Colonized, not conquered, tongues

In my Creole Poetics class this week, we discussed Caribbean poet and scholar Edward Kamau Braithwaite’s “Nation Language.” In essence – colonized people, who’ve had to assimilate to and be taught in the language of the colonizer – need a more natural form of expression. Part of independence, part of forging a national identity and establishing roots, was valorizing that language. Making poetry in the diction and rhythm of that language – iambic pentameter, for example, is not native to Barbados. (Is it actually natural to English? debatable).

I’ve seen this in Cameroon – French is, technically, my first language, but for the first few weeks in country, my “French” was translated into “French.” As I now call it, that’s French-French to Cameroonian-French. I was incomprehensible. I understood what was being said to me, or I thought I did. In time, I changed – I had to. It’s the inflection, the diction, the choice of words, the syntax, the prosody, the sentence length, word order, ways to get attention, non-verbal sounds to punctuate phrases…

Everything.

It’s not the same language.

I see it now as general, amorphous “French” for the basic structure – and there’s the French-French, the Cameroonian-French, the Senegalese-French, the Malagasy-French . . . they’re all different.

(And why shouldn’t they be? It’s obvious enough for Belgium and Québec).

But Africa was colonized.

The marks are there. Senegal was more closely held for longer – the French is closer to French-French in accent. Cameroon got passed over from Germany. French is different – the culture, too, is different.

And then there’s Anglophone – as PCVs, we defined at least three (basic) languages in the Anglophone (previously British-held) provinces of Northwest and Southwest. “Grammar” is the “Queen’s English,” or so they say. (Grammar – reductive; it’s language without culture or any social attachments. Pejorative? True? The way English was taught in former colonies (and is still), it’s the generic, over-arching Language. This Is. How could something so authoritative have meaning to real people, terre-à-terre?)

Anglophone. Not quite grammar, or – it is “grammar”, but we call it something else. English? No. That’s British-English. “Anglophone” is, like Cameroonian-French, related to accent, inflection, diction, syntax, vocabulary… it’s neither British nor American English nor any other Western form. We Americans were not always well-understood speaking American English.

So what did we do?

We spoke Anglophone.

(And many volunteers who lived in the NW and SW learned and spoke pidgin, as well as other local languages – as a visitor to the Anglophone regions from my own francophone province, I didn’t go further than Anglophone and a few phrases in pidgin).

It’s reflexive, now.

This is what we do.

The Vegetarian Carnivore - Rhumsiki, Cameroun

The Imposter

17 August 2011

For several reasons, I wrote this approximately 3 weeks ago, but I haven't been able to post it until now. To be read in the context of mid-to-late August. I'll write soon about the up-to-present. And how I saw the writer from "Stahnding Room Only" (February) again last week.


After a job interview, my new boss suggested I check out St. John the Divine. “Have you been there?” “No .” “It’s the largest cathedral in North America.”

I walked up Amsterdam to 110th . I like cathedrals – it’s a place to commune, to be quiet. I like the stone and cold, windows and dark light. In Paris, it’s Notre Dame (however clichéd) and everywhere else. Here, it’s…

            I went in, similar feeling, similar, except not nearly as cold. Quiet. Leaving, I walked up the street to discover more of my new New York. Next to the cathedral, there is a hospital. Pause. Ridiculous – no – nothing to do there – to see whom?

Pause, but there's a small pull and I walk towards the main entrance. It’s unfamiliar (but I’ve worked in 7). It’s private (never done that) and there’s a guard at the desk.

The Mental Status Exam and obsolete ethernet cables

I’ve written the neuro exam, the respiratory exam, the cardiac exam? (not yet) – what else. Pelvic exam will certainly deserve something. Anything that intimate. Eye exam (except I’m not good at it/we don’t really learn a good one, in med school). Musculoskeletal could be interesting.

Dermatologic, again, we don’t really learn, but that sort of scrutiny to the outside might be the most similar to psychiatry’s scrutiny of outside-to-inside-to-outside.

It’s applicable to anything. In psychiatry, actually, I did a presentation on the mental status exam and interpreting poetry – poetry I blurred on the projector screen so that you couldn’t read the words.

Mental status includes action, includes movement and speech and anything that indicates internal state in externalization.

I spend a lot of time, lately, searching for wi-fi.

Crossing into Chad

The Procedure

(This was written several weeks ago – refers to all month of July)

Today I used sound waves and a plastic transducer to take moving photos of a fetus-squiggle. I was outside, it was inside, and now it doesn’t take long for me to find the uterus, to see the black-filled-collapsible bladder on top of the double-stripe collapsible uterus that now, in pregnancy, isn’t so collapsible (potential space). The black-fill is water, and there’s a tiny yolk sac (depending) and there’s a little squiggle (this early). And it turns and turns and turns on a stalk, and I have to move, patient, to capture it. Length-wise. Freeze. I measure. My machine converts that to weeks.

And I print the photo, attach it to the woman’s chart on which I’ve written LMP/Gs and Ps/prior c-section or surgery. Bleeding or pain? Prior ultrasound?

I’ve filled in provider (the attending), the clinic, the date, and the patient’s name, DOB, medical record number are stamped at the top of the carbon-copy page. White copy on top.

I write in the length I found (if it’s first trimester-early, it’s crown-rump length - descriptive, no?) and I write it in mm and I write the gestational age.

I mark: + IUP.  + FCM

Single, intra-uterine pregnancy

Fetal cardiac motion

Under “reason for exam” I write “dating – undesired pregnancy.”

Learning language

The following is slightly modified from a recent graduate admissions essay. (The first paragraph, alone, was posted in December). It may be a cop-out to post something I've already written - and, quite differently from everything else I write here - this one is highly edited and revised. With help.

This, however, is the manifest - and I wanted to explain what the connections are, for me, between the disparate interests. It's like writing poetry - once I've written a poem about something, describing that (event, feeling, person) in other words and sentences falls short. It isn't exactly, not quite, what I mean. Hence the quoting-of-self that happens. Inevitably. This, I imagine, must happen to all writers. So, rather than expound upon what's already been written:

***

It starts when I enter the room. How many words can my patient speak without needing

air? Is she leaning forward to breathe? Are her fingers clubbed? My stethoscope hangs without weight. My hand is on her shoulder now. My eyes close. “Breathe,” I say. “Relax.” And I am listening to the inside of her body. It’s telling me things my patient knows but lacks vocabulary to describe. It is my privilege to explicate this poem.
            I was born speaking two languages, and, as a bilingual child, French and English were imprinted in entwined synapses. I do not always know which language I am speaking. If I read a book in English that takes place in France, I “remember” the dialogue in French. I transpose. In this way, I have learned that translations are only approximations. I connect most with those who speak both my languages because that allows me to use the most precise word possible.

            I speak two languages. From my early years in school, I was drawn to science because of its inherent beauty and creativity. I decided to pursue biology the first time I looked into a dish of pond water under a microscope and discovered an entire invisible world. I spent late hours in the lab, peering at 400x magnifications of cells I had stained green for mitochondria and red for nuclei in a 12-hour painstaking process. I would forget to count and simply stare.

Cacao field, Mvangan

Sustainable - Ecstatic.

Everyone talks about 'sustainability.' 'Sustainable development.' (which, by definiton, should be sustainable - otherwise - it's patchwork construction and shantytowns, metaphorical or literal). The environment.

Etc, etc, etc. It's as much of a generalized buzzword as "global health" is becoming in medicine.

If there's one thing I learned in Cameroon, it's that I can't take on things much larger than a village. A small part of a health district, perhaps. A health district (rural). A larger health district (someday). Part of a small NGO (someday). One project, perhaps two. Other things are less sustainable.

In medical school, the largest thing possible was a small, student-run clinic in a homeless shelter, operating for a few hours two nights a week and a morning every other weekend. That, in itself, was enormous. And there were several of us. (Alone? Possible? One person is not sustainable).

The Mall, Washington, DC, February 2003

In college, I was actively anti-war (can't even be apolitical in writing). (and I've learned that the strict position of 'anti' isn't useful anyway.) Peace marches, protests, demonstrations, a dizzying 'march on Washington' (to be done once in a life, at least, if politically inclined) gave a sense of community and something greater when the state of the world was terrifying. In this state, there are rallies at the state house for single payer healthcare. I haven't gone. It’s the global and local thing. Someday, maybe, WHO-type work. Someday, definitively, public health education/behavior change communication and program design. Local to larger to local.

Happy 50th, Peace Corps

(50 years total for Peace Corps. 49, continuous, in Cameroon)

My stock answer when people ask me what was Peace Corps like?: Best thing I ever did.

It continues to be true.

And it’s the group I’m proudest to be a part of – I saw someone else said that, with regards to this anniversary. Still true. Clichéd. True. I was strongly considering extending for a third year, and, if my MCAT scores hadn’t been about to expire, I might have. I’m one of the luckiest ones – a year and a half after leaving, I had the opportunity to go back. And it was paid for. (research project – see Cameroon posts from summer 2009). I’m one of the luckiest ones – I got to go back and see several of my projects still in motion, growing, and significantly stronger and better than when I had left, thanks to the volunteers who came after me.

I remember my Peace Corps interview, beginning of senior year of college. I remember the recruiter who had been in Mali, raising chickens. She asked me how I would deal without electricity, without any amenities, without anyone from my culture near me. I said I thought that I could do it, but I didn’t know. Peace Corps challenges you in ways that nothing else does. Nothing can exactly prepare you for it. Nothing can tell you if you’ll be able to, if you’ll be happy, if things will work out. There are millions of unknown and unseen factors.

Words we use with kids

Toxic. Non-toxic.

(sick/not sick)

CF-er.

(kid with cystic fibrosis).

Heme-onc-er.

(Kid with cancer).

FTT: Failure to Thrive

(losing weight/not gaining weight, either from chronic disease or from neglect)

Crumping.

(going quickly downhill/possible to death)

Two kids I saw in the office, who were completely fine.

Baby L. Perfect newborn exam. Perfect. Slight ductus arteriosus, I think, that was closing. Breastfeeding was going well. Mom had 4 other kids at home, lots of social stressors, but her husband was involved, there was a grandmother somewhere, and maybe one of the older kids was around to help out, too. History of post-partum depression and chronic mental health issues – we talked about that – but doing well, couldn’t take meds during pregnancy but on top of her symptoms. In touch with a social worker.

Minor issue – her 20 month old son had a cold.

Okay.

Well, try to keep her away from the new baby.

(easier said than done. Baby wants attention away from the new baby).

Sunday, I was in the ER, and I glanced over at the list of patients admitted the previous day. Baby L was on there. And Baby L was in the Pediatric ICU (PICU).

I had seen Baby L in the office on Thursday, I think, and the attending had seen her as well. Doing beautifully, as they say, with the requisite “congratulations!” and “what a cute baby!” “what a perfect baby!” Baby L was doing fine.

…and then Baby L caught RSV* from big brother. And Baby L started having apneic episodes, when she stopped breathing. And Baby L came in by ambulance and was in the ICU hooked up to monitors, now.

*respiratory syncytial virus. In adults, it’s almost asymptomatic. In a number of toddlers, too. But some of the ones who get sick, and some of the babies…get sick fast. There’s no treatment.

Where it is located

I’ve realized, again, that the lower back is the genesis of much movement in African dance. It’s the center, the core in a different sense than is described in Western forms of dance (the Western “core”, at least from what I’ve heard/been taught, focuses more on the anterior, the abdomen). It’s the center of gravity if you’re bending back, held up to the sun with an invisible force, giving homage with joy to everything above and around.

It’s different.

If you’ve been to Africa, backs – particularly women’s backs – look different. And this is why. Somehow (and I haven’t identified this, anatomically) these are muscles that aren’t used as much in other parts of the world.

It’s more than standing tall, proud, unadorned.

It’s carrying a bucket of water on your head, touching lightly with fingertips on one side.

Not swaying. Not spilling any.

It’s doing the same with laundry, régimes of plantains, furniture.

It’s walking back from the fields with the woven basket on your back, tied around your arms with the two lengths of fabric. Machete hanging out behind, probably, with the plantains and manioc and arachides.

It’s carrying children there. The crook not of an elbow, but of a back. Shifting on the hip sways you to one side – it’s uneven, it’s not ergonomic. It’s not long-term. You – they – can walk forever with the child cradled there, just so, tied in a pagne.

It’s the classical pose of the drummer reaching for the sky, pausing between tam-tam beats.

It’s the wooden statue of a women with a water jug on her head.

It’s the machete raised high overhead to reap plantains and papayas and coconuts and palm fronds and avocadoes and…

“You made everyone have to dance tonight.”

(for current lack of a better word - call this Zen Part A)

My African dance teacher, to me. Tonight.

I’ve started going to (West African) dance regularly again … and by regularly, I mean two weeks in a row. That I plan to maintain as much as I can. Again. I started dancing (this) in spring of 2002, and I got into it more seriously in the fall. My first teacher was Malian, and my first classes were in too-large-or-too-small-classrooms-or-sometimes-alcoves around campus. I had started modern dance around the same time, and I was doing step (African/American, not drill team-like), but once I started classes with Joh…I gave everything else up. It didn’t matter anymore. Nothing compared with this.

It wasn’t like that at first. After the first time, I wasn’t sure if I had done anything difficult, actually, or even athletic-like at all.

Then I woke up and I couldn’t move.

And the next time and the next time. If you’re doing it right (and there are infinite ways to do it right), you use muscles that Western life (and most Western dances) never touch. And the only way to do it right is to stop thinking.

Stop. Thinking.

The thing is, I'm not super - anything

(still on brains)

Wednesday, surgery from 10 am to 6:30 pm. We were standing, in lead coats from neck-to-knees (starting at thyroid), in an already unseasonably-warm OR. It was the same surgery on Friday (see last), but it took much longer, even though the patient’s case was technically easier.

No eating. No leaving.

A nurse brought in cold juice with straws for the surgeons – I guess it’s sterile if you do that below the mask – but they didn’t end up taking it.

(The lights are flashing in the neuroradiology reading room as I write. Am I leaving? Not yet. Things I ignore. Does it mean a machine is going off? Mostly, it’s not beeping. I’m early because parking was easy for once. In this city of public transportation and convenient shuttles between hospitals, neither option will get me here early enough. Driving alone at 5 am…that’s another story).

10 am to 6:30 pm. The intern and resident were closing around 5:30; they had already pulse-lavaged the spine, all clean, no active bleeders. The muscle was back together. The fascia. The subcutaneous fat…almost to skin. The attending walks back in. “WAIT – did we **???” The resident. “Mostly, yes, but we didn’t re-do that after the surgery.” The attending walks out. Few minutes pass. Attending walks back in, having deliberated. “..And we’re going back in.”

At this point, starting to feel faint – all of us had realized (and this was true) our scrubs were completely soaked through with sweat, it was so hot under full lead wraparound coat…), standing there a few feet from the surgical field and leaning, leaning to peer in as much as I can…(this attending did not let me do as much/get as close as the one from last week)…

I stepped away from the table. I went to sit down in the back of the room. Do I go back? Is there a point, at this point? After a minute, I pulled off the top pair of gloves, pulling the gown off with them, putting the entire spattered bundle into the trash. Second pair of gloves. Now, dear gods, the lead coat….

And I stood, hands crossed in non-sterile gloves, and I stayed.

(The lights are still flashing. How do you even evacuate a hospital? They didn’t, for Katrina).

There was another surgery that was going to go as an add-on. Maybe. The patient was stable, urgent but not emergent, and she’d taken two (full, 325 mg and not the 81s) aspirins that morning. (One of our attendings/teachers in the first two years tells the story of his famous third-year mishap. On morning rounds, he proudly pronounced that the patient was taking “ecasa.” Not knowing what it was. “ECASA”… is enteric-coated acetyl salicylic acid. Aka, aspirin). The attending was worried she’d bleed too much. The surgery was a ventricular shunt revision, which basically means they go in blindly, apparently, and if there’s internal bleeding in the brain, they won’t see it.

It was unclear when or if the add-on would go. I left. 7:30.

(Buckets on my porch in Mvangan, waiting to gather water before the impending storm)

The next day, I found out the surgery had gone, and rather than being fairly straightforward, as they had expected, it went until 4am.

A sub-intern would have stayed.

A superwoman, super-medstudent would have stayed.

I went home.

I couldn’t stay.

I was barely lucid even going home after the first one. We had to jump my housemate’s car, and I kept not understanding what she was saying, that we had to do it now (and could do it now) because she did have cables and I did have a working car and we were not, after all, waiting for someone to arrive, bearing cables, magically.

(if that doesn’t make sense as a sentence, neither did the situation in real-time in my head).

I just kept talking, and I alternated standing and jumping back onto the kitchen counter, finding odd bits of food I had. This was a day, and I’m even on a two week (done) rotation without evaluations.

There is nothing super or more than human about me.

And yet – and yet. I’m mostly close enough to see the surgical field when scrubbed in, in the OR. I’ve gotten used to crowding surgeons and they’re trained to be used to elbows. Small field, small incision (funny how scalpels are the symbol for surgery in word and in deed – they’re only used to cut skin, nowadays, and that’s so little of what’s done. Tiny minutes of the hours).

It’s a small surgical field and there are a lot of people. It’s useful to be claustrophilic.

(Kalabash! Market in Tourou, EN, Cameroun)

Time in the OR can drag, but that case didn’t feel like it was 8 hours long, and it’s fine and interesting. Fine. Then..I’m directly over the surgical field and I’m stunned. I’m fixated.

It’s unbelievable, unbelievable, unbelievably incredible that I get to be here. Looking into the interior of this person’s body. And not just looking but acting.

Part of me… a not small part of me…is a surgeon.

Proprioception is important at all times in the OR (see: the neuro exam). Proprioception – sense of your body in space. There are blue things everywhere. Blue means sterile (except for the blue non-sterile ubiquitous gloves by the door. That’s confusing). But everything else blue is sterile. The blue (Kimberly Clark has the monopoly, here) sterile surgeon gowns we spin around in. The OR dance everyone does. The blue gloves that go on beneath the whiter ones (though, sometimes, these are green). The blue cover on the instrument table. The blue towels. The blue drapes over the patient. The blue drape that separates anesthesia from surgery.

Blue.

And your personal sterile field is a tiny window, just-below-shoulders to waist, basically. Arms, but mostly up to elbows. And that’s it. The back of you is not sterile. Do not turn your back to the patient. Do not touch the front of a sterile person with the back of your gown. Do not brush against the instrument table with any non-sterile part of you; they will have to completely re-open (and if you come close to doing this, you get yelled at. A lot). And somehow, magically, in the large OR that becomes a tiny, crowded, space, this almost never happens. You have to know exactly where you are in relation to everything and everyone else at all times to know how you can move. Awareness of yourself. Awareness of where the patient is.

I’m getting better at this, maybe.

This Friday, I saw something I’ve never seen before.

An attending had to back away from the case, sit down, scrub out, put his head down, and not pass out. He didn’t pass out. Attending, high-powered way-up-in-his-career surgeon. Super-sub-specialized. He had to stop. Another doctor, a non-scrubbed one, went over to him. Checked if he was okay. Spoke to him, gently. Was he having chest pain. Did he need to lie down. Someone went to get a stretcher. Someone else went for juice and chocolate. The sugar helped with the hypoglycemia. Whatever else… he left the room for awhile then returned and resumed his part in the case as if nothing had happened.

Doctors are supposed to be super-everything, surgeons in particular. I had never seen this happen.

Later in the case, this attending’s resident had a break in his work; ie, the resident from the other surgical team (this was a collaborative case) was taking over for a bit.

The resident backed away and sat down. You can do this and be sterile. But he sat down. At some point, he also scrubbed out to go to the bathroom, maybe, get food, maybe.

This was new to me.

For the other cases, it’s amazing to count how many nurses come and go. They have shift changes and they have mandated breaks (doctors don’t have unions. Or clauses). Anesthesiologists take breaks, too. Every few hours they’re relieved by someone else. In and out, in and out, faces and names and voices (behind masks) change all day in the OR. The surgeons are the same. And they almost never leave and never falter.

(Rhumsiki, EN, Cameroun. Continuing to be random)

I might take back some of what I said about neurosurgeons. Maybe it's the hospital where I am. And the particular team.

But in medicine...

Take the case(s) of Ms. Lee and Ms. Li. One is 35, the other is 65. One speaks Mandarin, one speaks 7 Chinese dialects and some English. One has metastatic cancer to her brain. The other has a primary tumor, we think, without the full pathology report, and all that's been done so far is a biopsy.

One went home yesterday and the other is still in the hospital.

And the team can never remember which is which.

"The Lees".... luckily, they're on different wards in the hospital, but that doesn't actually end up helping a lot.

"This" thing. Woman dying. Old. Sick. How much does she understand? We're not always there with an interpreter, we don't know.... and the family won't get together to make her DNR. As if this is the only acceptable option. It's true that for this patient, intubation might count as battery in the sense of...do more harm than do good. Legally bound to, however, without that order. Without physicians declaring "futility of care." (I can't remember if I told that story... perhaps later).

There is an actual story coming later this week. Almost done. Perhaps a little more...upbeat? 

There's also a much funnier story about the rest of what happened on Wednesday, during the surgery. Perhaps. If asked. And with a little levity.

~j

November ending in red ribbons

Ok, it’s official, I didn’t win NaNoWriMo this year. (and by win, I mean write 50,000 words in November).

It may have been a bit ambitious to take on, alongside third year of med school and concomitant hours in the hospital/studying. Then again, I have been spending an hour – two every day writing; it’s just been poetry or essays. Or researching writing.

I did start. Like last year. I was planning to not write something new – I was either going to revise and finish last year’s novel (now at 65,000 words), work on poetry, or do…something. Else. But I sat down on November 1, taking one of the many, many breaks that are scheduled during anesthesia (seriously. The attending come into the OR every two hours. “Want coffee?” “Want more coffee?” “Have you had lunch yet?” Etc. No other specialty does this. I can imagine the surgeons glaring or snickering behind their masks, after they’re been standing for 8 hours without relief. At any rate)….

And a voice was there. So I started to write. It made me feel a little bit smug about my development as a fiction writer, as the voice arrived in first person and she is most definitely not me. Last year, I had started in first person and had to switch to third to keep myself out of it.

It’s an interesting story, maybe, though I don’t yet understand what’s happening, at all. I’ll finish it someday. The characters are: the main character, a little girl (nameless so far), the president (maybe Obama, probably not), and a few three-headed, wooden dogs. So far. I appear, as well, as a bystander at one point; I’m not sure if “I’m” going to be a recurring character. (At least, it’s someone who looks like me at a very particular point – ie, in Zoebefam when I was building the water project there. Only time will tell, I suppose, if it’s “me.”).

            This was a very different experience, in terms of writing – last year’s came to me in words. It’s very fluid, very poet-y prose, perhaps Jeanette Winterson-ish (if I flatter myself. All my influences are somewhere, after all). This year was all images, like I was flying/gliding somewhere and just writing down everything that I saw and encountered.

And it makes no sense. This story takes place in a world that is magical realism, perhaps, in another time period, perhaps. It seems to be some sort of speculative fiction – a genre I’ve read only small amounts of and do not know much about.

A sample of this year’s story, somewhere beginning-middle-ish:

(Context: I have no idea).

The girl looked strangely familiar. She probably lived in a candlestick. She walked toward me with a bounce, little flaring navy dress over transparent knee socks. Looking back at the president, his hand came off in her hand and she continued, unconcerned. The girl started floating a little, like the hand was attached to an invisible balloon without a string (and what do we need strings for anyway except cheese and hamsters?)

Looking into glass, she bit my ears. “This isn’t a wishing well,” the little girl said, “but I’ll throw coins on you anyway. Are you made of stones or salt? I’ll try not to melt you.”

“How would I know if I melted?” I asked her. This sounded concerning.

“Do you carry an umbrella?”

I looked at my elbows, Nothing there except some trailing ribbons.

“Then probably you don’t. “

Compare with last year’s random sample:

(context: Sera, main character, just smashed her finger into a wall, and she’s watching the skin change colors. This is from the middle/end of the scene).

Prisoners, tower-locked in membranes. Not the ones filling her skin. Catabolism – sanitizing catastrophe. Reversal of what is expected, from katastrophein down and turn. Strophe like ballads. Body like dead.

Delicate cleaving, coordinated cycles. Green comes first, biliverdin (Verdi like spring), carbon monoxide floating into tissues. Silent killer. Verdin turns to rubin, darkened red stone, breaking cells – monk-like chambers - into light. The white carriers, protein, to eat and build and break, albumen from alba, docks filled with too much color. In bodies red and green makes yellow, turning eyes and skin to gold.

Insensitive, unseeing to the slight new crook in the bone, Sera went to X-ray to earn more narcotics. White on black, gray for fat, water that wasn’t water. Photographing bones. Calcified proof of how long it would take you to dissolve.

The mind is strange and fascinating.

...And then the patient who does not have schizophrenia (who I thought, previously, likely did).

 This is relieving. I’ve been seeing him most days for the past few weeks, over which time he’s come to think of me as his psychiatrist or similar. – No, I never told him that, and he does understand I’m a student/in training. I am the one who recommended staying with the first drug regimen and adding one, though. I am the one who wrote the initial psych note and the follow-up notes. And somehow, somehow, this is counseling. Therapy. What I do with him, what we do. There was a study that did a case-control (not double-blind, but…something) on therapy with trained professionals versus therapy with other sorts of professionals masquerading as therapists (ie, architects, scientists…whomever). The patients did decently well. I’m not saying the discipline is useless – I believe the contrary, these days, actually. It is specialized, it is important, and the drugs can and do work.

Point being – part of the whole deal is just having someone to listen to you, who cares and is all-in. Who’s unbiased – as much as any human can be – because the only context in which they know you is what you’re telling them. They might get collateral (friends, family, previous physicians). But in general…

So I sit, in the yellow disposable isolation gown, with gloves on, and we talk. He talks, I ask questions, sometimes. The narrative bit is amazing. I have the agency to ask And then what happened? It’s an unfolding story to me, and somehow, in the telling of the story, he feels better – he says, at any rate. And I don’t think he has schizophrenia. Something, certainly, but it doesn’t seem to be that.  One of the psychiatrists who taught us a few years ago called it the “cancer of the mind.” True. Not for everyone – some people can recover from an initial episode of psychosis, and that’s it, or maybe they’ll have another one far down the line. That’s not what we see as often, though – but working in the hospital is its own bias. We only see the people who are sick.

(banner below is from AIDS Action Committee's website. Because I think they're really cool (used to volunteer there)). 

......And I’ll segue into World AIDS Day, a thought debate on does-this-sort-of-“visibility”-help-anyone, and December.

Addendum on the One Campaign – as far as I could understand, in 2005, their main message was “Africa is poor. Africa has AIDS.” Both of which are DUH, as in, clichés in language, at any rate, empty of meaning, digressive, pejorative, and oversimplified. Take that. But THEN, you get celebrities to play concerts around the world, bringing together tons of liberal, left-leaning, world-loving young adults to chant “Yeah!” to that sort of a message. And you don’t harness the energy. At all. You don’t use it to raise money. (“Awareness” in that arena is… what. Meaningless, in any manner I can see. Maybe someone with far more vision than I could create something spectacular). So, money. Volunteer hours. Donations of other sorts. ANYTHING. Millions of people there for free. Nothing happens. Except they buy rubber white bracelets, maybe (are those still in fashion?) And they go home feeling good about themselves. It’s like expensive shoe stores in Berkeley or similar telling you some minuscule percentage of the shoes you buy goes toward breast cancer research, or something. So you feel good about going shopping – there’s your good deed for the day. (at least that’s raising something for something. maybe. maybe.) At any rate.

I work in an HIV clinic in the states, now. This is a poor town (where I am currently). These patients do not have much income, and they get assistance from the Ryan White foundation (and federal) for ARVs and such. There are social workers in the clinic, case managers, a psychiatrist, nurses who do home visits…

And the patients look good. They look damn good, in fact. For 90%, you’d never know. They may have presented with AIDS, even, cachectic from tuberculosis or PCP or something in the hospital. Then they got into a care, on a good regimen, and they got better.

And damn, they look good. They come to the HIV clinic, get refills, basically, and take care of their hypertension, diabetes, hypercholesterolemia, insomnia, depression, chronic back pain, headaches, sore throats, etc, etc, etc….

We give them graphs of their viral loads and CD4 counts. This is pretty amazing to see, too.

They look good.

In Cameroon, I did see some who looked good. And I saw a lot who didn’t. And I saw a lot of babies die. (Another day. Another day). World AIDS Day? It’s pretty incredible what’s happened here. I won’t say it’s not. It’s absolutely incredible what the transformation has been, from GRID to the 1993 HIV/AIDS definitions from the CDC, ACT-UP, AIDS memorials (movements that did, I think, do something), the literature of HIV of that era (Mark Doty. Thom Gunn. Etc…), Angels in American, And the Band Played on, Rent, even... We’ve come a long, long, long way. So it’s easy to forget sometimes. Even fellows doing infectious disease/HIV don’t often see the kinds of opportunistic infections I’ve seen (wow, lucky me). We should celebrate the progress. We should disseminate the progress by figuring out ways that make sense to do that for other countries. And we should show the rest of the world – the southern world, the developing world, whatever – how well people can do with ARVs (HAART), and how well life can go on. This is the reality. “Poor” and “AIDS” and “Africa” have lost all meaning in connection to each other.

Far away, on the forgotten continent, who remembers Africa as more than a pop cause?

~j

And I leave you with a photo of my health club in Cameroon, performing a skit they wrote for World AIDS Day. December 1, 2006. (friends of mine). Below. 

The Joy of Inflicting Pain

In a discussion of DSM IV axes of psychiatry, Dr. A, the department chair, asked us what we thought the most common psychiatric diagnoses amongst physicians were. We came pretty close to guessing. His top 3? Obsessive-compulsive disorder. Masochism. Narcissism.

The first is probably self-explanatory. The second…in brief… is related to the extremely delayed gratification process we willingly go into. I’m not sure any other career (tell me) is like this, in the time between deciding what you want to do, the years and pre-reqs until you can actually start school, school, training, and practicing on your own. And the hours, oh, the hours…

Between my starting pre-med classes and finishing residency, at least 14 years will have elapsed.

(it is possible to do a bit more quickly. But not by a lot, actually. Shortest duration would be approximately… 9).

The third. This may seem interesting in juxtaposition with masochism, but I think it goes along with a martyr complex. Do we talk about the hours we work? How hard it is? How much debt from school? The pay in residency, which works out to close to minimum wage, calculated per hour? (assuming 4 weeks vacation, 80 hours per week (and it’s really closer to 100), not taking out taxes, hourly is about $11: 4 years of college, 4 years of graduate education, and an MD).

(I just said it). Do we complain about pre-med classes, in particular organic chemistry, and the weeding-out process that does make things brutal, demoralizing, and…just…mean at times? (Professor for my second semester orgo lab course – “congratulations! You’ve made it this far, we don’t have to weed you out anymore. We’ll stop deflating grades.”). To get into medical school, we take an 8 hours- straight – test. It’s not that it’s hard. It’s about endurance. So much of this is about endurance, sacrifice (because of the god/martyr complex. Because you’re going to be, to do something “good” in the world).

Do martyrs complain?

Maybe.

But this goes along with narcissism. It’s a very elite club. We believe we’re “special.” And, as Dr. A said, we’ve grown up being told we’re special. You’ve got to be high achieving for awhile to get into med school, later. Not smarter. More competitive? Harder working? Maybe. Goal-oriented? Yes. And getting in – well. Families like to brag about that. There’s an awe, a halo, a cachet about the profession. We’re “special.” Orientation week, we were already in the alumni association (true). We had a white coat ceremony – a whole ceremony, with parents/etc, to have our advisors put the *&^%#$$ (my current feelings about them) white coats on us as we walked solemnly across a stage. And then we repeated, solemnly, the Oath of Lasagna (formerly…Hippocratic. This is the updated one. And yes, it’s really the oath of Lasagna).

You get a new name when you finish medical school. My preceptors, many of them, will walk into a room and say “My name is Dr….” (Somehow, I prefer “I’m Dr….”. Yes, you are that. But saying it’s your name? As if you were born with this, this indelible…? Maybe the verb “to be” seems more permanent than “name.” Maybe it’s just me). PhDs don’t get called doctor as often. My patients often call me doctor, even though I do tell them I’m not one. Nurses will call me doctor, and I tell them too. (Some get annoyed, sometimes, asking me a question, calling something to me, “Doctor!” when I’m sitting down, back to them, reading a chart. I don’t turn around. Talking to me? Must be someone else. “Doctor’ isn’t my name anymore than Ntangen was. It’s not their fault. They don’t always know my name. And calling out “medical student” might sound odd. But I’m not in the habit of responding, anymore than I would respond to someone else’s appellation).

Our entire lives, we have been told we’re special. We’re “special.” And then we enter a profession in which we are allowed to defy societal norms of behavior, every day. I walk into a room and tell someone to take off their clothes. Do they? Yes. Do they let me touch them? Yes. Granted, it is with a therapeutic purpose, and that’s why they came to see me in the first place. Particularly in exams where they can’t see my hands, I tell them “You’re going to feel my hands now.” Or “I’m going to start by examining your neck.” Or your eyes. I ask questions that, if I asked to any other strangers, I would get yelled at, hit, or thrown out of the establishment (potentially). At the very least, people would probably walk away. While examining…say, a person’s abdomen, if I see a scar (particularly if the patient told me she had never had surgery – this happens more often than you might imagine. People forget. A lot), I ask “what’s this?” “What happened?”

And they don’t get to ask me questions back – though sometimes – very benign ones. And they don’t get to touch me.

We think we’re special. I was thinking about medicine in relation to massage, the other day. Supposedly, doctors have “healing hands.” (some surgeons insure their hands. I’m pretty sure this is true). Overall, in the grand scheme of things, yes – things doctors might find with their hands could lead to serious findings, could lead to healing. But our “healing hands” often cause pain. During the exam, discomfort, at the very least. If I find something that hurts, I’m going to press on it at least twice. I need to check. And then, again – “does it hurt more when I press down, or when I let go?” After a visit to the orthopedic surgeon, my hands ache – a lot – for at least a day, if not more. Does this hurt. “Tell me, if at any time, this hurts.” And I write it down.

We have the power to inflict pain. “Things that are good for you.” Injections. Drawing blood. Procedures. I like procedures. I like having practical skills. So, do I enjoy lancing the abscess, doing the incision and drainage (I&D)? Yes, I do. Did I enjoy doing my first paracentesis the other day? (after ultrasound, I used lidocaine to numb the skin of the patient’s abdomen and then stuck in a large bore needle to draw off fluid from his ascites, 2/2 liver cirrhosis. At least 5 L of fluid. Getting the fluid out helps him breathe better, be able to walk without stopping to catch his breath every few feet, being able to sleep at night without waking up, gasping. He knows this. I know this. But when I put the needle in… victory! For me. Pain – for him.

One of the patients I I&D’ed asked me if it was the worst abscess I had ever seen. Well, it wasn’t, not remotely, and I told her I’d seen worse. Did she want to hear that, or did she want to hear that she was “special”, too? I hastily reassured her about her pain – I know it’s very painful. Can’t intimate that this is, should be easy for her. I learned suturing on foam, then pigs’ feet, then patients in surgery. Now, I do it on patients who are awake. We tell them, the lidocaine, the numbing medicine injections, hurts more than the procedure itself. Is it true? I don’t know.

Surgeons, actually, don’t inflict pain. It’s much easier to forget that the space you’re cutting into, that layer that takes a little pressure from the scalpel to slice neatly through and start spreading open layers, separating beautifully….

Is human.

It’s draped. The surgical field is draped in blue, there’s a hole, and that’s where you cut. The hole might actually be sticky plastic wrap, which helps keep the skin in place and keeps the area a little neater. Slice through the plastic. Into the skin. You can’t see the patient’s head – anesthesia gets that, on the other side of the curtain. It’s not sterile on that side. But to anesthesia it looks like a head with tubes sticking out of it, maybe, eyes taped shut. Things beeping. Lots of machines with things beeping. And vacuums and containers and things flowing out of tubes, and the smell of the cautery…

maybe not everyone wants all their senses engaged with this one.

I will always be grateful for the first surgery I observed. This was in Mvangan (Cameroon). I won’t say “scrubbed in on”, though in American parlance, I did. I walked in, wearing sandals. December 30^th, 2005, must have been. It was the same day I left village for the first time after moving there, going up to Ebolowa to celebrate New Year’s with other volunteers and some of our Cameroonian friends.

Doc knew I was interested in surgery, so he’d invited me in – I was hesitant, the first time. He was scrubbed, and he was the only one in scrubs – no, maybe Eco was too (first assist). The room was hot, humid, in the perennially 85-95⁰ rainforest with 90% humidity. Approximately. No screen on the window. No power – but this was daylight. We did have sterile drapes. No general anesthesia, without electrodes or intubation or any other way to monitor. It was ketamine and..something else…that I wish I remembered. Description for another day.

The patient, 30 or 40 something year old man, had been in a moto accident. His bowels, perforated. Had to be fixed. They had trouble putting him under – everyone was saying he must use drugs, he must, he must – they couldn’t do it. He wasn’t lucid, but he wasn’t completely out, either.

And so for the entire operation he was moaning. Moaning as he was cut into. Moaning as he was eviscerated, bowels piled on his abdomen as Doc searched for the defect. And then he started kicking. Knee into Doc’s stomach. I reached over and grabbed his leg, held it down, whicle the surgery was finished. No one in that room could ignore that this patient was alive, that what they were doing, this violation of bodily integrity and autonomy in the purpose of – to put it succinctly, playing god – was to someone with a beating heart. Whose lungs were function on their own – proof, the moaning. Proof, the kicking. ABCs? Check, check, check. He was alive.

And he lived.

When you’re operating – open, laparotomy – on someone who is moaning, you know you’re inflicting pain, you know the pain will be even greater when they wake up, and you have to concentrate even more (I imagine) on the task at hand. With a patient fully sedated, you can focus. Hands. Anatomy. Moving things carefully.

I do remember that day. First worried about what my own viscera would do when faced with…viscera, outside of another person’s body. But then, you do what you need to do. I wasn’t quietly in a corner, holding a towel over my hands if I hadn’t scrubbed. Trying not to fall over , standing for so many hours, as I kept shifting my weight. I was there, I was active, I was doing something basic to help. Keep the patient from kicking the doctor whose hands and knives are inside him. Can’t get sick when you’re concentrating. And not a single thing about me was sterile. My hands to his foot. That, too, is necessary.

~j

Mon amie

From the hospital, United States, today.

She reached her hand for mine, gentle clasp, and shook it. Simplest human contact.

I almost cried.

Over a month ago – 6 weeks – she couldn’t have done that. She could barely hold anything. Barely speak intelligibly. And we didn’t know if it was ever going to get better. Today, she was dressed in her own clothes, not a hospital gown anymore (strange what a hospital gown does to a person. More on that later). Six weeks ago she didn’t want to live.

Yesterday I was laughing with her and her friend about how she owes him money, has to get back to work and overtime, fast, to make it up.

And today she shook my hand.

And I almost cried.

Beaming, dazed, I – again, it’s not marked! – opened the stairwell that sets off an alarm. Ohwell. Wandered around to find the staff exit (you’d think I would know, by now, what was where). It didn’t matter. I have been so sad about this patient, so desolate, and over the past few weeks, I have spent so much time beaming. And laughing. Laughing with her.

Today I almost cried.

From Mvangan, Cameroun, today.

And today I almost cried.

I don’t cry enough, I think, maybe I’m numb to this sort of thing.

Email from good friend in Cameroun: Alice la commercante est morte suite d’un incendie dans sa boutique au marché. Megan était malade mais ça va un peu. Régine ne cesse de penser à toi.

« Alice, the one with the boutique, died from a fire to her boutique at the marché. »

“Megan (friend’s niece) was sick, but she’s a little better.”

“Régine (another friend) thinks of you all the time.”

And this is how the news goes.

I have been so, so incredibly lucky. I am so incredibly lucky – born here, basically things are going to be okay. (with my circumstances of birth/family/etc). But there…not even that matters. None of my close friends have died since I left (that I know of). Friends of friends. Young friends of friends. Babies. And no, no – that’s not true – I think I had heard that the boutique owners near my house, the ones where I went in the mornings sometimes for breakfast or just to pick up something quick from the ‘corner store’ – died. One or both. When I was back a year ago in Mvangan.

Alice, the one with the boutique, died.

“MON AMIE!” She exclaimed every time I walked by. My friend. Every time. I walked past her old boutique at least once a day. At least. Alice was anglophone, but mostly she spoke pidgin and not anglophone English, so we communicated best in French. Some Bulu (hers was much better than mine, of course). I bought things from her –  kerosene (I stayed faithful with that) and various others. I realized after a few tries that her bags of pasta were so old they had weevils in them, which I wouldn’t see in the dim light of the kerosene lamp or flashlight when I was cooking. They floated to the top, and after the first, disgusted viewing (very, very early in my service), I would skim them out, no bother. Kerosene, candles, other. She ended up buying the boutique that had better hardware (nails, basically, rope, locks). I would get those from her when she moved to the marché. I didn’t see her as much then. There wasn’t much I went to those boutiques to buy, except on days I did manage to get up early enough to go (ie before 6 am. Funny, now it sounds pretty relaxing… ). Occasionally tomatoes from the girls there during the week, and I’d look at kabbas or babouches (the only ‘window shopping’ available in Mvangan, on those wooden stalls).

I do miss living there.

Alice died. Alice had a goiter – no iodized salt, probably. Maybe hypothyroid, maybe not. Alice with the three little kids running around – third born when I was there, but I hadn’t even known she was pregnant – kabbas, larger woman. Alice taught me to make beignets. There. I must have bought those from her, in the mornings I would brave crossing the mud. I sat in her kitchen. After awhile, I would just stop, having nothing to buy, feeling slightly guilty that I did so much of my shopping at other boutiques, now. But I would sit with her. Mon amie.

Mon amie taught me to wrap pagne. I walked by one day, early on, with pagne around my waist tucked in the way any Westerner might imagine. Somewhat like a towel.

It’s wrong.

It doesn’t stay.

(I also realized soon after that…who the hell wears pagne into town? no. At home, sure. Au quartier, sure. Then again, I could get away with just about anything. But in general, you don’t wear that into town. I learned. Ca ne se fait pas).

So she taught me. She called me (yelled me) over – I may have been a bit annoyed, I was probably on a mission to get somewhere with as much of a goal as I could have managed  – "MON AMIE!" – Alice pulled me into her shop and started taking my clothes off.

The pagne, I mean.

(oh….Cameroun). I hadn’t been in Mvangan very long, maybe a month. So it was strange, a bit, and I had no idea what the *&$# she was doing… but, okay. (and no, it’s not so strange).

“Non, comme ca!” I don’t remember what she said. She redid it for me, showing me.

And that is how they do it – so miraculously, it doesn’t come off. I can walk, dance, carry water on my head without it slipping. Without safety pins, without anything else holding it up (the elegant, subtle, confident brilliance of African women).

So chastised, I walked the rest of the way into town (she was half-way). I know how to wear it now.

She probably fixed clothes for me a few other times. Mon amie.

Never Ntangen. Never la blanche. Or la whaat. Whiteman! No. But not my name, either – and she did know that. She had her own name for me (and no, it's not what she called everyone).

Always. Mon amie. Always.

Alice, mon amie, slept in her shop. Most people do that. I’m not sure if she had a new room behind the marché one – her old one was much bigger, lots of space to walk around. The marché one was more of a counter crowded with many, many items. I bought locks there. The mugs I coveted for months – then bought, matched set. Probably cost me about 1000 F CFA ($2). Maybe more. The comparisons to life here. Online shopping. Amazon storing my credit card number.

Mon amie slept in her shop. Her mother was there, not when I first met her but later. Her older mother – we didn’t have a language in common. I would alternately ask things in English, French, Bulu, my broken pidgin – probably asking where Alice was, or that’s what she was telling me. Her mother did more of the cooking. I learned with them.

I should have sat more.

I should have been more.

I wonder if I have any photos of her. Probably not – the dailies, the true fixtures of my life, I didn’t. Alice. Ma’a Monique. Pa’a – still forget my Fulani boutiquier’s name. I learned it eventually. We spoke a lot, though. Pa’a Jerome. Ma’a…Dorothee, I think.

Names are slipping. And yet – and yet – when I was there, last summer, things came to me that I didn’t think I remembered. Bulu. People’s names. So many people I remembered, that I can’t recall now. As if the memories are stored in a particular place. I got in a taxi in Limbé, and until I got in I had no idea where I was going. I knew exactly where, but couldn’t think of the name of the town. I started to describe it, and a few words in I remembered the name. It was there. It was I needed it. That is enough.

Mon amie died. Megan was sick and got better – she’s three now, maybe. Sick doesn’t always get better, there. I know she’s in good hands. Régine thinks of me.

Régine’s sister died, TB. Other....? AIDS? Probably. Maybe. Most likely. She was coming back from Gabon – seemed that was always the story, or so often. Gabon as a source. Not that Cameroun didn’t have its own sources. But travel, travel of any kind…

 I took photos of Régine’s dead sister in the morning – that’s tradition, before the burial. Morning after she died. I got up, went to take pictures, and bought avocadoes in the marché. Must have been a Wednesday, then. The photos are on Régine’s wall.

One of the strongest women I have ever known or will ever know.

Régine thinks of me often.

Mon amie died.

Megan was sick and now is a little better.

Mon amie died.

Régine is there – and in health – that’s what he means, he would say so otherwise. Régine has been sick and almost not gotten better, before. Malaria. Yellow fever. Etc.

No news of her soeur (another sister) in the Camerounian sense, or of her soeur’s daughter, who was named for me. Her môn-a-minga . Little girl. My mbombo. Namesake. 

And the friend who emailed me has email now, has a job, and has a facebook page. He has skype too. All of this at the government office where he works, and internet cafés.

He has all of this (and may be reading. Mbamba mos, N! Akiba.)

Some people are doing well.

Alice, the one with the boutique, died.

And some people are doing well.

As in the hospital. Some people are dying, have died. And some are doing well. Some will go home, some even better than when they came in.

There are things doctors try to do, maybe, that work, maybe.

In Cameroun – things happen as they happen. People are fatalistic – don’t often think or plan past tomorrow, which or what will happen dieu voulant (god willing). A Zambe.

A Zambe wôm.

Because you don’t know. Shops burn down – might have been burned.

Children die. Crops die. Not enough food or water.

Some people – so few people – get lucky, get jobs or opportunities to go to school, the 10% (maybe) of the examinees who get by on merit (the rest on corruption).

Probably less than 10%, most of the time.

(Things that stop being shocking, surprising after awhile. They shouldn’t).

Alice, the boutique owner. Mon amie, always smiling and with the voice carrying out to me, she heard/saw me somehow from the inside of the shop and would come out to greet me. I don’t yell or project as well – but I would do the same thing to her. MON AMIE!

Mon amie.

And some people are doing well.

~j

Sustainable development - and YOU!

Dear all,

Two years ago, I emailed asking for help about a soy and nutrition project in Mvangan. Thanks to your help, the funding came through, and I trained nurses, teachers, women's agricultural groups about soy, how to plant soy, how to cook with soy, how to sell and market soy, how to prevent, recognize, and treat malnutrition. I published a manual in French on malnutrition, nutrients, and prevention and care. We had a soy fair one week before I left village, publicizing it to the community, and selling over 25 different traditional dishes the women's agricultural groups had created with soy. When I left, I had heard nurses talking to mothers about nutrition and doing nutritional consultations (something I had started at the hospital), I saw people planting, promulgating, and cooking with soy, and people from farther away villages coming up to me to ask about the projects.
(see http://jenny-and-cameroon.blogspot.com/search?updated-min=2007-01-01T00:00:00-08:00&updated-max=2008-01-01T00:00:00-08:00&max-results=4 and http://jenny-and-cameroon.blogspot.com/2009_06_01_archive.html for summary and photographs of what I did).

In the past two years, this small "soy project", thanks to the hard work, creativity, and determination of new volunteers in Mvangan and Ebolowa and their wonderful Cameroonian counterparts, has grown beyond anything I could have imagined.

The South of Cameroon is probably one of the most challenging places to work, and to work in real, person-to-person, capacity building development. And that's where all of this has taken place. Sustainable development isn't just a buzz word for multinational NGOs - it's real, it's been happening, and through the training of trainers and capacity building that the new volunteers have done, it's going to continue.

And now they need your help, again. Please donate, if you can - any amount is helpful. If you can't, please pass on to others who may be interested.


For the SOY PROJECT:
https://www.peacecorps.gov/index.cfm?shell=resources.donors.contribute.projDetail&projdesc=694-137


Another project (see links above) I worked on at post was getting library books donated from a French NGO, Les Enfants de Madame Ici. The books came to village and people have - and are waiting to - eagerly enjoy them, but there's still no structure to house them. Another ongoing project is the "Reading Rainforest" (see below), to create a library and multimedia center, in collaboration with the mayor and other officials in town. In a place where almost no one has books (including school books), and there are few 'distractions' in town, this would be an amazing addition and a very enriching resource to last for many years to come.
LIBRARY PROJECT:
https://www.peacecorps.gov/index.cfm?shell=resources.donors.contribute.projDetail&projdesc=694-144


Peace Corps Partnership is the major way Peace Corps Volunteers can get projects financed, especially in Cameroon where we have no USAID or almost any NGO support. Donations - in any amount - come from anyone, to make up to the project's total. The community contribution is at least 25% of the total, in material and work hours donated. Our grants undergo a rigorous review both in Cameroon and in DC at the national level.

I'm currently back in Cameroon, doing HIV/cancer research for the summer, and it's wonderful to be back. I'm on my way to Mvangan tomorrow for the first time in over a year and a half, but I've been very lucky to see many friends from Mvangan already, who have come to Yaounde to see me. 7 weeks - shorter than even our Peace Corps training time, before being posted for 2 years to village, is fleeting quickly, and I will be in France and back in San Francisco to start my second year of med school before I know it...

In the meantime, have a wonderful summer - and thank you for what you've helped us to continue accomplishing already.


Jenny

Dictator Pants.

le 5/7/09
Sunday afternoon, meeting Roger, Ton-Ton’s best friend from village (Makak). He names a place to meet and I thrill that I know exactly where it is, and I walk there. I’m getting to know my neighborhood. It’s like a very crowded village…
I scan the tables for him, re-scan, don’t see him, then laugh at how easily I forget how not inconspicuous I am. I can sit down, wherever. He’ll find me.
Church times were my favorite times in Mvangan. I went a few times early on, socially – good integration thing. Different churches (there are at least 5 there). Later..I realized that 10 am to noon Sunday morning was the one time all week I was guaranteed to have to myself – and I cherished it. We blancs have set up our society so individualistically. Even in a room with others, we’re often alone (online, reading, cubicles, etc). We insulate walls, soundproof things, don’t want to disturb the neighbors.
I thought today I would get time to myself – 4 glorious hours before meeting R. Pascale was going to go to church was a 10 oclock service…she ended up leaving after one. Taking awhile to get ready, especially with a baby, isn’t remarkable. And I didn’t feel I had the right to be annoyed – didn’t, really – it’s herhouse. It really is the perfect situation for me now. It’s just funny – and Cameroonian – how Eric described it to me, and I – Americanly – misconstrued it. He said his sister would take a neighbor’s room. I’d pay that rent, she’d move out, and I’d stay in her place. Not saying his sister shared room room with her younger sister, Flora, and her (Pascale’s) baby, Megan. They’re the ones sleeping in the other room (Megan and Flora), but cooking and most things take place in Pascale’s room. (Just learned that the permanent occupant of the second room – which is called “Hollywood” – is also staying there, in-between her various trips. She was apparently one of my running partners on Sunday). Anyway. Full house. Last night, Sol came over for dinner. I’d met him, once before, in Mvangan, and he hugely annoyed me. He just finished a PhD in radiology and nuclear medicine here. He came to Mvangan, seemed kinda slimy, had a printed and bound 20 page HIV project he was going to drop in and implemenent – to the cool tune of 1 million ($2000) for a 2 day seminar. It was written in the normal Cameroonian flowerly, pompous government language that doesn’t mean much, with a ridiculous budget that he was expecting to get financed by some NGO somewhere. All under the name of some youth association in Mvangan he was the president of – a paper association, with probably a very nice stamp. Doc was all excited about the project that I was going to do with Sol. I was jaded – I’ll talk the talk while he’s there, whatever, knowing it was never going to happen – and not caring because I did the same sort of trainings, with no budget, at least once a month, with continuing activities in-between.
So, Sol came over for dinner last night. I helped prepare (which VP found funny. Ohwell. The other morning, when I was getting ready for work and she was still in bed – I swear she’s the only Cameroonian who sleeps later than I do – and said “don’t get up.” Her reply “What, you make breakfast? You’ll burn yourself. No, no, I’m getting up.” All protests feeble. (My qualifications in fancy French and improvisatory cooking really don’t count here, apparently). Even reminding her that I did everything for myself in Mvangan, she was still a little incredulous. (another subject for later). Gombo and couscous de mais (fufu corn). They’re friends, she and Sol. Ok, I’ll start again with him.
News is on. We talked politics (Cameroonians – including those with much lower education levels than these, can discuss politics from Cameroon to Africa to Europe to the US. The big political happenings lately have been: 1) Omar Bongo’s death in Gabon 2) A French NGO declaring in a newspaper that Paul Biya (president here for the past 26 years, and prime minister for 21 years before that) has “ill-gotten funds.” 3) Biya suddenly and without warning shuffling around a bunch of ministers, including the prime minister.
1) Bongo was younger than Biya but had been president longer (since Gabon’s independence – longest-running president in Africa, I believe). Those two hierarchies created a rivalry between them. I used to live about 60 km from Gabon – it’s the same tribe in the north of Gabon as in the South of Cameroon (Bulu-Fang). There are more jobs in Gabon than in Cameroon, supposedly (also much smaller population), and the Gabonese are “lazy” – they don’t “produce anything.” (supposedly. I don’t know). Rumor is Gabonese used to come to the Mvangan market, one reason it was from 5 -6:30 am (aka market with flashlights…). Anyway. People liked to cross over to Gabon to sell bush meat and other things because they could get much higher prices there. That’s CEMAC (Central African Economic Union) at its unofficial best.
So, Omar Bongo died. Apparently, a few months before his death, an NGO (see 2) “broke” a similar “shocking” story about him. With the stress of not wanting to be deposed and go to jail before dying in office…his heart gave out somewhere in Spain. And the country’s been peaceful, which is good and tenuous for a country that’s never held elections. (free ones anyway. Although “free” elections in Cameroon are another story. Yes Biya is the democratically elected president. By over 90% of the vote, somehow).
** I’M NOT A PCV ANYMORE SO I CAN SAY ANYTHING POLITICAL THAT I WANT!! Just saying. I could also take a moto without a helmet, legally, and cross national borders, legally… At any rate **
Rumors go between Bongo’s son and daughter, both ministers (sim. to Secretaries in the Cabinet in the USA) in the government taking power. Other people think it’ll be another family, another party. We shall see. So far it has perturbed Cameroon’s World Cup qualifier against Gabon, moved it back a few months.
2) So after what happened to Bongo, Biya is afraid of the same thing happening to him. Supposedly. It’s amazing, seeing him on TV, how exactly he looks like his state photo that hangs everywhere…it’s over 20 years old. That’s a lot of makeup and hair dye. But what’s hilarious to me – and what I expressed to my Cameroonian friends, who agree, is the absurdity of officially refuting what EVERYONE knows is true. Everyone knows he’s really a dictator, and that everyone in government steals money. A lot of money. This is a rich country where the people are poor. Though, the illegality of the taking money is questionable. Biya likes changing laws in his fashion. If he wants to run for another term, he changes the constitution. So the maximum number of terms, legally, is always one more than his current one. So maybe the amount of money he gets is also in the constitution. A few months ago, a man was arrested for complaining in a taxi about Biya blocking all the roads in Yaoundé whenever he moves through the capital. He had the misfortune of being next to a policeman (military police, gendarme) en civile. He’s been in prison since then.
So, to “prove” how unfounded the rumors were and how aghast and offended the “whole” country was by this NGO’s declaration, the secretary of the RDPC (BIya’s party, also CPDM) went on TV, and there was a youth rally/march in Yaoundé. The last is the most honteux. Shameful? Despicable? Disrespectful of the people. Basically the police/army paid a bunch of youths and gave them free t-shirts to march across the city “in support of Biya” and say so on TV. Whatever. Open secrets of corruption around here…gods, I just laugh at the news. Does the government think the people are stupid or blind? They’re sure as hell not.
3) Changing of government made huge news. It’s mostly shuffling old ministers around to different posts, that have nothing to do, of course, with their fields of study or qualifications. Biya is wily, though. He removes an anglophone prime minister and replaces him with an anglophone prime minister from a similar area. Removes an Ewondo from one post and replaces him with another Ewondo. Etc. Meanwhile, people get double posts – double salaries – wherein there is no way, according to me, that one can actually act as director of a hospital and minister of women and family. Or minister of defense and head of police (totally different branches here). Etc. There are so many reasons things in this country don’t function better….
I also found out from Sol that the constitution says the president is replaced, in case of death or incapacitation or whatever, by the Secretary of the Senate (like Senate pro-tem?) There isn’t a Senate here. Cases on the constitution, etc, are also supposed to be decided by the Supreme Court.
There isn’t one.

Going to Ebolowa this weekend, one of the first steps in going home...
to come, post-partum death, being called Dr. here, and research in Cameroon.