My first home visit

We made arrangements for the patients to come to my house at 7:30 in the morning so that I could give quinine injections here. I was excited about seeing patients in my house. I’ve never done something like this before. Eric Lan was waiting for me when i woke up. We have a tradition of running in the morning. So, thinking there was enough time before the patients would arrive, I set out with Eric. The sand was hard under our feet. We ran toward the mountain. We could see the Jehovahs Witness guy surfing in the breaks far out. We passed abandoned mansions whose walls have been carried away by the sea so that only the structural skeletons remain. Eric told me a guard lives in one of these destroyed estates (I might have misunderstood this part…it’s all in French and i understand <50% of the time). We swam in the refreshing crystal clear waves after the run. Then I hurried back to the house thinking I still had 30 minutes to get ready for the patients. But when i arrived at the porch, in my bathing suit and soaking wet, a mother and daughter were waiting for me already. Embarrassed I said good morning and please wait. I sprinted to my room, put some clothes on over the wet suit and hurried out with syringes and alcohol. This was a second-dose malaria patient: 0.45 mL quinine intramuscularly. My hands were shaking  just having run and swam and not having had breakfast. But i managed to get the long needle into the thin neck of the quinine vial. Eric Lan, who is in high school (or maybe its college…different system here) wants to be a doctor so he peered curiously over my shoulder. It was exciting to be the one explaining how to do it, rather than the one watching for for once. 

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Settling In

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I got to balance quite possibly the fattest baby I have ever seen on my hip as I bustled around in the clinic. His mom, a nurse, had to step out so she handed me the bundle of rolls and disappeared. He was fascinated by my different appearance. And terrified. He cried on my hip. What do I do with this fat little thing? I bounced him up and down and pretended to drop him. He laughed. The little guy spent the morning dangling from my hip as I hurried from the dispensary to the clinic to the pharmacy, as I took patients’ blood pressure, listened to chest sounds, and administered malaria tests. Whenever he cried because I was ignoring him I would just pretend to drop him and his fat face would crinkle into a smile. By noon my back and arms were aching from holding the baby for so long. Whoa. There are mothers who carry their babies around all day everyday and fulfill their tasks and here I am wiped out after two hours. Well to be fair, this baby is obese. But still, I’m pretty weak.

I left the clinic soaking wet. I pedaled to the market to go food shopping. I bought a kg of onions, 4 knobs of garlic, 1 kg tomatoes, some potatoes, red and white dried beans, rice, baking chocolate, milk, coffee, 8 eggs (one of them broke on the bike ride back), and rolled oats. Camille and I have a stove and we can cook and we have time to cook and I suddenly like cooking. I never have to buy mangos, limes, coconuts, oranges, or lemon grass because our garden is full of these foods. I pedaled back to the bungalow and spent the several hours cooking.

Ulcer dressing as meditation

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I rode my bicycle around town looking for the post office. There is no sign and the post office turns out to be part of an old cement bank. I asked about five people for directions, getting closer each successive inquiry. I explained that I am trying to send letters to America and Germany. My envelopes, carried from India, are torn and thin, not suitable for the long journey over oceans and continents that they will be making (hopefully). I found a role of medical tape in my bag (my new accessories in the purse are 2 sterile syringes, micropore medical tape, rubbing alcohol, and some injectable steroids). I bolstered the envelopes with micropore and then covered them almost completely with stamps. I have no idea if they will make it out of this bank postoffice, let alone off the island into the air, over the oceans and continents to their destinations in the northern hemisphere.

I hopped back on the bicycle, pedaling contentedly to the Jules Leprosy village. Six patients were gathered peacefully under the medical pavilion. They were listening to island music from a portable radio in the grass. Modest, the wonderful care taker who helps me with ulcer dressings, was putting tape over Fidel’s foot (he’s the Cinis capsella guy). I am learning the patients’ names and little bits about their lives. I know which ones have pain and where it is and how they will react to my treatment. I took the scalpel and began carving dead tissue from the first foot. Although gruesome, these are the moments when I know absolutely that I want to be a doctor. When I sit with a patient, I make a commitment to work with him/her as a team toward health. The patient and I are both striving for the same thing and the only way we will make it is if we work together. I cut and scrape and cause a tremendous amount of pain and the patient holds his foot still, knowing the only way to heal is to trust each other. It is during these moments of team work— whether eliciting patient history in India, or dressing wounds or giving shots in Madagascar— that I know this is what I want to do for the rest of my life and this is my commitment to the world. I want to connect with people in the pursuit of health. Connecting does not just mean  connecting the tip of my blade with flesh, it also means looking up at the patient, reading his/her face, seeking to understand his/her life narrative. It is a special opportunity for two humans to connect and care about each other’s lives.

I work slowly and carefully which fits in nicely with island pace. Nobody is in a rush. We hear the soothing hush of the ocean from where we sit. The sun sinks lower in the sky and shadows grow long. The light, now coming from a lower angle in the sky hits my back as I work facing the patient who sits against the back wall of the lean-to. Beads of sweat gather on the patient’s face and pool in his wrinkles. My shirt sticks to my back and sweat seeps out of the wrists of my gloves. The flies land on various parts of my body, on the instruments, and on the patients. But none of this matters. The work is a calming meditation.

They hide the bones under the bridge

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I was taking pictures of a neon green gecko when I stumbled upon a heap of human bones. Mostly femur, tibia, fibula, radius and ulnar. No spines, no skulls, no pelvises, or phalanges. They were concealed in the place where the gecko was wandering under the bridge. I asked Eric Lan later about the bones and he told me they were deposited here by human traffickers. “Very bad people” he said in French. He doesn’t know how long they have been there or if the pile is getting bigger. Shocked and bewildered I beheld the bones. Who were the people to whom these remains belong? Where are their families? What happened to spines and skulls? Are they heaped under another sinister bridge? Seeing these pieces of bodies clustered carelessly in their hiding place undermines the value of precious human life in the most appalling manner. Every bone in this pile used to be a living part of a human being. Somebody who climbed to the top of mango trees, shaking the branches to screaming kids below; someone who pulled nets heavy with seaweed, crabs, and fish from the estuary; somebody who sat in the sunshine all day flipping plantains over a grill; somebody who made rice for her family over coals; someone who went to the discotheque dancing into dawn with friends; someone who carried sixteen children into the world; someone who ran to the beach from the schoolyard to do flips on the sand, someone who had dreams about what he would do when he grew up. These bones belong to Malagasy people who were murdered.

Saturday Jan 19th: The Mountain

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No clinic today so I went on a hike with Eric Lan up the mountain. We could see a lot of Madagascar coast from up there. And we could see the whole town of Antalaha. It was beautiful!

In the afternoon I taught the teachers in Belfort village an English class. I got caught in the rain on my way back to the bungalow and the bolt on my saddle snapped so I had to pedal standing. Marie-Helene let me borrow another bike and gave me a basket of shrimp to cook for dinner. So sweet!

I got to Skype with my dear friend Marina which was the best thing ever. It is so hard to be so far away for such a long time. Skype makes it almost bearable. Right now it is still raining outside but we are lucky tonight because we have electricity. So we will eat our coconut shrimp with lights. And i can read my new book, White Tiger tonight!

Friday Jan 18th: Swiss Ulcer Ointment

I felt physically fantastic when I woke up. Energy! There is something about the feeling of good health after it has been in the gutter that is exhilarating. I went on a long walk/run down the beach.  I saw this big chunk of land emerge from the ocean. An island? It was pretty far from the coast so I couldn’t make it out. I swam in the ocean letting the big waves carry me where they pleased.

I peddled to the clinic feeling strong and happy to be healthy again. I tested many young patients for malaria. I am confused about the protocol here. Why do I bother testing these kids for malaria if we are going to give them a quinine injection no matter the result of the test? Many kids who come in complain of having fever but when I take their temperatures they are normal. And their malarial tests are negative, but STILL we give them quinine. Why? It is difficult for me to ask questions about this protocol because my French is still basic (to be kind to myself). I really can’t communicate in French yet which is  huge problem in the clinic. I gave many quinine shots and one contraceptive shot.  There were some interesting STD cases and one jaundice case indicating possible hepatitis.

After the clinic closed I biked to a little restaurant for my favorite snack: a cup of creamy fresh yogurt with fresh mango juice. Delicious. I bought a shirt for the clinic that turned out to be see-through, so scratch that. Back at the bungalow Camille had set up our stove so we could cook! I made eggs and tomatoes for lunch. Then I biked to the Jules Leprosy village. I put the special ulcer cream (Cinis Capsellae)I have been carrying since Switzerland on one of the patients with a particularly persistent ulcer. I will be using this cream on his ulcer for the next few months and monitoring his progress. The little group of patients at Jules village are really tolerating.  Even though they have leprosy ulcers, they still feel pain when I cut, scrape, and scrub their wounds. I have to say sorry and do it anyways, otherwise the wounds will never heal.

I biked back to Antalaha, went shopping for vegetables in the market, and jumped into the ocean. The salty water washing over me felt so purifying after digging around in people’s cuts all afternoon.

I went to sleep around 8:30, listening to NPR as I fell asleep (our house has wifi).