this was the billboard i passed on the way to town today.
i'm not sure.
today i got mad at the many things that are broken around here and the lack of fixing. i was driving home from clinic, on some back, barely paved road with a slow*** tanker truck in front of me. it was spewing black diesel smoke from one side and pouring what i hope was water, from it's tank which had stenciled in small letters H2O. it was like the little engine that couldn't. the thing could barely get up the small hills. i really wanted to get away from it- for all the obvious reasons especially that who knows what was really in that tank. the thing wouldn't let me pass- every time i tried he moved over into the middle of the road. now i usually have road zen here- it's not worth getting mad- but today i was mad. swearing out loud mad. thankfully i was driving alone.
then i came to a place where i knew they were doing some road work but it was in a dead stand still. like, put your car in park, stand still. in typical fashion all the cars behind me began pouring onto the other side of the road and forming another lane going in the same direction. this infuriates me, because of course it creates a bottle neck and we're stuck longer. when we finally move a little i see that they'd begun to do more road work and had some how created a lot of mud and the road was now two levels that an ordinary car couldn't go between, but several had tried and were stuck laterally - as in across both lanes stuck. as had a matatu and that stinking H2O truck. of course there is no signage and no police helping to direct traffic. instead there are several road workers in hard hats pointing and commenting to each other about which car would make it out of the mud first.
i began to reflect on why i was so annoyed and i realized it was about much more than the leaking, broken down old truck and the bad road work. it's being constantly faced with the broken systems all around me.
today at clinic i saw a woman for the second time. the first time is saw her she came in for her regular visit and thought she had malaria which i tested her for but she didn't have. i happened to also take the time to look through her chart and saw that she'd been sent for a work up over the summer for dysfunctional uterine bleeding, lots of it, enough so that her hemoglobin was 4 (less than half normal). when i asked about what had happened, in typical fashion, she wasn't sure- she may have had surgery, she did have some lab tests done, and maybe a biopsy. no follow up had happened. i rechecked her blood, put her on iron supplements and told her to go get her records, her results, all of it from the hospital. i gave her my phone number and wrote a note to the doctor who was 'treating' her with the questions we needed answered.
today she showed up looking pale again, and with her results. a cervical biopsy had been taken, it showed severe dysplasia- it was from 4 months ago. no one had followed up- not the person who had ordered it- nor the pathologist reading it. i know this situation can and does happen in the states- but somehow it seems almost the norm here. as i'm discussing with her the need for treatment and that likely it will be more aggressive given her HIV status, i realize that i can't fall back on the promises i'm used to giving. i can't promise that she will have very little post operative pain- i can't promise that this is a routine surgery that will go perfectly smoothly with very little chance of a bad outcome. i don't think either are true! this is a country where women die in childbirth while in a hospital from lack of blood or sutures! a place where you pay first and if you don't have money you lose. a place where the drug you need may not be available- or where there might not be enough nurses to get your pain medicine. i sat there trying to explain why it was so necessary for her to go back to the gynecologist and get treatment but i just kept thinking about trust. how can she trust this system to not fail her? how can she trust a doctor to cut her belly open if the same doctor didn't even follow up on the tests ordered in the summer? how can she be sure she'll not have intense pain, or that she'll even survive the surgery? it made me sad and mad and feel quiet helpless.
after that i saw a man about 60 years old who had been on ARVs for over 2 years. i looked as his CD4 count it was 30. we put people on ARV's when there count drops below 350, he'd been put on ARVs when his was 25, but over two years ago. it was now only 30. i couldn't find any work up about why this was and what we were going to do about it.
while i was talking to him about adherence, the woman who had the baby with the seizures stopped over to give me an update. i'd given her money last week and she'd taken him to get a work up with a CT scan of his head and an EEG, but was told she was supposed have come on a monday not a thursday and sent away. he'd had another seizure that night (although not sick) and she'd had to bring him to a small local hospital where they treated him for guess what..... malaria as usual- and then IV antibiotics because they needed to 'treat his infection' (although they couldn't tell what or why or even if he was infected) before any scans or further work up could be done. so all the money for the work up was now spent on probably a lot of unnecessary medical 'care'.
so driving home i passed the sign again. "is it possible?" it stood there looming over me- asking an ambiguous but hard question. and after my day, i wrestled with my answer. is it possible? i don't know, but i have to believe yes. something is possible on some level. some things must be possible- over time things are possible. and then a matatu sped by and i remembered all the wise old sayings that i pass numerous times each day written on their rear windows. they are expressions of hope- reminders of our place in the universe, phrases of encouragement and i'm beginning to see why they are so prevalent. i'm not the only one in the country wondering 'is it possible?' so it's good to read - 'God is able', and maybe tomorrow i'll see my new favorite, 'with God, it's possible'.
today i got mad at the many things that are broken around here and the lack of fixing. i was driving home from clinic, on some back, barely paved road with a slow*** tanker truck in front of me. it was spewing black diesel smoke from one side and pouring what i hope was water, from it's tank which had stenciled in small letters H2O. it was like the little engine that couldn't. the thing could barely get up the small hills. i really wanted to get away from it- for all the obvious reasons especially that who knows what was really in that tank. the thing wouldn't let me pass- every time i tried he moved over into the middle of the road. now i usually have road zen here- it's not worth getting mad- but today i was mad. swearing out loud mad. thankfully i was driving alone.
then i came to a place where i knew they were doing some road work but it was in a dead stand still. like, put your car in park, stand still. in typical fashion all the cars behind me began pouring onto the other side of the road and forming another lane going in the same direction. this infuriates me, because of course it creates a bottle neck and we're stuck longer. when we finally move a little i see that they'd begun to do more road work and had some how created a lot of mud and the road was now two levels that an ordinary car couldn't go between, but several had tried and were stuck laterally - as in across both lanes stuck. as had a matatu and that stinking H2O truck. of course there is no signage and no police helping to direct traffic. instead there are several road workers in hard hats pointing and commenting to each other about which car would make it out of the mud first.
i began to reflect on why i was so annoyed and i realized it was about much more than the leaking, broken down old truck and the bad road work. it's being constantly faced with the broken systems all around me.
today at clinic i saw a woman for the second time. the first time is saw her she came in for her regular visit and thought she had malaria which i tested her for but she didn't have. i happened to also take the time to look through her chart and saw that she'd been sent for a work up over the summer for dysfunctional uterine bleeding, lots of it, enough so that her hemoglobin was 4 (less than half normal). when i asked about what had happened, in typical fashion, she wasn't sure- she may have had surgery, she did have some lab tests done, and maybe a biopsy. no follow up had happened. i rechecked her blood, put her on iron supplements and told her to go get her records, her results, all of it from the hospital. i gave her my phone number and wrote a note to the doctor who was 'treating' her with the questions we needed answered.
today she showed up looking pale again, and with her results. a cervical biopsy had been taken, it showed severe dysplasia- it was from 4 months ago. no one had followed up- not the person who had ordered it- nor the pathologist reading it. i know this situation can and does happen in the states- but somehow it seems almost the norm here. as i'm discussing with her the need for treatment and that likely it will be more aggressive given her HIV status, i realize that i can't fall back on the promises i'm used to giving. i can't promise that she will have very little post operative pain- i can't promise that this is a routine surgery that will go perfectly smoothly with very little chance of a bad outcome. i don't think either are true! this is a country where women die in childbirth while in a hospital from lack of blood or sutures! a place where you pay first and if you don't have money you lose. a place where the drug you need may not be available- or where there might not be enough nurses to get your pain medicine. i sat there trying to explain why it was so necessary for her to go back to the gynecologist and get treatment but i just kept thinking about trust. how can she trust this system to not fail her? how can she trust a doctor to cut her belly open if the same doctor didn't even follow up on the tests ordered in the summer? how can she be sure she'll not have intense pain, or that she'll even survive the surgery? it made me sad and mad and feel quiet helpless.
after that i saw a man about 60 years old who had been on ARVs for over 2 years. i looked as his CD4 count it was 30. we put people on ARV's when there count drops below 350, he'd been put on ARVs when his was 25, but over two years ago. it was now only 30. i couldn't find any work up about why this was and what we were going to do about it.
while i was talking to him about adherence, the woman who had the baby with the seizures stopped over to give me an update. i'd given her money last week and she'd taken him to get a work up with a CT scan of his head and an EEG, but was told she was supposed have come on a monday not a thursday and sent away. he'd had another seizure that night (although not sick) and she'd had to bring him to a small local hospital where they treated him for guess what..... malaria as usual- and then IV antibiotics because they needed to 'treat his infection' (although they couldn't tell what or why or even if he was infected) before any scans or further work up could be done. so all the money for the work up was now spent on probably a lot of unnecessary medical 'care'.
so driving home i passed the sign again. "is it possible?" it stood there looming over me- asking an ambiguous but hard question. and after my day, i wrestled with my answer. is it possible? i don't know, but i have to believe yes. something is possible on some level. some things must be possible- over time things are possible. and then a matatu sped by and i remembered all the wise old sayings that i pass numerous times each day written on their rear windows. they are expressions of hope- reminders of our place in the universe, phrases of encouragement and i'm beginning to see why they are so prevalent. i'm not the only one in the country wondering 'is it possible?' so it's good to read - 'God is able', and maybe tomorrow i'll see my new favorite, 'with God, it's possible'.
3 comments:
Wow. Just wow.
Well, at least you got training for driving in that kind of circumstance here in Atlanta. As for the rest of it, it is too sad for me to contemplate. All we have is hope. I can't imagine life without it.
Kris, this is a beautiful post. Thank you so much for sharing. I also hope it is possible...I feel like I see that sign in my mind very often.
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