Shower Psychology

          We all need to shower. Even if you choose to disbelieve that statement, all those around you will begin to heartily agree within a matter of days, so, for the sake of argument, let’s agree that showering is a given necessity. Despite its essential nature, there’s a funny kind of psychology that goes along with showering. Sometimes before stepping in, I spend a few minutes letting the water run and think, “I don’t really want to get in. I don’t want to get wet. I’m comfortable out here, and I’m not really interested in changing that.” Yet, inevitably, I succumb to my desires to maintain personal hygiene, have friends, etc. and step behind the plastic sliding shrine. A few moments might be spent doing a touch-and-go tango with the streams of water as my skin adjusts to whatever temperature difference there might be, but after a short time, I find myself turning round and round like a contented rotisserie chicken beneath the showerhead (when the water heater is working, mind you). Even after all the washing and cleaning are done, I usually find myself thinking, “I don’t really want to get out. I don’t want to dry off. I’m comfortable in here, and I’m not really interested in changing that.” Yet, inevitably, I succumb to my desire to function as a human being in society, eat food, etc. and leave my watery happy place.

            As much as you might be hoping this final blog post will consist entirely of my thoughts on showering, I’m actually attempting to convey how I feel about transitions. I recognize the necessary nature of transitions in life, yet I cannot help but feel a certain resistance or general “I don’t wanna,” when they come around. From stepping into a shower to changing which continent I’m living on, transitions tend to come with an intrinsic level of unpleasantness. That’s not to say all transitions are unpleasant, of course. Sticking with the shower analogy, I remember taking a shower after hiking Kilimanjaro (the first after a solid week of hiking) and actually laughing out loud because it felt so good. If I were to point out something unpleasant about that experience, it wouldn’t be the transition itself but rather the recognition that something great was coming to an end. Unfortunately enough, our current state of existence demands that time always move forward, so endings and beginnings appear to be unavoidable until further notice. I can recognize this truth, but it doesn’t mean I have to like it.

            My final month in Kenya brought with it many great things. Construction on the clinic has progressed very well, the logistical projects I had been working on have reached a point of sustainable practical benefit (hopefully), and the final steps are being taken to be officially recognized by the Kenyan government. 

The clinic has walls!

As gratifying as it is to feel like I have done something that will make a tangible difference in the development of the clinic, I can’t help but feel the weight of the work yet to be done. It would be nice to feel like everything has been wrapped up in a neat little package, but the reality is, work against poverty and sickness will never be finished. If I leave with nothing else, it will be an appreciation that such efforts are not aimed at “completion,” in the absolute sense of the word but continued, meaningful progress in the improvement of people’s lives. Of course, I will leave with much more than that, but this is an understanding that has significantly changed the way I understand humanitarianism.

            Ten days ago, my best friend since the 1^st grade came to visit me. Since then, we have traveled to several places all over Kenya, enjoying the main tourist sites and reliving many of the experiences I had when I first arrived in December. From hiking in the Rift Valley to taking a 3-day safari on the Maasai Mara, I felt a certain sense of poetry in having almost mirroring events take place on either end of my time here. 

Hiking Mt. Longonot once again

The Maasai Mara, beautiful as always

Not only did I have a blast revisiting some of the most beautiful places in the country, but I had the opportunity to see how my perception of these experiences have changed after living here for almost 6 months. While much of my enjoyment and marveling remained unchanged, the marginal sense of familiarity I now have contrasted with the sense of foreignness I had before. While I have yet to shed my American skin and become a Kenyan national, my inward sense of being an outsider has diminished in a noticeable way. Apply the shower analogy here.  

            I have a lot to look forward to when returning to the States. With preparations for medical school to be made and friends and family to reconnect with, I will have no shortage of incredibly exciting things to anticipate. Like I said, transitions aren’t necessarily unpleasant in and of themselves; it just sucks that something great is coming to an end. The degree to which my time in East Africa has changed me is difficult to articulate, but its incredible value on so many levels is impossible to deny. Put simply, I am not leaving as the same person that walked off a plane in Nairobi 168 days ago. Some lessons are easy to encapsulate into a sentence or two, yet others may elude the powers of language for the rest of my life. While it might be nice to have a final sweeping thought that could sum my experiences into a compact life-lessons-to-go doggy bag, I won’t be able to do that. What I can do, however, is express my renewed appreciation for simplicity by saying it has been nothing short of an absolute privilege to be here. I may not be able to separate the sadness and reluctance that comes with a transition like this one, but I can be grateful that I will have the opportunity to miss this place, the relationships I have made here, and the experiences that will forever mark this period of my life’s history. As with so many pivotal times in my life, I find myself taking solace in the words of one of my favorite philosophers, Dr. Seuss:

            “Don’t cry because it’s over, smile because it happened.”

Unaccustomed Eyes: Tanzania

Three lines of red embroidered words interrupted the dark navy background of his fraying beanie:

NCAA Indoor Track & Field

1993 Division III Champions

DePauw University

That beanie had seen a lot, but not nearly as much as the old man wearing it. I took notes on the clinic computer as the doctor continued to ask questions and the man responded in soft rasps from the front of his throat, almost as if his esophagus were a tube of toothpaste and he was squeezing out the remains of a voice that had carried him through a lifetime. He had a spattering of thin gray hairs on his upper lip, and when he spoke, only his bottom row of teeth showed, revealing the dark brown stains indicative of growing up with a mineral-deficient water supply. His grip was firm as he shook my hand, and with a nod of his beanied head, he left.

. . .

            In the hyper-green expanses of coffee fields that are only interrupted by the occasional cloud crowned freestanding mountain, in the smiles that easily welcome and offer advice to improve your terribly inadequate knowledge of Swahili, in the indefinable yet undeniable rhythm of music, traffic, and conversation, richness exudes from Arusha, Tanzania. Though I only spent a week and a half as a medical volunteer at Olorien Community Clinic, I was privileged with a wealth of experiences and relationships that seemed almost disproportionate to my short time spent there. One part service, one part research for how we might develop the clinic in Kibera, the trip as a whole was dense with value on many levels.

The majority of the time, I could have been found in the laboratory drawing blood and setting up various tests that the doctor had ordered, though at other times you might have found me in the consultation room taking notes or observing minor procedures in the (very) small theater room. By far my least favorite experience about working in a blood lab was having the duty of obtaining samples from babies. Here comes mama carrying her bundle of joy wrapped in 15 blankets and wearing a teddy bear hat, pudgy cheeks and trusting eyes meeting me with a happy gurgle that conveys the little person’s utter joy at getting to meet me, and all the while I can only think, “You’re about to hate me.” And, sure enough, as soon as I poke the little finger offered to me in complete confidence, the baby’s world of trust and happiness crumbles away into shadows of deception and evil bearded men that prick your finger when you offer them friendship. Scarring children for life notwithstanding, getting the hands-on experience of working in the lab definitely represented one of my favorite day-to-day activities while in Arusha.

Some of the lab crew hard at work

 The doctor who presides over the clinic, Dr. Robert Byemba, is an incredible man whom I had the distinct pleasure of working with most of the days I spent in the clinic. I admire this man, not only for the 7 languages that he speaks, his personal stories that could easily serve as the premises for Hollywood movies, his ability to handle the wide-ranging patient presentations that come into the clinic (performing operations on the head with a chisel and a hammer if need be), but also for his extreme humility and evident hunger to continue learning whenever the opportunity presents itself. He even came to me on a few occasions when he was curious about the use of some English words or certain nuances of American culture. These two traits, humility and the drive to continue learning in diverse subject areas, are quickly becoming notable consistencies in the doctors for whom I have the most respect.  

Dr. Byemba also amazed me with the efficiency with which he could reach a diagnosis during consultation sessions. His experience with tropical diseases makes him particularly well suited to make determinations quickly in this context, but to the uninitiated, it almost seemed like wizardry. Of course, I'm not expected to be at a level of diagnostic expertise at this point in my medical pursuits, but I couldn’t help but draw some parallels between the contrast of a doctor and premed’s ability to readily discern a patient’s condition and my own continued journey to see the world as it is. Why did that man with the beanie stand out to me during that consultation I described at the beginning of this blog? I could have told you that the US and other Western nations regularly send the preprinted clothing of runner-ups in major sporting events to third world countries before I came to East Africa. I knew this. Yet to unaccustomed eyes, confrontations with hitherto unseen realities, even if they are conceptually recognized, take some time to reconcile. Whether blinking into the light of new beauties or staring into the inky depths of ugliness, our visions of the world take time to adjust.

Along these same lines, there was another moment that made an impression on me at the school just across the street from Olorien Community Clinic where I would often spend afternoons playing games with students, employees, and members of the community:

            He couldn’t have been more than 10 years old, but his clothes were noticeably dirtier and more torn than the other kids’. As I taught a small group of 10-12 year olds how to throw a Frisbee, I noticed him engaging some of the other children in a combative manner, even knocking things out of their hands as he ran past. One boy was holding some sort of cookie-like snack, and when the kid in question took a swipe at him, a few small crumbs fell onto the outdoor courtyard floor. Stooping down quickly, the aggressive boy snatched up the crumbs and stuffed them in his mouth, all the while glancing over his shoulder as if he expected someone to come snatch his prize away.

            I could have told you that there are 10-year-old boys who are hungry enough to eat crumbs off of the ground because of the extreme poverty in which they live long before I arrived in Tanzania. Believing in the realities of poverty, hunger, and suffering was never an issue; it’s just the seeing itself that makes the eyes sting a bit. To be honest, I don’t know what to do with some of the things I’ve seen during my time here. I don’t know how to fix poverty or alleviate systemic suffering (shocking, I know), but I do believe that seeing these realities, in all their nitty-gritty complexity, is the first vital step in any honest effort to have a meaningful impact in these areas. As such, I welcome the growing pains of expanding perspective in recognition that effectiveness is often determined by one’s depth and clarity of vision. Impatient as I may get to act beyond my current abilities, I’m grateful for the amazing opportunities I have been given to grow kidogo kidogo (little by little).

            At the end of my stay in Arusha, Dr. Byemba and some other men presented me with an honorary Maasai outfit, complete with a blanket, shoes made from car tires, and an “authority stick” to thank me for the time I had spent at the clinic.

I was absolutely blown away by such generosity, especially since I felt that I had far more to thank the people of Arusha for than I had given. I’ll certainly treasure these gifts, but far more the memories that will accompany them. Interestingly, the name for a single Maasai male is a moran. So, if there were any doubts before, I’ve now officially been dubbed a moron. I’ve even got the stick to prove it.

Daktari

            In trying to think how I might approach the almost impossible task of summarizing the events of my final weeks in Kijabe and now the first few weeks spent in Kibera, I decided a retelling of a select few important moments would be preferable to an unending slew of “…and then this happened…”s, though I apologize if you were looking forward to a meticulous recounting. The last couple of weeks that I spent in Kijabe were rife with fascinating surgical moments, not the least of which included me being able to scrub in for a revision orthopedic case in which I felt like a handyman’s lackey as we removed screws, repositioned bones, and inserted pins. Though there are many ways to describe an experience such as this one, the simplest way I can think to do so would be to say that it was insanely fun. They say if you enjoy hands-on work such as fixing or building things then you’ll love orthopedics, and I can’t say I disagree. Whereas building and repairing picture frames as my summer job brings its own kind of satisfaction, being a part of repairing a human frame represents an entirely different level.

In Kenya, as in many parts of the world, an operating room is more commonly referred to as a theater (or theatre for you European types). In my case, this terminology felt particularly apt as I would often find myself strolling from room to room, peering in and wondering what show was playing that day. Oh, looks like Neurosurgery is putting in a ventricular shunt today; that could be interesting. Then again, Plastics will be creating new fingers for a man that lost most of his hand in a work-related accident. Decisions, decisions…

Exaggerations aside, I mention that redigitization procedure intentionally because it was one of the most amazing operations I have ever witnessed in person. The plastic surgeon responsible for this operation carried himself with such an easy air of expertise and lighthearted humor that I felt like I was watching a maestro conduct a symphony while cracking jokes on the side. Plastic surgeons often get a bad rap in the States for the heavy load of cosmetic procedures many of them do, but to see what they can do in a developing world context very nearly took my breath away.

I did not strictly remain in the operating room during my final weeks in Kijabe, however. While on rounds with a visiting internist, I met one patient that made a particular impression on me. He was a 17-year-old boy from Somalia who had most likely suffered a small bowel rupture due to typhoid, and as such, weighed about 25 kilos (around 55 pounds) when I met him. I’m not attempting to be facetious when I say his appearance was that of a skeleton wearing a suit of skin that was a few sizes too small; every anatomical detail of his bones was readily visible just by looking at him. Though he had some mobility with the use of a walker, he was most often confined to his bed without a means to venture outside apart from someone wheeling him out in a wheelchair. As such, I volunteered to be that someone on the day we met. I rested a hand on his shoulder (or rather, into the sunken space between his clavicle and scapula) and asked him if he’d like to go outside. With a toothy grin and quiet nod, he assented. Dr. Abraham Verghese, professor at Stanford University Medical School and author of several bestselling books, has been asked on several occasions what he thinks the greatest innovation in medicine will be over the next 10 years. While giving a TED Talk, Dr. Verghese encapsulated his answer in just six words: “the power of the human hand.” As I wheeled this 17-year-old boy through the halls of the hospital and out into the early afternoon sunlight, completely unable to communicate except through a translator (my small arsenal of Kiswahili was to no avail as Somalians, shockingly, speak Somalian), I thought about this core value of medicine implicit in Dr. Verghese’s response. There I was without the knowledge to help this boy in a medical sense or even communicate verbally, but somehow I understood that what I was doing mattered. As trivial as 30 minutes in the sun might seem to you or me, it can mean a world of difference to a patient that spends every waking hour staring at the same four walls. This interaction, more than most others, reminded me of the simple truth that even when medical expertise, ability, and knowledge are stripped away, you can still reach out and put a hand on someone and, in so doing, partake of the most powerful essence of medicine.

[Insert Kilimanjaro trip here]

Since moving back to Karen, a suburb city just outside of Nairobi, I have spent much of my time working with New Hope Academy in their efforts to establish a health clinic that would provide basic care for their students, members of their high school scholarship program, and the women of a business co-op called Project Biashara. The complex of buildings in which we operate is located in Kibera, the largest slum in Africa, and is only about a 15-minute drive from where we live (unless, of course, traffic is bad, in which case it can take a couple of hours). I think it is always exciting to be involved in the initial planning and development of a new organizational entity, though one has to be willing to accept the inherent challenges and speed bumps along the way as well. Even when resources are not an issue, though they very frequently are in this case, the logistics of coordinating people and systematizing internal operations from scratch serve as constant reminders of the necessity for adaptability and patience above almost anything else. For instance, construction on the clinic was supposed to be finished by February, but even now in the middle of April, the room consists of little more than bare wall frames, a medicine cabinet, a single cot, and a desk.

Construction frustrations aside, I’ve been having a blast working with the nurse who will be running the clinic, helping her complete initial health assessments and treating the women and kids that come in with minor health issues. I’m also proud to announce that I’ve achieved what most people would consider impossible by becoming a doctor without ever going to medical school. “Daktari,” (the Kiswahili word for “doctor”) is the title by which I am addressed by children and adults alike that come into the clinic, though I’m pretty sure this is largely due to an unclear conception of what a premed student is in Kenyan culture. I’m thinking about getting a certificate of my medical qualifications made so I can frame it and put it on the wall behind me:

Daktari Robert Elrod

Band-Aid Specialist

Additional Degrees In:

Taking Temperatures

Asking “How are you doing?”

Referring Patients to the Nurse

As silly as it might seem, I really enjoy my role as a small cuts and scratches healer, probably because it’s the one thing I can do that resembles helping patients in a tangible way. It’s also amusing to witness how dramatic some of the students can be when I’m wiping down or removing debris from a cut. In my mind, I’m cleaning a scratch on their knee, but based on their reactions, I’m apparently removing their entire leg.

This guy came in screaming and crying like a crazy person after falling and hitting his head while playing with friends. Turns out he only had a small scratch on his head. Crisis averted.

            On rare occasions, we have patients come to us with more severe issues. During my first week in the clinic, a 6-year-old girl came in with what the nurse diagnosed as clinical malaria. I’ll never forget the way this little girl’s face looked, barely poking over the other side of the desk, fat tears rolling down soft, brown cheeks and fever-glazed eyes that conveyed the simple truth, “I hurt.” Her temperature clocked in at over 105 degrees Fahrenheit, though you only had to place a hand on her forehead to know she was burning up. We had her sit on the clinic cot as we started an IV and plotted the best course of action. The nurse eventually left to contact the girl’s parents and advise them to take her to a hospital so she could be properly diagnosed and treated while I remained in a plastic lawn chair by the girl’s side. My crippling inability to do anything of medical relevance was once again driving me nuts, so I did the only thing I could think to do aside from twiddling my thumbs and offered the girl some gauze pads soaked in cool water. The eagerness with which she rubbed those bits of soggy cotton over her forehead and face made it seem like she was trying to wipe away her fever, as if it were a blemish that could be removed with enough scrubbing. Though I could do nothing more than re-soak the gauze pads when they became saturated with her body heat, it was enough for me to see her stop crying and relax just a little bit before her father came to take her away.

            I can’t deny the intense frustration I feel at being unable to actually help that little girl and patients like her, but with medical school set to begin in the fall, this frustration can be translated into motivation. Of the nearly countless privileges I feel my experiences here have provided, I count the opportunity to spend time with patients among the greatest. Though unholy amounts of studying and academic inundation will provide the “how” of practicing medicine that I so desperately lack right now, my time here has reinforced the “why” time and time again. For those of us that suffer from occasional simplicity blindness, reminders such as these are greatly appreciated.