African Mornings

Remember the days when you didn’t need an alarm to wake up?  When you woke with the sun rise, and your body was so anxious to rid itself of sleep that it was insufferable to stay in bed?  The song in your head is not one you heard on the radio and can’t shed, rather it’s the background music of your life.  You knew that the day ahead was one to remember.  One where you will experience the payoff of weeks, months, or perhaps even years of planning and anticipation.  Possibly one in which you will meet challenges or opportunities you have never had before, ones you feel prepared to overcome, with meaningful experiences as your reward.

That’s what this morning was like.  That’s what nearly every morning has been like during my time in Africa.  At night, the darkness is absolute, an almost palpable heaviness to the air.  The lack of sensory input gently and slowly turns the brain off.  It is disarmingly relaxing, and I find myself in bed and asleep well before I had intended to rest.  Come morning, the energy of the world changes with the sun rise.  The light calls to action dozens of songbirds and crowing roosters.  You can nearly feel the world waking up, and the call is hard to deny.  Then you remember what you’re here to do, and it really is impossible to stay asleep.

This is my view while I eat breakfast.
I can literally see where my morning coffee was grown.

Breakfast is eaten outdoors on well-used sofas.  The view is of a sunrise, cresting over three consecutive ridges of mountains.  Directly in front of me opens up a field of tall grass that gives rise to a young forest.  Bizarre, foreign birdcalls surround me, and it seems as though all of nature is at play.  A bee encircles a small bird, who keeps hopping to and fro to escape his nagging buzz.  There are three wild cats nearby; two take turns jumping at insects that chance fly too low.  The third, the oldest, has slowly made her way to sleep at my feet.  The cats stop playing at the sight of a hawk flying directly overhead. It lands on the awning above me; its claws scrape loudly at the aluminum covering as it finds its footing.

I have gone to zoos before and have seen far less impressive displays of nature than this, a routine African morning.

The medical experience thus far dwarfs my time in Botswana.  Morning starts with 8:30AM rounds.  The facility has just 6 inpatient medical rooms, each with 2 beds.  Despite the low numbers, the acuity and complexity of patients is impressive.  Currently, over half of the admitted patients are children.  We spend a particularly long amount of time with one child who became neurologically devastated over the past three months; I come up with some answers, but without significant testing abilities, I’ll never know if I’m actually right.  The father, a proud warrior whose stretched earlobes and traditional garb could just as easily grace the cover of National Geographic, tears up at my explanation.  He will not be the last person to receive bad news today.

5 kids from a nearby orphanage, awaiting their turn
to see me.

The rest of the medical load, while significant, is African-casual paced.  Today, two orphanages delivered half their children to our doors, having heard that for the first time ever, a pediatrician has come to town.  I see five of them today.  The experience is exactly what I have come for.  These boys are largely castoffs, their motor impairments a fatal flaw in a society counting on them for manual labor.  Parents invest in children for the purpose of taking care of them when they're older; a disabled child is a poor investment.  So they are all withdrawn and forlorn appearing at first glance.  However, the way their faces light up at the sight of a five cent toy makes the thousands of dollars I paid to come here money very, very well spent.

The good news ends there, though.  For those two same boys, I can make a diagnosis: muscular dystrophy.  They will never walk again.

It is not all bad news, though.  A large percentage of families here do get the answers they've been seeking for a long time.  Down syndrome, Ohtahara syndrome; in these cases, I can offer a somewhat clear picture of the future, even if it is not the one they had hoped.  For others, they get confirmation of what they had suspected: that their severely weak, "disabled" child in fact has a full mind, capable of learning.

This is no small reward.  You see, schools here are very limited in their resources.  Any child with any somewhat significant problem is refused entry to school.  As an example, one 10 year-old boy was refused entrance to school his whole life because of a very subtle tremor, and they came to meet me to get a note saying he was medically cleared for school.  After TEN years!  In a more heartbreaking example, a boy with severely dystonic cerebral palsy, where he has basically lost control over all of his muscles (including his mouth and face), has a very full cognition, as far as I can tell.  When I asked his caretaker what I can help with, the boy replied, "I am a cripple."

Where schools have failed, the generosity of others have succeeded.  He was taken in by a Norwegian man, whose name I can't pronounce, let alone spell (it sounds like Skroli, but I'm sure there's an umlaut or two in there).  He has spent every cent he owns and has raised money from Norway to build an orphanage of sorts for children like him, children with significant physical handicaps but a lesser extent of cognitive impairment.  He takes them in and teaches them, not just basic schooling but also life skills, with the hopes of one day reintroducing them to their families.  So far, I have seen 7 of his sickest, and have given him half the money in my wallet to continue doing what he's doing.

Were it not for the FAME clinic here in Karatu and for Dr. Mike Rubenstein, the Penn neurologist who introduced me to the facility and is here with me now, none of these neurologically impaired children would have ever found the care they need.  Thanks to their charity, they are on appropriate medications now, and being cared for by people with the right mentality towards disability.

Skroli will have many more children for me in the coming days.  I hope I have the emotional wherewithal to handle them, and that I brought enough money to leave with a clear conscience.

My Own Personal Fight Club

It is 9:15 PM local time.  It is 2:15 PM back home.  My body has no idea what time it is or where it is; it just knows it wants to sleep.

I’m sure there are correct answers to this time/space conundrum.  The space answer is easy: I am at Addis Ababa International Airport, located in the capital of Ethiopia.  The time answer is disconcertingly relative.  Does local time even matter?  How often do I change my watch settings?  Should I put it at my destination’s time, as so many others have recommended?

I prefer to think pragmatically.  The time is 24 hours into my journey to Karatu, Tanzania.  24 hours ago I left my house with two bags weighing 50 lbs each.  Mercifully, those have (hopefully) made the journey independent of my efforts.  I have landed in Frankfurt, Germany; Jeddah, Saudi Arabia; and now Addis Ababa, Ethiopia.  I have watched a half dozen movies and taken probably a baker’s dozen naps, none more than 20 minutes.  I have seen the Arabian desert for the first time, even if only through a window of a plane.  I am typing through the last remaining charges on my electronic devices as I hunker down for quite probably the most painful travel hardship I have undertaken: a 14 hour layover in a very foreign land.

The airport is closing down for the evening.  Duty-free shops, tacky souvenir shops, and international cafés are shuttering their doors.  There are prayer rooms, separate for males and females, directly adjacent the smoking lounge.  There are a total of 8 gates at this central hub for much of East Africa, and probably an equal number of toilets.  (Side note: If I catch Ebola, it will be here.  The toilets are barely maintained, and no one was screened for Ebola upon entering.  I was forced out necessity to brush my teeth there, so if you see me in the news for having Ebola, please alert the CDC it was from Ethiopia)

Despite the late hour, the airport is alive.  Hundreds of people stream past, speaking dozens of languages, although English clearly predominates.  A group of men directly next to me are speaking in a language riddled with clicks and foreign consonant sounds.  There is a line of lounge chairs that people have staked out and are planning on sleeping on for the evening.  Clearly, I am not going to be alone in spending the night here.  I hope I find comfort and safety enough to catch another half dozen naps.

Reflecting on this moment, I am reminded of the movie Fight Club.  The movie, based on an existentialist, antiestablishment novel by Chuck Palahniuk, espouses self-destruction through violence as a means to break through the materialistic, manufactured life experience of millenials.  One of the many quotes that have stuck with me is, “It’s only after you’ve lost everything that you’re free to do anything.”  At this moment, I have no idea if my luggage will make it with me.  I have minimal access to food and water, and the overwhelming number of people around me threatens my innate sense of safety.

Yet despite these obstacles, the experience is liberating.  The lack of Internet means I have no idea what’s going on in the rest of the world, and quite frankly I don’t care.  The worry about publishing the paper I’m writing?  Gone.  The concern about figuring out what I’m going to do with the next 5 years of my life?  The new electronic toy I want to buy?  Even my ongoing struggle between atheism, agnosticism, and spirituality?  Well, it’s kinda hard to care about such things when life gives you more immediate concerns.  Traveling is my Fight Club.

I make it sound as though I feel threatened or in any sense of a panic.  It’s actually quite the opposite.  This is not an adrenaline rush type of satisfaction; rather an acknowledgement that I can no longer take the simple things for granted.  The experience is quite disarming.  There are dozens of travelers asleep nearby, with their possessions laying at their feet.  Others will leave their luggage behind to lay claim to their lounge chair as they go stretch their legs.  In other words, their possessions lay unprotected on lounge chairs in a busy airport with hundreds of people streaming by.  There is an unspoken amount of trust between these people, people who are very unlikely to speak the same language as the others here.  In America, inability to speak English is a tremendous barrier to trust.  Here, it is a fact of everyday life.

A lounge chair has opened.  It has been over an hour before I could find an opportunity like this, and one does not pass on an opportunity for comfortable sleep.  My flight departs in just over 12 hours.  2 hours after that, I will be in Tanzania.  Assuming no issues with a customs intake process where I’ll be bringing 50 lbs of medical supplies into the country, I will (hopefully) have a driver waiting for me.  He will take me on a 3.5 hour car ride into the desert, where I hope I will find the Internet to post this.

It’s only after you’ve lost everything that you’re free to do anything.