is this real life?

coming home was what i dreamed about for 6 weeks but turns out it has been a hard transition.  the first day back felt like i was living a dream.  i had one thought that kept running through my head and it was a quote from david after the dentist (yes the youtube video):  "uhh i feel funny.  is this real life?  i feel funny.  am i going to feel like this forever?"  i can't explain to you the feeling of arriving back in the washington dulles airport and walking by the same gate that we had just left from 6 weeks earlier.  it felt like what had happened to me was all just a dream.  we arrived back at the airport and everything seemed just how we had left it.  everything that we had just lived out for the past 6 weeks was so far removed from everything here that it felt like it must have been a dream.  it's hard to make the connection between here and there.  it's like two completely different lives and i don't know how to merge them.  standing back in the dulles airport i tried to grasp the fact that less than 48 hours ago i had been standing in the middle of bara, immersed in the story i was living there.  but already it felt so far away.  as i thought back on what had happened there it felt like i was watching a movie where i watched the characters play out the stories but i wasn't actually a part of them.  i felt like i was watching myself from the outside but it didn't feel like i had been personally involved in what had just happened.  i'm sure a psychologist could explain to me that it's some sort of coping mechanism or something, i don't know.  i just know that it is a crazy thing to feel.  it's crazy that one day i could be so wrapped up in the stories there: i was shedding tears over my patients, i was sweating in the un-airconditioned gym as i struggled to teach a patient to walk again, i was laughing with one of my patients as he made jokes about america.  and then the next day i can all of the sudden feel totally removed from those stories.  it's somewhat scary i think, how as human beings we can so easily remove ourselves from suffering and choose to disengage.  so my first few days back here have been a struggle.  the first day i was overwhelmed because i felt this burden to process everything i had just seen and it felt like way too much to handle.  derek told me that i just have to let the processing come in its own timing and not force it.  and that is definitely true.  but what i'm realizing is also true is that while i can't, and probably shouldn't, force the understanding and perspective to come as i process, i must force myself to engage in those thoughts.  the easy thing to do is to pretend it didn't happen, and that is actually easier to do than you would think.  but that would be such a waste.  the hardest thing for me to do right now is to quiet myself and let myself really think about what just happened.  to let myself think about the stories of my patients.  to let myself think about the disparity between there and here.  to let myself think about what it means for me and how my life here should change because of what i saw there.  it was hard to engage in those things there but i think there some of the emotion was masked because i was in survival mode.  i did what i had to do because i had no other choice, and i did the best that i could but i didn't always have the capacity to let myself experience the fullness of emotion that came with the situations.  but now i'm back here and when i think back on those things the emotion comes in its entirety and it's hard to make myself go to those places.  so i'm praying desperately that God does not let me run from it.  i'm praying for the strength to re-engage in what i just experienced and to figure out how to merge my life there with my life here.

stuck...by His mercy

i'm thankful that i'm stuck here.  i'm thankful that i'm half way across the world with no way to get home until i've finished what i signed up to do.  i'm thankful that there's no way out.  for that matter, i'm thankful for the past ten months of my life, that i've been stuck in the circumstances with no way out.  i've been thinking about that alot this past year because i've made alot of decisions that in hindsight i wouldn't have the strength to make again.  i'm thankful that in God's mercy He doesn't always show me the full reality of what i'm choosing when i choose it.  because i am too weak to choose the hard things when i know how hard they are really going to be.  i'm learning to see how it's a way of God showing me His grace...when He leads me into things before showing me completely where He's leading.  i think He does that alot...He leads His people one step at a time.  i've always been taught and believed that mostly that was because He wanted to increase our faith, because He wants us to have to look to him for direction at every step.  and i think sometimes that is the case, but i think sometimes the reason, at least in my life, is in some ways the opposite of that.  i think alot of times it's because i don't have enough faith to follow when i know what i'm getting into.  i think in His grace, He looks at me in my weakness and realizes that there are something He must reveal to me one step at a time because i can't handle knowing all at once.  i think sometimes God uses making decisons to increase faith, but for me i think my faith grows more in the season after the decision has been made.  i think that in the season of decision making sometimes God says, you know what, i really am calling you to make this particular decision and right now in this moment what i really care about is that you make the decision, i'm not so concerned about how much faith it takes for you to make the decision, the faith part will come-don't you worry about that.  so in His grace, He spares me the details and He makes the decision easier for me to make.  and then the season after the decision is made is where the true change happens. i need God to make me stuck.  i am too weak to choose suffering...i need Him to put me in the middle of it with no way out, but to walk through it. i've seen Him do this alot for me over the past year of my life and i am learning to be incredibly thankful for it.

the first time this happened was exactly this time last year when derek found out he got accepted into teach for america in jacksonville.  it sounded like such an exciting adventure and one we obviously couldn't turn down.  God was so clearly in the details of working things out as we prepared for that season.  but then the day finally came when derek actually had to leave to go half way across the country without me.  and it was another one of those instances where the idea was alot different than reality.  the idea sounded great.  sounded like the kind of adventurous story i wanted to be living.  but the reality was incredibly difficult.  i remember going home to an empty house the first night after i dropped him off at the airport and asking God what in the world we had gotten ourselves into.  i was certain that there was no way i could handle what we had just started, but i was also fully aware that there was no way out.  when we  made the decision for derek to go, i cognitively knew it was going to be really difficult, but if i had known the feelings i would have that first night in a lonely house, there is no way i could have choosen it.  i'm not strong enough i choose that extent of pain.

i began feeling really claustrophobic in this season....not in physical spaces, but in circumstances.  i felt so stuck.  i made decisions, not being fully aware of what i was choosing, and then i was stuck to live with the decision that i choose.  i remember derek telling me a story about his roommate paul who was a runner.  he said every night before a race he would find paul pacing around the house looking miserable.  one time he asked paul what he was thinking and paul said he was just thinking about the pain he was about to put himself through the next morning.  derek asked him why he did that to himself and paul said because it was worth it , because it  made him alive.  i have felt alot like paul in this past year.  miserable at the thought of the pain that i have chosen, but hopefully believing that it is worth it.

caveman medicine

let me preface this again with saying that this is in no way meant to criticize health care in south africa or pass judgment on what they do here.  i've said it before and i'll say it again...they are doing the best they can with what they have.  but because they have so little resources compared to what we have in the US, the resulting treatment approaches can be somewhat humorous...especially when we put it into the context of a US hospital and imagine what people would think if they saw some of this stuff happening in US health care.  so some of these stories are somewhat comical when taken out of the context of south african health care...but i hope they are also eye-opening.

story #1:  i walk into one of the wards and see someone laying in bed with a contraption that looks like this (see picture below).  my first thought was, "what the hell is going on?"  sorry for the language, but if you walked in and saw some of this stuff, i'm sure you would have the same response.  i mean, i walked out of a healthsouth hospital on a wednesday (which corporate health south means they have so much equipment and technology that they don't know what to do with it) and walked into this on the following tuesday.  it was quite a culture shock.  so i ask the therapist that i'm with what is going on there.  she looks at me like she doesn't understand why i don't know what that thing is.  i explain that we don't use those in the US; she looks baffled but provides some explanation.   i learned that it is called "cones calipers".  and yes what you see there is actually what it is...there are screws into the side of a person's skull and they cable attaches them to the bed.  it is providing cervical traction and they use them after a neck fracture if it is unstable or if they are waiting for surgery.  the patient is unable to get out of bed, sit-up, lie on their side, turn their head, move their arms above 90 degrees...they're basically stuck lying flat on their back 24/7 until either the fracture heals or they end up having surgery...which could be months.  CAN YOU IMAGINE?  it makes me incredibly claustraphobic to even think about it.  so after the therapist answers my questions, she asks me how we don't use them in the US, she is perplexed.  i told her the main reason is that we don't have patients lying around for months waiting for surgery...if they need spinal surgery they would get it immediately.  here they just don't have the availability of doctors for that to be possible.  so lots of the patients i've seen are simply sitting in the hospital until a surgeon is available...they have no idea how long they will be waiting there, alot of times they aren't even sure of what surgery they are waiting to have!  point of the story: they need more doctors.

story #2:  i started by rotation in trauma by 3rd week here so by that time some of the initial shock had worn off.  however,  a day still doesn't go by that i'm not shocked by something i see here.  and my first day in trauma was certainly no exception.  i walk into the trauma ward and see probably over half the patients there with huge incision straight down the middle of their abdomen.  and again, my reaction is "what is going on?!"  so i ask one of the other therapists and again i feel like she is surprised that i've never seen this before.  she tells me that its called a laporatomy aka laps.  she said that after a patient is in some sort of trauma (car wreck, assault, etc) alot of times the doctors just do this procedure to "check" and see if anything is wrong in the abdominal cavity.  i'll admit i found some humor in this concept....i feel like it's like 2nd graders practicing medicine...and they're like hmmm i wonder if everything is ok in the abdominal cavity, how am i going to find out?...oh i have an idea i'll just slice all the way down the middle of their stomach, open it up, and see what's going on in there.  i would love to introduce this concept to a US doctor and see their reaction.  but on the serious side, it is really all they can do here.  thankfully in the US we have imaging machines available to see what's going on internally, here they literally have to cut someone open.  i think they have one CT scanner at the hospital but last i heard it wasn't working.  point of the story: they need more equipment.

story #3:  i just started my neuro rotation last week.  my first morning in the gym, i see another therapists literally strapping slabs of wood to the back of a patient's legs with an ace bandage.  they wanted to get the patient to stand and their quads were too weak so they just strapped some wood onto their legs!  hahaha i can't stop laughing when i picture me walking into my first day of work when i get back to the US and bringing in a couple slabs of wood to put on patient's legs.   the US equivalent of slabs of wood would be a knee extension brace, but even that i've rarely used and when i did it was only on one leg.  here they use it on both legs at the same time.  and if you can imagine trying to sit back down when both your legs our strapped straight...not so easy.  in the US we tend to approach things in a different order.  if a patient didn't have a quad strength to stand at all, i would start with quad exercises like crazy to gain some strength.  here they never know when a patient is going to be discharged so they start trying functional tasks even when the patient doesn't have the basic requirements to complete them.  in the US, we would never send a patient home if they couldn't transfer from a chair to a bed, walk or use wheelchair.  on friday, i had a stroke patient get discharged to home and he had never even stood up and he had no wheelchair to take home with him (too expensive).  point of the story:  their treatment approach here is VERY different.

"africa" is where i live

so when i first got here i was overwhelmed by the amount of suffering i was seeing.  i had never seen so much brokenness in my life.  but as i've spent time here, i've come to realize some things.  i've spent a little bit of time away from the hospital and seen somewhat of "normal" life in johannesburg.  and i've been struck by the fact that there are people who live here that are so sheltered from what goes on at bara (the hospital).  there are people living 10 miles from that hospital that have no idea the depth of suffering in that place.  i'm sure the majority of people who live here "know" about bara...but they don't really know it.  i'm sure they've heard stories and are cognitively aware of what happens there, but they haven't experienced first hand the mess that it is.

and as i've thought about this, i've realized that "africa" is where i live too.  there are things that happen in my city that i cognitively have some awareness of but have no personal engagement with.  sure the magnitude of suffering here might be larger but suffering is suffering all the same and it is happening where i live.  i have realized that we tend to run from suffering.  not many people seek out suffering and choose to go engage in it on a consistent basis.  people deal with suffering as it comes to them but they don't go looking for it.  and i'm one of those people just like anyone else.  if i wasn't literally stuck here for 6 weeks, i can't say that i would have chosen to continually engage in this suffering.  it is exhausting.  it demands alot from me.  it's painful.  so i don't have the strength right now to choose to engage in suffering like this, (i think God is fully aware of that and it's why i'm stuck here with no way out) but i'm praying that i develop a toughness to be able to do that.

derek asked me if i thought i would want to come back to africa.  that's a hard question to answer right now because i think my perspective will change when i step back from this place and have time to process.  but part of that answer is "why?".  i think it took coming half way across the world for my eyes to be opened to the reality of brokenness in the world.  but i don't think it takes more than a 5 minute drive from my house for me to engage in the brokenness.  i think i could save the $1200 plane ticket and put it towards a lot of broken causes where i live.  obivously i'm here and i don't think there's anything wrong with coming to help people in africa.  i love it..it's meaningful work.  but i also think it's healthy to engage in brokenness in my own community on a daily basis.  in some senses what i am doing is easier than that.  i'm here for 6 weeks and when it comes down to it i know that there's an end to what i'm experiencing.  i think that's part of the appeal of short term "mission" trips like these.  they give you the ability to go engage in brokenness but in the end you go back to your happy little life and there's an easy out.  but to engage in the suffering of my city is a whole different thing.

i think part of what i want to take back from this place is that realization.  i want to find the "africa" in my city, the suffering that i am called to be a part of and i want to engage in it for the long haul, not for just 6 weeks.  i don't want to live a sheltered life, oblivious to what is happening around me.  i want to be tough enough to choose to put myself into broken situations so that God can use be to bring healing and restoration.

can i get a doctor?

so let's just say i have made my share of complaints about the US health care system, and i'm sure i'm bound to make more, but after spending 5 weeks here it sure does put my complaints into perspective.  let me preface this with a few things though.  i'm not looking down on health care here, they do the best they can with the resources they have....the resources are limited though.  so my stories are meant to just tell the reality of health care here....not pass judgment on what they are doing.  with that being said, here's a few stories...

i'm working in the trauma ward and get this patient, about my age, up to walk.  he was in a car accident and had a subdural hematoma (head injury) and a broken leg.  he was doing quite well though and had been walking a little the previous days without problems.  he kept asking me to take him outside so we decided to take a little walk.  i'm walking with him down the hall to the door and all the sudden he says he is dizzy and then collapses....luckily into my arms and not onto the floor.  so i'm standing there holding him up yelling at the closest nurse i can find to bring me a chair.  we get him into a chair and he starts sweating profusely and ripping his clothes off.  well there's no wheelchairs in the entire ward so i'm not sure what to do at this point....don't really have that problem in the US...so i go find another therapist to help me.  she comes back and says we're just going to have to walk back to the bed with him.  i'm pretty sure he's going to collapse again but i keep my mouth shut because things work differently in south africa than they do in the US.  so we stand up to walk...take a few steps and he collapses into my arms again.  so we sit back down in a chair and the other therapist says we're just going to have to carry him on his chair back to bed.  so we literally pick up the chair that he is sitting in and carry him on it back to the bed.  can't imagine the looks i would be getting in the US if i did that!!  so on the way back to bed he starts complaining of a pounding headache and then starts grabbing his chest in pain....bad signs for a patient after a head injury....major concern.  so i find a doctor as quick as i can and tell them what has happened.  they look over at him lying on the bed in obvious distress and say they will be with him later when they get to him on their rounds.  i'm in disbelief.  in the US there would have probably been at least 5 people surrounding the patient, checking his vitals, etc.  here they don't probably even have a vital monitor to hook him up to.  so i stand there, completely shaken up by the whole episode....feeling like if i leave the patient he could literally stop breathing and no one would even know.  i only know so much...and what to do with a patient after a head injury who is in acute distress is not one of those things.  in the US that's what we have doctors for.  so i do all i know to do and literally stand there and watch the patient keep breathing until the doctors finally get to him.  turns out the story has a happy ending and the patient is doing fine now.

second story happened today.  i'm working with another patient who is about my age. it's the first time i've seen him and he starts pouring out his heart to me...telling me about his 3 year old daughter, and how he's in prison and can't take care of her, and how he feels so alone and wants to be a good dad.  and then he tells me that he overdosed on pills last night..he took 25 and hasn't told anyone except me now.  well about this time he starts getting really dizzy, then he starts dry heaving and says something is about to come up.  then he starts having a seizure and isn't really responsive.  so i yell at another therapist to help me and she says i need to take him back to his room because they're aren't any doctors in the gym where we're at.  so we get him back in his wheel chair.  i keep yelling his name the whole way back to him room...trying to make sure he stays awake.  the walk back to the ward is outside and i'm back there by myself and the pt is really out of it.  at one point his eyes rolled back in his head for a second and i was certain i was going to have to put him on the cement in the walkway and start doing CPR....and i had no idea when someone would walk by that could help me.  luckily he kept breathing the whole way back to the ward.  so we get there and i find the nurse to tell her what has happened and she is completely unphased and says she will check on him in a bit.  so i find the head nurse and take her the bottle of pills that he overdosed on and she is also unphased.  it's craziness compared to the US.  again i'm scared he's going to stop breathing or throw up and aspirate and no one is even concerned about monitoring him.  so i find a doctor at the bed next to him and ask them about it and they say they don't know, he's not their patient.  again, thankfully, the story has a happy ending and the patient was doing fine this afternoon when i went to check on him.

but the craziness of the stories still baffles me.  i don't think there's such thing as a code blue here.  i feel like  anyone working in the hospital is potentially going to be asked to function as a doctor because there just aren't doctors around all the time.  like one day one of the other therapists got ask to intubate a patient...definitely not within our scope of practice.  so i am thankful for doctors, i am thankful for crash carts, i am thankful for the availability of qualified staff in the US, i am thankful that i don't feel forced to function as anything beyond what i am trained to do. 

this is why i'm here....

this has been one of the hardest experiences of my life.  there are moments when i wonder what the heck i'm doing here.  but then there are moments that remind me.  these are some of those moments....

i was in one of the wards (aka huge rooms filled with tons of beds...no private rooms here!) treating a baby and i saw this little boy lying in his hospital bed looking like he was about to cry.  he was probably about 8 years old and was lying in a room full of crying babies and you could tell their crying was breaking his heart.  and then there was this other little boy about 5 years old probably who was also in the ward.  well they found my bubbles and they came up to me with the bottle.  they can't speak english and i definitely can't speak their language.  but within minutes they were dying laughing.  we were making silly faces at each other and just being goofy.  then the next day i walked into the ward and they came running up to me, smiling so big.  maybe that doesn't sound like a big deal but when you walk around these wards for a few days it becomes a really big deal.  kids smiling at this place are rare.  so the smiles made my day.  i had a music box thing with me and they were intrigued.  we played the music box and marched down the hallway to the ward like we were having a parade.  in that moment they seemed like normal, healthy, happy kids and i remember thinking...this is what i came here to do.

another day i was working with this patient who had a stroke a few years ago and just recently had his leg amputated.  it was the first day i was seeing him and we were working on standing up out of a chair...which is incredibly hard to do with one hand that doesn't work and one leg that is gone.  he got frustrated and started saying he felt stupid and dumb.  i told him how amazing he was doing considering what he had been through.  by the end he was almost able to stand up by himself and he was singing me a song he made up about me.  he told me that i was good at my job because i am good at encouraging people.  that's what i came to do.

i have this 17 year old boy i worked with for two weeks who was burned badly on his leg and back.  burns over joints are incredibly painful because you have to stretch the skin while it heals so it doesn't heal back in a shortened position.  imagine stretching a scabbed knee and times it by a million.  the thing is though that he has the potential to be completely fine if he is just willing to work through the pain.  he isn't willing to work through the pain though.  one day i spent about an hour and a half with him.  we had a little "come to jesus" meeting.  he kept telling me that he would rather die than be in this hospital.  he's been there for almost two months and no one usually comes to visit him.  we had a heart to heart and by the end he finally believed that he was going to be better.  he was able to tell me that he realized he had to work through the pain but he would because he wanted to walk again.  he was smiling and laughing with me.  i was suddenly his best friend in the world because i spent a little bit of my time paying attention to him and showing him there's hope. 

i had this other little patient who was about two years old.  he had pretty much been abandoned at the hospital.  his grandmother couldn't afford transportation to come visit him.  it was the first day i saw him and i went to get him out of his bed.  he reached his arms up to me and just curled up in my arms.  then he pointed to my lips and his cheek...wanting to be kissed.  we cuddled that day for about 30 minutes.  he was so hungry for love, for someone to hold him.  i may not have done much good for him as far as physical therapy goes, but i'm realizing here that most the kiddos need to be loved way more than they need PT.   so i just let him curl up in my arms and kept him there.  that is what i came here to do....love the unloved.

soweto...the largest township in the southern hemisphere

we went on a bike tour of soweto yesterday.  the hospital that we are working at is in soweto so most of our patients live in this township.  there's about 5 million or so people that live there.  it was a cool experience to see where our patients are coming from.   we had little african kids running out of houses everywhere, chasing after us on our bikes, wanting high fives.  it was awesome.  we also saw some really sad things.  the government started building new apartment type things for the people there years ago.  when we were there workers were working on them.  the guide told us that it was only because the election is coming up in 2 weeks and they are trying to win people's votes and as soon as the election is over the work will stop again.  we live in a world with such broken systems.  we stopped at the hector pieterson museum and the guide told us the story.  he was a 13 year old boy that died in a student rally in the 70s.  the cool part of it was the guide talking about the way south africans feel about it now.  he said that often times tourists come to the memorial and are really sad but he said that south africans have healed and look at it as a good thing.  he said they see the progress they have made from that day and the change that it brought.   his perspective was really good.

Soweto

I obviously am disgusted at this african beer.  or maybe it's the fact that everyone drinks out of one jug that i'm disgusted at.  probably a combination of both:)  they serve the beer warm here and it comes in milk cartons....such a foreign idea to me.

outside the "shebeen"-african pub.  it's so hot in there and dark.  no tvs in there for watching sports while you drink a beer.  definitely not an american style bar:)

this was our lunch.  we didn't have a choice on the tour.  everyone was given the same thing.  let's just say our stomachs didn't feel so good after this one...bread, cheese, ketchup, egg, french fries, and mystery meat all piled on top of each other!

our hilarious bike tour guide

playground in soweto

Jen-This one's for you....it's a sink made out of bottle caps! 

Just wanted you to know i'm still thinking about you

all the way over here in south africa:)