Serving in Lubango

My flight leaving Lubango is tomorrow morning and arriving Friday evening.  It seemed a bit surreal to me that this morning was the last time that I would be driving up the winding mountain road to the hospital – the misty view of the city as the morning sun shines over it is one of my favourite scenes.  Before I launch into the many things that I will yearn for – let me paint a realistic picture of what it is by listing the things I will NOT miss when I return.

1.  Not having power for 6 days in a row. no power means no water pump.  No water pump means no shower.  No shower for 6 days means. ew. (alternatively, having cold misty showers for two weeks was also a little unpleasant)

2. flies all over the place – particularly those who aim for the nostrils and the eyes.  Walking into the wards and having to swat away 10 million flies before getting to the patient.

3. stench – there are days when the stench of infected wounds and bodies that have gone unwashed overwhelm me and all I want to do is gag.

4. Dust – from wood-burning, car exhaust, and just dry ground… whenever I walk around in the city my eyes tear up and my nose starts running like mad. I can just imagine how my lung is clogging up – although for the most part, if I understand anatomy correctly – most of the dust never really gets into the bronchi.  But I digress.

5. Feeling dirty – I always feel dirty. A combination of lack of showers, covered in dust, breathing in stench, and battling flies means it is hard to keep clean.  Furthermore, the incessant amount of handwashing has reduced my hands to dry paper.

6. Having to say “nao entendi” (don’t understand) every so often.  Language barrier is significantly draining most days, because there is so much limit imposed on what you can express and what the other party can express. However I really love learning Portuguese.

7. Having to say ‘vamos ver” (we’ll see) ALL THE TIME.  Life with no solid agenda can be a bit stressful but I have learned to go with the flow (re: confessions of an utterly inflexible person)

8.  Not being around friends and family for their most significant moments

Being two days away from coming home means that I have some conveniences that I am really looking forward to. For example, an electrical oven where I can turn the knob and know precisely what the temperature will be. Well, forget knowing about the temperature, I just want to turn the knob. The reason for this recent whininess is because I nearly burned myself. Okay, I exaggerate. Anyways, Dave (a medical student from the UK) and I, were assigned to turn the oven on. By that, it means lighting a match and sticking it near this hole while turning the gas on at the same time. Dave, being the brave person he is, volunteered to hold the match. After several miserable attempts, we decided it was time for valiant efforts, so I ramped up the gas and he stuck the match right into the hole. Little did we know that it would cause an explosion – Dave leapt back five feet just in time but all his arm hair was singed and you could see little specks of burning hair floating in the air (he later joked that this was the cheap way of avoiding laser hair removal). For me, I was standing, so I was not as close to the flame, but I just froze there. I did not even have the wits to turn the gas off, I was so shocked.

This incident made me think (after I calmed down). It is analogous to Christians – many of us are very eager to “light the fire” and hold the match. But when it comes time to bringing it close to the Source, and when it comes time for the lighted match to burst into flame – we jump back, afraid of losing our skin. Still there are others of us who are happy watching others carry the match, happy convincing themselves that they are part of the process by touching the gas valve. And when they witness the power that could take place when a lighted match is brought close to the gas, they are stuck there. Neither approaching to experience the heat, nor running away – lukewarm – giving the appearance of being close but not nearly close enough for any changes to occur in their hearts.

Many of you may object to this faulty analogy: “But wait – becoming a Christian isn’t dangerous but when you are close enough to an exploding oven it will cause severe burns.”

Funny, I seem to recall incidents of persecutions in the Bible and throughout history of Christians who are serious about God.

A Chinese who isn’t stingy, is a good Chinese

On Thursday, two new Canadians arrived – a surgeon and a medical student. The first thing the surgeon said to me was, “Bless your heart! The taxi driver who picked us up said that two months ago he met the nicest and loveliest Chinese lady. Congratulations on showing love to those around you.”

My proud smile suddenly froze when I realized that the only taxi driver I met was the one who had SCAMMED me (the one I mentioned in my first blog entry).

The surgeon kept talking, “You made such an impression that he went back to his boss and said, ‘There are good Chinese people out there, I just met one!”

The story unfolds as such: Taxi driver told me that he was only supposed to take me from the airport to the guesthouse, not to the town centre to buy my plane ticket. All the way, he kept telling me that he might get in trouble if his boss finds out because it is extra time and mileage. Anyways, at the end of the ride I asked him how much it cost, and he said 200R. This was the expected cost previously agreed on. But because I was so “generous” (or rather, did not have my frugal mind on after two days of flying) I asked him about the extra trip and whether he wanted me to pay him extra. At first he misunderstood me, and thought that I said he was scamming me. So he kept insisting that that was the right price. When I clarified my intentions, he said, “Oh no, we’ll just keep that secret.” But sensing an opportunity he said, “But right, what happens if I get in trouble?” At that point I had no change on me and the only change he had was 30 N. So I gave him 70R extra – which he said he would give to the boss if he asks where he’s been (because apparently they have GPS tracking devices) otherwise he will keep it for himself. Anyways, in context, 70 R is 10 dollars, but apparently the extra trip is only supposed to cost 20R – which was why I was kicking myself as soon as the manager told me. I felt the taxi driver had guilt-tripped me into overpaying.

Imagine the irony for me to hear that this driver was praising me to the heavens in front of two strangers. All of a sudden my careless “generosity” turned into a saintly deed; my  split-second-letting-my-stingy-guard-down turned into two months of remembered thankfulness; my (out of character) lack of frugality turned into a (permanent) shift in the labeling of Chinese people that certain Namibians have.

This amusing event reminded me that people are always reflecting on your identity by your actions. In most contexts, your identity is really made up of the groups you represent – Christian, Chinese, female, medical student…short people. In 2 Corinthians 5:20 Paul mentions being “ambassadors for Christ.” But it is not simply that you represent God’s kingdom so your actions become people’s impression of the country, more importantly, as ambassadors you are reconciling people to God. In this case, my lack of stinginess was a form of reconciliation – a channel for a Namibian to reconsider his label for Chinese people which I hope will lead to more positive interactions in the future.   This incident also led me to reflect – what about labels for Christ?   How have my interactions here and on my journey reconciled people to God?

For those who know me well, the first thing that may come to your mind when you think of my weaknesses is probably the militant nature I treat my time. Everything is divided into fifteen minute time slots, and in my mind there is only one word: Efficiency (with a capital E). I have this amazing propensity to say “I am going to have a hernia” every time I am made to wait, even for a couple of minutes because I feel like I am wasting time.

Perhaps God thinks this is bad for me, because life does not work that way here.

Example:

I am doing interviews at Rio de Huila, a rural area that had a well-structured net distribution program in which the moms had to come in to see a demonstration of the use and care of nets before they could receive one. Because I want to see how the nets are actually being used, we go from house to house to interview the moms.

Let me describe to you a typical day:

Board shuttle at 7 am. reach Rio de Huila at 8:15 am. Staff devotions till 9 am. Rita (the public health promoter I am working with, and depend on because I can’t speak the native language) chats and catches up with her colleagues. 10 am – we start walking to the houses in the villages. 10:30 am, we are at our first house. 11 am – we are still at our first house.

When we arrive at the houses, there is a formal greeting exchanged that goes back and forth about five times, I have yet to say the right things at the right time during this ritual. The women bring out their chairs and clean off all the dust so that we can sit on it.  Then Rita proceeds to introduce me and chat with them about various things (like what herb to use for colicky babies!).  After that, I can begin my interview, which should take about ten minutes but instead takes a lot longer because of the chatter in between.  Then after my interview, there is a bit more chatter before we can go.  At first I felt very frustrated, and kept looking at my watch – which I thought was a universal sign that “I need to get going because I have more important things to be doing” – but this signal is lost on them.  They do not have a watch and they do not have an agenda.  I have been learning to appreciate this culture of “no agenda” – of respecting every person who comes to your door and spending time with them regardless of who they are.  I have come to appreciate that the chatter I may see as a waste of time is also a form of building relationship, of building trust.  I don’t know why I ever thought that I can just land in Angola, ask people questions for ten minutes about the most minute details of their lives (like where they get water!) and expect that they will tell me these things right away.  I should be thankful that they are helping me with my research and sharing with me this information – but instead, I have this prima donna attitude that they should “work” at my speed so that I can be as efficient as possible.

There was one old lady who was the grandmother of the donna of the household (donna: the woman “head” of the household), and she lived in a separate hut outside of the house.  When we arrived, she came out to greet us – barely able to walk, completely bent over – and looking a little dirty.  I was a bit wary of shaking her hand.  When we told her that we wouldn’t be interviewing her, she went back to her hut – askng us to wait (meanwhile, I was itching to start).  Then she came back out and in her shaking hands were three eggs – one for each of us (That day, there were also two other summer students who were with me).  It was her way of thanking us, and she even apologized that she did not have more food to serve us since we probably would be hungry.  I was taken aback at the gesture, because we did not do anything for her – we were only here to ask annoying questions; we did not bring anything – only pieces of paper scribbled with indecipherable “results” that would somehow “benefit” them in the long run.  I can only imagine how precious these three eggs were to this lady – and yet – she gave them to us even though she probably knows that WE have eggs in abundance.

This is the culture of “no agenda” – of giving without expecting anything.

On Sunday I had quite the adventure. For those of me who ever thought of me as a princess, well… I still am. BUT, I can say now that I crawled on my belly through dark stalacite/stalagmites caves, waded into unknown pools that were chest-deep (helps if I were taller) barefoot, and chimneyed down crevices that seemed like they would never end and I thought at some point I was going to slip and fall to the bottom. I did freeze halfway through and said “I can’t, I can’t” and thankfully there were wonderful people to say I’m here to catch you, just keep going” It was awe-inspiring where at some points, the cave was uber narrow but when you looked up – you could not see where the “ceiling” was.

Here’s a picture of the inside – I took it before I got uber dirty.

I also spent around two hours hiking down (and then up, on return) a mountain to get to the Tchivinguirio Fall, which was well worth it. You can judge for yourself, anyways It took crossing three creeks though, were we had to skip from rock to rock and balance on tree logs. My legs were already jelly from a) all the crouching through the caves and b) the descent so balancing was definitely sketchy. There were several times when Auntie Tammy shrieked “HANNAH” because she was sure I would fall flat on my face into the water. I definitely would not have been able to do it with her and her husband sticking with me, pulling me forwards sometimes as I stand on a rock, afraid my short legs could not reach to the next.

There are many parallels to be drawn between life and this trek. Let’s start with the end point – most of the people went with the intention of jumping off the cliff and into the falls. As I stood at the cliff’s edge, everyone egged me on – come on, that’s what you’re here for! Inside, I felt slightly embarrassed that I was too scared, it was only 5 years ago when I stared into the depths of Lake Ontario from thirty feet and jumped in after slight hesitation. But now, as I looked down into the emerald green that froze everyone’s lungs as they pierced its surface, I realized that everyone has their limit and I have to respect myself for mine as much as I respect others. For some, it was halfway down the mountain, the trek was just too difficult and they had to turn back. For me, I was determined to finish the trek and get to the falls – to drink in its beauty but not be treading in its depth. It is important to stretch yourself, but also important to recognize when you are simply doing something to prove that you can be stretched, to add another trophy, rather than to learn something about yourself or the things around you.

There were so many points on the way up the mountain where all I could do was stare at the point half a feet in front of me and that was it.  I didn’t know how far I was to the top, nothing to measure my progress but that I had taken one arduous step before this one… and this one is before the next one… and so it is in life, there are times when you can not find that end goal, or even measurable “deliverables” that we are so obsessed about… we just have to put one foot in front of the other, breathing hard…until we get to the top.

And of course, the only way I was able to kept going was this: I had people in front of me to lead me on and people behind me to catch me as I stumbled.  That is what we should be for those around us: be in front of some – so we can lead by example; be behind others, so we can support them as they waver.

technology

For those who had difficulty imagining satellite dishes on houses made of wooden sticks

I have been interviewing moms in Rio de Huila, a rural area that is about 30 km away from Lubango. The first day I went, it was the weekly vaccine day, which included moms with young children and pregnant women. Because my study inclusion criteria was for parents who have children five and under, I had to make sure that I was not interviewing first time pregnant women.

One of the ladies who sat down did not have any children with her and she was pregnant. So I asked her, “Mai, tem crianças?” Without a pause, she quickly lifted her shirt and pulled out one of her breasts to show me that they had undergone the ardors of extensive breastfeeding.

At that, I quickly blushed and instinctively but my hand over my eyes. Then I realized what I was doing, so instead I stared intently at my questionnaire as if I had never seen it before. Previously, I had considered myself quite good at adapting to the culture of breastfeeding – here it happens anywhere, anytime, full exposure. But this threw me off balance. Other moms who were standing around saw my reaction and started laughing, and the woman I was interviewing also broke into a large smile. It was not one of mockery, but understanding that somehow I had been embarrassed by something that I was not accustomed to. Strangely, that built a bond with the group of moms and myself – I was not solely a “foreigner” coming to ask them incredibly detailed questions of what they owned, how they cooked, how they used their mosquito nets… but I was also a young woman, coming to terms with the different ways of defining the identity of womanhood.

Meet my namesake: Hannazio

I was helping with his delivery. There were many incredulous things that happened during this time:

1. They use a dumbell shape object to listen to the fetus’ heartbeat – and to my surprise, it works!

2. In order to suck the amniotic fluid etc out of the baby’s airways, they use a two tube system connected via a vial. So, one tube is placed in the baby’s airway and the other is place in the nurse’s mouth. I was too dumbstruck to take a picture, unfortunately.

3. Contrary to typical swarm of nurses who take care of the baby, the baby is left slightly unattended after the initial clearing of the airways. And, no cushy warm incubator either – just swaddles of cloth.

Despite all these challenges, the baby is healthy and 7 pounds. I asked what his name was, and mom did not know. I think she was rather tired at that moment, so she asked me what my name was. Confused, I asked again, making sure it was not a language thing. Confirmed it was the right question, so I said Hannah. She said ok, let’s name him after you. So the nurses came up with the creative name, Hannazio.

I thought they were joking. Later on, when I rounded with Dra Alessandra I asked the mom, so what is your baby’s name? She said, “Hannazio.” That’s right, it is on the official record.

There have been many serious posts so far (I want to justify that I am learning).  But it is time to lighten things up a bit.  So here is my muse on animals.

Contrary to popular opinion, roosters crow at all times.  There must be something wrong with the SCN (suprachiasmatic nucleus) because I thought they crow when they detect light.  Not these roosters here, they crow at 11 pm, 12:17 am… and any time they want to.  Also, they are not the loud and clear cookadoodledoo as represented in cartoons and Hollywood.  They sound like a dying gurgle. 

Along of the lines of birds, in one of the consultation rooms there is a swallow’s nest.  When I first saw a bird fly in, I thought how cute.  Then they kept flying in and I noticed the nest at the corner.  (the Chinese in me wondered whether it was the same swallow’s nest that we pay huge amounts of money to buy.  If so, maybe I will smuggle some in).  I got a little distracted by the risk of bird droppings, so I put on my hat.  The patient gave me a strange look at that point.  I chalked it up to coming from Canada, and she laughed.

I have also acquired a pet.  This dog waits for me outside the gate in the morning and follows me at a distance.  At first I was scared of it (rabies!), and tricked it onto the other side of the gate so that I could go on my merry way.  But it sat there, whining and looking at me with such sad eyes.  Well, I ignored it.  Then today, there it sat again, waiting for me and whining.  I am not sure what to do.  Poor dog – wrong target for those puppy eyes.

Finally, I have learned that when lamb bleat they sound like babies crying.  Several times my head has jolted towards the source of the sound, only to find a lamb looking at me innocently.

Did I mention that roosters, goats, lambs, dogs, donkeys, flies, and all other insects cohabit the hospital along with the hospital?  Yes, it is like a farm experience at the same time.  I love killing two birds with one stone (oops, no pun intended).

We were helping an old man get on the stretcher for his operation. Alberto, the surgical assistant, grabbed hold of the leg I had just lifted, but he paused and rolled up the pant leg of the man. Underneath the thick jeans, there was a huge infected wound on the tibia. Alberto let out a sigh. He then went about cleaning the wound meticulously.

Meanwhile, I was a little lost in a jumble of thoughts – hey I thought we were supposed to do the anesthesia right now. Hey, how did he notice the bump underneath those jeans and I didn’t. As I watched him dress the wound with care and gentleness, I thought about this man’s training.  EDIT: He was a sweeper at the hospital with grade 3 education.  Because there was a dire need for a technician, he was recruited.  He was sent to a one year training program.  Then 13 years as Dr. C’s surgical assistant. Not much in terms of degrees. Perhaps I have seen little, but I was inspired by both his clinical instinct and his compassion. In the midst of all the wounds and brokenness that you see every minute here, it is so easy to become callous – to shrug and say, just another wound. It is not my job. But he stopped everything else to clean it, knowing that if he left it, then it would fester, go on to cellulitis or become gangrenous to a point that it would require amputations (I have already seen a couple of these cases).

This moment of reflection was interrupted by Dr. C as he came in reassessing the patient before the surgery. Unfortunately, we had tried several times to dilate his pupil, but failed, indicating that there is something else other than the cataracts affecting his vision. So the operation was cancelled. But Alberto continued with caring for the patient. I watched him call the patient’s family members in and explaining to them about the wound and what to do. I watched him hand over a tube of topical antibiotics, precious, because we had so few left. He was not even “our patient” anymore but that did not change anything.

In medical school, we are taught the language of compassion. In fact, many of us probably got in by using that language during our interviews. But as I think of all the examples that I could have pulled to demonstrate my “compassion,” somehow, nothing seems to compare. As I look ahead to the many years of medical training I have I hope I am never “too busy” to pause and feel the wounds that are underneath. I hope I am never too busy to clean the simple wounds.