Saturday, May 21, 2011

Q: What’s worse than trying to understand French over the phone?

A: Trying to understand French on the phone when you are standing in a downpour with people talking all around you and the driver talking to you on the other end is shouting into the phone while driving with the window open.
This last week I went to Brazzaville for a conference on HIV/AIDS. It was my first time to take a commercial flight in Congo, as well as my first time in Brazzaville alone, and the first time at a week long conference in French. Needless to say, I was a little nervous, but it wore off as the week continued. Now that I’ve returned, I have a few reflections to share.
The flight to Brazzaville from Impfondo wasn’t too much to notice. Well, not for Africa. I gave my suitcase to Pastor Yvon to take to the airport around 8 am. There, he paid the taxes, weighed and checked my bag. Since I live very close to the airport, and one can here the planes come in, I waited at home until the plane got there. It was supposed to leave around 11am, I believe, but it ended up leaving around 3 pm, as it didn’t leave Brazzaville until close to 2 pm. During the waiting time, I was able to put together my bike, finish laundry, wash dishes, and many other things.  On the flight, one flight attendant actually had to demonstrate how to use the seatbelt to one person. I guess it was the first time he had ridden on a plane. Given that most people walk, ride a bike, or hire a motorcyclist to drive them around, and most vehicles do not have seatbelts, let alone functioning ones, I could see how he may not have known how to use one. 
The conference itself was very informative, comprehensive, and had a nice public health aspect to it. We discussed not only how to make the diagnosis, how to stage the severity of the illness, but also how to treat HIV along with other opportunistic infections, including pregnancy. One part I really appreciated that they discussed (though it could have been much briefer) how to do the counseling and screening-what to discuss, how to say it, how to react to the patients reactions, and how to tell them the results, whether positive or negative. Dom Vachon, our psychologist in residency, would have been proud. I found the questions many of the physicians asked interesting. It displayed the difference in their method of education and mine in the US. I’m not saying either is better than the other, just different. For example, after a lecture stating two different ways of staging HIV, one with clinical criterial AND a lab test and one using only clinical criteria, several people asked how they could manage their patient if they did not have this lab test.  The instructor replied that they could use the clinical staging format for treating their patient. At first it seemed to me that they couldn’t see how to work around a problem, to think outside the box. But as I think about it more, I think it was more than just that. I think they also knew that the lab test does aid in staging the patient more accurately, which may change your treatment regimen. I think they also would like to be able to do the test and are frustrated that the tests they need to do their job well are not available. I noticed at certain times things that were "understood"-implied, but not stated-were not 'understood' by some of the African physicians, while it seemed clear to me. I can't really explain it further. It was just different, ok?
Me with my T-shirt and Certificate

At the end of the conference we were all presented with a certificate, a cd with all the powerpoint notes, and a t-shirt from last years World Aids Day. We each went up as our name was called to shake hands with the Director of the Department of Health, and even get our photo taken. I was sad there was no one there to support me and cheer me on as I made this important milestone in my life. (note sarcasm)
The street is actually about 8-10 inches lower than the
sidewalk. And yes, there is a sidewalk there.
On Friday we finished a little early so I decided to try to make a quick trip to the fabric area of the market to look at some Pagnes (the material they use for skirts and other outfits here). It was just two short streets over. It had already started to get cloudy before I left the conference, but I thought I’d take a chance. I looked in several stores and ended up buying several pagnes while there. By that time it had gotten really dark and the wind had started to blow. As I walked back to the building where the conference was held, the plastic sacks and other debris in the dirt street was blowing up and into my face, and any dry dirt was also kicked up into the air. I tried to shield my eyes, but I still got dirt in them, which made seeing difficult. I got to the building, and called HonorĂ©, the driver, to let him know I was ready to be picked up. He wasn’t close, so initially I told him I’d find a taxi. As I walked to the main road it started to rain. By the time I was at the curb to hail a taxi, it was a light downpour. All the taxis were full that were coming by. It started to rain harder. I decided to wait it out in the building behind me along with others who had gathered there. Not long after, HonorĂ© called again. I could hardly understand what he was saying. Something about “bureau” and “ou etes vous?” and “taxi” and “SIL-Congo”, which is where I wanted to go. This was the conversation that gave the subject heading to this post. After we hung up, I didn’t know if he was coming to get me, or I needed to get a taxi. As it had now progressed to a torrential downpour, I decided it was best to wait.  He did indeed come for me, but as I stepped into the street (and into 1 foot deep river that had developed along the side of the road), I lost my sandal in the water. I managed to catch it with my foot before it flowed downstream, but it took a bit of fishing to grasp it well enough to retrieve it. I arrived at SIL-Congo soaking wet. Fortunately, I had purchased pagnes, so I took out one and wrapped it around me to make a dress of sorts, after hanging up my wet clothes. 
I realize this post is getting long but I should at least write about the return flight before I close. Returning to Impfondo is a little different than leaving Impfondo. Still similar with giving the checked baggage to someone to check in for me and pay the taxes, but the similarity ends there. We arrived at the airport around 9:00 am. We sat in the truck for about an hour, I believe. There were no planes taking off or landing-word had it that the president was on the move, so we weren’t. Finally, things started moving again. Adolphe helped me through the throngs of people to get into the waiting room. I had to remember again that African’s don’t mind crowding together, standing right against your back or backpack or pushing and shoving. It was a bit of adjustment to my American mind, even though I had experienced it before. After passing through “security”, in which I opened my handbag and the sack of apples I was carrying, but not my backpack, I took a seat in the waiting area. After a few minutes, three men came along to take up space next to me on the bench. In all honestly, there was really only room for two at most. This left me sitting very close to the man to my right, who then was sitting so close to the edge I feared he would fall off the end of the bench. I wouldn’t have minded  sitting so compactly so much except none of the 5 air conditioners in the waiting room were functioning at the time, and it was at least 85 F in there. After a short while I stood up just to be a little cooler. I glanced about the room-I was the only white person for a while. Some people smiled at me when I smiled, and some just stared or glared. I noticed “Le Paqillon”, the small restaurant serving cold drinks and light snacks. I believe it’s supposed to read “Le Papillon”, since there are butterflies on the sign, and papillon is french for butterfly. The ‘p’ is backwards. The occasional smell of stale urine passed by me, and I prayed it wasn't coming from the liquid on the floor at my feet. (Which I really think was from the non-functioning air conditioner I was standing next to.) Finally, after such a delay that would make Atlanta look timely, we boarded the plane. I believe it was around 1:30 pm. On arriving in Impfondo, I had to give my passport to the man at the door, then wait inside for luggage. As more of the passengers deboarded, the guard at the door to the waiting area began letting friends and family inside the baggage claim area. This filled up the room with even more people, and more noise. After such a long day, I was ready to be by myself, in silence. Becky arrived, we gathered my baggage, retrieved my passport, and headed home. 

Finally, I had the silence and solitude I needed. 

Sunday, May 8, 2011

Mother's Day

Normally I don't do posts themed for a particular holiday, but today I thought I'd mix it up a little. I haven't been home for five months now. It marks the longest I've been away from home so far in my life. So I feel like this Mother's Day is a little different than others I've missed. I won't have seen my mom in the week before or after Mother's Day, as is usually the case if I don't make it home the weekend of the holiday. In addition, I don't get to see my sisters, brother, and in-law siblings this day, nor my nieces or nephews. I am not a mother myself, but my nieces and nephews are the closest thing I have to children of my own, and I miss them terribly.

But back to my mom. She's encouraged me throughout my life, and without her support and that of my father, I don't think I'd be the same person today. We've both gone through ups and downs, but even when she wasn't feeling so encouraged herself, she was still encouraging to me. And I know she's proud of me. I remember moving to South Bend just after I graduated medical school and her telling everyone we met that I was a doctor. Even the cashier at Kmart. I was a little embarrassed, but knew she did it because she was so proud of me, so I took comfort in that. And through she knew my dream was to work overseas, leaving her and the rest of the family behind, she still encouraged me to follow my dream.

So thank you mom, for all your love and support. For protecting me and keeping me safe through childhood. For showering me with hugs and love. For providing for me, teaching me to cook, sew, and fix things. For sending me to school and making me do my homework. For disciplining me when I disobeyed. Being here in Africa has taught me how fortunate I am to have come from a loving, supportive family, who treats children as being important, and needing to be loved.

Happy Mother's Day, mom.
And Happy Mother's Day to all you other mothers and soon to be mothers out there.