reach out

finally fell asleep last night to the sound of the rain and drums beating and in the distance, music.  yesterday was wonderful. worlds better. i think zoe's adjusting. we went to an amazing ugandan church service yesterday morning, the music was half in english half in lugandan, everyone was smiling and swaying and clapping and there was so much joy in the air. the kids (of whom there were about 50) did a performance and afterwards zoe asked if she could go to sunday school and then trompsed off with all the little african children up the hill to the children's chapel.  she did great.

we tried not to be nervous.  we tried to trust.  i must admit i kept looking back at the hill- hoping, praying and trying not to anticipate her little blond head running down the hill with her head in stickyland.  but she stayed- she played, she did it.

we had lunch at a friends house- zoe went to play with 'her new friend michelle' and mike and i walked  to town.  mukono is a dusty little side road town on a very busy road.  i think it's the only road between kamapala and kenya.  there are lots of trucks and no emissions testing on any vehicle. and there are no sidewalks, no crosswalks, no lights, no order.  the people there are working hard- the children are wearing old t-shirts from the usa. it's not pretty or quaint.  it's poor. but it is life- for most of the world. 

today i went to Reach Out Mbuya to work in the HIV/AIDS clinic.  i had been there 6 years ago working and then again 2 years ago for a visit.  this is the place where i feel most alive. it is the place where i am most thankful for my profession- thankful that i'm doctor and have a skill that i love and that is useful- across the world.

on the way there- we passed through many streets and backroads that make mukono look like disneyland. so much poverty. tin roofs on mud shacks with dirty water and trash and kids playing barefoot in that water.  goats running down the street.  roosters crowing.  meat hanging from palm brances with flies, and people selling anything they seem to have from the front of their houses. 

Reach Out clinic starts each morning at 8 am with yoga- i'm not kidding.  it's a holistic model- the clients and the staff- do yoga for about 20 minutes then clinic starts.  we saw many many patients all with HIV, in different stages of illness- some for follow up and some for acute issues.  we sat on plastic lawn furniture on cement floors with fabric half-dividers between us and filled out paper charts.  we talked and examined and ordered and read x-rays- a man with fecal impaction- a young woman with disseminated kaposi's sarcoma-acute pneumonia- a few cases of malaria.  a woman carried in, too weak to walk, with profuse diarrhea and vomiting, dehydrated and wasting away- with obvious AIDS, but no actual diagnosis. an 11 year old girl, in her school uniform, in clinic alone, who is failing anti-retroviral therapy- her cd4 count is dropping on medicine.  where is her mother? is she still alive? i gave her a lollipop- because it was the best i could do.

i learned a few lugandan words; pain, cough, sputum and thank you. (that should serve me well touring around the city.)  it felt real- it was as i'd remembered it to feel- like for some reason i had found my skin. but then that kind of made me sad.  how does this reality mesh with my current reality? how can i do international medicine and homeschool a girl with special needs?  what is my "calling"?

so i left today satisfied, confused, eagar for more, saddened by this illness.  i left wondering about lots of things on the big and small scale.  about injustice and fate, and choices and the non-choices in life- the things we're handed.  about coping and still smiling. about how it's just shades of blue.  

now it's dark again, there are tree frogs and drums in the distance.