Another picture post

Because, seriously, is there anything cuter than a naked baby in a bucket?

Something to keep the grand-folks happy

Alright, so after my Debbie Downer post last week, let's have something happy. How about pictures of my adorable offspring?

Oy, those dimples. They kill me.

After Jorge doused him under the garden tap

At a friend's birthday party last weekend

Then he got car-jacked by the birthday boy. I had to put this in to show off the super-cute baby tux and that gorgeous hair.

Finger-painting! Awesome, mom!

OK, now that you're smiling, go call your lawmaker, and tell them you are serious about health care reform!!

A day in the life

After my post about healthcare in Malawi, I got a few responses that basically said “we are so lucky in the U.S. to have good health care!”

I didn’t want you guys to get to feel so smug. Yes, a slim majority of people in the U.S., if even that, are lucky enough to have quality, affordable healthcare. The rest of them either go broke, or get “indigent” care services, which is the government’s fancy euphemism for poor people.

I was indigent once. I got cancer. This is what a typical day is like when you are poor and sick. This is all true. Everything I’m writing here actually happened personally to me. I know this post is long, but it is close to my heart, so I thank you if you get all the way through.

**********************

I wake up at 6AM. I scarf down a quick breakfast, then Jorge drops me off at Charity Hospital, in New Orleans, for my bi-weekly oncology appointment. My first stop is the registration office. Although it is only 7 o’clock in the morning, the room is already full. The oncology unit doesn’t schedule appointment times, just days, so the optimistic belief is that if you’re the first to arrive, you will be the first to be treated.

I took a number. There were no seats available, so I hoisted myself up onto a table top and waited. 45 minutes later, my number was called. I go to my assigned booth, where a surly clerk does not say hello, smile, or look at me. She asks the usual questions, name, illness, age, marital status, then chastisingly tells me that I need to go to the accounts department to verify my income. I am intimidated by this woman, so I don’t tell her that no one has ever told me this before. I just acquiesce and hope she will say that my registration is OK. When you’re getting free healthcare, you keep your head down and hope that no one takes any special notice of you, always afraid someone is going to say “woops, we made a mistake! You owe us $53,752!”.

The clerk tells me to pick up my registration card, a little blue plastic card with my name and patient number. I have a huge collection of these by now. It is now 8, and I make my way down the hall to Oncology. Already, the waiting room is filling up. Although appointments are supposed to start at 8, there are rumors that none of the doctors have even arrived. At 9, the first patients begin to be called.

There never seems to be any order to the names called. One day you can come late and get right in. But usually for me, I come early, and I wait. For hours. So does almost everyone else. I hold my pee, because I’m afraid my name will be called while I’m in the bathroom and I’ll be skipped.

I don’t fit in here. I’m young, for one, and almost everyone else is old. I still have my hair. And of course, I’m white, definitely the minority here. Seated in the row across from me is a man in a yellow Orleans Parish Prison jumpsuit, literally in leg irons. I feel bad for him. I chat with the woman next to me. Her husband and son both died in the last year, and now she has breast cancer. The chemo has been very hard on her; she is feeling like she just can’t do it anymore.

Finally, just after 11, my name is called. The nurse is nice to me, she remembers me. But although I have seen the same doctor many times by now, my doctor never remembers me. I spend the first 5 minutes of every appointment telling her about my case.For all that wait, the appointment is short. After a curt 15 minutes, the doctor races off to another patient.

Today I am scheduled for CT scans. First I have to get bloodwork. I don’t mind the bloodwork so much, because the women who take my blood are always very friendly, and they stick my vein on the first try every time. Of course, there’s another 30 minute wait, but it doesn’t seem so long in comparison.

Then I travel to the basement for my scans. On the elevator, I bump into an old grad school classmate, who is studying to be a doctor. We used to be friends, but now she seems extremely uncomfortable by my presence as a patient. We are both relieved when the elevator doors open and she leaves.

The radiology department looks like it was last decorated in 1932. It’s grim and dark, but with jazzy art deco tile reliefs. It’s 12:30 once I get there, and I haven’t eaten or drunk anything since morning, as this is forbidden before the CT scans.

There seems to be some problem today, as the wait is even longer than usual. Hours pass. It turns out that only one scanner is functional, because in the early hours of the morning, a man bled to death on the other, and it needed to be cleaned. I can’t stop thinking about this man. I hear sad stories every time I come to Charity, and they all lodge inside me, this private club of tragic figures that keep me company for all my medical care. They make me feel heavy inside.

A little after 3, I am called to have an IV line put in. I ask to be able to put on my robe first. Apparently the nurses have never thought out the logistics of trying to remove one’s bra with an IV needle lodged in your elbow. I can tell you: it is very challenging. Always put on your robe first.

The nurse has trouble finding my tiny, dehydrated vein. It’s been 9 hours since I last ate. I’m tired. As the woman pokes and prods with the needle, I start to feel dizzy from the pain. The next thing I know, I wake up in the arms of a lab tech who caught me as I fainted. Fortunately they’d gotten the IV in, though, so a bit of glucose later, I’m fine and finally ready for my scan.

I’m old hat at the scans by now. I know when to expect the hot flash of contrast fluid being pumped into my veins. I can hold my breath and be as still as if I’m dead, sliding into the crematorium-like tunnel.

Jorge picks me up at 4. I get into the truck, then crumple. I’ve been strong all day, not a complaint, but now it’s too much. I sob from exhaustion, from hunger; I cry for all the sad stories I’m now carrying, but mostly I cry out of humiliation. I want to be a person again, not a patient. My husband strokes my head, promises to take me for pizza, and I reassemble myself. After all, what choice do I have?

Hello from the Deep South

The south of Malawi, that is. This week I am in the southern-most district of Malawi supporting one of our field offices.

It's hot down here, but not as hot as it will get once summer kicks into full swing here. Even the enormous mosquitoes aren't such a problem this time.

Today I went out to visit a remote health facility. It was 90 minute drive, with the last 30 minutes being a dramatic, nearly vertical climb up a rocky mountain-face. We ended up at the top, in the beautiful, wooded little hillsides of Lulwe. When we arrived at the health center, which is run by the Catholic church, not the Malawi government, no one was there except one sole mother with her sick child.

It turns out the staff hadn't been paid, so they had all gone to town to get loans. One Medical Assistant was left to man the center, and he was at home "charging his phone". We rousted the slacker out of his house while the government health representative with us tried to convince me that all the patients must have already been seen this morning (a simple question to the poor mother waiting there told us that this wasn't true. As of 10AM, not one person had showed up for work yet).

I honestly think the Medical Assistant would have gone back home after talking to us had I not pointed out that there was a patient who had been waiting several hours. Of course, I'm not sure how much help she ended up getting - the other health staff had taken the keys to the pharmacy with them, so there were no drugs available!

Sigh. Still, I had a nice day. I always like getting out to the field. I never tire of the way children run to the roadside, beaming and waving, their little chests puffed out. Seeing a white person in their village is about as exciting to them as it was to Jorge the time he spotted a Delorean parked by the side of the road in cozy little Bozeman, Montana. In the more rural areas like the one we were in today, even the grown men and women smile and wave. I felt a bit like Queen Elizabeth in her birthday parade.

We had visitors from another district with us, so we drove out to a viewpoint, where on a clear day you can see the Zambezi River flowing through Mozambique (today was not a clear day, alas. It's burning season.) We also stopped by the border with Mozambique, one little bar across the road and a shabby little immigration shack. All in all, it was a fun little tour of Malawi dysfunction.

So, I have a whole companion piece to my last post all ready in my head, but I literally have no time to write it. This last week I was in the office all of 5 hours, and, hard as this may be to believe, I actually had to work during all that time.

So today I'm here on a Sunday trying to catch up with e-mails, but I have promised my husband not to vanish for the whole day. So again, that post is just going to have to wait.

On Tuesday I'm traveling to the Deep South of Malawi - Nsanje. I will be there all the way up until Saturday afternoon. I'm hopnig after that things will start to ease up just a wee bit.

It's been a fun weekend so far, though. A friend dropped by yesterday with freshly baked goodies for us, then last night we went to a party, where we were asked to dress as our musical heroes. Jorge was Jimmy Buffet - we didn't have a parrot, so he taped a raccoon to his shoulder (oddly enough, everyone still knew who he was supposed to be!)

And I was Pat Benetar. My costume was AWESOME. I looked just like this:

I have pictures to prove it. Unfortunately for you, though, we left the camera cable in New Orleans, and so cannot upload any photos. So you will just have to believe that I was the hardest-rockin' 80's rocker chick at the party.

Let me paint a little scenario for you:

Your little one is sick. He has a fever, and a cough. You know from your friends, the websites you frequent, your parenting magazines, that a fever that lasts several days should be checked up by a health professional.

So off you go, off to the clinic. Unfortunately, however, you live in a rural area, so it is an hour-long drive to the clinic. You go early, because they don’t take appointments. When you arrive at 7:30, which is when the clinic is supposed to open, there is no one there apart from a rather surly security guard. He writes your name on a list, so that you can go in the order you arrived.

All the other chairs are already taken up by other moms and babies, so you find a seat on the floor. Then you wait. And wait. Around 9:00 AM, the clinic staff start to show up. They dither around for another 30 minutes, chatting amongst themselves, shuffling papers, hardly even noticing the presence of the patients.

Finally, patients begin to be called. Half the time, though, the patient list isn’t followed. Instead, the nurse lets in whoever manages to be closest to the door. So you shuffle, you scoot, you hustle your way ever closer to the nurse’s office every time the door opens.

Even though the little boy next to you looks almost comatose, and is clearly in need of emergency health services, the boy isn’t noticed, and his mother is not called in until it is ‘her turn.’ You hope that the baby doesn’t die while you’re waiting. Will that mean you have to wait even longer?

Almost four hours after you arrived, you are finally called into the nurse’s office. The nurse doesn’t greet you, or smile and say hello. She just motions you to sit down, and begins asking questions. What is wrong with this child? Why didn’t you come earlier? Don’t you know that fever is very serious?, she chastises you. You feel ashamed, but because she is a little scary, you don’t say anything. Then, without ever looking you in the face, the nurse hands you two pills from a jar on her desk, and tells you to give them to the child, and to come back if your daughter gets worse. You are not told what illness the child has, or how to prevent it. You are not told what the pills are. You are excused.

The next time your child gets sick, what will you do? Will you make that hour-long drive to the clinic? Or will you just go to the drugstore, get some children’s Tylenol, and hope that your daughter gets better?

We did a community assessment a few weeks ago where we went out and talked to local mothers in Malawi, and this is basically what they told us. They walk miles, wait for hours, then get treated harshly, sometimes even abusively. All for a couple pills. And yet they still go! This is the miracle of healthcare in Africa – that people even turn up at health facilities at all!

Almost every day I hear government officials and aid workers complain of the peoples’ ignorance, their apathy. ‘We tell them what they should do, why don’t they do it?’ they ask. What we should be doing is asking ourselves why we expect poor African mothers to consent to a standard treatment that we would never accept ourselves. Because they are poor? Because they don’t know any better? Because they should just be happy with the scraps they get? As you in America are debating the need to reform the healthcare system, please don’t forget that inequity is unacceptable, in rich and poor countries alike. All people have the right to quality healthcare.