Coming Home II
Breakfast in a tin box
Kenya Airlines passes out wet cloths too before meals, but they are not towels but napkins and do not come heated. On this flight, the bathroom floors are wet. Supper is served like in a metal holding tank—dropped and slopped. Suddenly, you sense musk in the cabin, the fray of cushion seams and the browned edges of plane safety cards. The laugh of the absent cabin crew blows from aft. The seat backs in the economy section are short and lumpy with non-extendable head rests. People writhe in their seats as if engaged in bad sleep or pain.
“The Pride of Africa” flickers across the few functioning overhead movie screens as if to summarize the problem. I look for the big five for strength—the lion, elephant, wildebeest, rhinoceros and leopard—but they do not appear. If I were epileptic, this light display would cause seizures. As is, I am seized by my disappointment that my first trip back to the Africa in six months is being framed by negative impressions.
When Seongeun and I lived in Liberia, even the eighteen-hour trip back from the States was filled with excitement. While we were certainly not Liberian, Liberia was our home. We knew exactly the song and dance that would be performed at the immigration kiosk; the rhythm of the rickety luggage conveyer belt which by its ability to produce one’s belongings might as well have been a roulette wheel; the crowds of people waiting at the airport exit-way offering most any service one would want, half real. One of the IRC’s ten or so Monrovia drivers would be there to pick us up, distinguished by black cap with bright yellow IRC logo. I would joke, “How come I have lived here for two years and I don’t have a cap?”
Kamu or Adolpho or Mustafa would say, “Doc, welcome back. If you want my cap, I will gladly give it to you.” We would argue about who would carry the luggage with the compromise being that we awkwardly carried the luggage together-- hand over hand.
My office mate and I are headed to South Africa for a conference on Newborn Health. Pancho is the sixty-year-old best friend who I never had-- hip, open and funny. Whenever we travel, Pancho wears a thick blue clothed cap not unlike a maritime general. He is a Pilipino born Indonesian (thus Pancho) and a master politician. He has spent a lot of time abroad in the international AID world, including in the U.S. In short, Pancho doesn’t take shit with a smile.
Attendees are coming from around the world for this first ever USAID sponsored conference. Since Save the Children – Jakarta works on newborns (and mothers) in Indonesia, Pancho and I are invited. The route is long: Jakarta to Bangkok. Bangkok to Nairobi. Nairobi to Johannesburg. The last leg reminds me of my mortality because both my lower and upper back hurt. There is an occasion of turbulence when our collective stomachs fall at least 50 feet, leading to half of the cabin crossing them selves. A buxom woman in traditional dress hits me in the face with her ass while moving quickly back to her seat. How do you ask for apology with the fasten seat belt sign is on? I thank God that she does not fart.
My life is so much changed but not. Seongeun and I now live in a city of enormous malls, nightclubs and sky scrapers. We live in an apartment building with a pool that no one swims in and an outdoor basketball court with lights played on by a single middle-aged man with unrealistic hoop dreams (guess who). I have accustomed to the grace of Asian hospitality to the extent that deviations from detail are blaringly obvious and the behavior of non-Asians basically rude. In Nairobi during transit, a large South African man asked for Pancho’s hat simply because he liked it. “I really like your hat. I would like your hat.”
Pancho
“You cannot have my hat,” Pancho told the man, “this hat is given to me by the Society of Indonesian Obstetricians and Gynecologists.”
“Well I want that hat,” said the man.
“I don’t think you are an obstetrician or gynecologist,” Pancho said, “and you are not Indonesian. You need a different kind of hat.”
At this point, the man looked straight ahead and walked away as if the interaction had never occurred. Did he think he had just encountered a race of Coolies?
But experiences cocoon us and earned relationships adhere. Even in Jakarta, I am involved in work in Liberia. First there is the matter of Augustine. If there is one accomplishment I am truly happy about from my days in IRC-Liberia it is the hiring of Augustine as IRC clinical manager. In this position, Augustine can make a difference while making enough money to eat. Long after I have left, Augustine continues to run our diabetes clinic and to make sure that the JDJ Hospital quality assurance systems that we established continue. Two weeks ago, Augustine wrote me to tell me that Daniel, one of our first diabetes patients, was sick. He had been in the hospital for one week but not improving and complaining of chest and stomach pain and weakness for over three months. While I perused the laboratory findings over the computer screen it occurred to me, “Why the hell am I doing this kind of consult from 15,000 miles away? Were there no doctors in Liberia?” And the quick answer was that 1) no there were not 2) ok, there were some but most don’t have diabetes expertise, and 3) however they come, doctors must bring with them both brain and heart.
Daniel Before
The case was actually interesting. Daniel had ketones in his urine, a classic sign of uncontrolled diabetes, but he had been on insulin for his hospitalization, which is supposed to get rid of ketones. Plus, his blood sugar had cone from 450 to 110. But ketones can also be caused by starvation. Through a lengthy Skype conversation, I learned from Augustine that JDJ had stopped serving food to patients-- Another one of my "achievements" in Liberia that has just gone kaplooey. “You've got to be joking,” I said, “ then what does Daniel eat?”
“Well doc, he eats things like crackers and whatever the nurses for his grandfather give him,” Augustine said.
“Augustine what do patients need more than anything else?” I asked rhetorically, “protein and complex sugars in the form of vegetables or wheat products. I have a feeling that Daniel doesn’t get much of that at home either.”
“That would be true,” said Augustine.
“Well then he is starving,” I said, “you are giving Daniel insulin which allows him to use energy from food but he has no food. This is what we are going to do. You are going to put up the money to make sure that Daniel gets three meals a day while he is in the hospital. Put some meat put on top of whatever you give him. You don’t have children do you? You can afford it. Joking. I’ll pay you back.”
“You know I don’t have children, doc,” Augustine said.
“Stop being so serious,” I said, “but then we have to make sure that Daniel gets the same treatment when he returns home. Work out a system with his grandfather. For example, pay one of his richer neighbors to feed him because I know his grandma cannot.”
“This could be a good idea,” Augustine said.
“This will be a good idea,” I said, “thanks to you. Kiss your money good bye.”
“Ok, I will do that,” Augustine said, “kiss my money bye.”
“By the way, how is your medical school application in Uganda going?” I asked.
Daniel After (with other children from Diabetes clinic)
Over three days Daniel got drastically better and within a week Daniel was out of the hospital and back in the mediocre school near his house that Seongeun and I are paying for. Augustine sent me a picture of Daniel and he looked great. The case got me thinking that common things are indeed common and that this dying organism’s neurons aren’t fried yet!
As for Augustine’s medical school application to Uganda’s best University, it is proceeding. We decided over the summer that the medical education in Liberia, just wasn’t good enough and we have through IRC’s Ugandan doctors, who are ransom to me by me hiring them, a few connections. But maybe Augustine is like the best damn inner city student in America you can find who is not at all competitive with students from the suburbs who have had academic enrichment from the very beginning. No fair but no contest, really. And there is the matter of transferable credits. How does the University in Uganda accept credits from the University of Liberia? Augustine does not understand this question at all. He asks, “Doc, why wouldn’t they accept my University of Liberia credits?”
The sincerity of Augustine’s question makes one understand that few things good come easily and that whatever the challenge, you just have to figure out a way. Augustine is a smart man who loves learning with amazing work and care ethic. Is there anything more than that?
Monrovia, Liberia from above
The plane is landing. I see from above the well-organized streets of Johannesburg and people’s houses in square plots. Many have yards. I swear I can see jumping Chiwawas. This might as well be Atlanta. This could not be Liberia. I think about how my replacement in Liberia promised to volunteer at JDJ on the weekends but still hasn’t. Bastard! I think about Famatta, IRC’s senior health assistant, how on our last conversation she told me that she was asked to manage one of IRC-Liberia’s health projects.
“Thank you so much, Doc,” Famatta told me. She was giddy. “You sent me to that project management workshop and then you urged me to ask for greater responsibility. Well, last month I asked the country director if I could manage one of our health projects and you know what? He said yes!”
“That is so great, Famatta” I said, “now you will be running both the administrative and programmatic side of IRC. The transition is almost complete!”
Farewell grand rounds, October 2012
