapes our life purpose and is what has brought me here, to the other side of the world. His birth allows me to have a new family here, not of blood, but of spirit. It speaks of transformation and change in a world dead-set on self-destruction. It breathes joy into a world full of hurt. His first coming gives light enough to see the glorious hope that is His second coming, when a world full of injustice and evil will be set aright. I have trouble imagining a place that makes these realities more crystal clear.

But it goes even one step further in remaking our existence, and it is this step that has been brought back to mind this morning.

Earlier this week, Christianity Today carried a quote from a pastor in Pennsylvania who spends 7 months a year in Uganda as a mercenary trying to hunt down Joseph Kony and leaders of the Lord's Resistance Army. (Where does he get the finances for this?) As just the latest in a string of quirky pastors doing off-the-wall things, he stated that people opposed to his work were just thinking too much of the God of the New Testament.

I mean the irony is so thick I'd have laughed hysterically, but for the fact that I too once wanted to do the same. In my junior year of college, I did some research on the LRA and Joseph Kony. The evil and atrocities of that organization (mass murder, rape, and child soldiers to name only a few) are sickening and frankly, enraging. On a run with my good friend Adam Thada, I proposed the idea that we ditch college and train to become "Christian Mercenaries." It made for a fun conversation during our run and a good joke afterwards, but we didn't seriously entertain the idea for long because our theology didn't permit us and neither of us would have made great mercenaries.

When I saw that quote, I immediately copied it into an email to Adam, who is currently working in Bolivia with an organization that provides dignity and a way-out for women trapped in the sex trade. Tongue-in-cheek, I lamented the fact that someone had beaten us to the punch and that if only we'd known we just needed to ignore the God of the New Testament, we'd be doing the same thing. I further complained that we had, since our college days, gone soft, him working with prostitutes and me with sick children.

However, that is precisely the point. When God chose to do His most important work in the world, He started with the humility and vulnerability of a child and completed it not as a military-commanding king, but with submission even to death. His is a Kingdom of love, charity, hope, and humility, and these characteristics rarely seem "winning" in this world. Yet, Christ's birth does not leave open to us the option of accomplishing the work of the Kingdom in typical "winning" fashions—coercion, dominance, and deception. His birth dictates to us not only what we do with our lives, but also how we do it.

Don't get me wrong, the elimination of the Lord's Resistance Army would be a great advancement in the world of social justice, but in light of Christmas, becoming a mercenary to accomplish this feat seems a bit wrong-headed.

This Christmas season, I'm finding that the story of His humble birth is continuing to remake my ministry here in Mali. I would be lying to say that our work here progresses without hitch and that we've only got winning stories. We have medical errors, sometimes repeatedly. With some in our staff, we've got lack of buy-in to the vision. Antiquated and dangerous ideas and attitudes persist. We have cross-cultural conflict and inefficiency and poorly structured systems.

And in such a milieu, Christmas reminds me that during moments of frustration, departing from the way of love, charity, hope and humility, even to accomplish the good, is to be off-track and wrong-headed. It is far more Grinch-like than disliking snow and "It's a wonderful life."

"Truly He taught us to love one another,
His law is love and His gospel is peace.
Chains he shall break, for the slave is our brother.
And in his name all oppression shall cease.
Sweet hymns of joy in grateful chorus raise we,
With all our hearts we praise His holy name.
Christ is the Lord! Then ever, ever praise we,
His power and glory ever more proclaim!
His power and glory ever more proclaim!"

O Holy Night

Just a name?

2010-12-05T20:48:00.003Z

(Another update letter story, here for blog readers who might not get those letters.)

Her name was Trash. Had I been more in-tune with what little Bambara I know, or perhaps not in such a frustrated hurry, I would have noticed that on her chart. As it was, she came to my door in the midst of a busy morning. To add fuel to the fire, she was persistent, a bit feisty, and she lied right to my face. She told me that Dr. Dan had sent her to me so that I could do a dressing on a wound that she had. Having just talked with Dan, I knew this to be a lie. (Not uncommon around the hospital when people are trying to work the system.)

I chastised her for lying, then took one look at her wound and knew she needed surgery. Looking at her chart, I realized that she had started treatment at our hospital, when the wound was smaller and more manageable but had skipped all of her follow-up appointments for two weeks. In my medical eyes, she wasn't winning any brownie points.

I tried to put her back in the consultation system to make sure she was seen by the physician with whom she had had the follow-up appointment. I even asked one of the nurses to personally see that she was taken to the right office. However, thirty minutes later she showed up with a note scrolled on her chart that she should see me for a dressing change. The writing was not that of any of our doctors, so I knew it to be another attempt to work the system.

I was truly frustrated, but fortunately medical ethics that are drilled into you in American healthcare insist that you don't have to like the person or feel nice, but you do have to take care of the problem. So I grumpily went about solving the problem. I took her to Dan and we told she would have to stay and have surgery that afternoon, after everyone was done being seen in consultation for the morning. It was evident that she wasn't happy with this solution.

When we were finally ready for surgery, she was nowhere to be found—a quiet, but definitive statement about what she thought of our solution to her problem. So it was quite a surprise when she showed up again a week later. Again, she came directly to me, instead of going through the proper channels. I decided that this problem needed to be handled by a Malian, if for no other reason than I was losing all patience.

So I took her to Rebeka, one of our Malian physicians and explained the situation. I left the room as Rebeka was asking her why she had skipped out on all of her appointments. I was relieved that the responsibility was off my shoulders, and felt like exacerbatedly saying, "People! Hmmph!"

Fortunately after I closed the door, Rebeka noticed the woman's name. Realizing there must be more to the situation, she began asking questions. Her tragic life story unfolded—she was born to a mother who had lost all her other children. Convinced that demons were to blame, she named the little girl Nyama (Trash) to show them that the child had no importance. She was neglected in her childhood, given just enough attention to survive, so as to prevent the demons from thinking she was valuable and taking her away. She was married into an unhappy situation, money was tight, and when she developed this infection, the husband wasn't inclined to help her get treatment. She skipped all her appointments because she didn't have the resources to get to the hospital or pay her bills. Manipulation and lying were the only options she felt she had left.

When I heard her story I was heartbroken and humbled, but was very happy to hear that Rebeka convinced her to stay at the hospital, have surgery, and finish treatment. (Financed by our fund for impoverished patients.)

I was reminded of Philippians 4:5, "Let your gentleness be evident to all. The Lord is near." Please join me in praying for women like Nyama who are in such difficult situations. May they receive treatment, love and dignity at our hospital. Pray also for us as workers that God would give us eyes to clearly see the life situations of our patients.

A moment of privilege

2010-12-05T19:00:00.002Z

A repost from my regular update letter, for those blog readers who don't get that letter.

"Please Lord, don't let him be dead," I whispered as I hung up the phone. I tried to reprimand myself for thinking so tragically, but this time of year tragedy is in the air, and sometimes it is catchy.

I was in the OR, doing I-don't-remember-what, when one of the nurses from pediatrics called me to tell me that Daouda's dad was here to see me. And I worried that such a visit could only mean bad news, since the family is quite poor and they live a good distance away.

Daouda, as some may remember, is a 9 year-old patient that came to us last year. He had been burned on the face and neck a few years prior and the resulting scarring was pulling his lips all the way down to his collar bone. Brett, the pediatrician, rightly said that it looked like the Picasso painting "The Scream."

Since then, we have done several surgeries on Daouda, with the help of many visiting surgeons. Though the scarring is still evident, he now has good movement in his neck, mouth, and face. He no longer has to wear a ski mask to cover the deformities.

During his last hospitalization, Daouda really grew attached to the staff and was having the time of his life playing with everyone who had a minute to just hang out. (They took to calling him the king of pediatrics.)

In early September, Saskia (the Dutch physician), Lazar (a Malian pediatric nurse), and myself took a trip out to Daouda's village just to visit with him and his family. He seemed to be doing really well.

So after hanging up from the call, I started walking towards pediatrics to find his father, hoping that he hadn't succumbed to malaria after all this.

But I was happy to see Daouda peek around from behind his dad as I approached. I greeted them and then took them to my office to talk. After some small talk, it became clear that the father was there to ask for help for something. He handed us a letter in French, which Jessica and I struggled to fully comprehend, but it was clearly a request to help send Daouda to school. He had never been allowed to go to school because of his deformity, but the family wanted him to start this year.

After pulling in another a Malian peds nurse (also a mom who knows about Malian school), we figured out that the request totaled a little less than $20 to cover the whole year of school, all his supplies, and even their transport to and from the village. We even purchased his supplies that day and sent him on his way with his notebooks, pencils, chalk and chalkboard all stuffed in a puppie-dog backpack. He was so happy as he skipped away that day... and I...well, I felt like a million bucks.

I tell this story not to pat myself on the back (you'd have to be a scrooge of the first order to NOT have given $20 to send this kid to school), but rather to tell you that I'm so privileged to be here. There are days when the busyness and the challenges of this place cloud my sight of that privilege, but there are moments of clarity which make the heart sing.

And I want to thank you for all your prayers, encouragement and support. You are truly a part of this ministry, and I hope you can celebrate in joy with me over these moments of privilege!

In that Holy City…

2010-09-23T23:29:00.001Z

I went to prison today with a local pastor. Wednesday was the 50^th anniversary of Mali's independence, so it was turned into a two-day holiday, and as a part of the festivities, the pastor had decided to take some gifts to the prisoners he ministers to on a frequent basis.

I've been with him to the Koutiala prison several times, but today found me in a very reflective mood. As I scanned the faces of the crowd that pressed in to get their soap and oranges, I was taken by the emotion of it all, blinking away tears and swallowing back the lump in my throat. So many young faces, in such a bleak and harsh place. (There are a lot of striking things in a place like Mali, but I must say that prisons here have to be among the most unpalatable.) Several were clearly mentally ill. Some were malnourished and I could imagine a life of poverty pushing them to desperate actions. Some were physically ill, and it was evident that their current life conditions were not treating them well. Others seemed aloof and maybe even haughty, and I wondered how long they would choose to kick against the goads.

As I looked into eyes I was just overwhelmed by the violence that has swallowed these lives. I'm not advocating their innocence, but at the same time, prison is the epitome of what is so wrong in our world. And I could not help thinking of Revelations 21 which talks about all that will not exist in the new Jerusalem, the Holy City—the personification of God's kingdom coming in all its fullness.

In that Holy City there will be no more prisons. There will be no need. There will be no more mental illness, no more desperate poverty, no more addictions, and most importantly, no more wickedness seeping up from the hearts of all of us. In that day, we will not have to make the choice to imprison another person—to violently separate them from the rest of society—because of their own violence. Until that day, prisons seem a necessary institution, but one that merits our shame.

Driving back to the hospital, I was trying to figure out what kind of interaction one should have with a prison, with prisoners. How does one best work with them and what does one do? Is there even hope in a place like that, for people like that? And by the time I even got to really just asking the questions, I was rolling into the gate of the hospital. It struck me that here again, was another institution waiting to become obsolete.

In that Holy City there will be no more hospitals. There will be no need. There will be no more illness, no more victims of trauma, violence and neglect, no more malnutrition, no more injustice, no more bodies that just wear out, and no more physical imperfections. In that day, "all will be well, and all manner of things will be well." Until that day, hospitals will be a necessary institution, but one that merits our mourning.

And there have been days lately when thinking that there will be no more hospitals is quite a joyous thought. There are days when I ask myself the same questions: How does one work here? Is there even hope? What is one to do?

But it seems that to these two institutions, which represent two antitheses of God's Kingdom—violence and illness—citizens of God's Kingdom are called to go. We are sent into places that seem dark, devoid of hope, and far from the warmth and light of the Kingdom—places of shame and mourning—in order to announce the coming of a Holy City, to proclaim boldly the end of the old order and the arrival of the here-but-not-yet-completely Kingdom.

"He will wipe every tear from their eyes. There will be no more death or mourning or crying or pain, for the old order of things has passed away." Rev. 21:4

You can just call me Cupcake

2010-08-01T23:07:00.001Z

Back by popular demand… a little humor. After a day like today, my choice is either humor or the most depressing blog you've ever read.

First, let me start by saying that I never had a little brother, but I think that I would have very much liked it. There is nothing wrong with my little sister. At age 5, I really didn't want her to be born. So considering, I would say that our relationship has really improved! But I still think a little brother would have been a lot of fun—at least in the Malian style.

Since coming to Mali, I have a variety of people that I refer to as "little brother." This is mostly a joke, since here in Mali, the older brother exerts almost god-like authority over the younger. To be honest, that has been one of the things that I've had to "get over" culturally. I found that it would drive me crazy to see an older brother order his younger brother around, but it seems the younger brother minds far less than I do. I was ready to become a champion of the rights of little brothers (being one myself), but they seemed not to mind, and it soon became apparent that these were my issues, not theirs.

But there is really only one person that I consider a real little brother. Joel is my friend Paul's little brother. Apparently, one of the benefits of friendship here in Mali is that you inherit little brothers. Before I even knew his name or really who he was, Joel was doing things for me. I can remember running into him after church one afternoon and him calling me "big brother." I was a bit confused and taken aback because I couldn't even really remember where I knew him from. Since then, our friendship has grown. He still always takes a subservient role—washing my moto, insisting on carrying things for me, making tea for me, referring to me only by the name "big brother"—but we can now have a real conversation and I enjoy inviting him over and just having him around.

One of the things that I have learned in observing Paul and Joel is that the Malian system takes care of its own. (Definitely open to abuse, but when done well, it is very interesting) Joel will unquestioningly obey Paul's orders, but the side that doesn't jump right out, is that Paul thinks quite a bit about Joel's needs. Paul has a job and Joel is a student, so there is a flow of money to cover Joel's needs. There is a protectiveness and a watchfulness over the younger sibling. And most touchingly, when things get serious, it is the little brother that Paul wants at his side.

So, sharing some of these same big-brother feelings, when Joel came to ask me a favor concerning his graduation, I was all ears. He wanted a cake to share with the people that he had invited to his graduation ceremony. I immediately agreed, knowing that I'm probably the only person with an oven that he could ask. And I would have been happy to make three cakes for him, if I had to. Let me just say at this point, though, that I can make a cake, even from scratch, without problem and have done so multiple times because of necessity; however, I'm not sure I want to be known as the cake-man.

Then, as we talked more, the details became a little more clear and I realized that I would need to make enough cake for 20 people and serve it at the school. This was getting more complicated, but I was struck by a wave of genius and realized that my answer was cupcakes.

Now, I'm not generally one to make distinctions between feminine and masculine work (I am, after all, a nurse), but the idea of cupcake-making just struck me as funny and slightly wrong for me. I knew that without a doubt it was the best idea for this particular situation, and it is not even like I consider baking to be below me. I've baked several things, and proudly so, but in the sense of it making me feel like I'm something of a Renaissance man. Cupcakes, I think, just can't do anything for that image. They feel like a trespass into regions that are best left alone.

But eager to help Joel out, I figured I would just do this and keep it quiet. And that would have been a fine plan, if catastrophe wasn't the order of the day.

As I was preparing, I realized that I didn't have enough paper-lining thingies. This raised big questions about whether I could just cook them directly in the pan. This necessitated talking to the ladies who work here, who were very kind in giving advice and not judgment. Though at one moment, in order to make myself feel better, I clarified that I was asking these questions because I had never made cupcakes before, and that that boded well for my masculinity. (I don't think they bought it…)

After devising my plan, I was about to start baking, when I got a call from the hospital. The story of today's hospital happenings is much too complicated to get into now, but suffice it to say, it goes down in the annals of all-time bad days. So afterwards, I came home to bake, but first sent Saskia (the Dutch physician) a text telling her that I was praying for peace for all of us. She texted back that she wanted to chat and wondered if she could come over. Knowing that I'd be in the middle of cupcake-land, I was a bit hesitant to say yes, but agreed.

She arrived right as I was in the middle of mixing the first batch. She sat on a chair in the kitchen doorway and we talked about the whole mess of the day. And there I was, heating the oven to 350, mixing, and sliding little paper-liners in to the muffin pan (I found some!). It felt apron worthy. And the fact that I was baking and giving comfort at the same time made me start to feel like I should be some, large Southern woman baking cookies for her heartbroken friend. (Or wait, was that God in the Shack?)

While the first batch was cooking, I made the frosting, which Saskia told me she thought looked disgusting. (Hope the Malians like it better… ) Pulling the cupcakes out of the oven, I realized that I was out of gas. So after telling Saskia goodnight and seeing her out the door, I went to change the gas bottle, only to find out that my spare was empty. Since I need to have these bad-boys ready by tomorrow morning, (and the refill station is now closed) I was a bit worried. But since it was still early enough, I thought I'd head over to the guest house to find a spare gas bottle.

Arriving on the compound, I found Sharon, a visiting nurse, coming down the guesthouse stairs. In my overzealous, large Southern women mode, I told her that I had a "Cupcake emergency." (yeah I know…hopeless. There is no recovery from this.) So together we searched the guest house, but didn't find a bottle of the right size, so we decided that I could just cook the last set here.

So I went home, gathered all the pans, the batter, the little paper-liners, and spoons and started walking out the door. My guard was a little puzzled as to why, at ten o'clock pm, I was marching out my gate with an arm full of pans and a bowl of batter. But really, how do you explain to a Malian man, who has probably never cooked a day in his life, that what seems like a bizarre set of actions is a very important mission? (Operation Cupcake) So instead of saying anything, I just grunted as I walked past, hoping that improved my image.

A few short steps later, in the middle of the street (with only the mercy of darkness to hide me) I dropped everything in my hands, saving the bowl and my computer. But undeterred, I pressed on. And here I sit, writing this incredibly lame story, while my cupcakes cool—by the smell of them, they'll be tasty.

And I'm not worried any more that people know I'm making cupcakes, even if that just can't help my image. Because, it isn't about cupcakes; it is about loyalty. It is about learning to be a good big brother. It is about looking after a little brother and helping him with something that will honor him on his big day. It is about hashing out the crappiest days with your team. It is about sticking together when the going gets rough.

And gosh darn it, cupcakes help.

Walking Slower

2010-07-10T17:53:00.001Z

Ironic. And if I can be so forward, poorly timed. In the final week before the return of a couple full-time hospital workers, I still had a lot on my plate. The busier I get, the more I lean on To-Do lists. Post-it notes are one of my most enduring friends, and their presence in my pocket is ridiculously calming. You can roughly approximate my busyness by the number of lists I'm carrying around with me. If I have one master list—no matter the number of things I've crammed onto it—then life is at a steady pace but overall very manageable. If I've got multiple lists that are well organized, life is busy but I'm still on top. When I pull multiple, crumpled shreds of paper out of my pocket, covered in chicken-scratch and 'X' marks, life has officially become chaotic. This past week, I've been carrying around a clipboard full of such paper shreds.

But I'm doing my best to keep my heart in a listening mode so that I catch what the Lord is trying to teach me in a somewhat quicker, less painful fashion. Call me what you will, but I sometimes find these lessons to be a little less than convenient. I'm not saying that I want them to stop or that I don't want to enact wisdom in my life, I just wish I could choose the timing. This week, in the midst of my chaos, the Lord decided to spring on me a simple, but inconvenient truth (thank you Al Gore for creating the internet and making that a cliché). "Walk Slower," He (God, not Gore) says.

It started Monday when I was walking between two buildings with one of my Malian friends. About mid-way, he said, "Jacob, you need to slow down. You walk too fast; I can't keep up." I'll admit it—I walk fast. At my natural pace, I walk about twice as fast as the average Malian professional or city-dweller, and roughly 6.5 times faster than the average Malian villager. In college, I used to run to all my classes, even when I wasn't late (which, admittedly, wasn't often). The busier I get—you guessed it—the faster I walk. I also tend to write notes on my lists while I walk fast. (This has roughly the same effect as texting while driving.)

This isn't the first time I've tried to slow down. Starting out in the ICU, I used to walk faster and faster if I was getting behind in my work, but I soon learned that I needed to keep my pace in check. Seasoned ICU nurses are trained to react to odd noises, bodily fluids, scribbly lines on a TV screen, and any sudden movements from their coworkers (doctors excepted). On several occasions, I had a crowd of nurses rush into my patient's room behind me, perceiving my fast walk as an indication of something urgent. At the same time, I started working with Somali refugees and quickly learned that walking through the city with them was to march to the beat of your own, very slow drum. We used to joke that if they walked any slower they would be standing still, which was especially true when you were late for some appointment. But well before that, in my youth, my grandparents tried to slow me down whenever we were in nature. They delighted in showing me interesting things that I had missed alongside the trail because I was rushing.

So I began to do my best to walk slower this week. I tried to keep pace with the person I was walking with, instead of leaving them behind. I knew there had to be more to this than just the speed I move my legs. I figured it had something to do with stress management or maybe with not having tasks as the object of my attention. As it turns out, God was trying to help me realize what I was missing alongside the trail.

Adama arrived late in the afternoon last Friday. I vaguely remembering looking him over, but I didn't investigate his case much once the other pediatric nurses said he was a malaria case. They prescribed the normal cocktail of treatments for malaria, and I took off for the weekend. Monday morning I got pulled into handling some issues down in maternity, and by the time I got to pediatrics, the other nurses had almost completed rounds. As I walked into the room, they were in the middle of demonstrating Adama's continued need for oxygen. Turning off his oxygen dropped his saturation levels from 100% to 50% in a hurry and it took him a long time to recover. (90-100% is normal for all you non-medical people.) We immediately shifted our thinking from malaria to some type of lung infection. We transferred him to an isolation room, ordered x-rays, and began to carefully monitor his lungs. The x-rays didn't turn out that great, but they also didn't seem to show anything horrible either. I wrote Brett, our friendly neighborhood phone-a-pediatrician-friend (soon to be the back-in-Mali-so-Jake-doesn't-have-to-play-remote-diagnosis-anymore pediatrician), who with my descriptions advised treatment for asthma. The initial treatments seemed promising.

However, the next day, Adama didn't seem much better, and worse, he looked absolutely exhausted. We puzzled over what to do with him, but nothing seemed clear. In the later morning, I was walking by his room headed to my office to complete some tasks. I made it to my office door, which is just past Adama's room, but was too troubled by his case to enter. So I turned around and walked back into his room. I sat at the edge of his bed. He sat there breathing hard and looking like he could pass out at any time. Brenda, a nurse who normally works in another part of Mali, but who has been down at the hospital helping us during these past couple months, walked in the room asking me if I had any new thoughts on his case. I admitted that I was clueless. She too sat on the bed, put Adama in her lap, and allowed him to lay his head on her chest. She began telling me that during the x-rays she would hold him like this to get him to calm down. I looked at the monitoring machine and saw that indeed his pulse had slowed and his oxygen level had risen. His little hand dangled at his side. I grabbed it and while holding it, I saw that the ends of his little fingers were oddly puffy. (Finger clubbing we like to say)

It suddenly all began to click…the finger clubbing, the sudden drops in oxygen saturations, and Brenda's calming position. I practically ran out of the room and into my office (so much for walking slower…). I grabbed the monster pediatric textbook off the shelf and paged through it until I found the title Tetralogy of Fallot. Reading through it, the description fit so well. Tetralogy of Fallot is a congenital heart malformation. Depending on the severity, children can live with the malformation, but the best treatment is surgery. Of course there isn't such surgery in all of West Africa. The only option is to get him to the capital to see a cardiologist who can hook him up with some charity groups that take kids like him to Europe for such operations.

Though treatment options are certainly limited, we did have some options, which we started immediately. And Adama is slowly but surely getting better. On a number of occasions, I've had to leave my office in the middle of trying to get paperwork done, go into his room, and cradle him in that special position. (With Tetralogy of Fallot, a knees to chest position helps redirect blood flow in the body, which helps the heart work like it should.) To be honest, like most of the pediatric patients I've grown attached to, Adama is a bit of a brat. Sometimes he likes to fight instead of assuming his position, which makes this a time consuming task. He sits there panting, ready to pass out, slapping your hands away instead of just allowing you to help. But as the week progressed, he began to accept our help more and more. His crises decreased in frequency, and we are looking to send him to Bamako in the middle of the coming week with Brenda.

In slowing down, we seem better able to take in the whole picture. With all our fancy machines and lab tests in the States, medical professionals don't have to spend as much time at the beside of the patient (which we all complain about), but here in Mali, correct diagnosis still largely depends on sitting in the room, examining every square inch of the patient, and putting all the details together. It takes time, and it is time you have to put in regardless of how busy you are.

I wonder, in life and in ministry how often I've misdiagnosed people because I've haven't taken the time to slow down. How many times have I rushed past someone because I was busy, when that was exactly where the Lord wanted me to be? How many times have I made some false assumption about a person and their condition, when, if I had slowed down and walked their pace, I would have seen their world with more clarity? I shudder to think of all the important things I've missed alongside the trail.

In a world and culture that gives us every reason to rush, we are called to lives of listening better, looking more thoroughly, taking time to sit on the bed, and walking slower.

Dry and Heavy

2010-06-29T21:45:00.001Z

Heavy is the only way to describe it. Damp and heavy. After the sun sets, the heat abates, but the air still feels swimable. This is most especially true the day after a rain when the sun's heat has had all day to suck the little pools of water up into the air, sending the humidity sky high and giving clothes, paper, and sheets a moist feeling. Fans help little since neither the humidity nor the sweat have anywhere to go. In another couple days, storms will roll in from the east, the rain will cool the earth and lower the humidity—temporarily—but for now, it is thick air all round, on the skin, in the lungs, and on the brow.

On these evenings, the body doesn't know whether to sweat or not, as the feeling is neither one of being hot nor comfortable, but it will come pouring out in great beads at even the slightest provocation. It is the feeling of tropical evenings or the feeling of summer, night air in a marsh; it's a feeling heavy with expectation of things to come; it's the feeling, if one could sense it in the air, of malaria.

In this soupy air, I stood in the doorway of Pediatrics Room 3 with beads of sweat rolling down my back. I needed to tell the young mother waiting outside on a bench that we had lost her baby to some unknown foe—perhaps malaria, but more likely a bacterial infection. She was anxious, keenly aware that something was deeply awry. She fidgeted on the bench, lifted her dirty shirt up above her breasts, and then adjusted a piece of cloth wrapped around her chest that served as a makeshift bra.

Seconds before I called her over, Safi, the night nurse said to me, "She's alone. She has no one here with her." Not knowing how she'd react to the news, we decided to investigate the family situation a bit more. We quizzed her on the whereabouts or her husband and parents. She had apparently been dropped off at the hospital and some distant relative in town was bringing her food. However, she mentioned the name of her village, and I happened to remember that we had a family from that village with a patient in the ICU. She knew the family but didn't know they were here. This was good; their presence would be a comfort to her. Problem solved.

I felt strangely light, as I called her to the doorway. This was, after all, not my first ride on the child-death-train. I explained that we had done everything we could, but that it was too late and the child was now dead. She didn't even wince—not even an eye twitch. We told her that she could spend the night on the other side of the hospital, with the other family from her village. We would put the child in the morgue and deal with all the paperwork in the morning. I offered my sympathies and condolences. We prayed for her, and then she turned and walked away.

It was so tidy and easy, maybe like telling a mom that her child was due for a vaccine and the appointment would take 5 minutes longer than expected. Or maybe something like telling a mom that her son had a cavity, which she was expecting. But it didn't feel like telling a mom that her baby was dead. It wasn't like looking someone who was completely alone in the eyes and telling them that their only flesh-and-blood attachment for miles around was now dead.

Ashamedly, it wasn't until I was on the moto headed home in dark that I was able to plumb the bottom of my emotional well. Up from its dry cracks, the waters of sadness and anger began to seep out. It wasn't the fountain I thought it should be, nor the deluge of drowning emotions I thought it might be. I wanted it to be thick, heavy, and suffocating like the night air, but it was more like a few drops of cool water on a hot, dry summer day.

But it was enough. Enough to stir me; enough to pull my heart up into a prayer.

I had forgotten the emotional burden of this place, until that moment. I am, admittedly, emotionally retarded, but I don't think that is really to blame for my state. I think this place is emotionally overwhelming, in a manner that dries you out so fast you don't have time to replenish. To complicate it, the sheer busyness of the work pulls your energies elsewhere and makes some of life's sacred and sad moments just another thing standing between you and your dinner and bed.

"Lord," I whispered, "I don't want to spiral off into fits of depression or rage. I don't want to walk around with an emotional weight all the time. I do want to be able to let things go. I don't want to be driven by the waves and winds of my emotions. But Lord, I don't want apathy, numbness, or disregard. I never want the death of a child to be emotionally negligible. I want enough sadness to offer true sympathy. I want enough anger to remember that this is not the world as You want it."

Cutting through the muggy night, I felt heavy and dry. And since it was too late to offer the woman my true sadness, I offered it to the Lord, and asked Him to multiply it for His purposes.

From Fragile to African: Part 1

2010-04-11T23:48:00.001Z

From Fragile to African: Part 1

Famorila is a village in what could be called, without exaggeration, the middle of nowhere. It had been described to me, before I had a chance to see it, as "driving to the end of the world, going a little further, and then you find Famorila." Having been there, I would say that description isn't too far off. Significantly, the NGO that I work with has a health clinic in the village, and my friend Paul used to work there.

We had talked many times about visiting but always had difficulty finding an open date or good weather. (The village becomes very difficult to reach during rainy season, so you are limited to the dry months.) So in late March, when Paul and Ecle suggested a trip during Easter weekend, I was stoked at the idea and agreed immediately. In typical fashion, our original conversation was followed by several planning meetings, in which details were discussed in indirect terms. (Read: these meetings took hours for things that could have been decided by three Americans in 5 minutes.)

The first of these details was transportation. They asked me whether I wanted to go on moto or go in a vehicle. I haven't figured out how to explain this, but they have this way of saying something very strongly without saying it at all (part of being an indirect communicator, I guess), and in this case it was abundantly clear that I was to try to find a vehicle. When several days later I told them that I could really only find a van, they balked at the idea of taking such a bulky vehicle all the way. So I told them we should just take our motos, to which they agreed, but with the caveat that it would be a long, hard trip. When I responded with a, "yup, ok, no problem," they felt it necessary to put it to me more pointedly. If I remember correctly, Paul's statement was: "I can tell you, if you make it on a moto, it will be the first time anyone has heard of a white person going to Famorila on a moto." Their putting it in the form of a challenge pretty much sealed the deal for me—we would go by moto.

Two days before we left, Paul said that I would "go down in the annals" for making this trip. To which I sarcastically responded, "And if I die in route, you can always write on my tombstone, 'At least he tried.'" Their initial burst of laughter was cut short by an awkward silence and uncomfortable glances that suggested to me that this wasn't at all an unlikely possibility in their minds. And at each new step of discussing details, they presented a mix of excitement to see me actually do these "impossible-for-white-people" things and trepidation over the thought that catastrophe could befall me on their watch.

For sleeping arrangements they were going to try to find a room to put me in. When I explained that I would be happy to sleep wherever they were sleeping, they chuckled, explaining that they slept outside, on mats in the middle of the courtyard with everyone else (which I knew already). Their reasons for not wanting me to sleep there were that I would be: A. outside; B. "too close to people"; C. bothered by noise; D. uncomfortable; and lastly, when I poo-poo'd their other concerns, snakes. They almost had me with the snakes thing, until I thought about it and then said, "So your solution is to lock me up in a room where it will be roasting hot and I will be alone, so that when the snake comes, I'm left alone to kill it, instead of having a whole courtyard of people to help me." They liked that logic and agreed not to search for a room for me.

However, their true thoughts came out, quite abruptly, when we talked about what I would eat and drink in the village. They were working very indirectly at conveying some point to me, and I was just not getting it, so Paul blurted out, "Well, you know, you are kind of fragile." I can honestly say that was a new one for me. (Especially ironic since both of them took anti-diarrheals in the village, claiming that all the meat we were eating was rough on the stomach.) I told them that I would eat and drink what was served me and leave the rest "in the hands of Cipro and God." (Little did I know how often I would ask the latter for help while eating.) I finally just told them that I would let them take care of details and do whatever would make them feel most comfortable, but that I would be most comfortable knowing that they weren't stressing over me.

The night before our trip, we got together and talked over the remaining little things. Paul and Ecle were visibly excited. I laughingly thought to myself that this might be the same type of excitement the Romans had while watching the gladiators before the lions. And then they told me that we would only be taking two motos on our trip. This is where I made one of those classic cross-cultural mistakes—I thought I understood what this meant. And after being here a year, I have reached the point where I'm quite tempted to think that I do understand things, but this place has a way of making you eat your "understanding." I assumed this meant that Paul and Ecle would ride together on one moto, and I would tie all the bags to the back of my moto. Ha…

The next morning at 4:45, I packed up some drinks I had frozen for our trip, grabbed my backpack and headed out the door to meet up with the guys, who were both there before I was. (Who says Africans aren't on time?!) Both Paul and Ecle were dressed in winter coats and expressed surprise that I was sporting only a T-shirt. I assured them that I wouldn't get too cold. We amassed all our bags, and they started tying them to Ecle's moto, which is when I realized that I would be driving with a passenger. (Now is an appropriate time to channel Dumb and Dumber or Wild Hogs as an imagination aid.)

Now without making this needlessly awkward or detailed, I feel it is important to talk about certain realities of having a passenger on a moto. First, pertaining to this trip, was the length of time. I've gotten quite used to going around town with a passenger (or as a passenger) on a moto, but those trips are rarely over 15 minutes long, and this trip would be at least 5 hours (8 on the way there and 5 on the way back). That length of time makes all of the "realities" a bit more difficult to deal with. So, you have the "added-challenge" factor, meaning that having a passenger adds to the technical aspects of driving, like balance, shifting, braking, hitting bumps, etc. etc. You also have the stretching-out issue; with a passenger there is not the space to really stretch out when you get tired of one position. And lastly, you have the issue of, can we say it: touching. Most people know that I have a well-defined "personal space." And though I think they would all be surprised at how accepting of "touch" I've become here in Mali, I'm still a Westerner with clear limits. Hours and hours of moto riding, on a bumpy, dirt road, with a rider (no matter how skilled) involves constant touching. And when you combine touching and mid-day heat, then you've got sweating… and well, need we say more. There is a reason we all laugh so hard at the images of this in the movies mentioned above—because it is weird and awkward for us as Westerners. But, I suppose, it is all part of becoming "non-fragile," and as I've done on a thousand other occasions, I decided laughter was my best coping option.

So after loading up, we took off in the cool of the morning. Because we had so much stuff, Paul and I still had our backpacks on, making the preciously small space, smaller. The first several kilometers were on paved road and we were going as fast as those little things would take us (roughly 50mph). At that speed, the engine vibrates terribly, causing your legs to have that itchy-falling-asleep feeling. As we pulled off the paved road onto the dirt road, I thought I was going to have to stop already to make different arrangements, but was worried about what message this would send my companions about my ability to survive. Luckily, Ecle solved that problem for me by popping his back tire less than a half kilometer off the paved road.

There we were, 5:15 am in the early morning dark, miles from any town, with only millet fields as far as the eye could see. We parked the motos and stood there looking at each other. Paul muttered, "What misfortune," to which Ecle added, "So much for leaving before the sun comes up." It just struck me as so funny that I laughed out loud and they joined me. And then I sat back to watch them figure out how we were going to go forward. For me, something like this is a deal breaker—I mean where are you going to get this changed? I thought we might have to walk the several miles back to town and wait for sun-up. But Malians are resourceful. They don't solve problems at all like Westerners—who tend to be preventative or try to go after the root of the problem—but they often come up with solutions to get through the problem that Westerners would never have even attempted. After a minute of thinking, Ecle said he thought there was a home a ways up and that surely someone there could repair our tire.

We walked the motos a couple hundred yards and then veered off the main road on a little path that took us another quarter mile back, till finally we came upon a little home. There were minimal signs of life, but Ecle boldly entered the compound and just started saying loudly, "Good morning, good morning." Finally, a woman emerged from one of the doors, looking still sleepy. They explained our situation and without a word, she grabbed three chairs, had us sit down, and went to wake up one of the young men. Sure enough, he came out and started working on the tire. I tried to imagine this happening in a Western country and didn't see any possibility that it would work out as nice as this.

After an hour or so, we paid our 40 cent bill, and loaded back up. We shifted the bags around on my bike and found a more comfortable solution. Soon we were cruising down the dirt road, sun coming up over the mangos and palms, breeze in our faces, and very coated in dust. But just when we thought we were making up for lost time, a short 30 kilometers after our last flat, my rear tire went flat. We had just passed a little hut about 200 yards back, so we walked the bike back and sure enough the guys there had the stuff to fix our flat. (You begin to get the impression that flats must be common on this road.)

As the young guy started working on our tire, an old man emerged from a hut and brought us tea and some tiny little biscuits. After asking for the complete details of where we were going, who I was, why I was traveling on a moto, etc. etc., the old man smiled and laughed. The young guy found two holes, so we knew it would take a while. There was a clinic in the village, so we headed there to visit and on the way ran into somebody Paul and Ecle knew (which seemed to be the case everywhere we went). After another hour of visiting and waiting, our tire was finally finished. As we were loading back up on the motos, I started to think to myself that maybe I should have come more prepared—with a pump, an extra tube, and a repair kit; or maybe I should have borrowed the better dirt bikes that some of the guys have. But, then I decided that this was an adventure and it was worth it to just "go with the flow." Can't say I'd want to travel like that every time, but it was worth it, once.

So once again, we hit the road. By now it was 8:30, and in the three and a half-hours we had been "traveling" we had succeeded in covering about 40 kilometers (25 miles, and for the record, I've run that distance in much less time). But we were nowhere near finished with our little adventure. In fact, a short 20 minutes later, Ecle popped his tire again, and we let out a collective groan, followed by a good laugh. Ecle and Paul were obviously frustrated, and I was starting to wonder if this was something out of the Odyssey, or for that matter, Jonah—a doomed trip requiring the sacrifice of one of the passengers. This time we were truly in the middle of nowhere—the last building we had seen was the shack where we changed my tire. We knew that there was a large village ahead, however, and so we decided to drive on the flat, knowing we could replace the inner tube (and tire, if need be) when we got there.

After some cold sodas (grace a my freezer), the tire was changed and we got on the road again. We made great time, and except for a brief stop for gas and some fried goat meat, we went non-stop for another 3 hours. At the gas-stop, Paul and I traded places, because being passenger is not very comfortable. This got especially interesting when we finally left the "good" dirt road, for the bad dirt road—essentially cattle paths—for our last 40 kilometers.

We didn't really know where we were going, so every village we came to required us to stop and ask if someone knew the way to Famorila. Usually, one of the men would climb on the back of Ecle's bike and take us to the other side of the village. There he would show us the path (or draw a map in the sand) to take to the next village. Outside our first village, on a path that ran through a barren expanse without signs of human life anywhere, we hit our first patch of sand. If there is one thing I absolutely hate while riding a moto, it is sand. (I've never tried a moto in snow, but I imagine it is a bit the same.) Because these motos are totally not designed for sand, and because we were two people, the patch of sand almost took us down. And this happened again and again, including once when I jumped off the bike to avoid going down with it. Finally we hit a 300-meter stretch of pure sand, and there was no way the bike could make it through with both of us. So I dismounted and walked through.

On the other side of that sand patch, Ecle, getting impatient from waiting on us, decided that we needed to switch up. We moved the bags over, and I became his passenger. We took off at a speed that was just crazy, and my knuckles went white while grasping my sissy bar. With Paul, I was nervous about falling in the sand but figured it wouldn't be too serious even if we did. With Ecle, I began to wonder if my Medi-Vac insurance covered instances of falls while driving a street bike in sand at break-neck speeds, while in the middle of nowhere. But after sailing through two or three sand patches, I began to wonder if Ecle was just that much better a driver or if his bike wasn't just better at handling the sand.

Just a few minutes after 1 pm, after 8 hours of adventure, we arrived in Famorila at the home of Paul's uncle. It was hot and we were covered in a layer of dust that you could easily write in, but the family welcomed us warmly, taking our bags and bringing out water to drink. After sitting in the shade and greeting all the various family members, we were offered the chance to wash up. We went into the small room where all our bags had been set. There, Paul and Ecle took off their winter coats, and that is when I learned to my surprise that both were wearing two pairs of pants and a long sleeve shirt over two t-shirts. As they peeled off all those layers, I realized that my experience of heat and their experience of heat had to be two drastically different things.

I was up first to take my bucket bath, so I grabbed my towel and change of clothes and was led to the outhouse. This one was a combined washing space and pit latrine (sometimes they are divided by a wall), surrounded by a mud wall that came up to my mid-to-low chest. This wasn't my first time in a Malian outhouse, or my first bucket bath, but this was the lowest wall I'd ever been behind, and I could clearly see Paul, Ecle, and the rest of the family. At this point I began to wonder if there was some unwritten list of do's and don'ts for bucket-baths, and if so, how exactly you go about finding what is on that list. I couldn't see asking any of the Malians for pointers. I mean, I understand how to get clean with a bucket of water (I'm not THAT stupid), but in the other situations where I've done a bucket bath the walls were high enough to stand; here, it was obvious that I would need to squat if I wanted some privacy. Are there other details out there that I need to know? Well anyway, the bath went along without incidence, and the fact that I was two feet away from the pit latrine didn't even reduce any of the refreshment.

After we all had a chance to clean up, we sat down for the first of 8 million meals that we ate in the village. This meal was hunks of roasted in potato in a great gravy, served with pork pieces. I still like pork (that, despite Ed and Andrea's story of cooking pork and having worms crawl out and start popping in the oven), but Paul found it necessary to throw the spleen at me. When you are eating out of the communal bowl, the "good-stuff" (i.e. veggies, meat, etc) is all piled in the middle of the bowl, and you just grab from that pile and combine it with the rice (or whatever) that is right in front of you. Occasionally, when your Malian friend thinks you aren't eating enough, or they want to give you some delicacy, they pick it up and throw it in your little area. So I was honored with a nice piece of spleen, which wasn't horrible once I decided I would just not look at all the blood vessels I was putting in my mouth. There were other pieces of pork that were good, but they also had several chunks of pig skin. For these, you chew the fat off the underside of the skin, and if you try real hard…well…no…it really just doesn't taste like bacon, no matter how hard you try. Luckily the potatoes and gravy were excellent tasting.

After lunch (#2), we drank three rounds of tea, and then went to visit the rest of the village. The village mainly consists of the workers at the clinic and their families. The larger village of Famorila is about a half mile away and is almost exclusively Muslim. They've isolated the Christians and the clinic to an outlying area. It was truly a joy to meet this group of people who live in such a remote area in order to serve health needs that would not otherwise be met, and who strive to be a tangible witness to Christ in a very unreached place. On the visits, we drank another 6 rounds of tea and ate another lunch.

And this is the way it was the whole weekend—lots of visits and way too much food. I had been told before that it was not impolite to turn down food if you've just eaten, but Paul and Ecle acted as if that was not an option. While walking between houses, I told them that I was just so full that I didn't think I could eat anything more, but they told me that that was just how it was "here in Africa" and that'd I needed to do my best. So after our three lunches, we had a couple-hour reprieve before starting our round of 5 dinners.

During one of our rounds of tea in the courtyard of a nurse's aide that works at the clinic, the butcher showed up and slaughtered a goat right in front of us. This wasn't too unnerving or new for me, but it did remind me how separated from our food we are in America. It wasn't until he had skinned and strung the goat up and then started pulling out the organs that I got uneasy. As he pulled out the small bowel and wrung out the digestive contents, washed it, and then cut it up in small pieces, I had the feeling that those organs would be back on some plate I would be eating somewhere. And sure enough, dinner number three or four, (I can't remember which) was at this same house.

Now, I feel that I'm a pretty good meat eater—I've eaten meat from a variety of animals, I've gotten used to eating meat with fat and gristle and cartilage, and I can chew meat off the bone with the best of them (including the spine, which is very tricky). I can eat liver with no problems, and I've come up with tactics for eating mystery pieces (usually balling it up in rice, chewing and swallowing fast). But organ meats still get me. And when the plate was uncovered at this home, despite the lack of light, I saw immediately that I was in trouble. It was only organ meat—small bowel, stomach, spleen(?), etc—with no rice, potatoes, or any other starchy aid. It felt a bit like being stripped naked in public—panic inducing and alarming.

We prayed to bless the food, but in my head I was speaking nothing of blessings, only "God help me!" After "amen" came "dig in," and so I cautiously picked up a piece of something I thought might be liver. But in my mouth I knew it was not; it had to have been some part of the digestive system, and judging on the taste, I'd guess it was near the colon. With heroic effort, I swallowed, silently gagged, and then smiled so as not to offend my host, who, then, immediately said, "Eat more." In desperation, I saw a piece of meat that looked like it could possibly be kidney. I snatched that up because I knew that small bowel would be the end of me. I put the piece in my mouth and the taste was better than the last piece. So—far too hastily, I'll admit—I grabbed a similar looking piece (mind you, it was dark), in an effort to keep from eating anything less desirable.

As I pulled my hand away from the plate with that second piece of meat (too late to retreat), I chewed through the piece in my mouth. It was at that time that my tongue felt the cord, and my hand felt the same. Suddenly, and with no small amount of horror, I remembered that the goat had been a male. Yes…I was eating testicle. The realization put me into a fit of gagging that threatened to end it all for me, but I regained composure, chewed three times and swallowed. I gagged silently until tears came to my eyes, and then I smiled again and set to work on the second. It was by some miracle of grace that I made it through that meal and lived to tell. After those three pieces, I was done, and luckily the plate was almost finished. I said my thank-yous, washed my hands, and wondered if everyone thought me greedy for eating both testicles.

We soon moved on to finish the rest of our dinners. At around 10:30pm, we were finally done eating, and I fell asleep in a chair for about 15 minutes, but was awakened when we all got up and headed to the Easter vigil. After a sermon, a portion of the Jesus video, and lots of singing, the dancing began. I didn't dance, and because I was tired, I returned home to go to bed at around 2am.

Paul, and one of his friends Yacouba, came with me to the compound to make sure that arrangements were comfortable for me. Ecle wasn't feeling well so he had been in bed since around 10. They grabbed a mat and asked if I wanted to go inside one of the rooms. When I told Paul that I'd prefer to sleep outside, he put the mat down in a corner. Yacouba objected and acted surprised at my request, but Paul told him, "No, he is tough. He is African." Not going to lie, I took it as a compliment and let it go straight to my head.

Adventures in Open-Gate Policy

2010-03-09T22:00:00.002Z

Dedicated to all my friends who have made snide remarks about reading my blog “WHEN YOU POST!” And to my mother, whose not-so-subtle reminders have kept me well-aware of the length between my posts.

The vast majority of homes in Mali are surrounded by some type of fence or wall. This seems so contradictory to their hospitable natures at first. However, it soon becomes apparent that for all their myriad purposes (keeping animals in/out, establishing identity, etc.), they have no intention of keeping visitors out. In fact, visiting friends and family at their home is almost a requirement (not really the workplace/golf course friend-types here). They love to be honored by the visit of a friend, even if (or perhaps, especially if) the visit is unannounced and unexpected.

Malian culture teaches the importance of visiting and hosting from both angles. The hospitality of a host is of utmost importance. A Malian pastor recently told me the Bambara proverb that says, “When someone leaves their home to visit you in yours, they should be considered much more important than you.” And I’ve heard many single guys say that one of the qualities they will look for in a wife is someone who would help them make their friends and family welcome in the couple’s home. However, on the other side, it is important to be the visitor as well. This (as strange as this seems to Americans) allows friends and family to play the role of host and exercise their hospitality. It is a way of honoring the person you visit, and nothing helps friendships here like a visit to the friend’s home.

I can say that I’ve worked hard to be a visitor, and I think I’ve been fairly successful—even if my American tendencies do get in the way. For example, instead of just popping in spontaneously, I usually call and invite myself over. Somehow, in my head that just seems so much better. And my friends visit me with a regular frequency now, even if they do call beforehand. (The differences between their calls and mine: Me—“Could I maybe, please, if it isn’t too much trouble, come visit?” Them—“Are you home…good…I’m at your gate.”) They know that the gate is unlocked and they can just come in. With some of my closer friends, I’ve even tried the route of, “when you are here, you are home—so help yourself. If you want something to drink, just go to the fridge.” This has yet to work, but I have high hopes—all this drink-fetching is getting old fast! However, always having more room for improvement, I was recently challenged on how I keep my gate unlocked but not open.

It started like this. There are women/girls in every neighborhood that walk around selling fruit and vegetables from a large plate they carry on their heads. If at first this seems cool and exotic, I can assure that it also fast becomes annoying to be constantly approached by women trying to sell you some piece of vegetation. My approach up to this point was always to refer them to my house guy and let him deal with it. On the weekends, when he isn’t around, I would always just tell them that they needed to come back and see him during the weekdays. My theory being that once you buy from them—much like feeding a stray, or more pertinently, buying from a door-to-door salesman—they’ll be back. This worked well at all the other places I lived, but then I moved to my current house where the setup is a bit different. The ladies started to let themselves in on Saturday mornings.

One Saturday morning I had just gotten out of the shower and had just started shaving when I heard two young girls greeting loudly at my front door. I decided to ignore them, but they just keep calling. This went on for like 5 minutes, and finally I snapped. I went to the door in my towel, shaving cream still covering half my face, and I told them rather forcefully that they were to leave and never open my gate again. I’m sure this made for great stories out on the streets about the crazy white guy who came to the door half-naked.

A few days after that, I was sitting with a few friends in a friend’s courtyard when two young girls walked up selling vegetables. They were not only politely refused, but in the typical Malian way, some joke was made and the girls parted laughing. So I recounted my story to my friends, and they laughed knowingly. They recounted stories of trying to sleep after a night shift at work and being woken by the girls knocking on their door. But to them, it was just a funny aspect of life and didn’t merit getting upset. That is when the conversation switched to my gate. They proceeded to tell me, with smiles but not subtlety, that Malians think you are mean if you leave your gate shut all the time. I told them I’d have to give the open-gate policy a whirl.

After that conversation, I decided that it wouldn’t kill me to leave the gate open more when I was at home, and I resolved to just sit back and enjoy whatever came through. So far, the traffic has been more of the same—girls selling fruit, curious little kids looking into the courtyard, and two guys wanting to have some leaves from one of my trees so they could make a traditional medicine for orthostatic hypotension. And then there was Amadou.

Amadou rolled up to my gate one Saturday afternoon while I was sitting out under the shade of a tree eating my lunch—a little reprieve in an otherwise chaotic day. He didn’t make it much further than the gate before stopping his bike, looking around briefly, and then blurting out, “Hey, Mr., give me a camera.” Now, a good number of kids in town know enough French to demand something—money, candy, etc—so I wasn’t exactly surprised, and I have formulated two responses to their demands. The first being, “I’ll give you money if you give me candy” or “why?” So I responded with the “why” option, to which most kids can’t respond because they don’t speak enough French. But Amadou responded with a rather hilarious account of his love for photography and technology. I was impressed at how well spoken he was for being young (14, I found out later).

So I switched the topic and we talked about his parents, his church, school, upcoming tests…the works. After 20 minutes of talking, he asked if he could leave me his number. I grabbed a post-it from inside the house and brought it out to him. He wrote his number, and then I asked him, “So you have your own cell phone?” When he said yes, I hit him with a line straight out of the “old-man-my-life-was-tough book.” “When I was your age… I didn’t have a cell phone or a camera.” He laughed, kind of, and then changed the topic. After a few more minutes he took off, but not before asking one last time—with hope dripping from his eyes—“So you’ll call me when you get my camera?” Nice try, Amadou, nice try. But being that he had impressed me, I invited him to stop back anytime he was in the neighborhood. He has been back a couple of times and keeps promising to bring me some peanuts. Haven’t gotten the peanuts yet, but I suppose he hasn’t gotten his camera yet either.

But aside from being a potential story-maker, the Open-Gate Policy was an important move in combating my most recent bout of culture shock. There are lots of descriptions of culture shock, and I think everyone has their own experience with it. I always thought it was a period of a few weeks where you struggled to come to grips with the differences between your present surroundings and your home culture. While this isn’t untrue, it gives the false illusion that once those few weeks pass, things go back to being happy, exciting, and wonderful all the time. For me, culture shock comes and goes in spurts. It is a feeling not unlike a head cold—it makes you miserable and all you really want to do is go lay down, but really you know that you aren’t sick enough to stop working, so you keep going with a vague but prominent feeling of frustration, a throbbing head, a heart wishing to be elsewhere, and a brain that is fuzzy and numb.

When I get in that mood, my temptation is to close up, to pull back into the things that are safe and familiar—my American friends, work at the hospital, Skype, Facebook, email, and movies. I know in my head that the cure is the opposite of retreat, it is further immersion. Instead of allowing myself to paint the culture and the people as “ridiculous and crazy,” I force myself to participate in the culture and enjoy the people. In that way, I feel like I constantly have to push my brain and heart open again. And honestly there are moments when I begin to think, “I’m not from a different country as you, I from a whole other planet!” The desire becomes strong to retreat. But then, just as many (and ever increasingly so) moments arrive where once I’ve forced myself open again, I realize, this is what I was made for, this is exactly where I’m supposed to be.

At my finest

2009-12-20T21:10:00.002Z

I rolled over, pushed “Answer”, laid the phone on my face, and mumbled “Allo.” “Jake, we just received a kid that has a fever and vomiting,” said Ecle on the other end. “Yeah, I’m coming,” I said, while hanging up. I was barely cognizant of anything around me, but I knew that I had to get out of the bed. I kicked both my legs off the side of the bed, hoping that would make me uncomfortable enough to lift my head. What time is it anyway, I thought as I fumbled with my clock… 4 am, so not cool.

With what felt like tremendous effort, I sat up, pulled on my scrubs and stumbled to the door. I was driving down the road on my moto before I was fully conscious. The cool night air woke me up just enough to become decidedly angry. “For real… I mean what parent decides to wait until 4 am to bring their kid into the hospital. The kid had probably been sick for days now, and they decide to come NOW? Ridiculous. Do they know that I’m on-call and they just want to spite me? And besides, I already paid my debt to the hospital tonight.”

I had been at the hospital from midnight to two admitting a baby that had come all the way from the capital city. I had lingered to make sure the baby was all taken care of, that the staff understood the orders, and that two of our staff that will soon begin training in pediatrics had a chance to see what I had done. To me, this is more than doing my duty. A second call-in felt really excessive. They couldn’t have come at 1:45?

Pulling up to the hospital, I was grumpy and absolutely convinced that the family had done this to ME, ON PURPOSE. I couldn’t have been more disgusted.

I took off my jacket in the nursing office, then walked into the pediatrics room and saw the child in the mid-seizure. Looking at the terrified expression on the face of the mother and father, my crazy illusions fell to pieces. I could only shake my head at my illogical, unreasonable emotional response. We began treatment on the kid immediately, and after making sure everything was in motion, I left for home. (He made a full recovery and went home a couple days later.)

I limped through the next day, staying at the hospital only because I was needed in surgery that afternoon. By that evening, I wasn’t feeling very good, so I went to bed quite early. The next morning I wasn’t feeling much better, and after three hours at the hospital, I came home again. I spent the rest of the day resting and doing a whole lot of nothing. But while lying around, I couldn’t get that event out of my head. I mean, yes, it was the middle of the night, and I wasn’t in my right mind, but I couldn’t believe how crazy and irrational I had become in my own head. I’m only thankful that I “woke-up” before I said anything stupid to someone else.

I’ve had the joy (ha) of being sick a couple times since then, and the month of December has been a little crazy in addition to all of that. Isaac has his vacation this month, which has left me as the only person on 24/7 anesthesia call. With that combo, I’ve been pretty tired this month and have had plenty of moments where I have felt like I was dredging the bottom of the barrel to keep going. Maybe it is the tiredness, maybe it’s that you run out of things to think about when you are curled up in the fetal position all day, but I have had several lucid moments, in which I have been very cognizant of my weaknesses.

For example, I thrive on busyness when things change enough to keep it interesting, but when the adrenaline disappears and it is the same old, same old at a non-stop pace, it just makes me grumpy. I’m also far too impatient, opinionated, and self-oriented, to name a few others. It isn’t that I didn’t have some inkling of these truths before. It is just that I didn’t feel like they were such prominent traits in my life. Those lucid moments come, and all of a sudden I see these imperfections hanging off my life, like I’m some kind of freakish monster. (And the thought does occur to me that perhaps I’ve been an exceptional brat during the past month, giving rise to my own self-awareness, but also meaning that others have noticed too… a thousand apologies.)

While I’m being honest, I should admit that I’ve never been so deluded as to think I was perfect. And though fair criticism could be leveled at my acting this way, I’ve never even felt like I was “top of the class.” But I’d be lying if I didn’t admit that I did think I was ahead of the curve. And then I moved to Africa. The first thing I noticed was that the other Westerners here, whom I thought would be like me (quality, ahead-of-the-curve types), weren’t exactly what I expected. They were just normal, and maybe even a little weird. Then I started to see their flaws, and this was a bit scandalizing. But it was nothing compared to seeing myself in them—a little weird, a bit complicated, and flawed. If the evidence wasn’t so damning, I might be tempted by disbelief.

To their (our) credit, living in Africa has its challenges. Uprooted from family, friends, and a sense of normalcy, you are always (at least) a little out-of-the-loop—and in my case, a bit confused—as to what is going on around you. The living and the work aren’t the easiest. And you are put smack dab in the middle of people who don’t seem to struggle at all with what you struggle with. For example, Malians, for the most part, thrive on the same old, same old. They have inordinate amounts of patience, they are very careful in expressing opinions, and they are by culture, community-oriented. (Everything that I’m finding, I’m not…)

It’s a bit like being naked in a dark room. You become aware that there are many other people in the room. It is impossible to avoid interaction with them, but you quickly learn to interact while keeping your nakedness hidden. Since it is so dark, no one really understands the extent of your nakedness, and you are unsure of the extent of the nakedness of others. The group quickly adjusts to the manner necessary to continue the polite interaction without things getting ugly. Occasionally, someone bumps into you, making things uncomfortable, but you write it off as their fault for not playing by the rules, not anything having to do with your nakedness. After all, you aren’t perfect, but you know how to play this game. This is life in your home culture.

Moving to Africa (or wherever) is like waking up in another dark room altogether. You stand up and gradually become aware that other people are in the room. No problem, you think, I know how this game is played. You begin following the tacit rules that were in place in the other room. But in the first 10 minutes, you’ve already bumped into several people, and there was that really embarrassing incident where you clobbered and then fell on top of another person. You already feel discouraged, but then with a sense of horror, you realize that your butt has been painted with glo-in-the-dark paint.

Yes, here I am in Africa, with my glo-in-the-dark butt, bumping into people left and right. At other times in my life this would have been discouraging or would have elicited a “I’ll work harder” response. However, this time neither of those options are appealing—maybe because I’m too tired, or maybe because I’m not convinced that either of those responses will do anything. Instead, I’m learning to lean hard into the Lord’s grace. More for myself and more for others. I mean, it gets a little ridiculous to pray, “Lord, forgive my sorry, neon butt,” a hundred times every day…but it’s all I got.

Semper Peccator, Semper Penitans, Semper Justus

Life in Koutiala: Finding the Kingdom

2009-11-29T20:33:00.001Z

Another post that was really funny and profound—when I started writing it, about 3 weeks ago…

This past weekend Dan organized a trip to the village of N’Golonaniasso. He and a team had done one other such trip last year, and it was a huge success. The goal of the trip was to do consultations for the women of the village—the consultations range from nothing more than a well-check-up, to prenatal consults, to screening for diseases that need referral to our hospital or another center for treatment. There is no health clinic in the village, so last trip the team did 200+ consultations. It is a very tangible way of showing the love of Christ. The trip was coordinated with the local pastor, a missionary in his own right. He started a church a little over a year ago in the village, which had no prior church. We came as a way of supporting his work and showing what the Kingdom of God is really all about.

I had the great privilege of going along. The team consisted of 8 Canadians who had come out for a two week trip, a handful of us missionaries, and several of the Malians who work at the hospital. It was really exciting to see how many of our staff wanted to join in. We actually had to put limits on the number of people that could come because the vehicles were too full. The days before the trip, Dan and I spent a lot of time talking about where to put people, and who should perform what jobs. We drew up a mock plan of what our impromptu clinic would look like. We would be using several classrooms and the school yard as our clinic.

The morning of the trip, we were busy packing supplies into cars, doing head-counts, and making last minute arrangements to the mock-plan. Several people had joined the team at the last minute, and others had dropped out. (Which was not a huge surprise to us…it is the nature of a trip here in Mali.) I was busy running around counting people and giving them their job position for the day. Despite all the changes that had to be made, I felt that my plan was coming together quite nicely. I’d be lying if I didn’t say I was a tad-bit self-congratulatory on my competence. (At this point in my life and especially here in Africa, I should realize that this is a big red flag, signaling imminent disaster for me. But some days, I’m just not that bright.)

Because the vehicles were packed full, I had agreed to ride Dan’s dirt bike out to the village. Barry, another missionary, was also riding his bike out, and we picked up a third when one of the Malian guys agreed to drive his bike. I was a bit nervous about riding Dan’s bike, because it is bigger than my little moto and it has a clutch (mine is a cheater bike, you shift, but without clutch)—in other words, it is a real bike. I’m not sure why I get so nervous about these things. I had practiced with it on Friday afternoon, and I felt like I had a rough handle on it, so by Saturday morning, I was actually anticipating the ride. However, in the morning, it became evident that the vehicles were so full that Barry and I would each need to take another guy on the back of our bikes. I had known this was a possibility, but was kind of hoping to avoid it, since it adds a whole other dynamic to the ride (like worrying about killing yourself AND the other guy!). We picked two of the new hires at the hospital, who are smaller and are very experienced in riding on bikes. (As good of a passenger as you could ask for.)

We all prayed as a big group, and then we all loaded up. We on the bikes took off immediately so as to be ahead of the vehicles and the clouds of dust they would create. Barry took off, and I had a little trouble getting my bike started. I finally got it started, but was a little too eager to catch up. Coming out the hospital gate, I shifted, let out the clutch a little fast and gave too much gas at the same time; this made the bike lurch hard and even picked the front tire up a bit. Michel, my very unfortunate passenger, had to grab my shoulders to prevent himself from falling off the back. I tried to laugh it off, but in my head I was embarrassed and I was beginning to regret my choice of passengers.

Now, I’m perfectly aware that what I’m about to say makes me look like an incredibly horrible and shallow person, but as the cliché goes, sometimes the truth hurts. Michel is one of our new hires at the hospital. He also happens to be, hands-down, one of the brightest people we’ve hired in a while. He is a natural leader and seems to have a very committed walk with the Lord. After lurching the bike, one of my first thoughts was, “Oh man, if I injure or kill him today, Terry (director of nursing) is going to kill me.” (Because it would have been so much better to kill or injure someone else!) This was followed by the thought that if I was going to make a fool of myself, I’d prefer to do it in front of someone who was a little less cool. And then immediately I did some self-scolding: “Didn’t you graduate from high-school a long time ago, dork?”

Well, that was the last incident for a while, and the ride progressed well. The sun was bright, the dirt road provided just enough challenge to keep things interesting but not difficult, and the surrounding countryside was beautiful. I began to feel more confident on the bike, and I was really enjoying the ride. (read: red-flag #2) I was riding behind Barry and Josh (the Malian driving his own bike). At one point the driver of a van headed in the other direction flagged us down. I circled back and pulled up alongside his driver’s side. He had just come from the village we were going to and wanted to send a borrowed water bottle back. We obliged and took it from him. I again, circled back and caught up with Barry and Josh. They had both stopped their bikes, so I rolled past them slowly waiting for them to take back their positions, but they had decided to let me lead. Bolstered by my increasing confidence, I decided to try my hand at leading. (read: red-flag #3 and #4)

It may be my imagination, but after I started leading, it seemed the road became considerably worse. I hadn’t been leading long when I came to a large hole in the road. It spanned the whole road, with only a small path around it on the far side. It seemed to have a high center that would be dry enough to drive on. I came up on the puddle a little fast, and not wanting to brake too dramatically in order to take the path on the far side, I decided to run right down the middle ridge. Had this worked out like I was planning, I would have avoided hard braking and would have looked like a very accomplished biker. Instead, the seemingly high and dry ridge through the puddle was nothing more than a quagmire of soft and deep mud. As soon as the rear tire entered the mud, the bike jerked to a stop, stalled, and promptly sunk into the mud. I stuck my feet down into the mud to keep us upright, and then tried restarting, as if, once stuck, I was really going to be able to drive us out.

It soon became apparent that we were going to have to completely dismount and pull the bike out backwards. I was soon muddy to my knees, and Michel lowered himself carefully into the mud, and helped pull the bike out. I emerged from the puddle, covered in mud, embarrassed, and shaking my head. I tried wiping the mud off on bushes on the side of the road, while Josh poured his drinking water on my hands and feet. Meanwhile, Michel brushed himself off and looked like he had walked on top of the mud without really touching it. This is one of those weird truths—Malians live in a world of dirt and dust, and yet they hate getting dirty if it can be avoided. And somehow, they have amazing techniques of staying clean. I, by contrast, am a dirt magnet.

We restarted, this time with Barry back in the lead. We left that dreaded puddle behind. Barry and the rest of the guys would later joke that the puddle was being declared my kingdom. This provided near endless fodder for the rest of the day. By the time we arrived in the village, I was covered to my knees in mud, my shoes were full of now-dry mud, and my face was covered in dust from riding behind the other two guys the whole way. So much for being cool…
After washing with a provided bucket of water, and changing into a pair of scrubs, I began to feel a little more ready to face the rest of the day. We quickly began to set up the classrooms, and prepare them to become impromptu clinics. The vehicles arrived and we unloaded all the gear. And though we were moving and getting things done, it felt very much laid back. There was some initial confusion as to whether or not we would be seeing children, but we didn’t have permission from the government minister of health to see kids in the village, so we had to turn them away.

The clinic went very well. While the patient’s waited, one of our nurses did teaching on basic health topics. Because rains were later this year, many people were out in the fields to bring in the harvest, so we only ended up seeing about 85 people. During the afternoon, we organized a soccer game with the local kids. The nurses did a great job of organizing them, telling them the rules, and praying with them before we started. As I reflect on the whole day, the feeling was that we were “not far from the Kingdom” as Jesus says to the scribe who correctly grasps the importance of loving God and others.

Around 6 pm, we closed up shop, ate a wonderful meal, and then began to setup for our evening event. That evening, we had invited everyone who wanted to come, to watch a film and hear the pastor speak. The group was small at first, but it began to grow and grow. At night fall there were already 200 people gathered as the pastor began to speak. Before starting, we learned that the local marabous (Muslim witch-doctors) had organized an event to oppose us and to distract people from our presence. The year before, after the pastor presented the gospel, a large number of people stood and started walking forward, and suddenly the older people in the crowd grabbed the people and forced them to sit back down. So the opposition was not at all shocking.

The night was pitch black, with a sky full of incredible stars, and people kept pouring in to the little gathering area. I was on the edge of the crowd and I was just completely overwhelmed. While the pastor spoke and then while the movie played, I stayed on the outside of the crowd, walking back and forth, praising the Lord and asking Him to be powerfully present. The excitement and possibility of people stepping into the Kingdom of the Lord that very night hung in the air, like nothing I’ve ever felt before.

In the end, no one overtly responded to the presentation of the gospel, despite the crowd growing to nearly 450 people (there are only 60 known Christians in the village). However, in the days following, several people approached the pastor to discuss what was said that night. Two people made concrete decisions to follow Jesus, and I trust that seeds were planted in many other hearts.

Over the past several years, there has been a correction to evangelical theology, which has changed our prior neglect of social justice issues. One large vein of this correction has come under a renewed emphasis on what Jesus said about the Kingdom of God. He taught that He had come to establish the Kingdom—literally a people among whom the will of God is done and who, empowered by His Spirit, work to repeal the effects of sin in their own lives and in the world in general. He repeatedly emphasized the two most important commandments of this Kingdom—loving God and others. And He gave repeated signs of how the world would look under the reign of God—healing from disease, justice for the poor, freedom from demonic influence, and a friendship with God. I’ve really appreciated this theological correction, and have seen how it has practically affected how I view myself in this world. Days like this past weekend, I’m delighted to be a part of advancing that Kingdom in all its fullness.

After all, in comparison to His Kingdom, my own fabricated kingdoms are nothing more than big, muddy puddles.

Life in Koutiala: Malian Flintstones

2009-11-01T21:31:00.001Z

Ibrehima stands roughly six feet tall; he is muscular but thin. His face is a series of sharp angles that are so pronounced that most people describe him as the “one with the angular face.” He walks with a confident swagger, arms swinging at his sides in a manner that could almost be mistaken for dancing—dancing being something he does incredibly well. He seems to have two moods, a serious and a funny one. In his serious mood, he is a bit intense, doesn’t smile, and becomes much more direct than the vast majority of his Malian countrymen. The angles in his face, sharpened by the intensity, make him look like someone you wouldn’t want to meet in a dark alley. When I was training him in the vaccination clinic, he turned to me one day, and said rather sharply, “You write your numbers wrong.” He began enumerating the differences in the ways Americans and Malians write their numbers. It was clear that I needed to change my style of writing. But in his funny mood, a huge smile spreads across his face, easing the lines, and revealing a large gap between his two front teeth. His manner relaxes, and he becomes quite witty. His laughter is contagious and he is a pleasure to be around.

Yaya is about 5’9’’ with a round face and cheeks that are high and a bit chubby. He smiles the vast majority of the time, in a manner that smacks of an excited, cartoon squirrel. He is a bit timid and sometimes downright nervous (enhancing the squirrel image). At the end of stating his opinion, he almost always ends with a nervous, “ou bien” (or…well?), providing space for someone to change or correct what he has just said. During the summer, he had to step up to the responsibility of being the nurse-in-charge during a couple days, because our other senior nurses were on vacation. The first day of these new duties, his face beamed with pride for having been selected for the responsibility, and he ran back and forth between nursing areas with a manner both excited and nervous. He laughs frequently, but isn’t the first in a crowd to crack a joke. He checks in regularly with the nursing director to find out her opinion of his performance. In addition to his duties as a nurse in the wards, he also works in the OR with us. He does a good job, but is slowed down because he wants to follow, thoroughly, the step-by-step process he was taught. I really enjoy Yaya, but he definitely gives off the impression of having been the kid that got picked on in school.

The two are inseparable.

I wouldn’t have picked it in a million years. The jock and the nerd as best friends. It is one of those funny realities of African life and friendship. They live rather close to one another, and according to their own statements, if they aren’t at the hospital, they are hanging out together. You wouldn’t have picked them out as your Fred and Barney, but they’ve got friendship loyalty down.

Awhile back, Yaya invited me to come drink tea at his place. Tea drinking is the major “hang-out” activity in Mali (possibly the “only” hang-out activity). It’s kind of like the American coffee-house scene...but not quite. They have these little charcoal stoves that they put the teapot on. They add loose tea leaves and lots of sugar. The rounds of tea are served in shot glasses (because it is that strong). More water is added to the pot, and another round is prepared. Each time, the tea becomes more sweet and less bitter. Three rounds (the normal use for one bag of tea leaves) can take a couple of hours to complete, if you drag it out. In between the thirty second intervals of downing tea, you are left with nothing but the heat, hopefully some shade, and lots of time to talk. It might be the incredible amounts of caffeine, but truthfully, I find the whole process intoxicating and completely enjoyable.

However, every time Yaya and I tried to get together, we were interrupted by something or other. So we finally set a firm date for a Sunday. He called me about 4 times in the days leading up to the “tea party” to make sure that I was doing well and to let me know he hoped we wouldn’t be interrupted this time. Ibrehima called me once, the day of, and said, “You didn’t forget did you?” “No,” I assured him. “Good. See you soon.” Click.

So Sunday, after eating lunch with Terry and Barry (missionary couple) and overstaying at their place, I rushed up to Yaya’s place. He rents a room on a compound. It is a room in a cement building with a door to the outside; this is where he sleeps and keeps all his worldly belongings (Much of your living is done in the courtyard of the compound, or out in the street under a tree.) The land-lady does his cooking for him, and overall it seems to be a good arrangement. When I pulled up, Ibrehima, Yaya, and Yaya’s younger brother (who now lives with him) were all sitting under a tree in the street by the compound.

I greeted them all, pulled up a chair, and was almost immediately served a glass of tea. I sipped some, and said, “Hmm… it’s the second round already.” Ibrehima, with a big smile, explained that the first round had been on time, and I was not. Touché. After this gentle ribbing, we settled into easy conversation under the shade of the tree. We were about 4 meters from a garbage pile that had the drain from an outhouse (the drain was for the water used for showering and for washing the floor for the outhouse…not excrement, I think...) running right through it. The wind was from the other direction, so it ruined the scenery but the smell didn’t come our way, until the local herd of pigs got chased out of a nearby millet field and began to dig through the garbage.

Ibrehima was a bit tired, but was being a good sport. He had worked all night and still hadn’t slept. We talked everything from the weather, to crops, to the differences in Malian and American dating. It was this last topic that kept coming back to the conversation, until finally Yaya blurted out his news. He was engaged as of the previous weekend, and his fiancée happened to be visiting Koutiala at the time. And it was then that I knew this visit was going to take on a different form. We had already had about 6 rounds of tea, so it was time to bring that to an end. The guys took turns going to their homes to change, and when they were ready, we took off to visit Yaya’s fiancée.

She was staying at the home of one of the pastors in town, so we headed over there. I wasn’t at all sure how all this was supposed to “go down.” Men and women rarely show affection for each other in public (and public being in front of any other person), so it wasn’t like they were going to sit there and hold hands while we all chatted. I figured that Ibrehima and I would be some sort of go-between, since that seems to be a big cultural tradition.

We pulled into the pastor’s compound, and walked up to greet the men who were all sitting in a circle. It was dark, but the night sky was clear, and the stars were incredible. (I’ve become a huge fan of sitting out under the stars, in the pitch dark, having relaxed conversation.) About the time we sat down, the cumulative effect of the 6 glasses of tea took hold, and I felt like I should be running, not sitting. But as jittery as I felt, Yaya was by far worse. He was visibly nervous. We made small talk with the pastor and his friends. I ask the pastor about some recent happenings, and about that time, Yaya’s fiancée emerged to greet us.

She started on the far side of the circle, greeting the pastor and his friends first. Then she approached the back of Ibrehima’s chair, kneeled, and whispered greetings to him. When she came to the back of my chair, I twisted around to look at her. Even staring at her, I couldn’t hear what she was saying. I understand the basics of the Bambara greetings now, but that didn’t help me. Luckily, it is standard practice for beginners to answer “No problems” to every question. (Granted, using this method, I have inadvertently told my fair share number of people that there are “no problems” with my wife and kids.) I greeted her back, and then she slipped behind Yaya’s chair, knelt, and spent the next couple minutes whispering to him. Then she backed away into the shadows; Yaya turned around, face beaming.

Now, normally I try to be chill and just roll with the cultural punches. Blame it on the caffeine, but that night, I just didn’t roll. In my head, I was like, “This is ridiculous.” We came all the way here, dragging poor, tired Ibrehima along, for 2 minutes of conversation!? I at least expected her to sit and chat for awhile. It is no wonder they act like perfect strangers at their weddings. I also really struggled with her subservient role. She was just doing what is culturally appropriate—showing respect to the friends of her fiancée. (Something that many guys have told me is important in selecting a future wife—that she respect their friends. It seems almost the inverse in the States—the friends must respect the fiancée.) I can handle the polite curtsy that the girls do when shaking hands with me, but being knelt before is a little much for me. I’m not a far-left feminist, but I think there is quite a bit to be said for elevating the position of women in a society. The whole thing just struck me as weird.

But we weren’t finished yet. Ibrehima still had his role to play. And that is why it pays to have a dedicated and culturally-wise friend in this culture. About two minutes after Anne (the fiancée) left, Ibrehima dismissed himself to go to the restroom. But instead of returning to the main circle, I could his shadowy figure talking with another young man who lived on the compound. Soon they were sitting against a wall of the house, a good 15 meters from where we were, and they were joined by more young men. I was pretty sure that he had just brilliantly acted out his role as the “go-between,” using tactics perfected from years of watching other people do the same. (That’s only conjecture based on my observations; they could be wrong, but seem to fit with the little that I know.)

Another five minutes of awkward small talk past, and then it was clear that Ibrehima had opened a door of opportunity for us. We politely dismissed ourselves from the group, and went over to greet the other guys. We sat down and were, immediately, much more at ease. I knew all three of the other guys that were sitting with us, and our conversation picked up a more lively pace. I leaned over, grabbed Yaya’s wrist, and pretended that I was taking his pulse. “Yup,” I said, “his heart is beating way too fast. I think we are going to get him out of here, for his health.” This elicited a howling chorus of laughter. (I’d love to congratulate myself on my comedic genius, but Malians love to laugh and will crack up at even the worst attempts at humor.) After more joking and laughing, Ibrehima brought his role to its completion. He asked one of the guys if Anne was still around, and if could she come and sit and talk with the group for a moment.

Sure enough, that worked, and she soon joined our little circle. But despite being a much more laid-back environment, she was still very reserved and shy. I tried to ask her a couple questions (like, where she grew up, etc), but what little response I got was in mumbled French that I could barely hear. I’m apparently very intimidating!

After about 20 minutes, Ibrehima looked like he was going to fall asleep on the bench, so we began to say our good-byes. We drove off, Yaya leading the way, and a very tired Ibrehima on the back of my moto. Yaya had gotten his opportunity to introduce me to his fiancée and to spend a little time with her; the giant smile on his face said it all. And Ibrehima, well, exhausted as he was, he had played well his role as best-friend/go-between/opportunity-creator. I was really impressed by his loyalty and self-sacrifice for his friend. I realize that in the grand scheme of things, it wasn’t a huge thing, but that night in my reflection, it seemed like the stuff that movies are made of; the stuff that is enviable in all the great “dynamic-duos”; the stuff we all long for—someone to love us and be loyal to us. It got me wondering how many times I’ve allowed my tiredness (or busyness) to get in the way of being loyal to my friends, or being there for them when they needed me.

Funny how that works so differently here. Often in the States, when one guy gets engaged, his time is swallowed up in his relationship with his fiancée, and he will get less “guy-time” to hang out with his good friends. Here, an engagement means that you are all the more dependent on your friendships. No judgment call on that, just an observation of difference.

It has become (almost) cliché to talk about how people in the third-world are so much better at relationships than we in the West. I’m not convinced that such a broad statement is accurate; I think it is more nuanced than that. For example, I would argue that Westerners, though far from perfect, generally have better male-female relationships in terms of equality, general friendship, and in marriage. (Our rampant sexuality and divorce rate suggests we still have a long way to go.)

Instead of being about who is better about “relationships” as a whole, it seems to be about the priority of our values that affect relationships. I personally, think it is very important to hold honesty in a high priority, whereas Malians might tend to tell you what you want to hear, so as not to create tension. But we have volumes to learn about loyalty, patience, and acceptance from our Malian friends. We all, in our fallenness, seem to get these priorities out of whack at times—elevating one too far above others, to the detriment of our relationships. We do well to learn from one another—even in those moments when you want to say, “Are you kidding me right now? This is ridiculous.”

Daouda Update

2009-10-31T16:32:00.002Z

This is our little guy that we've had so much trouble with. He arrived with an old burn, that had caused his lip to scar all the way to his collar bone. So his mouth was open all the time and his left eye was pulled open all the time. (Other pictures in previous posts.)

We are almost done with him. We did a skin graft last week, but it looks like not all of it took, so we'll probably need to do a little more. He is really fed up with the hospital and with us in general--never knowing what the new day holds. Friday, he was in a good mood, so he came to my office. What you can't see in this picture is the candy in his hands just below the level of the shot. (Hence the smile.) Continue to pray for him--he still has a road of healing ahead of him.

Abana!

2009-10-27T21:54:00.002Z

Yesterday was the last day of Aruna's chemotherapy (for the Burkitt's Lymphoma). We had been telling him all day that this was the last time he had to get an IV, but he didn't seem to be very excited. (I think his mind was still on the IV for the moment.)

This morning, I went in to take out his IV. After finishing, I said, "Aruna, abana." Bambara for "it's finished." He looked back at me and asked, with a face full of question and excitement, "abana?" (Is it really finished?) "Abana," I said. And with a huge smile he yelled, "Abana!"

It was so cute and funny that I went and grabbed Brett. The two of them started a little cheer. Below is a short video clip. (Unfortunately, the blog doesn't allow it to be super clear, but hopefully, you'll enjoy it anyways.)

I sat down with a pastor and Aruna's father yesterday. Brett and I felt like it was important for the father to know that we had done all of this work for Aruna because of our love for the Lord and His command to love others. I explained that to the father (with the pastor translating into Bambara). I told him that he was a great father for always comforting Aruna during his treatments and for bringing him back week after week, even during harvest season. And then I shared with him the thought that God is a Good Father and that He has given us gift. I let the pastor continue on with a short Gospel presentation. When he finished, Aruna's dad responded in a very touching way.

He said that when they came to the hospital, he had already lost all hope for his son. But when he walked onto the hospital, he said he could feel that God's hand was in the place. He said he could see it in the way we cared for his son and in the way our team worked together. He also said that before coming to the hospital, he had never heard of Jesus, since he is from a remote village. We have little radios that play dramatized Bible stories, and he said that he had been listening to those. He concluded with the fact that things were obviously different here and that he really needed to think about it all.

Continue to pray for Aruna and his father, Mumuni.

Pediatric Cases #2

2009-09-26T18:05:00.005Z

I thought I'd post a few photos of what we've been doing in Pediatrics lately. [And I should have grabbed some photos of our severe malnutrition patients, but these will suffice.]

Let me introduce you to Daouda (David in Bambara). This is truly one of the bravest little kids I've ever met. He's not a big fan of me right now (lots of shots and dressing changes lately...) despite my constant efforts to keep him hooked up with candy and coloring books.

Because of his deformity, he had to wear this ski-hood every time he went out into public. You can imagine how warm this was.

When he was four, Daouda was burned. The resulting scar pulled his lower lip down to his collar bone. This severely limited the movement in his neck, and held his mouth constantly open. It also pulled on his left eye and ear.

This is a picture of Daouda a couple days after surgery. You can see we were able to free up his lip. Though the scarring is still extensive, his mobility has been largely returned. Please continue to pray for Daouda. He currently has an infection in his surgical wounds that threatens to undo much of what we accomplished.

Above is Aruna. He had Burkitt's Lymphoma. We have completed several rounds of chemotherapy for him. At first, Brett and I (with minimal chemotherapy experience between us) had big pow-wows to figure out how to do his chemo and his management afterwards. We've now gotten much more proficient. The last two rounds of chemo I've done all by myself, including the spinal taps. The tumor is completely gone, and we have only a few rounds left to guard against relapse. In the first picture, Aruna at admission. The second picture is Aruna now. His facial bones are slightly displaced because of how large the tumor got (and we are hopeful that the bones will remodel a bit and you'll soon not be able to tell.), but the tumor is gone.

I snapped the picture above right before the family left the hospital, and of course, I forgot to get the kid's name. He was many of our severe malaria cases, but he was particularly bad. He had cerebral malaria and despite our best treatments he was in a state of constant seizing and didn't appear to be getting any better. I was on-call one night, and I went to look at him. He looked terrible; he was tachycardiac, his oxygen saturation was around 80% (normal healthy people should be between 95-100%) even with 5 liters oxgen (the max we can give), and his respirations were irregular and shallow. I figured he would be leaving us in a matter of a couple hours. I called Ecle (A-klay) the Malian charge-nurse, and explained my assessment. I asked if we could talk to the family.

We took the dad into the nursing office, and through Ecle, I explained the situation. In Mali, you don't say someone is dying, because this could be interpreted as cursing the patient. So I said that the child was "VERY sick," and that without a miracle from the Lord, there wouldn't be a whole lot of hope. After I explained all this, and it was translated, I asked the dad if we could pray for him. He agreed, and I asked for one of the nurses to pray for him in Bambara. Everyone was a bit reserved, but Ecle finally spoke up and led out in prayer. I'm not sure what he prayed, but the day this kid was leaving, I grabbed Ecle, took him to the bedside, and said, "This is your miracle kid. Proof that the Lord is responsive to our prayers." I also brought Mama Germaine, one of our older, "motherly" nurses who has a direct but gentle way of explaining things to the bedside and told her to express to the family my personal feeling that this kid was a miracle, and that they needed to thank Jesus for His work.

And what would another pediatric case update be without a picture of Miriam. She has gone home with her caretaker, Elizabeth. She made a recent visit to the hospital to see us. She is still cubby and now she is regrowing hair. Above she is pictured with Elizabeth (her temporary caretaker) and her "adopted brother" Abou. (You can see "before" pictures under the post "Medicine in Koutiala: Case Updates.") Continue to pray for Miriam and her safety. In another month or so, she is scheduled to return to her grandmother (who got her into this mess in the first place...).

Follow-up on Malaria Post

2009-09-26T17:56:00.002Z

I'm currently reading the book, "The Shackled Continent," by Robert Guest. This passage, I thought, went well with what I had written last week about malaria:

"One problem that Africans are almost powerless to solve, at least in the short term, is that most medical research is done in rich countries for the benefit of rich people. The fattest profits are to be made tackling chronic conditions that affect lots of Wsesterners, such as heart disease and cancer. The ills of the poor are neglected: of the 1,223 drugs introduced between 1975 and 1996, only thirteen were aimed at tropical diseases. In 1998, the world spent $70 billion on health research, but only $300 million of this was directed at developing an AIDS vaccine, and a mere $100 million was devoted to fighting malaria." (pg. 202)

Medicine in Koutiala: Malaria Bites

2009-09-19T18:17:00.000Z

I was working late in the office one evening, when my phone rang. “On a besoin de toi, tout de suite au Rea,” (“we need you, stat, in reanimation”) said a voice on the other end. “J’arrive,” I replied, rising, hanging up, and throwing my stethoscope over my neck. I jogged down to the Rea to see what was going on. I could hear the kid breathing before I entered the room. A four-year old boy lay on the bed, chocking on his own spit and vomit, after having just seized. I grabbed a suction machine and tried to clear his airway. After four or five passes, the rasping and bubbling in his throat cleared. I positioned his head and neck to allow him to breathe more clearly. Even with these interventions, his breathing was labored and you could feel the rattle through his chest from the stuff he had aspirated into his lungs.

While another nurse attached monitoring equipment, another helped me ask questions of the parents. The child had been sick for four days and this was his third seizure. Malaria. Not good, I thought myself, you don’t want to fool around with malaria. (It’s not that my diagnostic skills are that good, it is just that 99% of kids coming in right now are malaria cases.) But encouraged by our recent string of victories, I was still very calm. The monitoring equipment seemed to be malfunctioning, so I asked the nurse to go get a new machine. She left, and I pulled the lower lid of the kid’s eye down to look at the conjunctiva. (The third-world version of a quick blood-count.) Where normally you find a rosy red inner eye lid, I saw a pale white. “Oxygene!” I yelled. I sent one nurse running for oxygen and the other for IV start supplies.

In an instant, I went from calm to significantly panicked. Before either of the other nurses came back, I saw the boy’s chest start to move irregularly. Then a pause, and a gasp. I jammed my fingers into his neck to feel his pulse. Bump, Bump…Bump…….Bump……Bump………. The word I screamed in my head at that moment was very unsanctified, very not-missionary; but I hardly know a word that is more sufficient to express my feelings on this disease.

I pulled the sheet over the little kid’s face, and turned to look at the stone-like faces of his mother and father. Sorry, I half-said, half-whispered. Without making a sound, the mother got up and left. The father lingered a moment. I had one of the nurses translate my condolences, and then explained that the malaria had progressed too fast and there was nothing we could do. He nodded solemnly and then walked out.

I made final arrangements with the nurses and then walked out. At first I wanted to play the “what-if” game. What if I had started the IV sooner? What if I had gotten oxygen sooner? I should have looked at his eyes sooner. What if… But my background in critical care medicine has taught me that this is never productive, nor does it represent any form of reality. So I tried hard to stop. I called Brett (the pediatrician), played the what-if game a bit more, and stopped when he spoke the same words that I knew to be true. “The kid just got to us too late.”

And then I got mad.

And I’m still angry. At first, I couldn’t find one direction to point my anger. I wanted to yell at the parents for waiting so long, for not even getting some kind of treatment. I wanted to tell the government that they had done a crappy job at educating their people. I wanted to write the UN and tell them to ship an army here, because we are getting flogged by this disease. But the parents looked poor to me, so I knew that they had waited part because of financial pressure, part from lack of education, and more than likely, they lived in an outlying village and it had taken some time to get to the hospital. The government is already providing free medicine for malaria, and though it is far from perfect, it’s doing a decent job as far as governments go. And the UN…well, whatever…it just doesn’t feel very productive to get mad at the UN.

But I’m still angry. The next day, we lost two more. A little later, I watched two parents throw themselves on the floor in tears as their seven-year-old, their only child, passed away moments after they laid him on our hospital bed. (First Malian man I’ve ever seen cry.) This past week, we’ve had at least two or three new cases a day that we admit. (That’s a lot, considering that pediatrics isn’t even technically open. And that’s not counting the ones seen in outpatient clinic who are sick but well enough to go home on meds.) Some of them get better, some we lose. And all of a sudden this mysterious, tropical disease has an ugly face to go with its name for me.

Isaac, who before the opening of the hospital worked in a rural clinic, told me that during this season every year it is not that strange to have at least one death a day in the village from malaria. Brett has asked, more than once, out loud, “How do any children survive here?” I wonder the same thing. It’s no wonder that some parents stay a bit aloof of their young children. (They often don’t cry at deaths, first because they are so over-exposed to death and second because Islamic teaching says that if a child dies it is Allah’s will; to cry is to tell Allah that you disagree with his will. This is not true of every family.)

The problems are multifaceted. The first is a lack of education. Malians seem to be unaware that their malaria problems have a season. During the dry season, we don’t see malaria, but with the rains come the mosquitoes. So in May, when your kid vomits, you relax and figure it is just a stomach bug. If they vomit in September, you should load them on the moto and get to the nearest hospital. That doesn’t seem clear to them. The seasonal-ness of malaria here may also be part of the problem. If kids were exposed to small numbers of parasites during the whole year, they might form antibodies better. Instead they go through a period of little or no exposure, and then are hit with a wave of parasites.

Medicines are also problematic. The government gives out a very good malaria treatment. However, it comes in pill form. The pills work well, if they are started in time, and the kids keep them down. A frequent symptom of malaria is nausea and vomiting. Some parents don’t even have access to these pills. Others try traditional treatments first. Still others try single-drug syrups or injectable quinine, which can work, but malaria often develops resistance to single-drug therapies. The very best treatment (in country) is expensive and is only sold in a box set for adults (making it much more expensive). We offer this treatment much cheaper because we share the vials among our multiple pediatric patients. (i.e. making it possible for the kids to get just the doses they need instead of having to buy a box set that they won’t use all of.) So when a child comes down with severe malaria, parents often waste precious time getting them the very best treatment because they try other options first.

And then, frankly, the reality is that malaria doesn’t exist in first-world countries. We wiped it out with the use of DDT and other extreme measures. We have, however, placed bans on DDT as it no longer affects us. (And I’m not necessarily advocating the use of DDT here.) And this is where my frustration and anger have found roost. How is it that we know so little about this disease in the West?! (And truthfully, care less.) Between 100-300 million people (mostly children) die every year from malaria. 36 million people die from starvation every year. Contrast that with the 25 million HIV-related deaths BETWEEN 1981 and 2006! We hear a ton about HIV (and rightfully so…) but hear little about malaria, even though malaria kills 100 times the number of people! Or, do I dare say it? Yup, the number of world-wide abortions every year is estimated at 46 million. Not saying that HIV and abortion aren’t worthwhile concerns, but it seems like if we wanted the most bang for our buck, we’d go after malaria. I wonder why we have so separated ourselves from this disease. (Grain of salt…statistics taken from Wikipedia.)

I feel a certain moral-outrage about this disease. It is a smear on the face of our world. It is a symptom of our world, corrupted by our sin. It is made worse by our complacency. I’m ashamed that I didn’t know more about it before now. Do what you want…but I’ve asked the Lord to never allow me to become complacent about this disease. As long as He allows me the privilege, I’ll be here kicking back.

Life in Koutiala: Get out of town

2009-09-17T22:06:00.002Z

It had been a long few weeks. Isaac had been sick with some typhoid/malaria combination and that had left me on-call for anesthesia for a couple weeks straight. Then I added in Pediatric call starting September 2nd, so I was having lots of long days and late nights. So I was quite ready to wind-down into my weekend with no call, and when Paul proposed a trip to the village, I was all over it.

It was, as I’m learning, a typical Malian invitation. I was leaving the hospital just as he was arriving for his night shift. I stopped to talk with him, and the conversation switched to the weekend. He started talking about how he and Eclesiate were going to the village in which Ecle (A-klay; for short) grew up—Zamblala. And then—and this is the problem—some comment or question led me to believe I was invited to come along. But I don’t even remember what it was. It was definitely not a direct question, like “Do you want to come along?” It was way more subtle than that. So subtle, in fact, that driving away, I really began to wonder if I was really invited or whether I had just invited myself. Either way, I figured, their reaction to my “acceptance” (or self-invitation) had been positive.

That evening I ran my trip past some seasoned veterans in efforts to keep unexpected adventures to a minimum. They told me quite a bit about the town. One of the few places in Mali that is predominately Christian, as opposed to predominately Muslim; quite a friendly little town; take your own water; etc. Olive, a 30-year veteran of Mali living, wondered why the two guys were heading back to the village. Probably a young lady was involved, she mused. She recommended being prepared to spend the night. She called Ecle to make sure the road was good since I had agreed to drive. (Don’t worry, Jessica, the road was in really good condition and I took it nice and slow!)

The next morning I was up and preparing when the guys called to tell me they would be ready at 8:30. I threw together a bare-bones overnight bag. Change of clothes, toothbrush, deodorant, diarrhea medication… trying to fit all into a small little backpack. (I really dislike being the “white guy with all the luggage.) I took off, feeling quite ready to leave Koutiala. (I haven’t left Koutiala since arriving here in Mali, except for my wedding trip to Bamako and my vacation to Bobo. I was beginning to feel very confined.)

When I pulled up to pick up Paul and Ecle, I immediately knew something was not as I had expected. They were both dressed in their matching wedding shirts (from the previous wedding). They climbed in and we took off, while Ecle explained that the real reason for the trip to the village today was a wedding of his “big brother.” (Quotes because I think the guy was probably more like a distant cousin…) Sweet…thanks for the heads up, guys. And again, that nagging question, did I invite myself on this trip? Since weddings are more open-invite affairs here, I’ve learned to be a bit more comfortable going with friends to weddings without an invitation in hand, but inviting myself to the wedding of someone I don’t even know, is still a bit uncomfortable.

Luckily, I had packed a boubou (traditional West African formal wear) in case we had spent the night, much better attire for a wedding than my t-shirt. And I decided to trust in the unfailing hospitality of my hosts (self-invited or not). So we turned on the radio and enjoyed the ride. I had the guys help me rehearse my Bambara greetings, since there would be very few French speakers in the village. I’ll admit that my Bambara is terrible. In the hurry to acclimate and get to work, I spent all my energy working on learning other things. It is pretty pathetic that after 4 months in the country I can’t even properly greet people in Bambara (goes against everything I believe…really), but finally, it is starting to come.

After 15 kilometers on paved road, we pulled off onto a dirt, donkey-cart path and went another 10 kilometers. The road was narrow and surrounded by shrubs and millet and corn fields, but the surface was even and the going was smooth. We had to stop several times to figure out how to get around an on-coming donkey cart. And the best was when we came around a corner and stopped suddenly in front of an on-coming cattle plow-team, led by a boy that couldn’t be more than 7. It took him a full five minutes to get the team off the road, being less than 1/8 the size of even one of the cows. We probably should have helped, but we were too busy laughing and digging out my camera to take a picture of him pushing and pulling with all his might on the stubborn beasts.

[This picture made possible by me sitting in my car laughing, instead of helping the poor kid!]

Pulling up to the village, we had to drive over the narrow dam that has created rice fields for the village. The village itself is little collections of houses, interspersed with huge mango trees and fields of corn, millet, and cotton. Healthy looking chickens, pigs, and goats were everywhere. I’m not an expert on village living, but I would say this village was doing well for itself.

We parked the car in front of the compound of Ecle’s grandfather. The compound is a large, walled-in area that has houses for the grandfather and his sons. There were easily 80 people in the compound that morning. And the greeting began. And the greeting continued. This is what we did for the vast majority of the morning. We greeted, we sat for the appropriate length of time in their presence, and then we were off to the next family. We traveled the village on foot, meeting countless people, visiting the schools, the small health clinic, and the church. At each place, there was the rush to find chairs for us, to properly welcome us.

After our first few stops, Paul and Ecle began to explain that the village was very on-edge that morning because the bride had not shown up. (She was from a village a ways away.) Normally she should have come the day before, in order to have been there for the all-night party. They had thrown the party anyways, but preparations for the wedding were at a stand-still that morning. Some imagined an accident, others that the parents of the bride were playing some trick to get more gifts and money from the groom. A delegation had been sent to find her.

This was eliciting complaints from everyone, at every stop. Some of the concern was for the groom—the shame and disappointment of a failed wedding. Some of it—coming from the women—was over when to start preparing the food. And some was over the delay of an anticipated event. These events are clearly a highlight of life in the village, and people wanted to get on with the party. Paul and Ecle, who had worked all night, wanted to get on with it so that they could get home and sleep.

It was while walking around the village, visiting, greeting, and guessing with Ecle and Paul what had happened to the bride that the reality of my situation washed over me. I would occasionally get a similar feeling in Utah. It would come when I was driving on the interstate with a clear view of the mountains, I would suddenly catch my breath, and it would wash over me again—their grandeur, their majestic beauty—as if I was seeing them again for the first time. It was the same here. I looked at the blue sky lit up with a blazing sun, the palms and mango trees framed with white clouds, and the red dirt of paths and mud huts. And I felt like I should pinch myself. “I’m in Africa,” I thought. I’ve dreamed of this all my life, and here I am. I felt very blessed.

Around noon, the bride finally arrived. The story I heard is that a car was supposed to bring her to the village, but there were too many people wanting to go, so they had to take two trips. So they left the bride and her attendant and took the other people first. Very funny, but strangely not surprising.

We retired to Ecle’s compound. We sat in the shade of a room and talked for a while, not knowing when the wedding would start. And here I observed yet another fascinating thing about village life. All of a sudden, Paul and Ecle got up and said that it was time to go to the church. No one had come in to announce this. There was no ringing of bells or PA announcement, no phone calls, no text messages. I can only assume they heard people talking about it outside. We took off for the church and were some of the first to arrive, but less than two minutes later, the whole village was there. Much like the beats in music that they hear and I don’t, there is some kind of rhythm in the village life that I just am not tuned into.

We all entered the church just as the rain began to fall. And it came hard. The racket made it hard to hear the service, but Paul, sitting right next to me, was translating most of it into French for me, and he seemed to be able to understand enough of what was going on.

The ceremony was shorter than the one in Bamako. And after the service, we all made mad dashes back to the village for cover. Paul, Ecle and I ate in a back room of one of the houses. The food was excellent. A rice-and-sauce dish with pork and noodles with chicken. We ate and then brewed tea to drink. The rain continued to fall hard. I began to have fears that the road would wash out and that’d we would be stranded.

The rain slowed towards the evening and so we said our goodbyes, picked our way through the mud to the car, and took off. The road was very muddy on the way back, but still very much intact. We made it back without problems, and I dropped the guys off at their home. I thanked them for a great day, and they promised we’d do it again soon. I look forward to it.

[Ecle and I eating dinner.]

[Ecle and Paul]

Pediatric Cases

2009-08-22T22:10:00.006Z

Some days, it is just rough... (thanks Nienke for taking this picture)

A couple of twins that we have been working with. Looks like the worst of it is over for these little guys and they are starting to gain weight. Sheri and I have been the dynamic neonatal rounding team the past couple of weeks. We divide the twins up into "my baby" and "your baby" and then compare progress and weight-gain, as if it were our superior abilities that gave our baby the edge. (Sheri...I still say that mine is cuter.)

Miriam! Can you believe it?! She's getting fatter by the day. Cute as a button too. (See the post "Medicine in Koutiala: Case Updates" below for a contrasting picture.)

Osman, the 12-year-old with a cleft lip [before and after surgery]. He has never been allowed to go to school because his deformity brought shame on the family.

Our little guy with Burkitt's lymphoma. When he came in, the tumor was so advanced that it was pulling his eye lids down so tears would just naturally flow out of them and he couldn't even close his mouth. Again, because of shame, in public he wore a handkerchief tied around his face, so as not to be seen. About 5 days later, the tumor had already shrunk significantly. He went home with his parents for a week, and then will come back for his remaining treatments. I'll take pictures of him when he gets back, because the tumor was even more reduced his last day with us, but I'd forgotten my camera.

Life in Koutiala: In the hands of my friends; part 2

2009-08-15T11:04:00.002Z

The soft foam mattress sucked me in and I was immediately asleep. But I was awakened by a loud thudding, what seemed like only minutes later. I noticed that it was just starting to get light, so it had been at least an hour and a half. The thudding continued, loud and rhythmic. Then it dawned on me—someone is pounding grain. (The Malian women have huge mortars and pestles that they use to pound grain.) Sure enough, minutes later I heard the clatter of dishes coming in through the window. I looked over at Luther, who didn’t even seem to be stirring with this noise. I tried hard to just ignore the noise and go back to sleep.

I drifted back to sleep for maybe a half hour, when I awoke again, this time with Luther’s toes on my feet. I was still tired, but toes touching my feet, I just can’t sleep through. I rolled over noisily and this was enough disturbance to send him back to the other side. I had just fallen back to sleep when he did it again. This was quickly ending my sleep. In college, my friends and I would often share a hotel room on trips, and it was fine to share a bed with them. However, one time, the whole wedding party stayed in one room and I slept next to one of my married friends. He kept rolling over onto me all night long. You can’t trust married men—they don’t wake up when they touch you. And I’m here to tell you, you can’t trust African men either.

I drifted in and out of light sleep till about 7:30, when we had to get up for the wedding. I crawled out from underneath the mosquito net and stood up, still tired and a bit dizzy. Luther followed and then asked, “You want to wash again?” I agreed, so we grabbed a bucket, and this time I used all the water. It was cold and really woke me up. (Interestingly, they were constantly offering me the opportunity to wash whenever I came back to the house. Did that mean I stunk? Did they think Americans take 4 showers a day? Do they really wash that often? Or was it just politeness? Probably.)

We were a bit rushed because we were trying to make it to the mayor’s office at 9am. (First service. Always one at the mayor’s office and then a longer, more formal one at the church.) Not knowing where this was, I had no clue what time we needed to leave. Had I any clue, I would have laughed at the thought of us actually trying to make it. After my shower I put on my still-wet pants (which still had a dirty spot on one knee) and my wedding shirt. (Same one from the last wedding. There was no official fabric for this wedding, so the hospital employees decided to use their same outfits.) Luther sent his little brother down the hill with the moto to get the tire fixed, and we sat down for a quick breakfast of tea and bread. We didn’t leave the house until 9, and had to walk down the hill and wait 20 minutes for the moto to be ready. So by the time we were really on the road it was 9:30. We would be lucky to make it to the church on time.

We stopped along the way to get directions, and made it just before the service started. As we pulled up, other people were arriving and everyone was greeting each other with such joy and excitement, and it felt like old friends getting together to celebrate. Luckily some of the other hospital employees had saved us seats. So we tucked into the back corner of a very packed church sanctuary. I’m not the best at guessing numbers, but I would say there were over 500 people seated at this point. (Later, they set up another 50 chairs in the annex and packed in more behind us, so by the end of the wedding, there may have been more than 600 people there.) The stage area was elegantly decorated with huge white and orange sashes. Two choirs sat on either end of the stage area. And minus the fact that I was the only tubabu in the whole crowd, it felt like weddings I’d been to in the States.

The service started with the processional and lots of singing. After the signing, they started into long speeches in Bambara, which I don’t yet understand, so I contented myself by playing with Noel (the baby of one of my coworkers). She was pretty wound up and smelled like perfume and a dirty diaper. But her noisy playing and excited cooing were taken in stride by those around us, and only seemed to add to the ambient noises of the crowd. The speeches continued and Noel started to get tired. She laid her head on my shoulder and slowly fell asleep. It was all precious, and I began to feel warm, like I was surrounded by family, and I began to think that this really was my family, and then suddenly, I realized that my eyes were closed. I woke with a little start, having no idea how long I had been out. No one around me seemed to notice. (In fact, half of them looked like they could be sleeping too.)

In danger of falling asleep again, I gave Noel to her mom and began to try to take pictures. Now, in general, I detest taking pictures. I much prefer to go with people that enjoy photography and get copies of their pictures afterward. This is probably because, much like rhythm, the artistic eye needed for good shots just isn’t my thing. But being the only one from the hospital with a camera, I felt a certain responsibility to bring back pictures. So, I tried to convince my coworkers (some of whom have never even taken a picture) that they should get up and shoot photos. Some made feeble attempts. Luther handed the camera out the window to a complete stranger and asked him to go up front and take pictures of the bride and groom. He returned with one really good shot and a bunch of half cut-off ones.

At this point, two of my coworkers, Lidy and Rebecca, leaned over and noisily insisted that I go to the front of the church and take pictures. “It’s not a problem, it is expected,” they insisted. They didn’t seem to get that being the lone tubabu in front of 600 people was a little conspicuous (one of these doesn’t belong…), and I wasn’t sure why I was so reticent. So plucking up my courage, I crawled over a whole line of people, out to a side aisle. I walked crouched-over till I reached the front benches. Fortunately, there was a woman sitting on a chair in the aisle. So guerrilla-warfare style, I hid behind her, peeking around to shoot pictures then tucking back into hiding. After several decent photos, I hurried back to my seat.

No sooner had I crawled over everyone and sat back down, than Lidy and Rebecca started in on me again. “They are going to exchange rings soon. Get back down there and stay there until the end of the service. And this time, go all the way up to the stage!” I sighed, giving them a look that said, “please don’t make me do it mommy.” They looked at each other and then I heard them whisper Paul’s name. This is great, I thought. They will make Paul go down to the front and do it for me. Normally, I wouldn’t want to seem so helpless that I need my friends to do everything for me, but… this whole weekend had been an exception so far. So I quickly passed my camera up the aisle to Paul, who turned around, looking puzzled. Rebecca started loudly instructing Paul, who was several spots down and two aisles up from her, to take me down to the front. Ok, ok, I’m not going to be so childish as to need someone to take me by the hand to do my job, I decided. So I crawled over the row of people again and walked down front. Luckily there was a group of photographers amassing up front, in preparation for the ring exchange and the kiss. So I joined them and stayed there for the rest of the service.

Two and half hours after starting, the service finished. We joined the greeting line, took several group pictures, and then headed to the after-party. This was at the same location as the pre-party. It was the home of the groom’s father. Across from his house was an empty lot that had two tents put up. The dancing and music had already started under one tent, and people were packed under the other, attempting to escape the mid-day sun. The rest of us grabbed chairs and just lined the streets. Food was brought out in big bowls around which several people sit eating communally with their hands. Afterwards, we relaxed and talked. Much of the conversation took place in Bambara, with someone occasionally translating for me.

About 5 pm, everyone was looking and feeling tired, so the crowds began to disperse. Luther had to take his fiancé home, so he called his little brother to come pick me up. We headed back to the house, and I crashed for a quick nap. I woke up an hour later and made small talk with Luther’s two brothers. I was still exhausted and wasn’t feeling great. At nine-thirty, Luther called his brother to tell him that he was still at his fiancé’s place. So his younger brother brought out another meal of fried potatoes and plantains. And then, since I was going to take the morning bus back with Paul and Asim, I decided to turn in early. Luther’s brothers asked if I’d be ok alone, since both had plans that evening. I assured them I would, but felt a little bad for refusing their invitations to go along.

I had just lain down in bed, moments after they left the house, when it hit. I knew I deserved it—I had eaten everything set in front of me and downed more water—coming from who knows what source—from communal cups than was wise. The rumbling in my stomach told me I would pay. By this time I had found the outhouse, so grabbing my stash of wet-wipes (since there was no toilet paper), I rushed out of the house for the glorious commencement of my traveler’s diarrhea. I returned to the room, took a cipro and a pepto-bismal tablet, and prayed it would stop before the seven hour bus ride in the morning.

I fell soundly asleep, and at midnight Luther woke me up so I could let him back into the house. We had both lain down, when I had to make another mad dash to the outhouse again. And it continued. And continued. Every hour, at least. And all my self-congratulating for being so brilliant as to bring wet-wipes was all in vain because I had long-since run out. Did I discover why the left hand is considered unclean in Mali? You bet I did!

At six, I could no longer sleep. I felt miserable and dirty and somewhat humiliated. Now I had to make a decision—risk a miserable seven hour bus ride this morning or stay here waiting for the afternoon bus, hoping this would pass. I decided to make a mad dash for toilet paper and running water. So I did what any responsible medical professional would do. I over-dosed. I took a cipro, two immodium, and four pepto-bismals, and swallowed it all down with the prayer that nothing humiliating would happen to me on the bus.

I took a shower, packed my things, and said goodbyes. Luther’s little brother took me to the main road where I caught a taxi to the bus station. Along the way, Paul called to ask about my progress. I was ten minutes away, I told him, wondering what his hurry was. It wasn’t even 8 and the bus wasn’t scheduled to leave until 9. I pulled up to the station at 8:05, was immediately met by Paul and crew who rushed up to the ticket window. I wasn’t sure what was being said, but instead of buying tickets, Paul turned around and we started walking out of the station. At the same time, a bus was pulling out. The next thing I know, as if it is the most normal thing in the world, Paul grabbed my arm and started running after the bus. We boarded the bus while it was still moving, through a half closed door. On-board, the bus was packed, and all four of us were forced to sit in seats scattered throughout the bus. My seat was provided by a child that was forced to sit in the aisle on a bucket.

I turned around to look at Paul, who nodded reassuringly and then indicated that I needed to pay a guy who was carefully working his way down the aisle. I paid him, wondering if we were even on the right bus—thinking that it would not be at all funny if I ended up in the wrong city, or worse the wrong country today. Then I figured that maybe there was some kind of connection that we had to make in Bamako and that the Koutiala bus left from another station. About two hours later, I decided that this was indeed our bus. Only after arriving in Koutiala did I find out that in Bamako, when the bus is full, it leaves. Possibly the only thing in all of Africa that is ahead of schedule, and I was fortunate enough to make it!

The ride passed, thankfully, uneventfully, and we pulled up to Koutiala after just over six hours. I walked home from the bus stop, and moments after I entered the door, the torrent hit. But I didn’t care, because I had toilet paper and running water, and it could be typhoid or cholera for all I cared. I was home and I had had an incredible weekend, with a story to tell.

[You can check out pictures of the wedding at: http://www.facebook.com/p.php?i=589640293&k=Z51265W3W2WNUECCRE3TUU ]

Life in Koutiala: In the hands of my friends; part 1

2009-08-11T20:39:00.003Z

[Disclaimer: If this doesn’t make you chuckle at least a little, then either I’m a terrible writer, or you are a terribly dull person. But I want to make sure that you understand clearly that I’m in no way making fun of my hosts/friends and their culture—only making fun of my experience (and complete awkwardness) in encountering it. I firmly believe that every step of the way, my friends did their utmost to be hospitable and kind, and I would only want to offer them my sincere and humble thanks.

Secondly, I don’t claim to be a great adventurer. This is nothing out of the ordinary for some of my colleagues (and in the broad scheme of things, this is pretty minor for adventure), they just happen not to be as awkward as I am. (Nor do they, perhaps, publish their awkwardness so openly...) So, saying that, I often find myself in the middle of experiences like this, wondering what brought me to this point. Not bravery…stupidity? Caprice? Mania? But very often, when it is all said and done, I find that it was just what I needed.]

A month and a half ago, I walked into the office and Terry told me that one of our nurses, Catherine, had just told her about her upcoming wedding. She went on to share the details—beginning of August, in Bamako (the capital city), and “the wedding, you really want to be at.” Why so? “Because Catherine is a real classy gal.” And it is true. Catherine is classy. She changes her hairdo at least once a week and comes to work dressed to the nines. The way she carries herself says “African-city dweller”, not “African-village dweller” (in addition to, “I’m a classy gal”). So Terry and I hatched a little plan for my getting there and going with a group of nurses from here.

Like any good American, I tried to start organizing this trip from that day on. I quickly realized, however, that a month and a half is far too long in advance for anything to be seriously considered. So I sat on it for a month, and two weeks ago resumed my planning. But a little over a week before the wedding it became apparent that too many people wanted to go, and I would need to stay behind. (Especially since both the other anesthesia nurses were going.) I was bummed but figured other chances would come along.

Then Thursday, two days before the wedding, reality started hitting. Many of the nurses that said they were going, just couldn’t make it. The two other anesthetists weren’t going. So I began to think of ways to go. Unfortunately, by this time, a group of people that were going had already left. I thought about taking a car, but the cost was prohibitive. So I went to bed Thursday night not really sure what I was going to do. Friday morning after rounds, I found out that two other people, Luther and Asim, were leaving from the hospital that afternoon on the two o’clock bus. Asim is a lab tech and Luther is a resident physician here. I decided that I would head up with them.

Once I made this decision, I realized that I was completely lacking any details. Having traveled for a good number of weddings in the States over the past three years, I have a little mental checklist of things you have to have in order to go to the wedding: flight, ground transportation, place to stay, wedding invitation which includes times and addresses, directions from lodging to wedding and from wedding to reception, etc, etc. I didn’t have anything but the “flight” which was looking like a seven hour bus ride. This really hit home when Luther asked me, “Where are you staying tonight?” A reasonable question, I think. Where are you—foreigner—staying in the large, unfamiliar capital city that you’ve so impulsively decided to leave for in less than 4 hours? “Err…I don’t know,” I said feeling a little stupid and almost completely un-Western. But this, fortunately, elicited an invitation to stay with his family. Whether that was a sympathy-invite or a genuine desire, I’m not sure, but I don’t think he had a clue what he was getting himself into.

We finished up the morning work, and I headed home to pack and take care of some last minute details. (I mean, if you are headed into complete chaos, at least your home can be organized, right?) I left at 1:30, hoping that I had packed everything I really needed. I met up with Luther and Asim at the bus station and was getting really excited. However, after remembering that I had forgotten my malaria medication and my water bottle—possible the two most important things to pack—and having to call Elizabeth to bring them to the station (some people still need a “mom”—thought I was growing out of that…), my confidence in my packing took a real plunge. But I tried not to think about it. Why get mired down in all the details, right?

It was after this that in the midst of our small talk, Luther looks at me and says, “I’m selling you when we get to Bamako.” Selling me? To whom? “Oh there are people there that buy tubabus,” he says with a quirky half-smile and a twinkle in his eye. Somehow, even knowing that he was joking didn’t totally relieve that “Danger Will Robinson,” feeling inside. I tried to joke back, “How much will I go for?” His answer came a little too easily and quickly, “20 million cfa.” I texted Saskia, half-wanting to include her in the joke, half-wanting to make sure they would at least have a clue where to start looking for me. I tried to chuckle about this and then began to ponder what my worth being set at $40,000 did to my ego.

We loaded on the bus and had the good fortune to have enough open seats left that we sat with each other. (Not always the case…) It had been drizzling lightly, and when they finished packing everyone on, it began to feel a bit like a sweat lodge inside the bus. This happened throughout the drive too, when it began to rain, they’d close the two air vents and it would start to “cook” inside. But in good time, we took off and the air was cool and comfortable, and I had good conversations with Luther, in between looking out the window and trying to imagine what this weekend was really going to be like.

I’ve described these buses elsewhere, but I think it is worth describing again. They run all over Mali, and many continue throughout other countries in West Africa. They are widely used, and are usually full. And by full, I don’t mean that 95% of the seats are taken, I mean every seat is full, children are in the laps of adults, and some older children and 2 or 3 (or sometimes 6) adults are sitting in the aisle. And the luggage. It wouldn’t be your first thought that Africans would have a lot of baggage with them on trips, but they seem to pack all sorts of things. And since there isn’t a clearly defined policy on what is “checked” and what is “carry-on,” luggage is shoved everywhere, making the aisle virtually impassible.

But once you are in, you begin to realize that Africans are just way more fun to travel with than Westerners. There is a real sense of together-ness when you travel. Babies get passed around to whomever can make them laugh and not cry. Luggage gets rearranged and passed down the aisle. Sleeping children in the aisle are pulled closer to some concerned adult that wants to make sure they are comfortable. People buy food at stops by passing their money to the person by the door, who acts as the purchasing agent for everyone. The money is passed forward and the food passed back, and it’s like a little game trying to see if we can purchase everything everyone wants before the bus pulls off again. This food is often shared among strangers, and everyone just seems to be content. When the temperature isn’t stifling, it is almost cozy.

And I was really enjoying this togetherness until about the last two hours of the bus ride, when togetherness invaded my personal space. They had packed so many people into the aisle that a woman was sitting right between me and the person across from me, with all of her luggage. First, this severely restricted my leg room. But also, to get herself seated, she had to put her hand on my thigh and lower herself down. And every time she wanted to rearrange something her elbow would be in my lap. Togetherness: my legs and lap at your disposal.

We pulled into the Bamako bus station at 9pm, and unloaded. I had assumed at this point that one of the two guys I was travelling with actually knew how to get to the wedding party (the pre-party which usually lasts late into the night). I was wrong. They weren’t at all sure where the party was at, and they weren’t even sure where in the city we were. Luther talked to a taxi driver and tried to get him to take us somewhere (not sure where…), but didn’t like the price, so he said he was going to call his little brother. After a long wait and several calls, his little brother showed up with a friend in a car. We loaded up and started to head back to Luther’s family’s home.

It was quite a long drive back to the house. After several kilometers on paved city streets, we took a turn-off onto dirt roads and continued to pick our way through potholes for another 20 minutes before arriving at the house. We had long since left the neighborhoods with electricity, and up on the hill where the home stood, most of the houses were unfinished. So it was with this house. I was very impressed by it, however, and I think when it is finished, it will be a very nice home. It turns out the neighborhood is full of homes that are being built slowly—often as investments. The best way for Africans to save money is to put it into building materials and work slowly at building a home. Free cash gets borrowed or used for some “emergency need” in the family, so many will take any extra money they have and start building a new residence. So it may take years (or decades) to complete such a home.

We unloaded from the car and entered the house by flashlight. The floor was tiled, the ceiling intact, doors and windows were in place, and it was apparently wired and plumbed (just waiting for those services to reach the neighborhood). The walls were bare cinderblock and concrete. And since it was only three of his siblings (all in university) living there, things were a bit sparse. (His mom and dad live in a village several hours away. The house is their retirement investment, from what I understand.) I was ushered into the living room and offered a seat. A small fluorescent bulb attached to a car battery was illuminated, and I could now see the faces of his younger and older brother. Introductions were made, and then the little brother left for the kitchen. Luther took me back to the bedrooms, and after opening a couple doors and musing a bit, he announced that he and I would be sharing his little brother’s bed. Or perhaps we could say his brother’s little bed. Up-close and personal with the culture? You want it, you got it.

Luther announced that he was going to get some water so we could wash up. I quickly texted Saskia with an update. She texted back, “You are BFF now—bed friends forever.” I was already having a hard time keeping a straight face; this didn’t help. I bit my lip and reprimanded myself for being immature and ungrateful. I got myself under control right before Luther came back to the bedroom with a bucket of water. He took me around the corner to the bathroom, where he lit a small candle in the widow. By flame light, I saw the toilet, the sink, and the shower-head on the wall. A very compact, but nice little bathroom that would have been Western if it had had running water.

He set the bucket down and then gave me a pair of flip-flops to put on. He closed the door on me, and there I stood—in flip-flops 2 sizes too small, bucket of water in front of me, candlelight making my face look funny in the mirror, and my very amused mind trying to figure out what to do next. I mean, I get the whole bucket bath thing, and I saw that the floor slanted to a small drain at the base of the toilet so I knew I could just splash it on me there in the middle of the floor. I just wasn’t sure about how much of a shower this was supposed to be. Was I supposed to save some water for him? They might be buying jugs of water or pulling it from a well, so I don’t want to hog it. Or was this my only chance to shower before the actual wedding? No soap, no towel…but I had those in my bag, was I supposed to go get those? I decided to go conservative and used half the bucket to wash my face, head, hands, etc. I emerged from the bathroom, setting the bucket outside the door. Luther came around the corner to get the bucket and said, “What? The whole bucket was for you.” Guess I was wrong… Not having a clue of what to say in the awkwardness of that moment, I smiled and mumbled something about only wanting to wash my face and hands, and then quickly began fumbling in my bag to find clothes for the party.

After we had both washed and dressed, we went out to the living room to eat. I still get a little uneasy about eating here in Mali. I have enjoyed 95% of everything I’ve eaten here, so I think the uneasiness is a little unmerited. It might be more the pressure not to offend my host than the anxiety about the food. However, my fears were quickly relieved when the food came out. His little brother first brought out separate dishes and silverware, but Luther sent him back for one big main dish, saying something that I imagined was like, “My tubabu can eat with his hands.” I was thankful for this because in the midst of feeling so culturally incompetent, I needed a chance to prove my abilities, and eating with my hands, I can do. (Though, it is not as easy as you think. There are techniques…) So, out came the big dish piled high with fried potatoes and plantains, with a chicken in the middle. The fried stuff had a little onion, oil, and salt on top, and the chicken was cut in half, covered with mayonnaise and a pepper sauce. And it was incredible. Malian bachelor food—this I can do!

After dinner, we quickly cleared away the dishes and headed out. It was already close to midnight, but we figured the party would still be going strong. So we pulled a moto outside the house and loaded on. And here we must pause and discuss the “moto.” The most ubiquitous of the motos are little 125cc street bikes that have a vespa-like body. Their speed maxes out at a little over 80 kmh (50mph), but they are great for weaving in and out of traffic in the city and market. They are fairly reliable and cheap to own and maintain. But there are a couple tricks with these motos. First, while you may see as many as three adults (plus children and luggage) loaded onto a single moto, they seem better suited for a single, middle-sized adult. Otherwise they handle a little sloppily and the suspension, if at all worn, seems really strained as you go over rough road. Secondly, the moto was designed more for paved roads than for the dirt paths that are so frequent here in Mali. Again, they handle poorly in the sand, dirt, and potholes found on many back roads, frequently jarring the passengers or popping tires.

The Malians, however, have found several ways around all of this. First they are much lighter than Americans. (Even after losing 15 pounds here, I’m still heavier than most guys my age.) Secondly, the passengers have learned to really ride completely in-sync with their drivers—most don’t even hold on to the bike. And lastly, they have the majority of the roads memorized completely, so they can navigate around the worst bumps and rocks and holes.

Luther and I had no such advantages. I, the big, clumsy passanger, sat above the rear suspension which seemed shot. He, the normally apt driver, was unfamiliar with the roads, and was further inhibited by the darkness. So there we went, bumping and jarring our way down the hill—rear fender rubbing on the tire with every large bump—headed for the main road. We finally reached paved road and then took off with greater speed, which didn’t prove any more relaxing. I don’t really enjoy being the passenger. It is a mixture of fear (a few years of working with motorcycle traumas in the ICU) and personal space issues (I always think Wild Hogs as I ride), and though I have become much more comfortable with the concept, I still hold on with one hand. Furthermore, Bamako is much larger, busier, and crazier than Koutiala. Stoplights seem to mean nothing, and everyone moves along at a quick pace, with few clearly defined traffic patterns. Between the jarring and my being a little tense, I realized that by the end of the weekend I felt a little sore from riding the moto.

We arrived in one piece at the party, though we had to make several calls to our friend Paul to actual find the place, and he eventually had to come out to the main road to get us. The crowd was still lively, but much smaller than the last pre-wedding party I had been to. Someone explained to me that these parties in the city were more rare and more scarcely attended because of the restrictions on space (and music keeping up the neighbors). They are more common in the villages and rural areas. I was introduced to the parents of the groom, and then was taken out to the main tent where they were dancing.

After my last dancing episode, people paid me several (very undue) complements on my dancing. I think this was their way of being nice about me trying to adopt their culture. People also seemed to have the distinct impression that I loved dancing. And it is true, I had fun—but I didn’t think anyone was watching. So the group of people at this party that knew me insisted we go immediately to the dance floor. Unlike the last party, however, these people were all dancing in one large circle, and they were doing far more elaborate steps. (The dances go around in circles, like some kind of conga line, everyone moving in impeccable rhythm with a series of steps they repeat. It is really cool to see when they get moving.) The last party, I had tucked into an outer circle (one of about 6) that was doing easier steps and was less visible to everyone. Feeling tired already from the trip up, I wasn’t super excited to jump into this faster moving circle. I expressed some reticence, but friends, completely undeterred insisted I join in.

It became quickly apparent that I wasn’t catching on, and instead of just leaving me alone at the end of the line, they broke off and started a new line with easier steps. This was incredibly thoughtful, but just made matters worse. Now everyone could see the tubabu messing up even the easy dance. I felt like this is one of those times they should have just given me an “A” for effort and left me hidden in the midst of the group. But oh no, can’t do that. So just throw me on the short bus and call me rhythm retarded.

I ducked out early and went to sit down. I pulled up a chair next to Asim, who, always eager to practice his English, said to me rather brokenly, “Jacob, you are dancing small, small. Very good.” Yes, indeed—small, small. This coming from the French, “petit a petit” or the Bambara, “Don donni,” meaning little by little—a favorite African phrase for people trying to speak their language or adopt some other aspect of their culture. They would never admit it, but we tubabus clearly understand that the nuance behind it is, “Wow, you are really terrible, but maybe if we stay infinitely patient with you, you’ll get it…one day.”

The party wrapped up at around 2:30am, and we took off on the moto to go back to Luther’s house. On the way back, we tried to avoid a large pothole, but hit another deep one at such an angle that it threw us from the bike. We both landed mostly on our feet and weren’t hurt. So we picked up the bike and kept going, but a short time later, we shone a light on the rear tire and realized it was flat. This left us on foot, pushing the moto uphill. It was about 3:30 by the time we actually made it back to the house, and I was just exhausted.

But, when we went into the house, Luther noticed that my pants had gotten dirty during the evening. He asked if they were the pants I planned on wearing to the wedding, and when I said yes, he insisted that we wash them right then. So he got another bucket of water and a little laundry powder. He held the flashlight while I scrubbed at the red mud on the cuffs of my pants. He criticized my technique, which I took constructively, though every fiber of my being said, “I couldn’t give a rip if I go to the wedding with dirty pants tomorrow.”

We hung the pants out to dry, got rid of the water, and then got ready for bed. Luther lit the candle in the bathroom and asked if I needed to pee before going to bed. Feeling like a little child, I said, yes. So there I found myself, again, in the bathroom slightly puzzled about what to do. Do I pee in the drain or into the toilet? Unsure of how “connected” the toilet was, and not having enough water to flush it even if it was, I decided that I was supposed to aim for the drain. This was awkward due to the drain’s position, but I won’t go into the mechanics here. I finished successfully and picked up the plastic tea kettle that is used for cleaning things (think bidet) and for washing hands. Unfortunately, in the process of washing my hands, I spilled water on my feet. So upon my exit the flip-flops were a little wet. I kicked them off to give them to Luther, who shining the light on them, saw the water and decided to go in barefoot. GREAT! He thinks I peed on them.

Sufficiently humbled for one day and utterly exhausted, I collapsed into bed around 4am. I was so tired that I didn’t mind the fact that I was hot and laying too close to someone I only barely know. We were, after all, becoming BFF.

Life in Koutiala: Wedding, African Style

2009-08-02T20:56:00.003Z

I thought I'd also include a link to my facebook (yeah...I know...I sold my soul to the devil and joined the cult...) album of wedding pictures. I went to this wedding on the 18th of July. It was two of the hospital's nurses that got married. It was a lot of fun. You should be able to follow the link below:

http://www.facebook.com/p.php?i=589640293&k=Z6DX53T2V6VFUECCRE3TUU

The wedding started on Friday night. The family of the groom brings the gifts for the bride's family. They greet one another and then share a meal. (And when I say family, I mean the whole extended family...so we are talking hundreds of people.) After this, around 11pm, the family and friends start dancing. They dance until the early morning (like 5 or so...).

I joined in on the dancing, which was fun, but absolutely ridiculous because I have ZERO RHYTHM. The nurses that I was with were very kind and kept trying to coach me along. I tried to explain to them that it wasn't that I was so stupid that I couldn't understand the steps that my feet were supposed to be taking; rather, it is just that I don't have the rhythm to take those steps with an resemblence of how it is supposed to be done. I kept at it until 2:30am, by which time I was so tired that I was actually dancing fairly well because I wasn't thinking about it anymore.

The next morning, I went back out to the church (where the party had happened the night before) to pick up a friend to go to the wedding at the mayor's office. (Unlike in the States, you have to be married in the mayor's office and in the church here.) We ate again, despite my insistence that we'd be late. We missed the whole ceremony at the mayor's office, but arrived just in time to join the noisy caravan that drove with the bride and groom back through town and to the church. Then my tire popped and I had to stop to get it repaired. This made us late for the church wedding. So by the time we arrived, we had to squeeze into a little classroom desk designed for 2, now holding 3.

After the service, we...you'll never guess...ate again. The food was always rice, with a sauce covering it, and with meat and some vegetables thrown in the middle of the bowl. The bowl is large and up to 8 people sit around the bowl, eating with their hands. It is a lot of fun. (Someone asked how much rice it took to feed all the people at the wedding, and we found out that they had cooked more than 350 kilos (770lbs.) of rice.)

The rest you can see in pictures. It was a blast. Can't wait for the next one.

Medicine in Koutiala: Case updates

2009-08-02T19:50:00.011Z

After posting the last piece, I thought I probably needed to do something more light and fun (with a few more pictures). So I thought I’d through in a few pictures and update you on some of the cases I’ve mentioned over the past several weeks.

Let’s start with Ne. You probably remember that she came in really sick with typhoid. We did four surgeries to repair bowel perforations, and then left her with an ostomy. She went home about 4 weeks ago right after she and her brother came to know the Lord. She is gaining weight, looking great, and managing her ostomy well. This Thursday, she will have surgery to reconnect the ostomy, and then she’ll be back to “normal.” It has been a joy watching her get better. [Below: 1. Picture of Ne right after her fourth surgery. 2. Picture of Ne, Saskia, and her mom right before going home. 3. Picture of Ne, her mom, brother Amadou (far right), Saskia, and some random person.]

The next case was my little buddy that got hit by a moto. I was at the hospital one Saturday prepping for a case, when I heard screaming outside. I walked out to find this little guy in the arms of two guys, bleeding profusely from the head. We got him into the OR, washed him up, and then stitched him up. He took an instant liking to me (even though I was the one sticking him with the needle). This was bizarre until we found out that neither of the men were his father. They were just from the same neighborhood, had hit him with their moto. They didn’t get family, they just scooped him up and brought him to the hospital. I guess as a little kid you pick the less menacing of the two—the guys who hit you with their moto or the guy sticking you with a needle? He stayed in the hospital two days, and then went home, good as new (almost…). [Below you can see his road-rash on his head and then our self portrait the next day.]

Lidy, the little burn victim that I mentioned in the last post, is doing much better. The burn has healed up completely on her back and the majority of her leg. There was one small part still healing on her upper thigh, but we were able to send her home. [Below: 1. Lidy and her dad. 2. The closest I ever got her to smiling for me. She really didn’t like me, despite the candy, the coloring pages, and the toys…]

A little girl named Miriam has become close to our hearts. She is a one-year-old, severely malnourished baby. The mother has “disappeared” and the grandma was supposedly trying to feed the baby herself. At one-year old, she weighs less than many babies do at birth. The family refused to let her be checked into the hospital, so the pediatric team tried to manage her on an outpatient basis. When this failed after three weeks, it became apparent that the family was just not doing their part. (Current thought is that the baby is illegitimate, so the family is hoping it will die.) We convinced them to let us have the baby and care for her at the hospital. A nanny was hired and we have been taking care of her at the hospital. She was so malnourished that we had to start her out on tube feedings and slowly work her up to baby food. She is doing much better, gaining weight, and starting to have enough energy to smile and cry now. [Below: 1. Miriam on Jan’s lap. Jan was a visitor who came to help us out in our pharmacy/warehouse. She took care of Miriam the first few days while we looked for a nanny. 2. Miriam (age: 1year) next to Noel (age: 6 months).]

[Below: 1. A random picture of me giving blood while still doing anesthesia. We were still in the middle of the case, but we knew that the patient needed blood, so we had the lab tech come to the OR to take blood from me. 2. Yup, we sterilized Braafhart’s cat. That was a first for us…but it went surprisingly well.]

Medicine in Koutiala: Stark reality and vibrant hope

2009-08-02T19:47:00.001Z

[I wrote the majority of this a couple weeks ago, but am just now posting it. Sorry for the long absence.]

I remember the first time I saw someone die. It was my junior year of college, and one of my rotations was in a hospice center. The old man passed away right in front of me, and it was weird because I didn’t know how to feel. He was supposed to die; that is why he was in hospice. And yet, death felt so unnatural. I remember heading back to college and talking to one of my professors. I said it felt weird to have experienced something so profound and to then come back to a college campus where I was expected to eat lunch and joke with my friends, then go take notes on the “fine arts.”

Now, a full, four years later, I’ve seen more people die than I care to list. As an ICU nurse, I have turned off life-support and stood quietly in the background as family members sobbed over the loss of their loved one. I have responded to “code blues” to intervene in those precarious moments between life and death. I’ve watched life slip away, and I’ve seen life restored. And most of the time that is all so weighty and heavy that you just can’t process it, so you leave it at work—in the locker with your favorite pen and your stethoscope. Once in a while a case comes along that is different from all the rest, and it rides home with you, a weight around your heart and an endless source of pondering for your mind. Or a special patient comes through, and every once in a while, you think of them and wonder how they are doing.

Somehow, here in Koutiala, the losses sting a bit more and the victories taste sweeter. I certainly don’t remember ever C-section we do or remember every patient that passes away at the hospital, but I do remember a lot more individuals. I think it is because we are intervening in the lives of people who have little other option. We see very desperate cases that have run out of options, or have waited too long to seek treatment.

This afternoon, I was preparing a salad for lunch when my phone rang. The voice on the other side was one of our Malian nurses at the hospital. She said, “We need you at the hospital right away.” Normally, I would have thought C-section, but I wasn’t on-call today, so I knew it had to be a special case. Flying into the hospital on my moto, I tried to imagine—between prayers that the Lord wouldn’t let me wreck—what scene I would find upon arrival. I remembered having those same thoughts and that same rush of adrenaline as an ICU Code nurse, running to a different part of the hospital to a code. (Only, that was just a few flights of stairs, not a 10-minute moto drive through town.)

I arrived to find Saskia and the team working on a 17-year-old pregnant girl. She had arrived with high blood pressure (she was eclamptic) and a loss of consciousness. Somewhere in the mad rush to get her ready for a C-section, she had stopped breathing. They had begun resuscitation efforts. I jumped in and took over CPR while Saskia and Brett (the pediatrician) discussed possibilities. We had just called it quits when her heartbeat came back. We decided to get the baby out. The baby came out with a very weak heart rate. Brett and his team resuscitated the baby, but despite having a good heart-rate, the baby never took a breath, so we had to let it go. It soon became apparent that the mother was not breathing on her own and would likely die after the case. (During the case we were breathing for her using our anesthesia machine, but we don’t have a ventilator that can do that after the case. She had probably had a stroke from the high blood pressure and so wouldn’t be able to breathe for herself.)

I stroked her forehead and said a little prayer. From around the corner in the delivery room, a woman delivering screamed in pain. It made me think of Genesis, right after sin enters the world—of a world that cut itself off from God and so lives under a curse of sin and death. And so here we are, wading through the fall-out from the rebellion that started then and has continued in all of us.

Then I began to replay the past couple weeks. We had lost the young woman to cerebral malaria. The next morning we lost the woman we had done major bowel surgery on. These losses were not caused by our own negligence, but because we simply run out of resources and higher levels of care. And not too long before that we had the whole day where not a single baby born at the hospital lived (until midnight, when we did a C-section). Again, this is caused by the poor access to healthcare for women. Some women stop feeling their babies move days before coming in, by which time the baby has long since died. These loses are poignant, and you wish you could do more.

I’m reminded, however, that the Lord hears and is responding to this hurting world of ours. The past several days I have had to help take care of a little girl with major burns. This is truly a traumatic thing for all involved. It is definitely painful for the little girl, but it isn’t fun watching someone so little have to deal with that pain, or worse yet, be the one inflicting it by changing the dressing. But it has to be done. So every day, we head into the OR to change the dressings. She starts crying when she sees the OR doors. Her dad is such a champ. He always brings her in and stays right by her, talking to her the whole time while she hugs his neck.

Through her tears she asks him questions, occasionally tries to bargain with us, and often repeats things her dad says. Some of the things she says are down-right cute. For instance, the other day she told her dad that she wanted the Tubabus (whites) to leave, but he told her that the Tubabs are good people. So for the rest of the time, when the pain got bad, she would scream, “The Tubabus are good people, the Tubabus are good people.” Or she’ll tell us, “Ok, you’ve done enough, the other part is better.” (Her leg and back are burned, so we start with the leg and then go to the back.) Today, she stopped crying abruptly, and said in a strong, clear, almost sarcastic voice, if you can imagine that, “Are they using a knife to put on the medication?”

But it is her father’s actions that most impress me. He is attentive to her cries. He holds her and comforts her. And yet, he insists that she get the dressings changed, knowing that it is for her good. I am reminded that God is our good, patient, and healing Father—that He interacts with us in our best and worst moments and is always guiding us (and this whole world of ours) toward what is best. And our Heavenly Father calls us to join Him; to work alongside Him in counteracting evil, disease, and death wherever they are found. And sometimes, like this little girl’s father, all we can do is walk alongside people in their personal darkness, holding onto our Hope—His Soon Coming.

As the case ended and it became clear that the 17-year old wouldn’t make it, I prepared to let her go. My mind drifted once again to the night we did three emergency surgeries in a row (which was the same day we hadn’t had a single live birth…) We started at 10pm with a case of bleeding. We had just finished that case when an emergency C-section popped up. At 2:30, we were just closing the second case, when Saskia was called out to the delivery room.

Moments later, I heard her yelling my name. I rushed out to find her pushing on the baby’s head. The cord had slipped down and if the baby advanced any further it would cut itself off from its source of oxygen and circulation. We rushed to finish the second case while Saskia held pressure. Switching the room over as quickly as possible, we rushed this third patient into the OR. After giving the first dose of anesthetics, I took over for Saskia, holding pressure on the baby’s head till my fingers went numb. They covered me with the surgery drapes and I had to tuck my head down, my face precariously close to the patient’s butt. The case started, and I had to bark out orders to another nurse about which medications to push. And it was just too much. I started to laugh so hard tears formed in my eyes. And I laughed until they pulled the baby out through the incision and I was free to come up from under the drapes.

After the case, I went into the delivery room where the baby was laying under the warmer, doing just fine. I stroked his cheek just hard enough to elicit his reflexes. His eyes opened, and slipping my little finger into his grasping hand, I said, “You owe me one, kid.”

We aren’t an endless source of miracles here in Koutiala. We can’t save every case. But in working alongside our Lord in working out His redemption of this world, we do save many. For countless babies and moms, we are making huge differences—giving them hope and pointing them to our Hope.

Life in Koutiala: Know Your Role

2009-07-12T10:16:00.001Z

I’ve resisted it for two months now. Called it “a fluke”. Called it “a freak series of accidents”. Blamed it on poor construction, poor craftsmanship, and bad timing. But now, I’m just embracing it. My role here in Koutiala is to be the team klutz. I don’t know how it happened this way; I don’t remember being particularly klutzy in my previous life. In Utah, I was Captain Awkward at times, but that was mostly because of awkward things that would happen between myself and other people. Here, it was like there was a vacancy in the klutz department, and God said, “Oh good, Jake can fill-in as anesthesia and klutz.” (That sounds like a terrible combination, but luckily the two spheres haven’t interacted at all.)

The recent wave hasn’t included breaking things, as much as it has included losing things. For instance, in the past few weeks, I have lost both my favorite “fish” necklace and my sunglasses. Now, this wouldn’t even be a big deal in the States. The fish-necklace had sentimental value, but I wouldn’t have replaced it. The sunglasses were $12 at Target. But it’s annoying to lose things here, because they are so much harder to replace.

Then there was the incident of the bird. Yeah, I know…you’re kidding me, right? Lost the bird, again? I woke up Sunday morning this past weekend and could hear the stinking thing squawking outside. I occasionally hear the bird when the windows are open, so I didn’t think anything of it. I had seen it the day before, and it still had plenty of food and water, so I didn’t open the cage. (Which means, this is not my fault.) Well the morning progressed, and I was getting ready to go to church, when Saskia told me that we had a big case that needed to go to the OR in a little bit. So I canceled church-going plans, and decided to rest a bit, pray, and send out a pray request for this case. (It was a very sick lady.) I packed my things in my bag and headed out the door. Before grabbing my moto, I checked the bunny: Alive? Check. Food? Check. Water? Check. Headed back to the bird cage: Alive?… Buhler? Buhler? Anyone? Buhler?

The stinking thing wasn’t in his cage. Then I heard its ear-piercing screech above me, in the trees. I looked up, but couldn’t find it. There are two big trees close together, so I wasn’t sure exactly which one it was in. And to make matters worse, the screech was echoing off the house, so it was really hard to pin down. I shook a few branches, grabbed a broom and tried parting leaves, but was never able to see it. It kept screeching, as if to taunt me. I decided I not have the time or energy at present to be climbing in trees looking for this bird.

I headed off to the hospital and was there all afternoon. When I got home it was just getting dark. I was exhausted and really didn’t even want to think of having to find the bird. After coming inside and setting my stuff down, I decided that if I didn’t go find it, I would officially be the worst house-sitter ever. So I headed back out. The ever-familiar squawk rang out over the backyard. It sounded a bit different this time. I poked in the trees a bit more. I was starting to get desperate because it was getting dark, quick. I thought about going to get some neighbor kids. (That had worked for Elizabeth.) Then it screeched again, and the echo was really different this time. Then it dawned on me. I looked down into the now-empty pool. It had fallen into the pool and was running around down there. I smiled—breaking things has its advantages. I jumped down into the pool and threw a rug over the bird, wrapped it up and threw it back into its cage. Maybe I’m not such a bad pet owner!

Then, there was Klutz-Fest Wednesday. The night before, Saskia had thrown an all-night party from 10:30-4:30. We had three back-to-back emergencies. Afterwards, I went home to crash for a couple hours and then headed back in for morning rounds. I had intended to get out of the hospital by noon to take a nap. Unfortunately, I didn’t leave until 4pm. I crashed for an hour and a half, then got called for a diabetic woman that wasn’t doing well. I grabbed my stuff and headed out on my moto. It had rained really hard that day, and the roads were just a slimy mess. (A large section of my trip to the hospital is dirt.) In one back alley, someone had piled a mound of gray silt. (I had originally thought it was cement, but I guess it is silt that they find when digging wells. It turns clay-like when wet.) The pile had washed almost all the way across the road. It was a bog of wet clay, and would just suck your tires in. Approaching this little mess, I decided that I would try a different tactic. The far side of the road had puddles, but didn’t have the clay. I decided to just drive really slow through the puddles, and thus avoid the muck.

I approached the puddles at a slow but even speed. I was congratulating myself for being so clever. I entered the first puddle and before I knew what was happening, my front tire was swallowed completely into a sink hole. I climbed off the bike, standing in mud to my knees. I heard clucks and slight chuckles from the handful of on-lookers. I struggled with my moto to get it out of the hole. I finally freed it, but couldn’t go forward through the puddle, so I had to go straight back. This left me in the highly unenviable position of having to go through the clay-mire on the other side of the road. But not having any speed, I couldn’t get the bike through that mud while riding, so I just walked through the clay while pushing my bike, the clay squishing up over my sandals and between my toes.

So much for making it to the hospital quickly for this emergency. I arrived and a group of nurses that were waiting for me were sitting outside. They just laughed upon seeing me and led me back to the hose. I hosed off, went in and saw the patient. We got her squared away quickly enough. I wrote some other instructions, and then took off to make it to my Wednesday prayer meeting. I was already late, but thought I could just slip in.

I got to the Mission without further incident and ran up the flight of stairs to the meeting room. I opened the door quietly and heard one of our visiting medical students sharing a rather serious story about a mother losing her baby. I squeezed through the door quietly, and began to shut it slowly so it wouldn’t squeak. In the process, my back touched the wall right next to the door. And with the deadly accuracy that only a klutz could have, my elbow landed squarely on the light switch, leaving the whole assembly in the pitch dark.

The moment was gone. I flipped the lights back on, hung my head, and walked to my seat to a chorus of laughter and “Hi, Jake’s”. If it weren’t so funny, I might cry. Just too uncanny.

So here I am in Koutiala, embracing my role in life and being sufficiently humbled. And I’m thanking the Lord for humor, which seems to carry me through a number of my days here. I just pray that I learn this humility lesson quick.

Marti, Market, Mama Africa, and Moto-Moto

2009-07-11T16:26:00.004Z

This entry is dedicated to my little sister, because it’s all her fault.

Marti:

Marti just got engaged, and will be getting married next year (congrats!). She is also the most Type-B personality in our family. (It’s a close toss-up between her and my dad, but he is married to my mom, so that neutralizes him.) I am, as many of you know, not so Type-B. Well, my darling sister gave me a task, and she had my mom ask for her, which meant it had to be done. What a task it turned out to be.

See, normally type-A’s assign tasks to “B’s” and it really screws with the system when that gets reversed. “A’s” give very detailed, time-oriented tasks to “B’s”. And sure, we may be rather impatient, but we’ve gotten very good at understanding the delay that is inevitable with the “B’s”. (I mean, after all, if you’d wanted it done on time, you should have assigned it to an “A”.) But when the poles reverse and “B’s” give “A’s” assignments, it is virtually crisis provoking. Where are the details? The time-tables? The diagramed decision-making trees? We don’t handle ambiguity well, and “B’s” love it.

So the assignment seemed innocent enough at first: could I please look for a piece of cloth in the market that she wanted to use in her wedding. Both she and her fiancé have spent time in Malawi and wanted to use a piece of fabric that he had brought home from there in their wedding, but didn’t have enough. Find an exact match to your fabric which was purchased on the other side of the continent, in a market that has thousands of fabrics? Sure, no problem.

An “A” always knows when they are looking an impossible task in the face, but that, in and of itself, rarely daunts them. After all, if they succeed, there will be no end of lauding and thanks. It is the decisions that must be made after failing that “A’s” find daunting. This is why an “A” will always assign a Plan B and Plan C. For example, “If you can’t find that (Plan A), then I want you to look for such and such (Plan B). And if you can’t find that, then I guess we’ll just have to go for the other (Plan C).” Plan B from Marti? “If you can’t find it just look for something close.” Close in what way? In color? In design? In texture? Gloss? Quality? Did you need that exact floral pattern? I mean, I can barely match a dress shirt with a suitable tie, but even I know that the phrase “close” just doesn’t cut it.

So armed with my task, and with a picture of her fabric, I set out for the market in Bobo.

Market:

The market is an inescapable reality of every city, town, and sizeable village in Africa. I suspect, if given the choice, an African would choose the market over a Walmart any day. (Once the newness wears off…) On the other hand, Americans are wired to distrust markets altogether. 10 brief reasons.

1. There is a complete lack of plastic. Anything worth eating should be sealed behind so many layers of plastic that a majority of the product’s cost should be packaging. Everything is out in the open in the market.

2. No aisle markers. Where do you pick up flour? Second aisle, third shelf on the left, eye level. You have to hunt for everything you want in the market.

3. Markets are outside. We shop inside because we feel safer. There are just so many uncontrollable things outside. Like flies. The very sighting of a fly at dinner time ruins a meal, let alone seeing 50 covering your future steak.

4. How many times have you heard a mother say to her kid, “Junior, quit touching them all and just take one.” In the market, touching, examining, and smelling are all encouraged.

5. We like background music and store announcements over the speakers. The market is full of noise of every kind, and it is an unnerving cacophony to Americans. And store announcements are made in the market, but they are usually made directly to the person, as in: “Monsieur, you want necklace? I have very beautiful necklace for you. Good price.”

6. We prefer bright lighting and wide aisles. Markets have tiny pathways, and either direct sunlight or haphazardly constructed, dimly-lit shops and tunnels. We are by nature claustrophobic.

7. Markets have too many people. Americans don’t even enjoy seeing their neighbors at the store. We prefer to shop in complete anonymity. And people just crowd the aisles (see above). Markets are all about people. A person selling every product. A person on every side of you. Americans would buy everything from an unstaffed vending machine if possible (internet shopping?), whereas Africans love the human interaction provided by markets.

8. Much related to shopping in complete anonymity, Americans prefer to peruse the choices without any help and without pushy salesmen. The shop owner in African markets feels it a mark of his salesman ship to constantly find something new to say. They have no concept of the American mentality. This explains why the shop owners in Bobo had learned the phrase, “Just looking, no problem. Just looking.” He will then proceed to list all of his products without ceasing.

9. Haggling. You will find the rare American who actually enjoys haggling prices, but that is usually related to them being cheap and their thinking they have a chance to get a deal. Most Americans like to have prices stated clearly. Africans consider haggling something of a fun little game that bonds buyer and seller.

10. Because of everything written above, you just cannot get through a market quickly. A trip to the market will take a few hours. There is no such thing as “picking up something on my way home.”

Now every market seems to take on its own personality. Some markets have really pushy sales people, and others are very laid back. The market here in Koutiala is very laid back, but doesn’t have a whole lot of tourist-stuff. Bobo was a little bit more tourist-oriented, but still laid back compared to other places I’ve been. The one interesting thing is the presence of a group of guys that hang around and seem to have nothing better to do than help you buy stuff. I assume they must get some kind of kick-back if they sell something from someone’s shop.

Three of these guys attached themselves to our group. Although I did ask the one guy his name, I have long since forgotten, so I’ll give them names. The first, I’ll call “Boss-man” since he seemed to be the ring-leader and would direct our path through the market. The other was “Yellow,” since he wore a bright yellow shirt both days we saw him. He was a lot more laid back then the others, but always seemed to show up in every shop. And the third guy, I’ll call “Big.” Big looked like he should have been a UFC fighter. He was probably 6’1”-6’2”, lean but built, with an angular face that made him look mean and a confident swagger to match.

Mama Africa:

This could be a profile in medicine on its own, but I’ll include it here. Terry, or Mama Africa as she became known, is the director of nursing here in Koutiala. She grew up in Africa and has been working as a nurse in Africa for years now. I met Terry in Gabon four years ago during my first trip to Africa. She was just getting ready to leave Gabon for good, to get married to Barry, and to move to another African country (which turned out to be Mali). Terry was very close friends with Karen, the nurse who supervised my trip to Gabon in 2005.

A few weeks after Terry left, I went with Karen to pick up some furniture she had taken to a repair shop in town. She told me that it was especially at times like this that she missed Terry. She admitted that she wasn’t very good at haggling prices and usually caved at too high of a price because she either didn’t know the acceptable price or just felt mean trying to get the price lower. Terry, on the other hand, was an excellent negotiator. She could make herself emotionless and wasn’t afraid to just tell someone that the price was outrageous. Then Karen said, “And most importantly, Terry isn’t afraid to walk away. If she isn’t getting the price she wants, she just turns around and walks out, and they come chasing after her.”

I watched with great joy as this played out in front of my eyes all weekend in Bobo. The rest of our little crew quickly turned over our haggling to Terry, who was definitely better at it than us. She’d ask how much, they’d respond with an outrageous price, she’d counter with an outrageously low price. Quite a few times, she elicited chuckles and “ouches” from the shop owners. But most of them really enjoyed playing the game with her. And then would come her signature move. When the prices weren’t budging, she would just turn around and walk out. It got so the rest of us could see it coming. We’d stand at the entrance of the shop and say, “wait for it, wait for it…and go.” Then, we’d turn around and walk out with her. Usually, we made it 5 yards out of the shop and they were calling us back.

It was this tough bargaining and her ability to speak the local language (in addition to her excellent French) that won her many nicknames. Our favorite was “Mama Africa.” We were in one shop and the owner started speaking to her in French, and Yellow burst in, “Oh no, Mama Africa here speaks Dioula.” From that point on, Boss-man, Yellow, and Big called her Mama Africa, as did many shopkeepers. At one point, a guy selling postcards told me, “These are a great price, just ask my sister,” pointing to Terry. And one time, during one of our walk-outs, Boss-man cried out in desperation, “Madame-chaude please come back.” Madame-chaude meaning Mrs. Hot or more accurately, Mrs. Fiery.

Meeting Miss Moto-Moto:

For those of you unversed in Disney films, Moto-Moto is the hippo that Gloria (also a hippo) falls in love with in Madagascar 2. “Moto-Moto, he’s so big you have to say it twice.” (Don’t worry, I didn’t get it at first either.) A few in our group had seen this movie before coming, and it became a running joke, especially while seeing the hippos. Well, we met Miss Moto-Moto in the Bobo market.

We first entered the market on Saturday afternoon, close to the time it was shutting. Boss-man picked up on us right away, but we largely tried to ignore him. He didn’t seem to care, he just keep going with us. We began to look through the myriad of fabric shops, each containing slight variations from the last. Bobo has one of the largest cloth markets in West Africa, so there was a lot to look through. Boss-man encouraged us to buy fast because the shops were closing. I saw a fabric that I really liked (for me personally) but the shop-owner would only sell it in a bigger piece than I needed. Boss-man insisted he knew where I could get what I wanted. We eventually let him lead us through the winding paths back to another shop.

We were, however, still trying to be independent and ignore these guys. Eventually, however, Yellow and Big joined our group and seemed to show up in every shop we entered. I walked into one and Big began pointing out fabrics that I wasn’t even remotely interested in. He kept asking me questions about what I was looking for. I finally said, “Do you own this shop?” To which, a man in the corner quickly replied, “No, I do.” And so I said to Big, “So you are what? My personal friend for the day?” He smiled and laughed. When we walked out of the shop, he put his arm on my shoulders, pulled me close and while blowing the remnants of his last cigarette in my face, said, “Anything you want in this market, I can get for you. It’s all mine.” I didn't know whether to laugh or to be scared.

Boss-man was growing increasingly impatient that we weren’t buying and that shops were closing. Terry did eventually work out a deal on the fabric that I liked, though I bought more fabric than I needed. We started heading back to the entrance. So far, I hadn’t seen anything close to what my little sister was looking for. We stopped in one last shop on the way out, and I saw a several pieces of fabric that were “close” to what she was after, but no exact match. I told Terry in English, we can come back here tomorrow if we don’t find anything else. We left, and I was feeling a bit discouraged, but had hopes that the next day would bring more success. Exiting the market, we began to look for Terry’s husband, who had wondered out on his own. Boss-man assured us he was coming up the road just then. We couldn’t seem him, but in less than 30 seconds, there he was, heading right towards us.

The next morning, we entered the market, only to be greeted by Boss-man, Yellow, and Big right away, as if they were waiting for us. We had warmed up to them a little bit, and Terry began just telling Boss-man what we wanted to see next, and he would lead us through the little tunnels to a series of shops that had what we were looking for. If we took too long in a shop, Boss-man would get impatient and tell us he knew where we could find something better. Often, Yellow and Big would stand right outside a shop and comment on how nice something we were holding looked and how high the quality was. In a few smaller shops, I would enter and the shop owner would leave and let Yellow or Big take over negotiations. They always explained, “That’s my dad,” or “That’s my uncle.” If we wandered to a shop that they hadn’t taken us to, often our three guides would stay outside. I guess they didn’t have contracts with every shop owner. Boss-man stayed faithfully with Terry, always ready to take us to our next destination. He seemed always aware of what we wanted to look for next, even though we only spoke in English to one another.

I went into countless shops and didn’t see anything close to what I was looking for. Others in our group did buy some fabric, and I bought some bezin fabric as well. (That is a traditional fabric here that has so much wax pounded into it that it shines, as if you were wearing a plastic bag. It’s impressive, but stifling to wear.) Big had gotten on a new kick. Apparently he liked the sandals I had worn the day before, and he really wanted me to trade him the sandals for something else in the market. I explained that I didn’t have them with me, but that did not deter him. Everywhere we went in the market, he would pick things up and say, “Will you trade me for this?” At one point, he picked up a pair of leather sandals and said, “A pair for you and for your wife.” (Someone later suggested that I should have countered, “A pair for me and my three wives.”)

Then I made the mistake of telling Yellow that what I was looking for had flowers on it. Within minutes, every shop-owner I passed was telling me that he had flower fabric inside. Big and Yellow came up with countless floral patterns. We finally tired of the endless rat-race and I told Terry that we should just go to the shop from the other day. Boss-man picked up on this instantly (and I really don’t think he spoke English because he never said an English word to us), and said, “Follow me, I’ll take you back to the shop you liked yesterday.”

He led us right to the shop, and Terry, I, and Yellow walked in. There were two little girls behind the counter (one of the few shops that had anything like a counter), but when we approached, we saw her sitting there on the floor behind the counter: Moto-Moto. She rose to her feet. She hadn’t been there the day before. Terry whispered to me, “Oh man, I hate negotiating with women. They are the hardest.”

Moto-Moto was, as her name suggests, large, though more in bone structure than in weight. She had something of a commanding presence. Dressed in bright green with a head scarf to match, she had a lighter complexion, highlighted with dark but well placed make-up. Having risen to her feet, she rested her frame on her elbows, placed squarely on the counter, and with something of a sigh looked at us. She moved a hand to adjust the stick she was chewing on. Such sticks are often used to clean teeth, but she was chomping on hers in a way that was far too vigorous, and in sharp contrast to the otherwise lady-like nature of her appearance. “Attitude” was written all over her face.

We pointed out the pieces of fabric we wanted to see, and she barked at the girls behind the counter with her to grab them. She unfolded each with her heavy hands. I quickly narrowed the choice down to the one fabric that I really liked, and Terry asked Yellow, “How much?” Yellow shot off an over-the-top price, “17,500.” Before Terry could counter, Moto-Moto, snapped back in the local language (not knowing Terry could understand), “No, it’s not. Tell her it’s 12,500. No higher, no lower.” Terry picked up right away and said, “7,500.” Moto-Moto snapped her head towards Terry and glared. She took the stick out of her mouth and moved it to the other side. This was intense and almost funny. “12,500 is the price. This is high quality,” she said, as her heavy hands began to refold the cloth. Every other attempt was cut off, and she began to act offended by our very presence in her shop. I could see it was time to walk out. Terry and I turned to walk out, but completely unfazed, Moto-Moto continued to fold her fabric. Once outside, I glanced back in to see her placing the fabric back on the shelf.

It was definitely more than I wanted to pay, but she didn’t seem likely to budge. Terry said, “If you want it, you’re going to have to pay that price.” I decided it was worth it, and I didn’t want to lose this fabric. It was the only piece of its kind in the whole market. I turned around and walked back into the shop. Moto-Moto just glared, still chomping on her stick. She pulled at her dress top which hung loosely on her broad shoulders, as if she were preparing to free her arms to take a swing. “I’ll take it for 12,500,” I said weakly. She glared at me for a moment, as if pondering whether or not she should refuse. She moved the stick around in her mouth again. Then she barked something, and the girls behind her scrambled to pull it off the shelf. Not another word was uttered as she took my money, placed the cloth in the bag, and handed it to me. “Have a nice day,” I said, without receiving a response.

Yellow congratulated me on the high quality of my fabric as I left the shop. Big pulled me by the shoulders, sensing his time with me was ending, and pitched one more trade offer for my sandals. “You know my friend,” I said, “I’m really just not interested.” With that, he smiled, shook my hand, holding it for a little while in the African sign of friendship, and said, “Ok.” Boss-man bid us farewell, and we thanked him for his help.

Gotta love the market.

Hospital Website

2009-07-09T20:17:00.002Z

If you are interested, you can check out the hospital's new and improved website:
http://koutialahospital.org/

Bobo: the next big tourist destination?

2009-07-09T19:17:00.006Z

[Warning: If you are pregnant, this entry may cause you to need a C-section. Every time I have sat down to work on this, I get called in for one. Also, I apologize for my long absence. Some people had started to wonder if I had finally broken me. No, indeed, I have not. And though other things have suffered destruction at my hands, I’m alive and doing well. The hospital has been crazy the past two weeks, I had a brief stint of computer trouble, and I took this vacation to Bobo, all of which has delayed my writing.]

The last weekend of June, a group of us took off for Bobo, Burkina Faso. [The group included: Barry & Terry—church planter and nurse; Kelly—schoolteacher here in Koutiala; Ben—visiting med-student; Doug & Angela and kids—Handman extraordinaire and family.] With a name like Bobo, you tend to conjure up pictures of scary clowns, so who would have thought that it would have felt like a Caribbean get-away? It was an excellent vacation, and I hadn’t realized how much I needed to get away and relax until I was there. After coming back, I have just felt so much better and so much more ready to take on life here in Koutiala. It was as if someone pressed a reset button and now I’m booting up normal (unlike my computer…).

Bobo is only about three and half hours from here, as the roads are quite good. As we drove south, the red dirt was more and more obscured by green, the cattle became fatter, and the kids looked healthier. The biggest delay was the border which requires at least 5 stops, a few of them requiring stops to complete paperwork, and multiple others to verify said paperwork. These stops would be several kilometers apart at times, and it made you wonder if you could have bypassed some of them without any consequence.

At the first stop in Burkina Faso, we had to apply for visas and complete an entry form. The customs official was very friendly, telling us to skip large sections of the form and giving us the “correct” responses to certain questions. And since the forms sit in boxes in the back room, I guess it doesn’t really matter. I don’t think Burkina is in the business of turning away tourists. The best part was that you had to have a picture for your visa. I took in one passport picture, I had another one stashed in my stuff, but was hoping not to need to use it. Well, she said that I would need to have two, so I went and got the other. Then, Kelly realized she had completely forgotten her pictures, and the lady says, “Oh, no problem.” Two or none…one throws off the system.

The city itself has about 600,000 people and is a typical African city. The cities here remind me of a village pulled closer together, with a few more “modern” buildings sprinkled throughout. There are few multi-story buildings, and so the cities are expansive, in order to accommodate the population. The streets are lined with roadside-stands selling everything from fresh produce to cell phones. And Bobo was quite a bit more liberal than Koutiala—saw several women in pants and many people in shorts.

The first day, we unloaded our stuff at the guest house and then headed out to go shopping. There are several good stores in Bobo where you can pick up things you just can’t get in Koutiala. (And I even got a receipt at two of the stories!) Then after that, we headed to the Korean restaurant, which had AWESOME food. Who would have thought, a Korean restaurant in the middle of a land-locked country? But I’m happy it was there.

The next day we headed out to a waterfall to go swimming. Sounds like a bad idea when you say it that way, but it was also an excellent time. The falls are about an hour and a half from Bobo. We stopped along the way to climb some cliffs. Terry grew up in Africa and her family would come to the falls on vacation. She remembers seeing baboons on the cliffs as a kid. (below, baboons on the cliffs.)

The falls aren’t that impressive in terms of sheer height or water volume. But when you climb up on top, the river has carved all these little swimming holes into the rock. There are deep pockets you can jump into, little falls that you can sit under. We took a picnic and spent most of the day there, until a storm chased us out. (You can see the clouds behind us. Left to right. Me, Ben, Doug, Angela and boys, Barry, Terry (under) and Kelly)

(Creating a human dam and stopping the flow to the girls below, who were sitting under the little falls.)

(Me jumping off a cliff, and Kelly sitting under a stream, and Barry...well...)

The next day was like a scene out of National Geographic. We drove to this lake that others had told us had lots of hippos. We took some dirt roads way back in and eventually reached the trail head. There were a couple guys under a pavilion. (I’m guessing they see a group of tourist once a month.) They told us to take a path towards the lake. We all laughed at this because we had seen several signs on our drive that said, “Warning, savage animals,” and they had us walking, unaccompanied for a kilometer through the brush to get to the lake.

Once at the lake, others arrived, and we loaded into a big metal boat. Our four guides used long canes to push us around the lake. The lake was incredibly peaceful, and looked just like you would imagine an African lake to look—surrounded with lush green vegetation, diving birds, herons, and…HIPPOS. At first, we only managed to see groups of three, and they were mostly underwater. But then our guides brought us in close on a group of 40. Some were even on the shore. They were incredible. We finally turned around and left when some of the males started becoming unhappy with our presence. (Hippos kill more people in Africa than any other animal. They are very territorial and will capsize a boat that gets too close.)

The last day there, we did some more shopping and relaxing. (I’ll write more about our market trip in a later post.) Excellent vacation!

PS- I would be remiss not to mention that we found (as Terry called it) the best deal in West Africa: a little shop that sold homemade waffle cones and two scoops of ice cream for 600 francs. ($1.25) We ate ice cream every evening.

Personal Note

2009-06-15T22:10:00.001Z

Just a quick thanks to all who have expressed concern or have sent encouragement to me in response to my post, "Keeping it real." As I have explained to several people, by the time I was able to verbalize all that, I was well on my way to getting things back in order. Last week was a really good one for me, and although there are still lots of challenges here, I'm feeling more and more adjusted. Furthermore, a few of the staff here stumbled across that blog post and then reassured me that I had every right to be struggling with all that—that it is very normal. That was helpful in reaffirming that I'm not going through anything abnormal.

Again, thanks for your encouragement and prayers. I really do appreciate them.

Also, sorry for the inconsistent posting. I work on things in my head all week, and it is just a matter of me getting some time to sit down at the computer and type things out. I hope you'll stay tuned, and that you'll continue to enjoy the posts, but most importantly that you'll continue to pray for me and the work here in Koutiala.

Profiles in Medicine: Saskia

2009-06-15T21:52:00.004Z

Saskia will be upset with me for anything I say here. And that is precisely the place to start in meeting her. Saskia likes to hide. She’d rather not have direct attention. Only slightly ironic, since she is a 6’7” white woman in the middle of Africa. (I apologize for any earlier, exaggerated estimates that I’ve told anyone.) I call her my “off-line Skype” friend, since she likes to hid behind the off-line symbol and then text-chat with you when you are least expecting it. I haven’t ever asked, but I bet she was good at hiding as a kid.

Saskia is also Dutch. The C&MA has a sending office in Holland and so we work alongside a good number of Dutch people here in Mali. She resents the fact that the American C&MA has a booklet called, “Working with the Dutch,” which warns of all the cultural differences between the Dutch and Americans. She feels that is not necessary. Very direct, which is very Dutch. I’ve never seen said booklet, but that hasn’t stopped me from referencing my constant need for it.

Saskia is also a general practice physician, with special training in tropical medicine. She is kind of like a jack-of-all-trades. She does surgery, OB and delivery, pediatrics, and general practice. And she calls in trouble from all directions when she is on-call at night. I call these “Saskia’s late-night hospital parties.” Her two specialties: pregnant teenagers who refuse to push and fistula repair. (Her late night parties usually center around emergency C-sections.)

Saskia is also known as Sasha the Fierce. (Long-story-short, we had a visiting surgeon who called her Sasha the whole time he was here. I added the fierce part, in parody of Beyonce.)

Saskia is learning slang English. Her English is impeccable. (Dutch, English, German, French, and she struggles with Bambara…a true linguistic failure… ;)) However, I’ve made it my personal mission to teach her idioms and slang in English. I never realized how many of those things I used in my everyday speech. I have used an idiom and then used two more to explain it to her, and then realized I just needed to say it literally. She is very patient.

Saskia has a favorite patient. Ne (like a horse says…) is a 10 year-old who had typhoid, which caused her bowel to perforate. We’ve had to do 4 surgeries on her to get the thing repaired. Ne dislikes me because I only come by to change her ostomy. She loves Saskia because she comes by to give Ne coloring books, candy, cookies, pink lemonade, and to take her into town. Ne is a good judge of character. When’s the last time your physician gave you a manicure?

Lastly, but most sincerely and most importantly, Saskia has been a great friend to me. I mean, she owes me, since she is the one who got me into this whole ordeal in the first place. I met her in 2008, in Gabon, where she was just finishing up a year-and-a-half term there. Earlier this year, when I was looking into “short-term” opportunities, she came up with the idea that I could come over for a longer period of time. She set in motion the chain of events that led to my coming here. And she has been a very receptive and wise ear for my whining about the difficulties of transition. She has patiently endured my constant talking about my Somali friends that I’ve left behind and miss dearly. She has been instrumental in making me feel welcomed and plugged-in. All this despite having her own share of challenges.

Saskia is not on Facebook... and neither am I. (Except that I once started to sign-up which I aborted, and a million people have found that start-up and have now added me as a friend.)

Profiles in Medicine: the nu-nu’s

2009-06-15T21:13:00.002Z

This is an odd profile in medicine. (And really, the motivation for this post is Noel: see below) But it is important to not underestimate the importance of the Nu-Nu’s (have no idea if that is actually how it is spelled.) Not sure who the Nu-Nu’s are? Well, let me tell you. They are the hired help (usually girls of like 12) of the nurses who have infants. They sit in a little room (or roam around the hospital) all day (or night) watching the infant until it is time for the babies to nurse. It’s like on-site day-care, with all the intellectual nurturing that 12 year-olds can give.

Below you will see a picture of a nu-nu and baby in action:

And now, the real reason for this post. Meet Noel. She’s my new, cute little sister. I’ve always wanted a cute little sister. (Marti, calm down…it’s just a joke.) Noel is the 6 month-old daughter of one of our nurses. Her two-year-old brother is Jacob (pronounced with a long “ah” sound. J-ah-cob). That’s my name too. (In Bambara, they say, “Yacuba”) So I adopted her as my little sister. And the big plus: She’s not afraid of white people, which means, unlike 95% of the children here, I can hold her.

I tried taking a picture of her one morning, and I could get her laughing, but as soon as the flash for my camera would go, she would get the, above, wide-eyed look.

Life in Koutiala: Moto Peril

2009-06-15T20:48:00.004Z

There comes a time in every young man’s life when he has to lay down his bike. Yes, the kind of lay-it-down that sounds like you are quitting, but really is just a gentle sounding euphemism for a more gruesome reality: when the tires aren’t on the pavement, your not-so-resilient flesh is. I knew this was coming… I’ve seen far too many people with road-rash, scrapes, and various other injuries from riding their motos. At least the anticipation is over…

This is the story I’d like to tell:

It was late at night. I was rushing into the hospital to help save another life—maybe two, if I hurried, since mom and baby are at stake. I was rushing through one of the back alleys when a little child stepped out into the street. Having no way to avoid him otherwise, I intentionally laid down my bike-thrusting it out of his way, and taking the fall myself.

Alas, I’m no such saint. The truth is that I was heading home on a Friday afternoon and it started raining. Like some witch from Oz afraid of melting, (or worse yet, some techie nerd afraid that his electronics might fry) I started driving faster to get home. I was already soaked by this point, and I should have just slowed down (driving fast only makes it hurt worse) and enjoyed the shower. I was almost home and slowed up for a more major intersection…and… I don’t exactly remember what happened. No, I didn’t hit my head. It’s just that it happened so fast. One second I’m applying the brakes, and the next my knee is hitting ground and my hands are scraping across the pavement.

Neither I nor the bike were hurt. My hands are kind of road-rashy and my knee is banged up and scrapped…but only my pride was in critical condition. I jumped up, picked-up the bike, waved off the old man who was coming to help me (nice guy…), and got home without further incident.

Below is a picture of me after parking at home, as a way of commemorating the event. (And to prove to my modeling agent that my multi-million dollar face was in no way injured in the accident.)

In other “casualty” news…I’ve only broken a couple more things since I’ve last posted. The first was another tire on my moto. This left me “au pied” as they say (on foot). It was late in the evening and I was eating dinner with Doug’s family that evening, so I hitched a ride to their home and Doug took me home (always cleaning up after me…poor guy). I knew that I could get my tire fixed right across the street from the hospital in the morning (another $0.40…whew!), so I just needed to walk to work the next morning.

The distance from my house to the hospital isn’t anything prohibitive—I run past the hospital on my morning runs. So I set out on foot, trying to enjoy the walk and the time to think (and trying not to get run over…). I had completed the larger part of my trip when around the corner comes Elizabeth on her moto.

“C’est comment?” (lit. trans: “How is it?” More accurately: “What’s the deal?”) She says this with a half-smile while wrinkling her nose and eyes tightly, which gives the distinct impression that she is either about to laugh hysterically or spit in disgust. She slows to a stop. I start explaining the situation, but when I get to the part about my tire popping, I can neither remember the word for tire nor for pop, so I point at her tire and make toddler noises. This conveys all the point she wants to hear. She turns the moto around and insists that I climb on, now with the distinct air of walking being below her boss’s dignity.

I climb on and she takes off to the hospital with a sense of urgency. Fine. But then she starts beeping her horn like she is some kind of ambulance. She wasn’t driving incredibly fast, just determinedly and she wasn’t stopping for anything. The more crowded the intersection, the longer and harder the horn. We arrive at the gate of the hospital, which has a chain across it that has to be lowered. She holds the horn down as we approach and a guard looks around the wall and immediately lowers the chain. (Good thing, because I don’t think she was going to stop, regardless.) The ruckus this causes is noticed by the staff, who is gathered for morning devotions. So everyone sees me come flying into the hospital on the back of Elizabeth’s moto accompanied by horn blasts. Funny…I thought it would have been more preserving of my dignity to slip into the hospital on foot.

The second thing I broke was a plug that someone had just fixed. I’m incredible. We were gathered for our Wednesday evening prayer time, and Barry had just fixed a broken plug-end for a fan. He asked me to plug it into the power strip right behind my chair. I bent down and tried to get it in. Of course, it did not go. So to a crowd of on-lookers, I am failing at something as basic as plugging something in. They start to offer encouraging comments like, “It can be tricky.” “Wiggle it a little bit.” “Sometimes it gets a little stuck, just push it.” So I wiggle and push, and it breaks. Awesome! It was almost not-funny.

I think that’s all the damage I’m confessing to…for now.

Keeping it real

2009-06-07T19:07:00.003Z

(Apologizing in advance: this may seem like something of a rant or emotional drivel. Not intended to be…just honest thoughts that the Lord is working out in my mind and heart. Not funny or eloquently written.)

Fridays are my refocusing day. The other four mornings of the work-week I force myself to get up early so that I can run and exercise (didn’t used to look at running like a chore…), but Friday I sleep in a little later, then wake up and read and pray. Usually by Friday, I need a healthy dose of refocusing and reflection. [I needed this in Utah too, but my schedule wasn’t as conducive to setting a morning each week, which is sad because I think it would have really benefitted me.] Some Fridays I tell myself, “It’s ok buddy, just hang in there, the weekend is coming.” Some Fridays I’m a little bit harder on myself, making lists of things that I need to get done and mistakes I need to be careful to avoid.

I realized as I was surveying the list of blog titles I’ve written that most of what I have written is informative and focuses on the funny things here in Koutiala. And those aren’t exaggerations because trust me, there is lots of material (and I’m generating more all the time—there is a reason that certain friends of mine know me as Captain Awkward). But life isn’t all just a barrel of laughs here, as much as I wish I could make it be. Things can be very hard here, and I don’t like focusing on the harder parts but not doing so paints a very 2-D image. And I always get worried that I will say things about the negative things and people will think, “Oh he is miserable” or try to have pity on me—and I really don’t want to be a pity-charity-case. Ironically, I’m writing this after having probably three of the best days in a row that I’ve had here.

Friday morning I woke up feeling pretty rested and ready to start my day. After my cold shower, I was brushing my teeth, and I began reflecting on the week, which in some ways had been a doosie. Things tend to come in waves here. I will be doing great for a few days; then I’ll have two really terrible days where I hate life here. Those are the days that I ask why I ever came and I think about going back. Those are the days that I mound up all the evidence of how I’m failing at what I’m doing here, and I think about how other people could probably have come and done better. But they pass and then I’ll be feeling pretty good again. And so naturally after thinking about all this, I felt like I was some kind of emotionally unstable person. So I did what I do best with those crazy emotions, I thought about them, dissected them, and wrapped them up in little, manageable pieces that seem easier to control. And then I made a list.

Culture shock. Sometimes I feel like I’m on Mars. And it is not the food, the different living environment, or the heat. It’s the people. I mean, sometimes I’m sure it is blue and they see orange. I’m sure this is how it should be with x,y,z, and they confidently write out c, b, a. Really? And unless I want to be some tyrannical jerk I have to play by their rules, which isn’t so fun when you realize you don’t have a handle on them. And I want to love them, I want to serve them, and I really want to be their friend, but I feel like there is this enormous gulf that I’ll never be humble or loving enough to cross. And then someone does something that makes me think I’d rather swim back home through the Atlantic then to cross that gulf.

The language. This continues to be a thorn in my side. My French isn’t terrible (though sometimes I feel like I speak more Spanish and I really only know the phrase, “no hablo espanol”), but I can’t speak Bambara at all. It is most frustrating when I’m actually having a good conversation with somebody and I want to say something or ask a question and I fumble over verb tenses and vocabulary and end up sounding like a confused second-grader. I’ve been trying to study more. And I feel like I should be further along and that I should have put in more work before coming and that I should be studying more every evening. But frankly, sometimes I don’t have much of an evening, or I’m exhausted, or I’m called out for an emergency, or I’d rather read, talk with someone at home, or write something funny. And so in my head I give myself failing grades in language class and tell myself that I’ve been here for five weeks and I should be doing better.

My role in the hospital. I am feeling more and more confident about my role in the OR, though this was my first week on my own (since Isaac was on vacation), and I fumbled over some minor things (which of course meant that I had completely failed). But I’m still learning other things around the hospital and trying to wrap my head around the way things work. And I’ve been here for five weeks and I feel like I should have it all down, and I then I think the other people working at the hospital are disappointed that I haven’t caught on faster. And what I want most is to be helpful…to really make a difference and to be part of the effort here. But for now I’m still learning things, which can be painful. Like when I explain to one of the nurses here that I don’t know something about maternity or peds, and they ask me things like, “did you actually work as a nurse in the States?” Or better yet, when I’m working with a weaker member of the staff, trying to help them learn something, but not wanting to seem like some arrogant task master I try to get them to show me how they are doing things. This leaves them thinking that I’m a total idiot and that they have to train me. And by the fifth time they explain how to do a blood pressure, I’m ready to put the cuff on their neck and see if I can find their carotid blood pressure.

Friendships. Like I said, I want to make friends here and to love on people. I have several great friendships with people at the hospital, but I really want them to be deeper friendships, not just casual “work-friends.” So when I’m low, I think that I haven’t done nearly enough to bridge the gaps and that I haven’t put in enough effort in reaching out and getting out into the village to visit people.

Transition and adjustment. I finally let myself admit that both the transition from Utah and the adjustment here have been really hard…no, frankly, they’ve sucked. My friend Danielle (the most emotionally attune person I know) knows me as an emotional retard, meaning that it takes about 6 weeks for me to process something and actually let the emotions express themselves. So in the midst of all the adjustments the reality of packing up and leaving in less than 5 weeks came crashing down, and I’m still sorting some of that out. And then, to be truthful, my adjustment here hasn’t been easy, and I hate to admit that because I like to pretend that I’m some type of superman that learns quick and has infinite flexibility, but alas, I am not. The reality, though, is that I was under a lot of pressure to learn and be independent really quick, both at the hospital and in life here in general. And this wasn’t anybody’s fault and no one was trying to be mean about things, it was just what was needed. But I also have to be honest, it wasn’t the softest landing ever and I’m still dusting myself off a bit.

Calling, learning, and questions. So in additional to all the rest, this type of experience brings up all kinds of questions. Like, how do my personality, my gifts, and my passions fit into a context like this? Is this the kind of thing I could see myself doing for the rest of my life? And then there are the questions brought about by context. Is it wrong for me to live in a house with an air-conditioner when some of my friends don’t even have running water? Is that an unnecessary barrier to my ministry with them? And I really want to be open to learning these things, and hearing God’s voice and leading, and to listen to the advice and counsel of the veterans around here. These aren’t bad things, and I would be asking them even if my adjustment to life here was going as easy as imaginable. It is just that they get added to the mix of everything else going on inside of my heart and head.

By the time I was doing making this messy list in my head, I was dressed and heading for the kitchen. I grabbed a glass of water and my malaria medication and sat down at the kitchen table. My devotional reading that morning was Philippians 2. “Your attitude should be the same as that of Christ Jesus…” Humility. A huge transition and adjustment. Offering His very life. And I realized that my attitude and personality had not at all been that. In my all my flounders, I’ve been desperate to prove that I’m not an idiot, so I’ve been way too quick to share what I know. (Which just makes you look like a know-it-all idiot, huh?) And on the other side of all that, I’m way to eager to make people like me, so I become suffocating. I chuckled to myself about how silly it all was. Not that it wasn’t hard, but that I was reacting so extremely to it.

And I half sighed and half uttered as I exhaled, “I surrender.” I surrender. I give up my right to call things “fair” and “unfair.” I give up on the competition and the rat-race that says that I have to work hard to be the MOST successful. I give up on thinking I have to “win” friends.
And then I prayed one of those really dangerous prayers, “Lord, let me have your attitude. Let me have your humility.” (I learn humility the hard way, which is part of the reason I have so many funny stories. I hope this doesn’t mean I have to break more of Ed and Andrea’s stuff…)

Then something my friend Sarah said in a recent conversation came to mind. We were talking about transitions, calling, and loving people and communities. She closed the conversation with, “Jake, love unabashedly.”

Glanced down at my watch, realized I needed to get going. Took my cup to the sink and washed it out. Threw my wallet and phone in my bag, grabbed me helmet. I wheeled my moto out of the yard. I turned around to lock the gate, slipping my key in the lock. I paused, looked up, and prayed, “Lord, give me strength for today; let me judge myself by no other standard then living according to what You want from me, and let me love unabashedly.”

The Random Pictures Blog

2009-06-04T22:04:00.005Z

Some of you prefer pictures over my lengthy descriptions of life here in Koutiala (I think you're sissies!). So much like the way in which I take pictures, I have chosen to randomly and arbitrarily post pictures for your viewing pleasure:

Above: (first) The boabob tree that I described in an earlier post. You can see how big it is by comparing it to the woman walking next to it. (Second) The main Alliance church downtown. It sits on the main intersection in the market area.
Our team: Lidy, our scrub nurse (foreground, left side), then Dr. Petty (visiting American surgeon), me, and Saskia our Dutch physician.

Here we are, in-action, doing a C-section.

Dr. Petty pitches the baby to Joe, who catches and then rushes into the warmer to do any resuscitation needed.

Profiles in medicine: Isaac

2009-06-04T22:00:00.001Z

Isaac is the Malian nurse that works with me doing anesthesia for our OR cases. He has been a nurse for over 15 years and used to work at a clinic in a small village. Because of this background, the guy can do a little bit of everything. He does anesthesia, occasionally does prenatal consults, schmoozes the local government hospital and governmental officials to keep us in their good graces, and I’ve seen him deliver a baby on the OR table. He loves to joke and laugh, but seriously loves the Lord. Before every case (right before we put people out), he bends over the patient and prays for them and asks the Lord to guide the surgical team as we work on the patient.

He has three kids, that all seem to be afraid of white people. (I’m working on getting them over it…) Currently, he keeps his days busy by being employed full-time at the hospital, going to school to attain the next level of nursing degree (for lack of better word—the system here is different), and being the coordinator for the youth program, which is the group that works with all young people (teens to 35…haha) in the churches here in Koutiala.

My favorite Isaac quote: “In the village of the blind, even the one-eyed man can be king.”

Life in Koutiala: A Bull in a China Shop

2009-06-04T21:47:00.001Z

(This entry was started Monday evening…and I just now finished…oh, good intentions)

I wasn’t going to make this list because I’m slightly embarrassed. But after this morning, I was so ticked off I just didn’t care, and then as the day passed, I began to see the humor in it all. So I figure it is time to get it all down in written form.

Before Ed and Andrea left for the States they told me, “If anything breaks, no problem, just send us an email, so if we need to replace it in the States we can do so.” And like any good house sitter, I assured them that I would make it my goal to never have to write such an email. About three days later I sent them an email asking some questions about some things that I had forgotten. I cleverly wrote in the subject line, “Don’t worry, nothing broke.”

Famous last words.

Since then, I’ve been a non-stop wrecking ball. I regularly keep the other missionaries entertained with my ever-lengthening list of casualties around the house. I’ve written several apologetic emails to Ed and Andrea explaining “what broke now.” Then, I have to have “confession time” with Bob and Doug, the missionaries here that are in charge of all the maintenance for the hospital and houses. It’s rather humiliating. (So I might as well air it all my on-lookers.)

But before I spell out this list, let me just give a few words of explanation in my defense.
1. I don’t feel like I’m a particularly destructive person. A little clumsy at times, sure, but not maliciously destructive.
2. Hate to admit it, but I’m just not that strong. I mean, some of these “accidents” could be explained if I just was underestimating my own strength. Alas, I’m no Clark-Kent-turned-Superman.
3. Cheap Chinese crap. This is a widely known and accepted saying here in Koutiala. Not to debate the merits of Chinese products, but it seems that a lot of available hardware around here is poorly fabricated.
4. It is possible that Ed and Andrea timed their vacation at just the right time for all of these things to break. Like a ticking time-bomb, their house has chosen to detonate while in my care.

Alright, here’s the stinking list:

1. The pool. Ed and Andrea have (had?) a pool that they asked me to take care of while they were gone. It’s a nice little thing (underground even) in their backyard that they resurrected from 18 years of non-use when they bought the house. When I arrived, the kids were swimming in the pool daily, the water was mostly clear, and it was an inviting scene. Before Ed left, he gave me detailed instructions on how to manage the pool. They left and that evening I went to filter the pool; however, the water level was too low and the filter was pulling a lot of air. Ed had told me that he added water almost every day (but he didn’t tell me how much). So I added water instead of filtering that day. The pool still looked good. That weekend I filtered all day, swept the pool, added chlorine, but didn’t get in. The water started getting cloudy. Sunday morning I found two dead, swollen lizards floating in the pool. Monday, the pool started turning green. I desperately added more chlorine. Tuesday, I couldn’t see the bottom except in the shallow end. I could not (and still do not) understand what I had done wrong, except every day I would have to add water for an hour or so before I could turn on the filter. It was just really leaking. A week after they had left, Ed and Andrea’s pool looked like some green space alien. I thought it might possibly grow legs. However, I continued to valiantly fight the battle. After two weeks, the rest of the missionaries convinced me that it was time to call it quits. (After all, I was only wasting water, chemicals, and electricity.) I wrote my “sorry” email to Ed. The pool now sits, empty and uninvitingly in the backyard and has become a receptacle for rain water.

2. The washing machine. They did explain that it was “on its last leg,” and had some “quirks.” But four days after they left, the washing machine quit working. Luckily, Doug—missionary super-handyman—was able to play with wiring and resurrect it from the dead.

3. The bird. They have this little parakeet in a cage that sits back by the pool, hanging from a mango tree. (It was almost disgustingly picturesque…) I arrived home one afternoon, a week after they had left, to screams coming from the backyard. I rushed in to find Elizabeth (housekeeper) and a neighbor boy pushing the bird back into its cage. It wasn’t too pleased and was biting both of them. Having contained the creature, they walked away, muttering something about “stupid birds” and not knowing how it got out. How did they catch it? A quick survey of the backyard painted the picture well for me. The hose, the tree, the water marks in the dirt. A quick look at the bird brought it all to completion. Wet, half featherless, hanging upside down in its cage, hissing. I mean, I got to hand it to Elizabeth, if you lose a bird in a tree, a neighbor boy and a hose aren’t bad ways of retrieving it. I was sure the bird would die. It didn’t move for most of the next three days—just huddled on its perch and then occasionally hanging upside down, always hissing. It has since regrown most of its plumage and seems to be living happily.

4. The pool filter. I had to drain the pool, but the trick to this is that drain-feature on the filter pushes the water through a pipe that goes under my wall and into the street. This isn’t exactly a problem, except that it ends up flooding the front of my neighbor’s house (slightly problematic for neighborly relationships…after all, you never know when you’ll need one of his kids to catch your bird). I was attempting to move the filter/pump back a couple inches so that I could slip a flexible blue hose into that pipe, so as to drain the water into my yard, when a PVC pipe connecting the filter and pump snapped in two. I swear I wasn’t pulling that hard. Another job for Doug…

5. My borrowed moto. It’s one thing when you break your own vehicle, it’s another when it is someone else’s. One evening shortly after I had parked my moto and come inside, the guard came to get me and told me the moto was leaking gas. It certainly was, but it seemed like a simple fix—a disconnected hose. Felt really good about this “fix” till the next morning when it wouldn’t start at all. I had apparently connected two air vents that were leaking because the carburetor was blown. Again, Doug…

6. My front gate. This was just a few days ago. The metal plate that articulates with the dead bolt on the gate’s frame was warped. Then someone got physical with it and it snapped. Guess who got to fix that… Yep, Doug…

7. The bunny. Have I mentioned that Ed’s middle daughter, Lily, is an animal lover? I, however, am obviously not meant to have pets. Yesterday I go out to feed the bunny, who had previously seemed so happy and healthy, and he is dead. Are you kidding me right now? I buried it in the backyard, trying to count the blessing of not having to give up all my lettuce to the hungry little bugger. [You animal lovers out there will be happy to know that Elizabeth, quite unprompted I assure you, bought another rabbit on Wednesday. I have no idea why, or frankly, what she was thinking when she did. It is not even the same color and has floppy ears as opposed to the straighter ears of the other one. If it was a cover-up job, it was a terrible one—I’m pretty sure Lily is going to realize. If not a cover-up job, why now as opposed to two days before they come back?]

8. Then this morning…I come back from my morning jog. Frankly, it was a nice morning—hot as all get out, but peaceful. I was on-time to get to the hospital early while still having plenty of time to eat breakfast and enjoy some quite time. I stick the key in the lock and turn it several times. It doesn’t pull the dead bolt back. After a frustrating minute of trying to get the lock to work, I decide to pull the key out and go to the back door. I turned the key back to the neutral position and tried to pull it out. It snapped in the lock. Seriously, you’ve got to be kidding me!? Now I’m locked out, without a cell phone, sweating like a pig in labor, and with only my feet to carry me the two miles to the nearest place I can get a key. Fortunately, Elizabeth had forgotten to lock the back door, so I got in and was able to get my phone and moto key. And again, this job goes to Doug!

9. Then this afternoon, after telling everyone about having killed off the bunny and breaking my key in the lock, I pop a tire on my moto. The only thing I can say about this is, at least it is cheap to repair. It cost me the equivalent of $0.40 to fix it.

10. I’m afraid I might sneeze too loudly tomorrow and shatter all the windows...

Medicine in Koutiala: You could say, “Different.”

2009-05-28T22:13:00.002Z

I did something Tuesday that I think very few people have done before (missionary doctors and nurses excepted). I gave my blood to a patient yesterday. As in, I went to the lab, had them draw my blood into one of those bags you always see at the Red Cross, and then a short hour later, I hung that blood on IV tubing and gave it to the patient in the OR. That cheesy Hair Club For Men commercial kept going through my head: “And remember, I’m not only the president, I’m also a client.” “Remember, I’m not also your nurse, I’m also your blood supply.” Talk about having patients suck the very life out of you…

(After donating said blood, David, the lab guy handed me a little slip of paper declaring that I was Hepatitis B and C and HIV negative…woo, what a relief. I’d have been a little taken aback if anything was positive.)

But really, around here, this is all just par for the course. Things are done a little differently around here. And some of you may be thinking, “Oh, third world health care, I can only imagine,” but I’m actually going to give you several reasons why we may just be the best healthcare system operating in the world these days…

--We are preventative as opposed to curative. Those are fancy words meaning that we work hardest at trying to prevent disease instead of waiting until things get so out of hand that you spend lots of effort and money trying to fix it. (Many suggest this as the root of the problem in American healthcare…we are curative as opposed to preventative.) So for instance, the basketball size mass that has been growing for 25 years in your belly, that we all looked at with wide eyes and took pictures of today during surgery, yeah, we’d like to prevent those things. Therefore, we offer a wide array of consult services, vaccination clinics and prenatal clinics to prevent disease (unless yours is going to be particularly interesting, then we’d like you to wait 25 years to see what it does.)

--We believe in incorporating creativity into healing. Some would have you believe that medicine is all about exact science, but deep down we all know this to be a farce. And besides, creativity is good for the soul. So when we encounter a problem that doesn’t have an exact scientific answer, (in other words, we are just not sure how to fix), we like to stand around in little huddles brainstorming, after which, we head to the warehouse and sort through donated supplies. Whoever finds the best looking solution to the problem wins the creative touch award for the day. It goes something like this: Our nurses don’t have watches, so it is difficult to time things when taking vital signs. Go to the warehouse. Oh, here are a bunch of wall clocks. They now carry around wall clocks while doing vital signs.

This is how popsicle sticks and tape became a replacement for mechanical ventilation in newborns. (I’ve described this elsewhere, but it bears repeating. Instead of intubating babies—which would be fruitless since we don’t have ventilators—we use these contraptions to lift their chest (taped to the top of the incubator) and keep it from collapsing on itself. Upon seeing such rigging for the first time, I was stupid enough to ask if there was an actual device manufactured for this in the States… uh, duh, it’s called a ventilator.)

This is also how we ended up with a laparoscope that uses a giant hook and crane to operate. In the States, laparoscopic surgery is done with a scope that is passed through a tiny slit in the skin. The scope uses compressed carbon-dioxide to move tissue around so that the doctors can visualize the organs they need to see. Having no such compressed gas available, we make a slightly larger cut, insert a large hook, attach it to a bedside crane and lift. The effect: all that crazy tissue and skin is lifted up and the scope can go looking around inside! Works great on skinny people! (May be the reason it hasn’t caught on in the States yet…)

--We’ve said, “To heck with all those silly FDA regulations.” Expiration dates are nothing more than a bureaucratic power-trip that serve only to waste medical resources and money. We personally don’t believe in them. You poor saps still living under their tyrannous, bean-counting ways, can save your new (or gently used), but expired medical supplies and medications for us! We love donations! Oh, and don’t even get us started on JCAHO…

--We offer a personal, human touch. In addition to causing severe latex allergies, all the protective gear used in other healthcare settings makes the patient feel like some sort of lab rat. We offer a more personal touch here, using gloves in only extreme circumstances. Before donning gloves, we always ask these questions: Will I really be exposed to anything contaminating? Are there ways to move this or that item to accomplish what I would have done with my hands if I had gone through the trouble of putting on gloves? If I am likely to get some “contaminate” on my hand, will I be able to just wash it off really quick?

--We believe in helping people develop healthy body image. We all have bodies, and every body does some crazy things. Hiding these “functions” in the privacy of your own room is so over-rated and only causes you to have complexes about what is very normal and natural. Time to feed the baby? Go for it! The hospital ward is a little warm? Show a little more skin. Just had some random body organ removed in surgery? Don’t worry, we’ll take it out and show it to your family. You may think it is crazy at first, but it is a whole lot cheaper and effective then tummy-tucks and nose jobs.

--We involve family in your care. In the States, healthcare systems have gradually come back to the idea of involving families in the care of the patient. They’ve started expanding visiting hours and some “out-of-the-box” doctors are now including them in rounds. Well, here in Koutiala, in addition to cooking all of your meals for you while you are hospitalized (I mean, really, who is a fan of that hospital food anyway?), family will be on hand to clean you up and help you get around. They’ll be sleeping outside under the tree on their mats if you should need them at night. You need medications? Great, we’ll write your family a prescription and they can go get it from one of the local pharmacies. Emergency need for medications? No problem, we’ll just supply it up front, and you can restock us at the time of your discharge.

--We have gone green. While the words, “Single-use only” and “disposable” have become commonplace in American healthcare systems, we believe them to be dirty words. We much prefer, “reduce, reuse, recycle.” If it can be sterilized, we do it. If we can wash it with dish soap and bleach, we do it. Oh, you are done with that nasogastric tube? We’ll take it and wash it up for the next patient. Done with that foley catheter? Yup, we can sterilize that too! (On a personal note, this one gets me…) Empty bottles or plastic trays? Save them, our nurses will take them home and find a way to reuse them.

--We have cut costs. Who needs insurance companies? Come to Koutiala and you can have your baby for $21, out the door. Or if you can pony-up and pay the $12 for your 10 prenatal visits with us, we’ll cut the cost to $17. Prenatal visits + delivery + hospitalization=$29. Can you even pay your deductible with that? Sick kid? Swing by on any week day, pay the $0.75 immunization fee and we’ll make sure the baby is current on their vaccines and we’ll see them as well.

--We recover all our costs. In the States, healthcare systems believe in the reliability of the mail. But what if the patient moves and the bill gets lost in the mail? What if they simply don’t pay? We’ve solved this problem. Before you can be discharged, one of your loved ones will be given a bill that they will need to pay at the registration desk. Once it is paid and stamped, we’ll give you discharge teaching and instructions. (Charity aid is available to those who need help paying.) The couple with the largest bill ever seen in our hospital just checked out the other day. They had a $900 bill, but it was for a month and a half in the hospital for mom and the triplets. Two of the triplets had multiple operations, and the family had a private room. (They were a family with means…)

Mayo, John-Hopkins, and Intermountain Healthcare…please take note. You’ve just been schooled.

*I may be off in some of my above figures. I don’t have the hospital price list in front of me (nor the bill of the family), but they are as close as I can remember.

A look around the hospital

2009-05-26T21:31:00.003Z

[Above, my incredible filming job. You start with the pediatric building, which is currently only used for administrative offices and also for consultations and vaccination clinics. The you see the next phase of building. This will become three distinct buildings that will house more maternity beds, new ORs, etc. And then lastly, you see the current maternity where the hospitalized patients, the delivery room, and the OR currently are. Also, note all the people outside the maternity building. These are family of patients who spend all day and night outside, taking care of their loved one. The maternity has close to 50 beds, about 30 of which are all in one giant room. The Western concept of private rooms doesn't exist here.]

Medicine in Koutiala: His Name is on the Gate

2009-05-25T22:05:00.002Z

I have avoided writing about the hospital until now. Frankly, there is too much, and I have not yet figured out how to break it up in to small amounts that are both easy and coherent to write, and enjoyable to read. The sheer volume of material makes it a daunting task—the people and personalities, the patients and families, and the actual medical care. And also, I’m worried about not doing justice to the reality of the hospital.

That being said, I think the best place to start is with a quote from Dan, the main OB/GYN (and everything else) surgeon. I was able to spend a little time with him before he left for 3 months of reprieve in the States (and I look forward to working with him more in August). Despite the fact that there are many other dynamic people involved in the hospital that are making it what it is, most would say that it was Dan’s sense of vision and his personality that really got the hospital going. When he arrived in Koutiala four years ago, the land was purchased, but the supplies need to have an actual, functioning hospital were nowhere to be found.

So over dinner, during my first week here in Koutiala, Dan said something that has stuck with me. In talking about the needs present in Koutiala, and the bizarre cases that come through the hospital, he said, “We are doing things that we have no business doing [but do because there is no one else to do it], and we have an incredible success rate. It’s like God keeps us from making big mistakes, because His reputation is on the line and His Name is on the gate” (not a verbatim quote…but close as I can remember).

And honestly, I think that is about as good as anyone could sum it up. We are in a city that is about 6 hours drive from the capital city, Bamako. The capital is the only place where any level of advanced care can be provided (and even that care is minimal in many respects). Though any of us could easily afford the trip to Bamako, and we could probably afford to pay the medical bill out of pocket, this is not the reality for the majority of Malians, who live on $2/day. Very rarely do Westerners factor finances in life-and-death decisions, but here it is an unfortunate reality.

Koutiala Hospital offers affordable, high-quality care. And the medical personal here bend-over-backwards to help the women and children that are in our care. Sometimes that means doing things that they never done before—something their training did not prepare them for. Dan also said that the list of surgical cases for each month reads like the complete list of OB/GYN emergencies found in his med-school textbooks—things that are just not seen in the States on a regular basis. There are a lot of cases that just stretch everyone to the max of our abilities. And this is why we pray before every surgical case.

Far from being people with a Messiah-complex (though we certainly are here for the Messiah), the staff approaches their work humbly, often desperately pleading with the Lord to protect the patient. And though death is a more-accepted reality here (you do eventually run out of resources here), the work is not approached half-heartedly, or fatalistically—as if the patient will die anyway, so we can just attempt some surgery out of our league. The staff here is constantly researching procedures and conditions, often spending hours reading in the evening after working all day at the hospital. They have a wide network of people they consult in the States. Speaking personally, I’ve never before read so much, with as much intensity, concerning the drugs I give and the procedures I perform. This position has called me to a higher level of understanding and practice, and I’ve responded with a great deal of study, research, and humility.

Because His Name is on the gate, the Lord is gracious to us and to our patients. The number of lives saved and touched by the hospital is enormous. As Brett, the pediatrician, said, “It blows me away that premature, less-than-2-pound babies stand a chance here because of our simple protocols and procedures.” (Our incubators are wood boxes with plexi-glass and a series of light-bulbs. To help premie babies breathe, we tape their chest up and suspend it from the top of the incubator, which prevents their immature cartilage from collapsing in on their lungs. We make up our own special tube feeds for the premature babies.) Very affordable prenatal care and consultation are provided to about 50 women every day. As many as 60 children come for vaccinations and consultations every day. And we have a steady stream of emergency surgeries that prevent fetal and maternal death.

So, we continue to build, to plan, to learn, and to serve. The hospital is bustling with changes being made, supplies arriving, new personnel arriving, and new buildings going up. How can we do less? His Name is on the gate.

Life in Koutiala: Food

2009-05-19T21:40:00.001Z

It is sitting there at the edge of my plate, staring at me—my mistake. If it had beady eyes, I’m sure they would be rolling around in its little head. But much like Dr. Frankenstein, I feel responsible for this monster, my monster. I feel obligated to it. That is why it is still sitting there—a monster of my own creation.

There is such a thing as being overzealous. And when you mix “overzealous” with “eager-to-please”, a bit of “adventurous spirit”, and too much “accommodation”, you get a monster. Before you know it, you’ll have eaten part of it, and you’ll be seriously contemplating devouring the rest.

In my first few days here, Andrea (in whose house I’m living) was busy trying to help me settle in and to prepare me to be on my own. She was trying to help me make grocery lists, and we had a couple conversations with Elizabeth, the house help who would be cooking for me. Elizabeth was very worried about what she would make me. She does occasional cooking for Andrea and her family, but only on occasion and usually she works with Andrea to make more “American” cuisine. The thought of a new person, who might be very particular and who wasn’t going to be around to direct the cooking, was intimidating to her. And given her personality, I can understand her anxiety.

I’ve mentioned Elizabeth before, but a little more about her personality. She is the kind of so-over-the-top and eager-to-please person that it makes me nervous. If she is in the house, I can’t even take a plate into the kitchen without her taking it out of my hands. The house is always spotless when I come home. The other day, I arrived home to find out that the washing machine had broken; so she had taken my clothes (which I hadn’t even asked her to wash) out of my laundry basket and washed them all by hand. Today I arrived home in an absolute down-pour, and she ran out to try to pull my motorcycle inside (don’t worry…I didn’t let her). I mean, don’t get me wrong—she is wonderful! I just wish she could relax a little around me. If the laundry doesn’t get done today…who cares? She obviously has no idea the standards of an American bachelor. And I know from conversations with Andrea, that she has tried to get Elizabeth to slow down and not worry so much. But I’m sure it this personality that makes her an awesome housekeeper.

So it was during one of those early conversations, that I thought it would be wise to reveal that I had eaten with Africans on a regular basis over the past three years, and that I would totally be flexible in eating whatever she wanted to make. I was trying to assure her that I wasn’t hard to please, and that I like a lot of different foods. So she agreed to cook for me in the Malian way, which I thought was both a good idea and a tasty one. Mistake number 1? That remains to be seen.

In a later, follow-up conversation with Andrea, we were talking over ideas and the costs of various food items around town. And then I said it… “Oh, we can tell Elizabeth that I don’t mind eating goat meat.” This is a true statement. Having eaten with Somalis at least twice a week for the past three years, I have eaten a lot of goat. Well, Andrea told Elizabeth this, and she made immediate plans to go buy goat meat. Mistake number 2? Definitely. (The good news is, due to the large number of goats in town, it is cheaper than other meat around.)

As I said, I came home today in the middle of a bad storm. I had enough time to come inside and spit the sand out of my mouth (the storm was preceded by wind that caused a mini dust storm which I got caught in the middle of), and then I got a call from the hospital saying there was an emergency C-section. So I rushed back into the hospital. I didn’t get home until about 7:30pm, and was quite hungry by that time.

Elizabeth had left the food on the stove, waiting for me. I opened up the pots… Rice and peanut gravy with carrots, green beans, and meat. Undoubtedly goat meat. I threw it in the microwave and came out to start reading emails and taking care of various other things. I went back into the kitchen, grabbed the plate out of the microwave, and headed back to the table to continue reading emails. The first few bits were awesome. Peanut gravy has a great taste. I thoroughly congratulated myself on the great choice to have Elizabeth cook Malian cuisine and to use goat meat.

I was about halfway through a Christianity Today article about immigrants in the United States when I noticed that I had been chewing on a particular piece of meat for too long. I’ve gotten used to chewy meat, and while I don’t love it, I have a higher tolerance than I used to. So I switched it to the other side. After one chomp on the left, I decided to pass the meat over my tongue again. This thing wasn’t even breaking apart with vigorous chewing, and I thought I had felt something “funny” the first pass over. So with a sense of impending disgust, I let the meat fall onto my tongue. I knew immediately what I had in my mouth, so I shoved it to the right, gave three good chomps, swallowed it whole before I could let the thought settle in, and then immediately chugged my coke.

Some things you just know, instinctively. And when it is chewy and has taste buds and it is in your mouth, you somehow just know you’re French-kissing a goat.

I then dissected the rest of my plate looking for more offenders. And I found quite a bit. I can only hope that she used every last bit of it in this dish. (I mean, how long can a goat tongue really be?) We will see, and I suppose other dishes may contain other organ delicacies. On va voir?! (We’ll see)

So there it sits. And I feel like I should suck it up and eat the rest of it. I mean, what if Elizabeth finds in the trash tomorrow morning? Oh, the perplexities of Frankenstein’s monster.

Life in Koutiala—Driving Miss Daisy

2009-05-19T21:32:00.002Z

I’ve only been here for about two weeks now, but I’ve had several opportunities to drive around Koutiala both in a SUV and on a motorcycle. I’m by no means an expert, but in my time here, I’ve tried to take it all in and I think that I’m catching on to the rhythm. Now, to the untrained eye it might seem like unorganized chaos, but there are well defined rules that guide what each member in the swirling chaos must do. (And the chaos in Koutiala is nothing compared to Bamako, the capital.)

So I present to you: A Wing and A Prayer: A guide for getting to where you are going, in one piece.

The Matrix: Road surface and other natural elements

The city of Koutiala consists of three, paved, and intersecting roads. Dirt roads make up the rest of the roads and alleys.
Pot holes are the expected norm; swerving around them is also the expected norm. Driving in a constant zig-zagging motion is not reason to suspect drunk-driving here.
Speed bumps have been placed, for your convenience, at random, unmarked intervals.
If there is some path around a speed bump, you may take it.
Garbage day is every day, and it may be placed in the street…no need to bag it.
Dirt road surfaces change with wind and rain. So just when you’ve got your swerving pattern mastered, you’ll need to readjust to accommodate new holes and trenches.
High wind causes mini dust storms in open areas. No matter how tight you hold your mouth closed, it will get between your teeth.
Heavy rains shut the city down. You may think this a bit bizarre. Just wait, you’ll see why.
Small flash floods occur in back dirt alleys with heavy rain. Please be prepared to get wet.

Dead Man Walking: Pedestrians of the human and animal kind

All pedestrians share the actual road surface with any other vehicles. Sidewalks are non-existent.
Cattle, goats, dogs, and chickens cross streets at random intervals. Hitting any of them is considered bad form.
There is no age limit placed on drivers of donkey carts. Young boys of 8 are thought to be, by some, the best drivers.
Everyone understands that donkeys are not the brightest animals (except in the movie Shrek), and so it is commonly accepted that the cart motions will be a little bit erratic. Jumping off the cart and pushing the donkey to the side to avoid collision is always much appreciated.
Carts should be loaded as much as possible. Whipping up the donkey and causing it to run and thus become even more erratic is a form of flirting that most girls find irresistible.
Men pushing their carts (push-pushes) may walk in any direction, on any side of the street, even if their load is so high that they are rendered sightless.
Adult, human, pedestrians participate in a secret, but universally played, game. Points are awarded on the proximity that can be obtained to moving vehicles while crossing the street. The highest points are awarded to those who must turn their heads in order not to lose their noses as the trucks pass by.
The singular rule for children crossing the road is caprice. At one moment they should approach the road with a great deal of caution. At another, they must foreswear such caution and make a mad dash across the street without looking.
All children must unite together in the chorus, “Toubabou, Toubabou,” (white person) upon the sighting of any exposed white person. This is analogous to a Neighborhood Watch. It often serves as an in-the-nick-of-time warning to clear the road to avoid the erratic driving whities. (New arrivals to the country are to be considered especially hazardous.)

Fast and Furious: The operation of your vehicle

Horns do not have a negative connotation here. They are more like saying, “Umm…excuse me…could I squeeze through here,” rather than “Move it, you idiot.”
Turn signals need not be activated for any turn. However, once activated they should remain active during the duration of your drive around town.
Headlights are not needed during night time driving. However, they should not be turned on during the day, as this may waste gas (unconfirmed as that may be).
No emission checks are required. The white clouds produced by even the smallest mopeds only add to the “atmosphere.”
Gas may be purchased at local stations, or at road side stands where it is poured from glass bottles into your gas tank.

Planes, Trains, and Automobiles: Motorized transport

In broad general terms, the goal of traffic is to be ever-flowing, without any complete stops, while still accommodating the above stipulations.
Cars, trucks, and buses have some, albeit ill-defined, right-of-way, mainly on the basis of their size and capacity to cause bodily harm. However, if the car shows a moment’s hesitation in taking said right-of-way, it should be challenged and taken when possible.
Roads are generally devoid of any type of speed limits, stop signs, and the like. Where signs are posted, they must be viewed as suggestions, largely ignored, as opposed to hard rules.
If a left turn must be made, one need not cross oncoming traffic to begin proceeding. Instead, the left-turning-vehicle occupies the shoulder and begins to accelerate into oncoming traffic (i.e. contra the flow of traffic) until an opening sufficient for crossing the street presents itself.
On open road, motos drive to the side, allowing cars to pass; however, in the city motos may pass vehicles in whatever fashion they deem necessary. A car may be surrounded on both sides by motos.
Any load that can be carried in a car, can be carried on a moto. Babies wrapped on the back of women are considered adequately secured. Older children ride behind parents, oldest child farthest back on the seat. While four children can be transported on a single moto with parents, three is the recommended maximum.
Heavy and compact loads are carried in the hands of the back rider, while the front rider drives.
Heavy and long items (like, say, a queen size mattress folded in half) rest on the heads of both riders, while the back rider uses his hands to stabilize the load.I hope these rules are helpful to you in your driving endeavors.

And remember, coming to a complete stop in the road is bad form. Please continue with the flow of traffic.

Life in Koutiala—I’ve got people

2009-05-19T21:30:00.001Z

I left the States right after tax season, and I can still recall the annoying advertisements of various tax agencies. One such agency promoted their services with the slogan, “You’ve got people.” (A slightly discomforting thought, since the implication is that you’ll have someone there to help you if the IRS chooses to audit you. Can I skip the “people” and go with the “no-audit” option?) Well, not to be contentious, but they don’t have a clue what they are talking about. Now, I, on the other, know what it is like to have people.

I’ve got people, or I should say that Ed and Andrea have people that continue to be employed here at the house while they are away. Now lest you start to think, “Whoa, look at the extravagance” let me explain. In this context, it would be considered incredibly stingy not to hire people to work at your house. If you have the means, it is expected that you provide jobs. Also, we don’t have all the same modern conveniences as in America, so everything takes quite a bit longer. There are no Walmarts, and walking through the market to find your produce takes time. And with all the sand and dust, you just about have to dust and mop the whole house every day. So it is helpful to have help.

That being said, I still feel a bit pampered (though I’m finding myself so busy at the hospital that this is a good thing). Elizabeth is our house help. She comes in the morning and leaves in the afternoon. She cleans, she shops, and she cooks for me three times a week. I’d pretty much starve without her. She is absolutely incredible. She definitely knows more about the house than I do, and has the scoop on everything happening in the market.

The house help for other hospital staff are mostly men. It is more traditional to have a male house worker in Mali, since they are good paying jobs that provide steady income for families. And every house worker takes on their own personality mixed with the things they are taught by their various employers. So for instance, one guy has mastered the art of making flour tortillas, so people buy tortillas from him. Others are known for being able to find the best cuts of meat in town. So you can often here in a discussion, usually centering around food, “Oh, my house guy can do that for you.” They become indispensible parts of family life here.

Brahima is our night guard. He is a friendly, out-going guy who speaks so fast that most of the time I just smile and nod because I have no idea what he is saying. I’ve asked him about five times to slow down, but he apparently doesn’t have the gearing for that. It doesn’t help that the topic of discussion is often English soccer leagues, an area in which I’m mostly clueless. He is also making it his personal mission to teach me Bambara (but I think he has begun to realize how dense I really am, so his exuberance is wearing off). He arrives around 7pm (or 8 if he is running a bit behind). And it’s not exactly like you need a “guard” at night; I’m confident I would be safe without one, but again it is tradition. If I arrive home after he is here, he opens the gate and helps me get the vehicle inside. He is also in charge of keeping up the grounds. So he cleans up the yard and waters the plants. But then later in the night, he drinks tea and watches television—unless a soccer match is on TV, in which case, the match is watched first and other work is done later. (And most night guards sleep quite a bit, from what I can tell…this is neither encouraged nor actively frowned upon.)

That is all the help at the house (except a young guy who guards on Sunday nights—Brahima’s day off), but the sense of having people goes much beyond this. I’ve been reading this great book called, “African Friends and Money Matters,” which talks about the difference in Western and African mentalities concerning relationships and money. One of the best points it has made is that Westerners tend to dichotomize their relationships into “business” (i.e. those that concern money) and “personal” (i.e. those that involve friendships and not money) categories. Africans tend to not make such distinctions. So there is often a greater sense of loyalty to customers. (But there also tends to be a lot more “messy” money situations with friends as well.)

So we have the gardener. He sells plants, but he also comes by to check on the progress of the plants. If something dies, he digs it up and replants it for free. Most of the hospital workers here prefer one particular store (ok, well, it is really the only “store,” besides the market, in town). The guys at the store are very friendly, and if you ask for something they don’t have, one of the workers will often jump on their motorcycle and go find it in the market for you.

The loyalty works the other way too. Everyone has certain people that they purchase things from. You have your particular gas station. You have your certain guy that you buy your phone cards from. You have your grape-selling-lady. You have your favorite tailor (who sometimes stops by work to talk—as in, “Oh, I know we are in the middle of things, but I need to step out and chat with my tailor for a second.”) You have your pork-selling guy. Very rarely would you consider buying those specific things from someone else.

So yeah, I got people…I’m either borrowing them or giving them money, but they are still “my” people!

Life in Koutiala: The lay of the land

2009-05-19T21:03:00.005Z

When you drive through Koutiala, whether on a bus or in a comfortably air-conditioned vehicle, you immediately notice the contradictions. The city is neither a bustling metropolis nor a quaint village. Developments in technology seem to have lurched forward in some areas and remained far behind in others. This eclectic make-up disguises the rhythm of life from the outsider—rendering them lost in a cacophony—but the local residents seem to march to its beat instinctively. (But then again, people around here seem to be able to feel the beat way more than most people I know.)

The downtown area feels incredibly busy, and the stereotypes of laid-back Africans don’t seem to play out; that is, until you’ve been here for a bit, and you realize that the downtown area is just really full of a bunch of laid-back people. There are cars, trucks, buses, donkey-carts, motorcycles, and a hundred pedestrians all surging forward in one chaotic flow on the downtown streets. The city sits on a main road that goes through to another main city and then either down to Burkina Faso or to Cote D’Ivore. The bus ride I took from the capital city was all on paved roads. The main road forms one side of the city, and another “Y’s” off the main road just as you enter the city limits. Most of the city sits between these two paved roads (like the middle of a triangle). Though you can drive from one end of town to the other in about 10 or 15 minutes on the main roads (and that includes slowing way down in the market areas), the city expands out in thousands of dirt alleys that make the city much bigger than it feels. There are about 120,000 people in Koutiala (some estimates are closer to 100,000), and at moments you feel as if they are all on the main-drag with you. [Below: a picture of one of the million donkey carts that drives everywhere in the city. You can see how young the driver is...and how attentive.]

During the day the city is noisy with people, animals, trucks, horns, and the Muslim calls-to-prayer being blasted out from the local mosques. But at night it seems to quiet down to the quiet whispers of people having conversations in the street. Sun up is at 6am, and people get moving early. In the evening, about 6:30-7 it grows dark, and people retire to their customary sitting places (usually in front of their house in some fashion), drink tea and entertain visitors. Most people in Mali speak French and Bambara. Bambara is actually more commonly spoken than French, and at very least people will greet one another in Bambara. The greeting is quite extensive, with questions being asked about the person’s health, their family, their work, and anyone that is accompanying them; and this is then reciprocated. In some cases, the greetings are closed with a blessing that is pronounced on the other person. I really only know how to tell people, “No problems,” and “God bless you.”

Pulling off the main drag down one of the countless back alleys, you find more of the eclectic feel. The alleys can be fairly narrow, or quite wide, and there seems to be no rhythm or rhyme to this. The road conditions can be smooth and nice, or full of trenches and bumps requiring careful navigation. The housing ranges from quite nice concrete houses that are more amenable to Westerners, or to the adobe houses. Every house, or group of houses, is surrounded by some type of wall. Many Malians live in a compound with their extended family, with several houses enclosed in one set of walls.

Inside the more modern houses, you have running water and electricity (though these are sometimes rationed [i.e. cut] without prior warning). You also have internet service available from the various cell phone companies in town. Almost everyone has a cell phone, and some of them are very nice even by American standards. Many people do not have access to other electronics, so they go for the cell phones with the MP3 players and cameras. Here again a contradiction: my internet access is so good that I can call you using Skype, but I have to filter my water in order to drink it.

On the city limits you find more barren areas. The ground is mostly dirt or sand, with an occasional shrub giving the landscape an arid feel. However, there are mango and citrus trees everywhere, and the wide array of fresh produce available in the market reveals the thriving gardens that can be planted. There are also huge trees called Baobob trees. Many of them grow so large that five men could hold hands around them. During other seasons, cotton is grown everywhere. The city of Koutiala is home to a huge cotton factor that employs many people. They call cotton, “white gold.” [Below: a road-side stand where people sell all sorts of things. Empty because it is a Sunday. Also, a look at the out-skirts of town, just to give you an idea of the topography.]

Lastly, the weather… Well, it is hot, very hot. And it is not exactly a “dry” heat either. We usually have 30-50% humidity. The temps have usually been nearing 110 every day. In the OR, we have two air-conditioners on full blast, which usually only succeeds in bring the temperature down to around 90 degrees…but it feels wonderful! However, we’ve had some rains lately, and in addition to cooling things off for a bit, they indicate the coming of the rainy season, which is still hot but a bit less intense.

Right now, I still feel a little lost in my surroundings, but I’m praying that this place will feel quite like home by the time I leave.

Arrival in Koutiala

2009-05-10T21:02:00.002Z

I have arrived. After about 56 hours of straight travel, I unloaded my bags out of the back of Ed and Andrea’s Prada. After shaking Ed’s hand and wheeling my bags back to my room, Andrea offered me a drink. I downed the cold water, and began to drip sweat. My bus ride to Koutiala had been warm…very warm. And I had run out of water.

After leaving Casablanca, it was about a four hour flight to Bamako, the capital of Mali. Not a single person I asked understands why the flight departs Casablanca at 11:30pm, only to arrive at 3am. Maybe the runway is too hot during the mid-day heat. Maybe so you’re so utterly, drunkenly tired that the customs officials can get the truth out of you, should they choose to interrogate you. Either way, I touched down at 3, having caught about one and half hours of sleep. (In addition to taking off at 11:30, the airline finds it necessary to wake everyone up at 12:30 to enjoy a lovely meal [and it wasn’t bad]…so sleep is limited.)

I made it through customs with relative ease. “C’est le premier foi de visiter Mali?” (It’s your first time to visit Mali?) “Oui” (Yes) “Ah bon, bienvenue a Mali” (Oh good, welcome to Mali.) It’s not like I really want a real interrogation at customs, but I did pay about $200 to get that visa, they could at least look at it and ask me if I was smuggling drugs into the country.

So I grabbed my bags, which all made it—something I’ve learned to count as a true miracle. I had to fend off some bag handlers, but they were relatively tame compared to others I’ve encountered. For those of you who haven’t been to third-world countries, some people make a living by hanging out at the airport. They will carry your bags to your car for a tip. But if you don’t hire one right away, they will just come up to your bags and pick them up. Once they have your bag, they expect a tip, even if they don’t make it all the way to the car. (One guy laid a hand on my bag as I pushed it into the back of the Rover, and he complained loudly that I didn’t tip him for his help.) So you have to be very vigilant. “NO MERCI, NO MERCI.” In these cases, I always wait for the person picking me up to hire someone. This is one of those shocking realities that greets one just moments after setting foot into the country; unemployment is high, salaries are low, and so people will try to earn money in a variety of ways. You feel bad for them, but riots would break out if you tried to hire more than one person; so you pretty much have to ignore the barrage of insistent, very insistent offers.

Keith, the guy picking me up, took me back to his house, where I crashed for about four hours. Then I had to be up for the bus. The morning was pretty “cool”, only 37 degrees C (98.6 F). We had breakfast and took off for the bus station with all my bags. We pulled up to the bus station, and I saw my luxury liner. It looked like a brand new RV. The windows were tinted, the seats were lush; it definitely had A/C. And then…it pulled out of the station. And it was the last one from that company going to Koutiala that day. Early bird gets the worm. No worm for me.

So we were off to find another bus company. Somehow the missionaries here in Bamako know which companies are the best (and there is definitely a hierarchy). There are probably 10 different bus lines. These buses go all over the country, and many of them will continue through either to Dakar or to Abidjan. (Port cities in other countries; those bus rides would take days) So we went to the next best bus line. We purchased a ticket on Diarra Transport.

The bus station was like an actual bus station, with third-world flare—no computers, just carbon-copy ticket books; outdoor seating; street vendors abounding. We had seen a Diarra bus further down in town, close to where I watched my luxury liner pull out of its station. So Keith asked the lady at the ticket window if that was our bus, and she said yes. So we took my ticket and drove back up to that bus. We pulled next to the bus, and hopped out—trying to ignore bag handlers and people trying to sell us tickets for the bus or something. We went to a little table set up by the bus door and began talking to the driver. He immediately made it clear that I could not load my bags at this location; I would have to go back to the bus station and wait there. You have to load at the location where you buy your ticket. And then he asked us why we hadn’t just bought our ticket directly from him. (Oh, because it was so clear that we could have done that…) This just made me realize that no matter how long you’ve lived in Africa (Keith has lived in West Africa for a long time) that you just can’t always get the rhythm of things.

We drove back to the bus station, asked the lady at the window, to ensure that the bus really did come to the station. She said yes. Keith asked why she had sent us down to the bus, and she replied that she hadn’t. We asked if that was the bus, and it was. Ok, very true…

So my bus pulled in. I knew that it was not as nice as my luxury liner. But I had hopes. It looked nice enough from the outside. We loaded my bags, which were an additional cost. After talking down the price, Keith ran to grab cash for that. When he came back, he handed me a little fan, and said, “I don’t think the bus has A/C so we bought you this fan.” So my trusty fan—a piece of a plastic mat, stapled onto a stick—and I boarded the bus. The interior of the bus looked like something out the 1970s. The seats were brown, green, and orange polyester. There were tan window shades. The windows didn’t open, because at one time the bus had clearly had an air conditioning system, which was, as clearly, not functional. The heat was staggering. It was 10am and close to 40 degrees Celsius (104 F) outside, and probably 15 degrees warmer on the bus.

I sat down in an empty seat. We pulled out of the station shortly after. When we got moving, it wasn’t terrible. There were two vents in the ceiling of the bus that allowed a decent breeze. I settled in for my 7 hour bus ride. But I wasn’t prepared for the numerous stops. We had to stop for other passengers, to clear security points, to drop off random cargo at points, to deliver a battery to another broken-down bus. Each stop brought back the heat. My fan was effective until about noon. At that time the heat became so intense that moving the fan just pushed hot air into my face. The only saving grace was that I had inadvertently picked a seat next to a broken seat. So only when the bus was at max capacity did I have someone sitting next to me. (And I was so tired, I sleep intermittently the whole way, despite the heat and the bumps.)

Each stop got hotter and hotter. When we stopped people would surround the bus and try to sell us stuff—drinks, mangos, pastries, etc. I had a 1.5 liter bottle of water and some snacks that Keith had packed me. That lasted me until about the last two hours. I wanted to buy more bottled water, but the only water I saw looked like it had definitely been opened and refilled with well-water. They also sell water in pint-sized bags that you bite the corner off of and then drink. But they keep these bags cool by soaking them in well-water…all of which meant that I couldn’t buy any water.

When I finally reached Koutiala, I wasn’t sweating any more, and I knew I was near trouble. But I had made it. The temperature was about 45 Celsius or 115 Fahrenheit. Andrea met me at the station, introduced herself, and told me that I would be staying with her and her husband Ed (and three girls). They are leaving for furlough on Thursday of this week, and so I will be house-sitting for them for 3 months. Andrea has informed me that her goal is to never ride a bus in Africa!

Oh, and remember how I didn’t get a hotel in Casablanca? Well Ed and Andrea informed me that when you book a ticket from the States to Bamako, Royal Air Maroc is obligated to pay for a hotel for you in Casablanca, since it is such a long lay over. There is a desk you go to, a bus to pick you up, and a paid-for room waiting for you at the airport hotel…if you are smart enough to ask. Haha…oops, that was one piece of information that would have been really helpful. Guess I missed that in the rush.

Well, regardless the Lord has been good to bring me through it all. And besides, it is character enriching. I’m here now and excited to start.

Pictures Are Worth a Thousand Words, huh? Well, Here’s a Thousand Words…

2009-05-10T17:37:00.005Z

I’m not a photographer. I don’t believe that I possess the capacity to become one. So, I’m not really all that sad that after four pictures of downtown Casablanca, my camera battery died. Besides which, my camera is never handy when I need it. And to add to that, I never seem to capture the moment. My pictures almost always consist of awkwardly posed people, or the back of someone who just finished the action I would really have liked to catch. So here are the pictures I would have taken.

The first picture would have been shot in JFK. The airport was interesting. People everywhere were walking around with masks on (some were wearing them on their head or neck…I’m not sure they understood that they need to cover your mouth to protect you). I sat next to an AeroMexico flight headed for Mexico city…that was mask central. I hope not to be the first Swine Flu case in Mali.

My camera was tucked away in my carry-on luggage as I boarded the plane in New York. But picture number two would have been taken as I made my way to my seat on the Royal Air Maroc airliner. I was near the back, and this was a big plane. I had just set my stuff down, when I heard loud crying. I looked up, and in the other aisle, three FBI agents were leading a young African (American?) man down the aisle, video camera shoved in his face. Crying and stripped down to his boxers, the young man was obviously distressed. He kept saying, “why me?” “This isn’t fair!” “Why did you come for me here?”

Soon, my seat mate arrived, a Guinean woman whose father is a diplomat in the States. We began comparing notes. We concluded that he was either smuggling drugs (but smuggling drugs from New York to Casablanca, didn’t seem like a likely route), or that he was wanted for some other felony, and the feds picked up on it when his passport was scanned by the airline. The word terrorist was bouncing around, but I preferred not to think about that. Either way, it left the passengers on the plane feeling very uneasy for the first couple hours of our flight.

Not that I would have actually taken a picture of her, but we’ll call her picture number three. The Guinean lady and I had several good conversations. We spoke mostly English. She finally asked me, halfway through our flight, if I spoke French. I ashamedly admitted that I did, but that it wasn’t very good. So from then on, we had Franglais conversations. And I had other French practice listening to the flight attendants. Everything was announced in Arabic, French, and choppy English.

The plane took off at around 11pm. They served us dinner at around 1 am. The food was good, but I was tired and wanted to sleep. I slept fitfully for the next four hours (I was on the aisle and kept getting bumped), and then they woke us up for breakfast. The sun was coming up over Morocco, and it was beautiful—the grain fields below and the early morning light.

Picture four—the passengers right around me. I had been watching the several Moroccan families around me. They didn’t seem to know each other, but they all helped one another. One of the passengers in front of me was an old lady who apparently could not read. When she made it to our part of the plane, she handed her ticket to the Moroccan man next to me. He helped her find her seat, and put her luggage up in the rack. When it came time to fill out our customs form, she handed her form and passport back to the man sitting next to me. He in turn gave it to a young man sitting at the end of the aisle to fill out. (The man sitting across from me had a family of 5 for which to fill-out forms.)

The young man at the end of the aisle was definitely not related, because when he sat down next to the man and his baby, he had asked, “Does her mom want to sit here?” But the mom was in aisle behind with two other kids. During the flight, the young man would often hold the other man’s baby, help him get the baby settled into its seat, and hold the bottle for the baby if the man was otherwise occupied. I’m not sure whether he was just a really nice guy, or was trying to make the most of being next to a baby on a trans-Atlantic flight. But for the most part it seemed to be a Moroccan trait to be mutually helpful.

I had 15 or 16 hour lay-over in Casablanca, and I was toying with the idea of getting a hotel or exploring the downtown area. So when we began our descent, I leaned over and asked the two guys across from me about what I should go see. The young guy was again the one called on to help. He told me that I should go to the coast line to see the mosque and the light house. He told me to take the train and then catch a taxi.

When I stood up to deplane, the couple behind me, told me that there was a hospitality desk that I could go talk to, and they would give me advice on hotels and help me get there. (more on this hospitality desk in the next post) So after making it through customs and waiting for my one carry-on bag, which had been checked jet-side and had to be claimed with all the normal bags, I ran into the young Moroccan man again. We small-talked for a little bit, and my bag came out. I grabbed it and went to find the hospitality desk. I had planned on grabbing a room, taking a shower, grabbing a nap and then going out to see the town. However, I couldn’t find this hospitality desk, and no one seemed to know what I was talking about. So I changed over some dollars to the local currency, Dirhams.

Picture five would have been me catching a glimpse of the young Moroccan man heading toward the train and me stalking him. I followed him to the train station, which left from the outside of the airport. I figured I would head into town on the train and find a hotel somewhere there. I ended up, “conveniently,” right behind the guy in the train line. When he turned around he smiled a half smile. I smiled back, and tried to pretend like I was neither some freaky stalker, nor the completely lost tourist that I really was. He helped me get my train ticket to the right part of town.

When we boarded the train, I intentionally chose another car, just to prove that I was neither stalker nor clueless. I managed to get off at the right stop, though they were not announced. I walked into the station and was approached by a taxi driver. He would have been picture number six.

He was friendly, and spoke a little English. So between my French and his English, we talked about the coast line, what to see, and the city of Casablanca. He told me that it would cost me 100 dirhams ($12) to go to the mosque. I agreed. I felt a little silly carrying my back-pack and carry on all around town, but I was feeling pretty awake and was wondering if I needed to get a hotel room. And besides, the last time I had a long layover in another country, I didn’t make it out of the airport, and I have always regretted that (Paris).

While driving, he answered a call on his cell phone, and promised someone that he would be there in less than 10 minutes. I knew that the coastline was quite a distance from our stop, but I figured he was driving fast enough that maybe that was accurate. He was weaving in and out of traffic, as was everyone else. It was organized chaos, and almost fun. Horns would start blaring the moment a light turned green.

We finally stopped at a corner. He jumped out and greeted the people that I can only assume were the ones he had taken the call from. He then showed me on a map that I was just a block or two from the coast, and explained that because it was labor day (which it was) there was a parade on the main street, so he wouldn’t be able to get me all the way there. And like an idiot, I smiled, paid him, and started walking.

After going six blocks, I knew the jerk had lied to me. But I was more mad at myself for being a stupid tourist. So dragging my carry-on over the brick sidewalks, I tried to make the best of it. I did manage to snap a few pictures of the downtown, most of which didn’t turn out. I followed my nose to the salty coast—a full 10 blocks from where he dropped me off. Then I had to hike another 3 blocks down to the mosque. When I finally finished my day, I caught another cab back to the train station. This cab took me twice the distance and since he turned on his counter, it only cost me 20 dirhams, a fifth of what the other guy charged me. I told the new cabby about what the other guy did. He offered to take me to the police station to turn the guy in…but I didn’t remember the guys license number, and I didn’t have my camera!

The coast line was fun. I didn’t go into the mosque, just walked around the outside. The minaret is 250 meters high. The central prayer room is big enough to fit St. Peter’s Basillica inside. The dome of the mosque is fully retractable and motorized. It was an impressive sight. The light house was also very cool. I have included pictures, for your enjoyment and to save us another 2000 words. Shortly after I shot the long distance shot of the light house, my camera died. So that’s all your getting picture wise.

But after all that walking, I was just plain worn out. So for much of the afternoon, I sat on the break wall, and just enjoyed the afternoon sunlight and warmth. Soon, a guy came and sat down next to me. He talked to me for about an hour and a half. I decided early on in the conversation that this guy was a little off, and possibly a little sketch. So I was pretty reserved. He claimed he was a Christian and quoted a bunch of pieces of scripture to me. But like I said, he was off, a couple dirhams short of a cab ride to the mosque, if you will, and much of what he said simply didn’t make sense. When he didn’t leave after the hour and a half, I decided it was time for me to leave. I decided to make my way back to the airport. I was tired, but didn’t want to pay for a hotel for only like three hours of sleep. (Later that night, I decided it would have been worth any price.) I said goodbye to the guy. He asked for money, I gave him some, but not enough for his liking. When I explained that I had a very limited number of dirhams and needed to save it for the ride back to the airport, he offered to take me somewhere to change over more money. I declined. A back alley would definitely have been a place to change money—my hands to his. Like I said…a couple cabbies short of a crazy Moroccan city.

I made my way, uneventfully back to the airport. I still had 7 hours till my flight took off. Royal Air Maroc wasn’t even listing the gate of my flight, so I couldn’t figure which security point to go through. (And the worker from Royal Air Maroc said I would have to wait until it was posted.) I grabbed lunch and then milled around the airport for a while. Picture ten would have been of me curled up on a luggage push-cart, with the caption, “Do not be lured by the siren song! You will only end up with a numb butt and an incredible headache.”’ After 2 hours of milling, and still no gate assignment, I was exhausted, and I got one of those crazy, exhausted thoughts. I grabbed a luggage push-cart and wheeled it into a corner. I pretty much figured this was the most genius idea I had ever had. I set up my bags in a seemingly comfortable way, and promptly fell asleep. 45 minutes later, I woke up, barely able to move, unable to feel my legs, and with a throbbing headache. Like I said…one gate short of an airport. (Err…wait, that was the other guy)

I finally decided to go through a security point with the largest number of gates. I figured being able to have an actual chair was worth going through the wrong security point. (It turned out that picked well.) On the other side, I found a seat and, of course, couldn’t sleep. I milled around more. Finally, a guy sitting several seats down from me, came and sat right next to me. (Leave it to Africans to infringe on your personal space.)

We struck up a conversation, which was very fun. He would have definitely been picture 11 (or whatever number we’ve made it to). He basically told me his life story and showed me pictures on his laptop. He is an engineer from Tunisia, who goes down into Guinea and Mauritania to build phone towers for cell phone companies. Some of his pictures were very cool. He treks out into really remote places to build these towers. He got more reflective as the conversation went on. He started to tell me that he wasn’t happy because he wasn’t married, but that he couldn’t get married yet because he didn’t have money for it. He told me that life was pretty much about making money.

He then asked me what I thought life was all about. And I told him. And we spent another 2 hours talking about Christianity, Islam, and what God wants for us in this life. It was really awesome. We talked all the way up to my boarding time. I said good-bye, told him I would be praying for him, and boarded my plane.

A very exhausting day, but full of adventure, and well worth it. Even the 100 dirhams for a cab ride.

Silver Medallion Status

2009-05-10T17:34:00.002Z

This is one of those funny little stories of God’s blessings that both amaze and amuse me. He has put things together so well for me in preparation for this trip. His strong hand of providence has been on me over the past 5 weeks. I often laugh at this goodness and my inability to anticipate it and trust in it.

So, “randomly,” four months ago, before Mali was even a glint in my eye, I received a letter from Delta Airlines congratulating me on attaining Silver Medallion status. I almost threw away the envelop because I was sure it was junk mail, (and I’ll ashamedly admit that I almost threw it away after I opened it because I didn’t know what it was.) I knew it had something to do with SkyMiles (frequent flier miles), but I really don’t have a ton of those because I almost always choose the cheapest flight I can find, so I wouldn’t have anticipated a big upgrade from any particular airline. So I set it in my junk pile and forgot about it.

A month or two later, still before plans for Mail were developed, I booked a trip to a wedding in Indiana. I booked on Delta because I had a free flight (my first ever…). I was excited about the trip back to Indiana, but I didn’t know the extent to which that trip would be helpful to me, until a few weeks later. When I got the invitation to go to Mail, and then the request for me to get there within 5 weeks, my little brain began to work overtime. In that short amount of time, I had to quit my job (and train someone else to take over my few administrative duties), wrap-up my work with the refugees and ensure that the organization had enough support to continue in my absence (in both cases, the people taking up my slack were bright and hardworking, so this was not quite the trial I make it out to be); move myself and my stuff; and lastly get ready for a year in Africa—not exactly something one does every month.

So when it came time to go to Indiana, I knew I needed to take as much stuff with me, to put in the trunk of my little sister’s car (she goes to school in Indiana) as possible. That’s when I remembered that I had signed up to fly with Delta and they charge for each checked bag. I logged on to the website to check prices. I was feeling a little discouraged at the thought of having to fly home with all my stuff and how much that would cost me (since I was going to sell my car—a 26 hour drive on a limited time frame didn’t appeal to me at all). That’s when I saw it. The small print that announced that Silver, Gold, and Platinum medallion members could check 2 bags for free. Problem solved. I packed my bags, headed to Indiana, and had a great time there.

When I got back to Utah, I booked my flight home on Delta, so that I could take advantage of the free baggage allowance. The weeks flew by, and before I knew it, I was attempting to pack my bags. And there was just no way it was all going to fit. So I sent a couple boxes home via FedEx; packed some more; sent another 2 boxes home. The day before I left I called Delta to see what a third bag would cost ($125). Having already spent a small fortune in FedEx shipping, I wasn’t looking forward to mailing more things home. So like any good irrational person, I decided that though the situation looked hopeless, I could make it happen. That afternoon, I got an email from Delta announcing that I had been upgraded to first-class for the first leg of my trip from Salt Lake to LA (yet another perk of my Silver Medallion Status); but while this was a nice thought, it was only an hour of the trip, and I would be flying coach for the long part of my trip. Besides, I was too busy worrying about accomplishing the impossible to have time to celebrate such trivial rewards…

The day flew by, and the next morning I woke up to the grim reality that my luggage was not going to fit and that I was going to have to go back to the FedEx store, where they were beginning to think of me as a regular. Defeated, I sat down at my computer to check-in for my flight. When I reached the scroll down menu for checked bags, I noticed that a “(free)” was listed next to 3 bags. I flipped to the baggage allowance page—oh, yes! First-class fliers get 3 free 70lbs. bags (but only if you are flying first-class on your first leg). The life of a high-roller. Again, problem solved.

And really, when I look back over the past five weeks, I feel like I have been flying first-class the whole way. Though I’ve worked hard and things have been busy and emotionally hard, the Lord has put things together so well. Two more quick stories of His Providence.

The first took place on that trip to Indiana. I ran into a couple with whom I’ve stayed in casual contact. They told me excitedly about how they read one of my emails about Mali, and were excited to support me financially. They explained that 2 years ago they had felt God laying Koutiala Hospital on their hearts. They felt that He was telling them to purchase a generator for the hospital. They were all set to buy it, but drug their feet a little and someone else bought it before them. They felt they had missed a very clear directive from the Lord. When they received my email, they felt like God had given them another chance to invest in Koutiala Hospital. So they wrote me a check covering the amount of my tickets over there. And this wasn’t the last big check I received.

Throughout the weeks following, two additional couples gave me $1,000 checks. I was blown away, humbled, and so grateful. But these people knew that I was raising funds. I received a card from a co-worker who only knew that I was volunteering, not the extent of my financial need, and she had tucked $500 into the card. Again, I was so thankful.

And I should pause here to say that I’m not advocating some type of prosperity gospel here. (Claim first-class and you’ll get first-class.) It’s not because I claimed God’s goodness or “riches” that He blessed me (in fact, it was in spite of my lack of confidence that He blessed me). And it wasn’t because I’m some holy-rolling, saint on a mission to help the poor. I hope to be doing this type of thing for the rest of my life, and I doubt that I will always be flying first-class. Rather it is because of His unmerited goodness, and because when He brings us up against the impossible, He will mobilize whatever resources He needs to, in order to assist us in accomplishing His will and advancing His Kingdom. And as O.B. O’Brien told me just before leaving Salt Lake—the scary part of all of this is that when God orchestrate things so clearly, He does so because He has a purpose for you where you are headed, and sometimes that includes big challenges. (O.B. would know, having spend years overseas…so gee O.B….thanks for the encouragement!)

So here I sit, writing to you from my first-class seat—my second this month. (Don’t worry the flight is only an hour—so I’m not getting completely spoiled.) As of Sunday, the total amount needed for my trip had been raised in either one-time gifts or in monthly pledges. I’m truly blessed, truly humbled by His goodness, and grateful for His Providence and for those whom He has used. I could not have guessed all this five weeks ago, when I decided to quit my job, move to Africa, and live on donations during a time of economic down turn.

The Lived Experience of Curious Misadventures and Orchestrated Opportunities

2009-05-10T17:33:00.001Z

I have to confess that I’m a die-hard type A personality. And sometimes I get the feeling that there is a whole world of type B people who are mooching off all of us Type A’s—that while they are having “fun” we are getting all the work done; that they have no idea what it takes to make “all this” happen. So to be honest, I am usually initially resistant to admitting that I don’t have it all together.

Fortunately, God makes a regular habit of showing me that I don’t have a clue what it takes to make “all this” happen. (I think He gets a kick out of it.) He shows me up for the fearful, imperfect and sometimes hilariously incompetent person that I am. And then He allows me the privilege of sitting back (after I’m exhausted from the exertions of my failed type-A striving), to watch Him make it all happen, and often all I can do is laugh—from the mix of my sheer delight, my embarrassed incompetence, and the lovely mess I’ve made that I now find myself in. And this is a journal of just such times.