everyone has a collection of their favorite
travelling malapropisms. beauty saloons are mine. they
abound here in addis, and in other places in africa. when i see
the sign, i can’t help but think of a dusty beauty saloon in
arizona. the swinging doors burst open. people look up from
washing hair and peek from underneath hair dryers.
“must be the wind.” someone says.
just
then you here the tack….tack…..tack of high heels on a parquet
floor. a middle aged woman with a beehive hairdo and wearing a
pancho turns the corner, a curling iron hanging
dangling loosely from her right hand, the business
hand. everyone is silent, watching. the only sound is
the drone of an upright hair dryer. she fixes it with a steely
glare and it whines off.
“i don’t suppose anyone here knows anything about a straightenin’ hair….”
“umm….ma’am…ah do…..” says a stylist crouching behind the washing sink.
people
breathe a sigh of relief, the dryer goes back on, and
the beehive woman collapses into an old barber chair, dusty
and relieved.
arrived to ethiopia yesterday. have
successfully avoided any beauty saloon trouble. the weather is
mercifully cool. i needed some time to regroup from abyei, and
will find some. i am grateful.
i am not sure who
noticed, but the picture of a girl i spoke of, one who was abandoned at
the hospital dehydrated and motherless, was taken down. my
colleagues at MSF communications called my attention to it, and rightly
so. after posting it, i felt uneasy, and looked to take it down
myself, but was unable to access the web. luckily they were one
step ahead, and removed it until they could discuss it on monday.
it
is probably better down. on matters like this, it is better
to err so far on the side of caution, that the chance of harm is
zero. when i speak of patients, i am careful to make them
unidentifiable. when i send pictures, i spend considerable
amount of time discussing possible consequences with each
family. i try to make them understand that others will
see their pictures, and one day might recognize them. of course that
will likely never happen. few of you will go to sudan, fewer still to
abyei, fewer still cross
paths with anyone here. it remains my duty to
explain it as best i
can. when i travelled africa last time, with a photographer, we
were exhaustive with our consent forms because our subjects were people
with HIV, and the stigma towards the illness is
strong. no matter how well we did, it
is likely that they never fully appreciated their right to
refuse. a similar criticism is often levelled at clinical
studies in developing countries. we speak in our language, from
an insoluble position of power.
i have been meditating on the the picture before it was
brought to my attention. both because it made me
uneasy, but so too to better understand my reasons for posting
it. it was obvious that this one patient had been occupying my
thoughts. she typified a problem that i did not have the tools to
address. i can’t properly explain why it was her when there
are five children a week whose positions are as
tenuous. the best i can come up with is that when there are
so many battles, one can choose only a few to fight
completely.
her at first, she was so dehydrated, and so, so thirsty. she
simply needed to be offered water. in canada (sorry…i
know i promised), if i had such evidence she was being neglected, i
would make a phone call, and she would be taken somewhere safe within
the hour. but there are no similar options here. no
orphanages, and people are so poor they can’t afford another hungry
mouth. as someone for whom the family/kids
scenario is not even a faint “ping” on my radar, i thought long and
hard about trying to care for her. i don’t think i can.
because there was noone to ask. a small sin, but one better
corrected. by putting a face to the story, it made her more
real. afterward, someone kindly offered, through my blog, to try
and adopt her.
what a generous thing. i don’t imagine it is
possible. i think it more wise to work towards a more
sustainable solution. to use it as an opportunity to inform
myself better of how similar situations are handled in the community,
and if there aren’t any methods, to formalize some with the community
leaders.
young girl to get lost in a larger shuffle towards something as vague
as “sustainable solutions”. you want her to
be cared for as well as possible. do you win this small
battle (i.e. pay someone to care for her) and wait to
wage the longer war, or accept that in the early part of the
campaign there may be a human cost?
remember first facing it in rural cambodia when
i examined a man who most certainly had appendicitis. i
had a landcruiser, and could take him to the hospital, even pay for his
operation. but i was leaving in a month, and there was noone
behind me. what then? would people stand by the side of the
road, hoping to wave me down like they did this time, and be farther
from a correct answer to the problem? i thought they would.
better to inform them of the seriousness of the illness, the need for
surgery, and point them in the right direction.
i compromised a bit. i gave him enough money for transportation,
and a good, long dose of antibiotics in case he decided to keep the
money. he did, and survived the appendicits without
surgery. i saw him two weeks later in the fields.
the longer run, it is better to solve the larger problem to spare more
lives in the future, what does the future matter to a man who needs
urgent surgery for appendicits, or a small girl as her mouth
grows dry?
“…austere as the Sudanese landscape, this book has poetry in it along with pain…” – The Washington Post
hiii there..im a soon to be med student in england ive alwasy been passionate about volunteer work and living here in sweden ive worked a lot with the swedish MSF division…ive read loads of msf blogs but i jus got in touch with ur and im really loving it.. it is (as a note!) better than zach braffs blog lol… he is a very funny person but urs is just more intruiging and appealing to me…well thank u for writing and continute to do so..and take care…, also my msn is nahedeh.eqdam@hotmail.com and i was wonderin if it is possible for you to send me some pictures of the camp ur working at currently. Thanks a lot and take care (of your patients).. God natt as they say here in sweden (good night)
Just returned from vaction and caught up on ‘the blog’. good stuff, my ass is in the chair waiting for words to come but it seems others have removed them from my brain and placed them in their comments, no wait the beer dissolved them, oh well. Anyways ‘ditto’ to what you’ve read and here’s something you didn’t….Ryan Smyth was traded to the Islanders BOOOOOOO! Seagull jim sends his regards, us too.
Laren
James,
You continue to amaze….your words are truly inspiring
Stay safe.
Take care of you,
George
there are plenty of beauty saloons in kenya as well. i often feel compelled to ‘correct’ the pronunciation and then think better of it. who am i to say that it is a salon and not a saloon? on a dusty afternoon, it probably makes more sense!
Working for the same cause through a different path, as a psychologist I spend most of my time encouraging abusers to recognize the impact of their actions onto the lives of others and to limit their sense of entitlement to what is listed in the Universal Declaration of Human Rights. I spend the rest of my time empowering people who are on the receiving end of the abuse – life can be lived w/o experiencing violence. At the end of the day though, it seems like most of them have lived similar experiences and very few have a healthy dose of self-esteem.
In need of a new culture…about one that takes responsibiltiy for the consequences of its actions?
I cannot wait for the day when I will be let go from my work due to a shortage of people experiencing trauma…that would truly be the highlight of my life…
A perm? Is this a creative way of dealing with your hair getting longer? :)) …then please post a picture of the results!
Take good care James!
I read your last blog, and smiled. It was a smile of recognition. I often feel the way you do towards the cute orphan with malnutrition and the Cambodian man with appendicitis. But I feel that way here, in Toronto, Canada. I felt that way only two days ago. Plugging through my shift at emerg, a 24 year old woman, who is 12 in crack/cocaine years, comes in after trying to overdose on 3 grams of cocaine with the intent of killing herself. She is tired of her habit and her life-style. Instead she wakes up in our department after having a seizure. She declares that she wants to shake off the habit, and that she will try to overdose again if she leaves the emergency department. There is a sense of urgency…her sex-in-exchange-for-cocaine-supplier is on the way to the emergency department. If she starts craving she will likely leave with him…5 minutes of sex for a 5 minute high. I put her on a form 1, and referred her to psychiatry. Psych discharged her. She had been seen too many times in the past, with the same intent to "shake off the habit"…the words are empty now. So she is out there, banging an asshole that feeds her addiction. She will never be able to afford $20,000 dollars to check herself into a proper detox center. And her dysfunctional family life was never a safety net for her in the first place. One day she will die of cocaine toxicity, she will be beaten to death, or if she lives long enough, of AIDS or other medical conditions that afflict drug-users.
As I drove away from the ED, I could not stop thinking about her. I thought about her youth, her potential, her predicament. During my next shift I’ll probably see another two or three like her. If our society lacks the infrastructure and resources to deal with the marginalized, what can I offer her? Do I pay for her to go to detox? And what next? Do I then wait for a "sustainable solution"?
The children with malnutrition in a war-stricken, starving country; the sick who can’t afford healthcare; the addict/street-youth/prostitute in a developed country where he/she is marginalized…all are human costs in the war for a long-term solution. Here at home, and there. And maybe, one or two will be lucky enough to cross our path and touch one of our hearts.