Rocket waits at home with Alex.

Sunday, April 29, 2012

shikamoo

When walking by people in Tanzania you have to acknowledge and greet just about everyone. Its demeaning if not. And since I am a mzungo I have to be a polite diplomat for not only Americans but white people in general.

Most of the time its “Habari” ( whats the news, but really”hello’) or Habari gani . Habari za leo ( whats new today?) Jambo ( greeting), mambo( hows things). And if you’re trending toward Islam its”Salamu” or Asalama alekum. Then there is ‘vipi” (whats up)?and then there is all sorts of other local slang which I hope and assume, is friendly. This can go on for ever with many kinds of hand shaking which is an art form in itself.

The simple hand shake( like what we do) is formal and really just not enough here. If your friendly, know the person, had a few beers or jut in a good mood the hand shake is a 3 part process. Part 1: orthodox had shake, 2) change to the “brother” handshake then 3) back to the orthodox handshake. This often followed by some other contact, slapping, fist bonking, wrist clinking all the while exchanging greetings and news. Then it is OK to hold hands and be lead somewhere to show something near by. This part was really cringy for meat first, just too uncomfortable. But now its OK to hold hands with a man as you walk, I get it, nothing intimate just genuine friends. But not in the United States thank you.

When I met the Bishop here for the first time in a casual setting (not church) , I did the routine orthodox western handshake and he immediately continued on to the 3 part shake. I knew he was cool and I was “OK” . We are bro’s.

There is another greeting which I have totally missed and it has mystified me until today. Since this is my 3rd trip here I guess that qualifies me as a slow learner or maybe I am just in denial. Often when I walk out in the country a mile or so ( the only exercise I get) to another village or “neighbor hood” I pass people who have never seen me and so the greeting is different. Young children are fearless, uninhibited and curous and they usual run up to within 5 meters and point and say “mzungu”. After a few words or a petcha ( picture) they are all over you.

Older kids, teenagers, women stay away and either say nothing or say something that I have never been able to figure out. It sound like “shh” or “shiiiit” or maybe “sheek”. I just reply nzuri( good, fine) and keep going. They know they shouldn’t mess with strangers specially white men strangers and I am not going to mess with any women….in a strange village.

Guys, guys are different. They may be friendly ( as above), neutral or out right mean street, bad ass hostile. Some guys just look bad ass, and know it. But even lots of guys, mean or not, say ‘shhh”or something that sound like “Shiiit or” shiik” or “sheek”. So this has been going on for a long time I just chalk it up to another thing I have to learn..someday.

Yesterday I walked to a new village maybe 2 mi. north. No white people there at all. I am alone, a little uncomfortable “entering town” like in a western. New guy in town. New WHITE guy in town. The town is just a bunch of shacks, really stalls with tin roofs, it was hot and smart people ( every one but me) is in the shade. The men are always hanging, sitting not really doing anything. The women are out getting food, water, preparing. This is standard procedure. No cars, couple of abused Chinese motorcycles, dirt road. The backround color for all of this is poverty. You get it.

So one guy says “shhh”, I wave and say “nzuri” ( good) but really unsure what this means. I pass by a few mid age guys ( in there 30’s here) and I hear “shiiit”. Now I am nervous. Like, I am in Harlem, it’s 1969 and the brothers look at me a say”shiit man , whats whitey doing here?” I mean I could be disposed of here and no one would ever find a single piece of me….ever. Anyway I say “nzuri” “vipi” and walk tall with kind of a strut – bop…just so they know.

Then a cool ,older “dude” comes up to me, right there on Main Street and says “sheek” Then in fractured English says “that is a greeting. People are greeting you. you should respond”. He says “SHIKAmo”. It means respectful greetings to an elder” Respectful greetings TO AN ELDER?? ELDER? are they respectfully greeting me because I am an elder? OK, this is an issue with me. Me, an elder.? My mental self image is I am everybody else’s age. I know I have this inflated self image that in my mind that I am forty…AT THE MOST! How can it be so obvious to all these people that I am older then them? All of them? Do I really look that old? In my delusion of denial I just assume I am everyone else’s age. Then I don’t have to deal with the reality of my age.

Well, look that way or not, I am older then 90% or more of the people here. In Kagera the young look younger then their stated age and the old look older then their stated age. This is because of malnutrition in the former and hard living in the later group. Life expectancy here is about 55. I should be long gone.

The dude tells me the response to shiikamoo is “marahaba” ( thank you for your respectful greeting). So suddenly the fear, the anxiety, the chopping me up into little un- findable pieces is gone. These people, living in such incredible conditions of poverty are so respectful, so graceful. I am so embaressed by my ignorance. Later that night I learned that “shikamoo” literally means “ I touch your feet” Blown away by my western paronoia and prejudicial bias, I am the one who is humbled and should be touching their feet. Al of this proves once again that most fear is based on misunderstading. And using symmetrical logic, most misunderstanding is based on fear.

A good lesson for the world to learn. Shikamoo

Wednesday, April 25, 2012

Did the neck exploration ( Ludwigs angina, google that) today. Every thing is like the first time here. Kinda funny if your not tired. Anyway, I asked Andrew, the best anesthetist here to do the case. Explained the threat to his airway, ketamine. It was a bit of a flail, really gross, really stinky...maybe anaerobes. Got A LOT of pus!! Transverse incision at base of his neck, R. side, big cavity. Stuck my finger along his trachea up to the mandible and then down onto the supraclavicular fossa. Couln’t get behind the trachea where I thought the tract might go. Swept over to the L. side, not so much. No tonsil sucker, just a big thick black tube connected to weak sxn but it worked and sucked pus. I then made another incision at the supra sternal notch, watching out for the plexus of veins that is always there, With no bovie and no good sucker that would have been scary. Looked for a cavity behind the sternum: none. 2 drains and packed open. Waking up was crazy. We moved to the "minor theater" as a recovery room. He was bucking, coughing pus, had low sats for a while( yes have oximerter!) and hallucinating. Bottom line: right now he is better, but I am afraid there is more and I'm sure he is bacteremic. On Ceftriaxone( max dose 2gr q 12) and Flagyl. Want Clinda but there is none. I'm afraid the family will run out of $$ soon, Tomorrow: CXR to look for air fluid levels, collections. I know, why wait???....because "sababu tech anakwanda nyumbani" (tech went home).
Worried. Never see this in the US.
Best of all I went and got the dental tech( Barnabis is gone) who sent this pt home with H2O2. last week. He said " he looks better!! Ha!!
I told him the pt. was going to die from a preventable infection that never should have happened.. meaning :"you screwed up Bub". I don't think he got it.
More to come.....

always get a good dentist

in the old days

hello Larry, goodbye Tex


I  had a dream about my shower at home . I know that’s worrisome and maybe a little strange but I haven’t had a shower in a while and my shower at home is such a nice thing. Its new, shiny with glass walls and a shower head that is adjustable  with the option of holding it in your hand…like European showers. Barbara did all the ordering. I just inherited it.  As  they say you don’t what you got till its gone and I really miss my shower. Anyway, in my dream, I was in the shower and got out and stood on the green stone tile floor ( it might be marble, Barbara  ordered it)  it felt clean and safe  and there was nothing to worry about  and then I just got right back in the shower. It was warm and clean and safe and I think I stayed there a long time. It’s hard to tell time in a dream. But then I woke up and went to my “bathroom” here and I knew I wasn’t dreaming any more, but maybe in a nightmare.  In my bathroom there is no bath. there is a shower but it doesn't work. There is a toilet and even though it is "manual" ( you have to fill the tank by hand) its OK. I had the toilet seat delivered here from Mwanza in 2008. Since  the shower doesn't work I am very good with bucket baths, that is the standard here and that is just the way it is.
  The problem is I share my bathroom with others. They don’t care about the things I do, like cleanliness. Among the "others" that I can see one is a lizard/salamander/chameleon. He is really pretty cute. I know he is good because he eats other bugs and things  that I don't see. The less of us in here the better. I call him Larry but he doesn't respond to his name. Another one  is Tex. I call him Tex because he’s bigger then Texas. He is an NFL sized cockroach. He likes to hang out under my  toilet seat but I think he lives in the drain.Tex is not only big, he is fast. Really perfect NFL material. I am trying to be Buddhist about Tex but I don’t think it’s going to work out. Peaceful co- existence is not an option.  Not in my bathroom here and  not in the bathroom of my dreams. I think its going to be hello Larry, goodbye Tex.

Sunday, April 8, 2012

My Dedication

When I first came to tanzania in 2008 I was a different person and my world was a different place. I was married to a marvelous women. It was more then married, we actually felt star crossed. I mean we met hitchhiking in Vermont, I was 20, she was 18. And it really was a done deal at " hi where are you going?".
We were sure we were the luckiest people we knew but being human we didn't jump up and down and shout it to the world everyday. In addition to a life together,we made 2 trips to NW Tanzania, educated ourselves to what world poverty is, educated others, saved a life or two and planned to keep coming back because...well because we could. It really is that simple. Maybe it was a payback for our good fortune but really? what are you suppose to do here? We are here to make things better for ourselves and others . In that order, I assume.....
Anyway in Oct 2010 the bottom dropped out, the wheels fell off, the dream ended. Barbara died from untreatable triple negative breast cancer just 9 months after diagnosis and I found myself kicked out of the luckiest people in the world club. Traumatized, trunkated and eviscerated, for the first time in my life I felt old and very mortal.
I received lots of help and support but the best words that clicked with me where what my friend Jerry Doherty just sort of spontaneously blurted out in mid paragraph one day: " hey we are all just renters here man".
It has not slipped by me that it is 9 months since Barabara died and that it was 9 months between her diagnosis and her death. There is symmetry in life ....and death. Will I close the loop? Pick up my guts? Pack them back in, heal my wounds,stand up and walk, and be left with my scars? This is my story.
I dedicate this journey of healing to Barbara. The journey will not just be the next 3 months in NW Tanzania, it will be the rest of my life. How long is that? Who knows? Some times measurement of time is meaningless. Maybe I will take it in 9 month segments. After all we are just renters here.

Friday, April 6, 2012

Diving In....in slow motion or, karibu Tanzania

Sometimes when people come back from assignments over seas or deployments to different cultures they reenter slowly and with support and guidance. What is sometimes called re-immersion therapy. Maybe to prevent or treat post traumatic culture shock. I am initiating a new preemptive treatment called
PRE -IMMERSION culture shock therapy. Its really quite simple. Go to the country your are about to be immersed in and just sit there. Don't do anything, just be with the new culture and its people. Forget your schedule, your appointments, your expectations. Just be there,in the now, in the moment. If its really a different place( like Tanzania) you will stand out and people , being universally inquisitive by nature, will be drawn to you. I did my first session in Dar esa Salaam( like Jerusalam) airport the other day on my way to Mwanza. My flight was repeatedly delayed and I spent 11 hrs just sitting in the departure terminal.We were never told why; its all part of the therapy. It's not a comfortable place, its noisy, hot and stinky and and there is no first class lounge or club and that is all part of the unproven therapeutic effect. People stare a little, little kids stare a lot and come up to you and sat" mzugu" Later on, around 10pm when all the other flights had left and there were only passingers on my flight left and the lights kept going off and on, we all bonded no matter what our race and culture and entered sort of a survivor mode. By this time the only lights working in the terminal were those soft yellow sodium lamps they use in the parking lots in places like Newark Airport. It created sort of a surreal sepia environment. When I am in that light for a while something happens to me and I enter sort of a slow motion world, as if I was traveling in hyperspace and time itself actually slows down ( try to figure that one out). Again, this is all part of the therapy. I, for one, was convinced we were never going to get out of there that night. I wasn't alone and as the minutes and hrs ticked by and the sepia sunk in we started little conversations and became a survivor tribe....an airport survivor tribe.
We finally took off into the African night in a twin engine propeller plane for a 2 hrs flight thru thunder storms, fear and doubt to Mwanza. When we landed we felt like we had survived together, no matter what your backround, race, creed, color or culture. After a total of 13 hours of "therapy" the last thing on my mind as I picked up my bags in Mwanza was culture shock. I, along with my new tribe, were aware of only the strong desires to get off our butts, get horizontal and fall asleep. See, I knew this would work......its all part of the the therapy.
Karibu (welcome to) Tanzania.