Blog has Moved!

Hi all!  My blog has migrated to:

https://carolsduty.wordpress.com/

Thanks for reading for all these years, and for your constant support.  Enjoy the new format!

The art of ART in Kampala, the city of seven hills

The mighty Murchison Falls (our first week was spent traveling!)

Rolling tapestries of green give way to dense forests, but with the light at just the right angle, the blue waters of the Nile peek out from behind the trees.  We race past villages, fruit stands, and goat-herders seemingly as swift as the white-water gushes down Murchison Falls.  The car slows as we near the seven hills that make up Kampala, and purrs to a stop as we enter the ranks of cars arranged haphazardly in bumper-to-bumper traffic that never seems to let up.

View of the Nile from the top of Murchison

The stillness of the engine allows us the time to examine the scene around us – mothers rushing home in the impending dark with a lesso wrapping young ones to their backs, men jostling and taunting a wobbling, drunk teenager.  A boy, hardly four years old, laces fearlessly in and out of the traffic and weaves between the crowds, gleefully intent on his game of the day – chasing a simple plastic bag with a stick.  We watch him for 5 minutes, then 10, then fifteen, and he doesn’t tire.  The hustle and bustle hides some of the uglier truths of these streets – the pervading hunger, endless cycle of poverty, an endless list of diseases.

Working and observing in a hospital that specializes in providing compassionate, personalized care to those affected by HIV/AIDS, we see some of the worst stories of these streets.  In this hospital, hard realities are faced as a matter of business each day.  Raped walking home in the dark. Raped walking home from church.  Innocent children present to clinic for refills on their medications – all were infected with the notorious virus on their exit from the womb.  Still, many things are encouraging.  Youth at the Kisakye Youth Center who have mastered the art of ART (antiretroviral therapy) work to empower their peers to do the same.  Women, yearning to be the best mothers they can be, show up faithfully to clinic visits to prevent their unborn children from infection.

*Note: photos aren't allowed at Mildmay, but know that it's beautiful, and no words could do it justice!

While 1.5 million people are newly infected with HIV/AIDS in sub-Saharan Africa each year, this represents a 33% decline since 2005 (Kharsany and Karim, 2016).  It is facilities like Mildmay Uganda that are trailblazing the way to an AIDS-free generation.  In 2016, Mildmay had zero incidents of mother-to-child HIV transmission during pregnancy, delivery, and breastfeeding.  The word “patient” isn’t used in this facility – each client here takes an active role in his or her care and the dignity that comes along with it.  With 89,889 clients receiving anti-retroviral therapy to overwhelmingly positive results and 22,354 girls and young women in rural districts engaged in empowerment programs to reduce HIV risk, Mildmay reports that 8,170 new HIV infections were averted in 2016 (Mildmay Uganda Annual Report 2016).  What’s more, the vast majority of their services are provided at no cost to clients.  That’s a lot of lives positively affected by a tremendous collaboration between clients, physicians, nurses, educators, administrators, and even the CDC for funding so central to the hospital’s mission.

What’s a typical day at Mildmay like?  The first clients trickle in by 6 a.m., when the world is still dark.  It’s impossible to know what time they left their homes to beat the Kampala traffic and make it to clinic at this time.  By 7 a.m., a sizeable crowd lines every bench and free space in the waiting room.  At precisely 8 a.m., the light is switched on at the reception desk, amid bursts of applause from the waiting room.  Most days, about 400 clients are seen in the order that they arrived and picked a number before the healthcare team has a chance to rest their feet.

It might not be the most timely and organized system in the world, but it’s hard to argue that it’s not efficient.  It’s a far cry from the other outpatient hospitals that we’ve visited in our four weeks here so far.  At many of these facilities, thousands of patients seem to be spilling out from waiting rooms, on benches, cracked plastic chairs, and squatting on the red earth.  They are waiting for pre-natal visits, medications, maybe even minor surgeries from a staff that consists of one trained physician, a few clinical officers, and a handful of overworked nurses.  Their dour expressions speak to the many hours that they’ve already waited, but also the determination with which they will strive for medical care.  If they are able to be seen that they, they are extremely gracious to the physician.  And, if they are turned away that day, still many will find a way to return the next day.  Mildmay Uganda, as the staff will proudly tell you, is a center of excellence where clients count their blessings to be receiving care.

Every aspect of care is carefully coordinated.  New clients are identified at HIV testing and counseling services, and with words of encouragement and support, enroll in clinic and start their first dose of ARTs that very day.  The youngest clients arrive still attached to their mothers’ breasts, and mothers beam when they are congratulated on suppressing their viral load and protecting their infants from harm.   Realistic conversations about family planning happen alongside point-of-care cervical cancer screenings and breast exams.  Vials of blood are drawn and sent to the state-of-the-art lab that crests the Mildmay hill.  If you visit Mildmay, the vastness of the compound will amaze you as you climb the steep brick incline, and realize that an entire additional hospital system accompanies the clinics in the lower half of the hospital.  Some of the buildings on the top include the private Bethany clinic, two inpatient pediatric wards, the youth center, and the building that will host 300 medical students this coming September.

My role at Mildmay is still being defined.  We are enrolling clients in a study that will analyze the effects of computer-based cognitive trainings to slow the progression of dementia and cognitive deficits in older adults with HIV.  Still, enrollment is slow because our team is battling with red-tape placed by the Ugandan equivalent of the IRB (Institutional Review Board) – #ThisIsAfrica, after all.  I welcome clients in my broken Luganda sentences, help them to get breakfast and lunch, and take some vital signs.  As our study moved forward this past week, I was able to do their clinical assessments under the not-so-watchful eye of a physician.  The East African language I do know – Kiswahili – is helpful in some parts of Uganda, but not used in the slightest in bustling Kampala.  It’s frustrating not to be able to help with the tedious consent process, or initial assessments, but the few Luganda words I have picked up at least bring smiles to all.  The responsibilities given to myself and my three industrious, Type-A medical student colleagues are not quite enough to keep us busy, and we all find ourselves with ample time for side projects.  We were able to get in a day and a half of clinic observations in which I may have learned more than my entire first year of medical school – before we were asked by hospital administration to pay hefty fees to observe in clinic, and flatly refused.  Still, I have found that working in this part of the world requires infinite ounces of patience, and a willingness to accept that nothing will ever go quite as planned.  I take joy in the priceless experiences along the way - writing this on a Sunday after a joyful worship service filled with jumping, dancing, and jubilant screams.

The people closest to me know that one day, I hope to practice medicine in the developing world in some capacity.  I don’t know what my career, or my life, will look like in 10 years, but experiences like these continue to help me distill the world around me, and realize how much more I have to learn.  Thanks for reading and sharing in this exciting journey!

My classmates and I on a recent trip white-water rafting down the Nile
...with our sweet nurse friend we've attached ourselves to!

L-R: Gina, Brianna, myself, Emily, LaVana

References

Kharsany, Ayesha B.M., and Quarraisha A. Karim. "HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities." The Open AIDS Journal 10.1 (2016): 34-48. Web.

Mildmay Uganda Annual Report 2016. Rep. Kampala: 2016. Print.

Waiting on the Sunny Spells

One final exam squeezed unceremoniously between a late Friday lunch downtown and a class bar crawl– my first year of medical school came to a rather abrupt end.  Since the late July day in which my classmates and I were first draped with our white coats – a day of intermittent sunny spells mixed with rainstorms – my year had likewise been filled with brighter days and grayer days.

Here are a few themes that pervaded my year, for better or for worse:

Futility

On many days, long hours at the library often turned fruitless for me, as I would find my attention drifting away from the scores of Powerpoint slides in front of me, and to the people moving on the streets below.  I had entered medical school from two years of what I saw as immense personal growth.  I felt that, during my service, while I was constantly challenged in new ways by longstanding traditions, by difficult situations, and by the natural elements, that I was using my time and talents to serve those around me, and to better myself.  I remember being resilient and positive when faced with the impossible.  However, during medical school, I found myself thinking increasingly negatively about myself and the world around me.  I longed to feel like a contributing member of society again.  I found myself feeling increasingly distant from my coursework and my classmates – partly because I craved much more than the cycle of cramming for the weekly exams and hitting the bars afterward that many of my classmates were wedded to.  On some days, I dreamed about my days coaching sports on the field under the African sun and holding Chemistry review under the shadow of Mount Kilimanjaro – and how heavily this reality contrasted with the stark white hallways of the hospital.  I was not sure that a career in an academic institution was one that would bring me fulfillment.  Honestly, I am still not sure, but know that I will continue to think about this as I progress through my career.

Fulfillment

At the same time that my time in the library felt futile, rare moments brought me back to the reason I chose this profession in the first place.  A patient in the student-run free clinic who left me with a tight, long hug after her appointment said that she could tell I was “all in,” and it was the best moment of my week.  Our interview that day led us through her medical concerns and deep into her psychological needs, and a nursing student and I were able to get her the help she needed.  Moments like these sustained me on days when I spent dawn to dusk at the med school.     

 Anxiety

At multiple points during the year, anxiety rocked me to my core.  I remember during my very first exam, my heart began beating like a bass drum as I opened the exam, the words blurring in and out of focus on hazy yellow pastel background until I pressed the “Submit” button and surprised myself with a respectable grade.  Often, my stomach turned would turn to knots on the day of an exam, and I had to slip outside to walk off breaths that had become shallow and labored inside the tightly thermoregulated air of our library. 

In March, one exam that I had dreaded for a full month, solely because of the dozens of students before me who had failed it, pushed me to what I felt was my breaking point.  Anxiety hit me in full force, and I couldn’t rid myself of it.  I had obtained permission to take the exam up to two days later as I worked through this stressful episode, but as the exam day drew closer, I found little breathing room.  Prayer, yoga, running – all of these helped for a while – but as soon as I sat down again at my desk to study, the anxiety returned.  I began to see the rest of medical school as merely a series of increasingly stressful exams, and became convinced that I was not cut out to deal with the stress that lay ahead.  Every time I sat at a computer and tried to study, I would instead find myself searching online for “ jobs with Peace Corps” or “NGO openings in Detroit.”  It seemed like I welcomed any escape from my current reality.  My school counselor – bless her – got to know me far too well during this week, and offered words of encouragement and understanding that helped me through the process.  It became clear to me that I needed a break from school – and luckily, one refreshing night of going home and spending a relaxing night with my parents was enough to give me the courage to go back to school and take my exam – and ended up passing the sequence, to my immense relief.  Anxiety is a very real part of medical school that I will continue to work through.

Fear of Failure

Those who knew me before medical school might have trouble believing how pervasive the fear of failure became for me.  Before medical school, I’ll admit that most things in life came easier to me than they did to others.  I was blessed with a lot of talent, and I found that a little bit of hard work could place me at the top of anything I set my mind to.  Medical school was different.  For the first time in my life, I did not excel.  Sometimes, fear of imminent failure paralyzed me with fear such that I was unable to study – like in the episode I had in March.  One recent moment of growth when I was finally able to leave behind my fear of failure.  I went in to a difficult exam sure of impending failure, and was ready to calmly accept a failing grade if it was my rate.  I had not studied at my best that week, yet surprised myself with the knowledge that I had absorbed, with a grade that I was happy with.  At the tail end of the year, this became a lesson to leave fear of failure behind, to trust in myself, and above all to trust in God.

Mentorship

As I watched the gray hairs multiply on my head, I held onto one thing that kept me young – mentoring youth.  Through the Doctors of Tomorrow program, I met and mentored young people from the famous Cass Tech High School in Detroit.  I had my feet in all arms of the program – the ninth-graders working through their adjustment to high school, upperclassmen nervous for their SATs, and even college students at U of M!  One of my favorite parts of this program was guiding young people to grow and become independent thinkers.  My ninth-grade capstone group, who constantly kept me laughing by eagerly doing my silly  “Mama Jamila”  cheer, ran into a few roadblocks in their project with a Detroit shelter and outreach center for women.  At one meeting, just a month before we were supposed to have the final results of our outreach project, I delivered the news to them that their “cute clothes drive” wouldn’t be possible.  They were dismayed only for a minute, and then we rolled up our sleeves and brainstormed.  “What unique challenges do girls face?”  In just a few minutes, they brainstormed an intervention to raise awareness about menstruation, and collect menstrual products for the shelter.  They mobilized their resources, divided tasks, and one month later had filled five large boxes with pads, tampons, and new underwear, and had collected over $350 in donations!  Thinking about these students, and the courage with which the faced challenges in their lives, helped me to deal with a year that challenged me in so many unexpected ways.

Strained Relationships

During my first year of medical school, I missed every single important family event, being unable to travel across the country for graduations, birthdays, and anniversaries of my extended family.  I felt out of my element without this strong connection to family, and felt less-than-adequate about my ability to devote time to my family.  With my parents, I was able to talk to them frequently enough, but felt unable to explain everything that I was going through.  With friends, I felt that there were few with whom I could share my true feelings, so I placed most of my relationships on the back burner.  A few close friends remained on my speed dial, and we were part of each others’ lives on walks home and in hushed tones at night.  My rapid transition from Peace Corps to medical school didn’t leave me with enough time to catch up with all of my old friends.  I didn’t know how to go about re-forming connections when it had been more than two years since our last encounter – how could I say it all in a text message?  It would take hours and hours to catch up with a phone call or Facetime – how could I afford that?  Pondering these silly questions took days, which turned to weeks, and then months.  Where do I pick up from here? (Actual question)

Love

My family, who had gotten used to evolving relationships throughout my service and my return back to the U.S., were not able to completely understand my feelings – but were well used to this feeling.  However, their overwhelming love and support strengthened me in my weakest moments.

I got into a new relationship beginning in October of my M1 year.  Dating someone who shares my Indian heritage and Christian faith has been a first for me – and has made things easy and familiar from the start.  He is good to my parents and has helped me to grow in faith in my weak moments.  He gives me tough love when I need to stop complaining and tells me bluntly to grind my teeth until I finish my work.  He will drive a two-hour round trip to Ann Arbor to have a weekday picnic lunch in between classes.  While he is wonderful to me in every way, I found myself getting frustrated with petty issues, and realized in horror that I was turning into the crazy girlfriend that I promised I would never be.  Maybe it's an artifact of being in a relationship during a time that is metamorphosing me.  Since my realization, I've tried to leave the crazy behind (really!) with communication and understanding.  Working to speak the same love language has taken time and patience, but this process has taught me much about love during my M1 year. 

This year was a year of exploring parts of myself that I never knew of.  At times, I knew that I wasn’t being my “best self.”  I was hard on myself for it, but learned that I needed the little things – morning runs in the cool mist off the Huron river, the smell of onions and garlic simmering on my stove, or 10 minutes of prayer at night – to stay sane.  Luckily, after ever gray day this year came a sunny spell.  Ahead of me is a summer of travel, new experiences, and time to rest, reflect, and gear up for the year ahead.

Insomnia

After publishing my previous post, closing my computer, and falling into bed, I woke up in the middle of the night with some additional thoughts.

My service cannot be described simply as a 2-year stint.

I often get asked the question, “How was your trip?” 

And I have NO idea how to respond, because this "trip" was an indescribable journey and provided me with perspective that continues to change through the lens of my current experience.  All in all, my service still continues to affect me because my life has become integrally tied to the lives of the people I lived among.  They continue to be a fundamental part of my life – through constant facebook messages and whatsapp calls, often more frequent than my own parents’ messages!

It can be difficult deciding where to draw the line with whom to help out back in Tanzania.  A few months ago, I sent an amount equivalent to less than a month’s rent to help a dear friend finish school.  And I wasn’t sure I did the right thing.  Peace Corps and most development organizations prohibit volunteers from giving free handouts.  In the long run, yes, this kind of aid is unsustainable and doesn’t do a lick to promote development.  Regardless, almost all volunteers give these kind of handouts at some point because we aren’t stoic warriors of peace – we are emotional, compassionate human beings with a strong desire to make an impact.

Similarly, while in the midst of a challenging unit studying kidney function in medical school, I saw the clinical correlates in my Tanzanian community.  Two of my dearest friends had a father and a husband, respectively, battling end stage renal disease.  On a visit to the dialysis clinic here at the University of Michigan – a tertiary care center – I saw how treatment of this disease is incredibly painful and difficult even in a heavily-resourced, state-of-the-art facility.  How are my friends coping in Tanzania, where access to healthcare is a different story altogether?  One of my friends requested materials that are readily accessible here – a catheter insertion set, an extension, an adapter – that would greatly improve his father’s quality of life.  How can I get them to him?  How can I do so in a sustainable manner?  Conversely, how can I stoop so low to move such a life-threatening matter to the back burner as my life here takes over?

These are a few examples of the battles I face as a place my service in the context of my current experience.  I will continue to think about these questions as my life continues to intertwine and cross paths with my sisters and brothers across the Atlantic.

1492

This week marks six months – six months! – since I left the steep, winding red road, the humble homes scattered among waxy green banana fields, and the rushing streams of Uswaa, Tanzania.  Six months since my best friends lovingly wrapped my belongings into a suitcase, and closed the door of my home behind me for the final time.  Six months since we sat in the fading glow of the African sunset, waiting on the step for rickety school truck to pull up – our beloved driver, again, was late because he was selling chickens to the villagers – and begin the dreaded journey to Kilimanjaro International Airport.

Six months have passed since this day, and they have not been my most gracious days.  Still, those six months have been spent with the uncommon luxuries of doing laundry by machine, pizza at my beck and call, and seeing my family whenever I please.  Former volunteers speak of the challenges of readjustment after service.  What they don’t tell you is that Columbus discovered the New World in 1492, but rediscovering America is a mission for each returning American to do alone.  My readjustment process, save for two-and-a-half strangely quiet weeks spent at home, has been spent exclusively in medical school.  School began for me before I could properly unpack my bag, and on most days leaves me without time to process and reflect the readjustment process.  In a rare hour of assembling my thoughts, here is a collection of the 10 things that I miss most, and how rediscovering them in America could transform all of our lives in baby steps:

1.     Incessant knocking

A photo a friend shared yesterday - arriving home
from a day of teaching to a balcony full of girls waiting
for me at home.  What's to be done with them?
PC: Mary Gillis

·      The first three months in my village were strangely lonely for me -  while I worked to find my niche in the community.  Then, once Uswaa Village and my school realized I was willing to do anything I was qualified or preposterously unqualified for, there was a constant flood of humans knocking on my door.  My assignment in Peace Corps was to teach science subjects.  What did I spend most of my time teaching?  Football, netball, and morning yoga.  Computers, music, and art.  Energizers and silly songs.  Choir!  A village drama group.  Malaria, HIV, and first aid.  My living room became a place where painting, drawing, and dancing would take place on one side, and an impromptu meeting with a youth leader on the other.  I learned to always have a thermos full of the sweet, spiced milk chai that Tanzanians loved so much, and plates of sliced fruit and corn to pop for visitors who might drop by.

·      Some days, when I had 5 am visitors, I cursed them under my breath.  Let me elaborate.  In the U.S., when a visitor rings the doorbell, he might wait a minute before ringing it again, then take his leave.  In Tanzania, doorbells do not exist, and neither do the rules.  Visitors will come at all hours of the day, only knocking and calling louder if you don’t immediately answer.

So what do I miss about incessant knocking?  I miss knowing my neighbors.  Last week, I arrived home on a blustery, frozen evening, to remember that I had left my keys inside that morning.  My roommates weren’t home, nor were a few friends that I had in the area.  In our community here – clean, white condominiums skirting an impeccably-manicured, under-utilized courtyard – I couldn’t just knock on a random door and expect to be shown inside.

It occurred to me that I don’t know even know half of my neighbors, and I’d hardly feel comfortable knocking on their doors.  Something to think about, reflect on, and make conscious changes about.

2.     Sunday afternoons

·      In Uswaa, there is no day like Sunday.  Morning services start in the morning at the various churches – and the villagers trickle into the pews for the next two hours or so.  Clapping, song, and dance are heard from all sides of the mountain, while goats, chickens, and other goods donated to the weekly auction join in the celebration.  In the afternoon, when services conclude, women in their parrot-hued dresses, men in their shiny, bright dress shirts, and children who seem to have already lost their shoes head back for the most awaited time of the week – Sunday afternoon.

·      Sunday afternoon, for me, often meant that a village family would slaughter their fattest chicken because I was coming for lunch after church.  It meant receiving armloads of bananas, passion fruits, avocados, and greens on my path through the village.  It meant feeling in the truest sense what it means to “love your neighbor.”

If only, if only, a small part of these glorious Sunday afternoons could make its way back into our lives.

3.     “Manka”

·      “Manka,” is a fond nickname in Kichagga (the tribal language of the proud Wachagga people of Kilimanjaro) for the second-born girl in a family.  The second-born girl is particularly beloved in Chagga culture because she’s a little bit sweet, and a little bit sassy.  I had many, many nicknames throughout my Peace Corps service (not all of them favorable), but Manka was my favorite.  My closest friends in Tanzania called me “zaidi ya familia” – more than family.  During my two years in Uswaa, I felt not only accepted, but truly loved by these people.

Is it possible to feel such a deep sense of contentment within my community here?  Maybe with much-needed changes in the structure of our society.

4.     Evening hymns

·      Without a doubt, the family that I was closest to during my service was that of Rev. Okuli Nkya (who we fondly call Baba Ivan), his wife Aneth (Mama Ivan), and their innocent-looking but mischievious tykes, Ivan, Ester, and Dorcas.  The very first thing I did upon arriving to Uroki on September 19, 2014, was pray with Pastor Okuli, and it was the last thing I did upon leaving on July 7, 2016.  In between were so many beautiful memories of prayer services, choir events, and diocese events where he introduced me as his first daughter.  However, my favorite experiences were the time taken each night to sing simple hymns and worship together.  This family had a multitude of challenges, but never failed to end each day with praise and thanksgiving.

I often think that if every family ended their day in a similar way, fewer families in the world would be broken, and fewer people alienated from modern society.

5.     Chai, chai, chai

·      In Tanzania, chai is not so much a beverage as an institution.  Impossible is not a word that I like to use, but I truly believe it is impossible to find a Tanzanian who does not pause his or her routine mid-morning for a hot cup of chai and andazi (fried dough).  At my school, chai and porridge time was a staple of each school day – as was beginning the period after chai 45 minutes behind schedule.  As much as I insisted on gulping my chai to start my class on time (my students were assigned one push-up at the door for every minute they were late to class following chai), I did see the worth in these daily siestas.  In Tanzania, relationships are more important than the sum of efficiency, work ethic, and industry combined.  While progress is slow, discussions are paramount.  While solutions are difficult to come to, consensus is always the goal.

In our precision-oriented, goal-focused American world, it wouldn’t hurt every once in a while to truly listen to the ideas of one another and to come to consensus on something.  In short, chai is everything!

6.     “Alipo Bwana, yote yanawezekana”

·      This is a Swahili hymn that translates to, “Where God is, everything is possible.”  While I served as a schoolteacher during my service, I constantly found teachers in the most unlikely places – my beloved “Babu” on his deathbed, a girl younger than me with a baby on her breast, and a chatty mama on the long walk to the market.  My students taught me SO many practical skills – how to scrub the dirt out of my socks, the life-changing power of fried green bananas, and the hippest Swahili slang. A majority of my students had overcome far greater challenges in their few years on Earth than myself.  The most important lesson they taught me was placing one’s trust in God.  One particular girl, Jenipher, comes to mind when I think of this.  She came from an extremely loving family, but faced challenges too vast to get into here.  Still, much like the biblical Job, her faith never wavered.  I could see this in her fervent prayers, and in the passion in her voice when she poured her heart into a hymn.

True trust in God, or in any higher power that one might believe in, is something that I rarely see demonstrated in my American life.  I believe that a return of this unwavering trust could truly transform society.

7.     Running hugs

·      Whenever I arrived home, whether from a week-long trip to a training, or from a 4-minute run to the nearby shop, my little friends – Ester and Dorcas – came running from wherever they were to greet me with long-lasting hugs.  After all, “safari ni safari” (a trip is a trip), and coming home is a wonderful feeling.  In Tanzania, it is impossible to come home to a dark or empty house – home is the center of society.  It is where life happens – even weddings can happen completely inside a home!

Another running hug from my mini-me!
PC: Rob Neda

Here, where coming back to the condo means coming back to leaky faucets and stopped-up drains rather than the people one comes home to, a daily reminder to reverse this thinking is welcome.

8.     “Utundu”

·      This is not a world with a simple translation (Swahili is such an expressive and emotional language that translation is HARD!).  Google translate came up with precocity, and that will work for now.   Being baby-faced, young to boot, petite, and a woman put me at a disadvantage for gaining respect throughout my service.  However, a little bit of utundu was how I worked my magic.  During the second year of my service, I finally became tired of being muted by men.  I began to assert myself, and this is the day when change happened.  I started a vital dialogue about the need for a girls’ bathroom at our school and about the realities of dealing with menstruation when bathroom breaks were prohibited by a grown man wielding a tree branch.  I began educating my community about the dangers of their rampant antibiotic use.  I began to be respected in the village for my knowledge of treatment of simple ailments.  And, most importantly, I demonstrated to my girls that a good woman can have a voice and still be respected in society.

This courage to defy the status quo is something I wish that each and every one of us has the opportunity to do in our lives.

9.     Waiting for the daladala

·      Transportation was another challenge of my service, and the best option was often taking the daladala.  The daladala, a minibus outfitted to cram about 25 people in it, including a risky driver and a shady “konda” (conductor), is a surprisingly efficient mode of transit in East Africa.  In Uswaa, daladalas were available every Tuesday and Saturday – market days.  Waiting for the daladala could be an ordeal of 45 seconds or 2 hours – it was either luck of the draw or a statistics game too complicated for me to decode.  I often started hiking, and got lucky if a passing bus (or truck of bananas) had an extra seat (or space above the bananas).  And, I’d find that the mamas who had told me to wait patiently with them rather than beginning the walk, were usually on the same bus.

Often, good things come to those who wait.  We often feel that opportunities that pass us by are the end of a road.  May we all have the grace to patiently wait.  The next daladala, the next big break, could be rolling down the hill as we speak.

10.  I have no idea what’s going on, but I’ll go with it

·      I saved this as the last one, because luckily, it’s still true currently.  During my service, I perfected the art of accepting strange situations.  Funerals spent wrapped head-to-toe in swaths of fabric under the blazing sun.  Accepting that a child urinating on me on the daladala was truly a “blessing.”  Realizing that I was often the gossip of the entire village.  Agreeing to teach seminars in Swahili, and subsequently making one-letter grammar errors causing widespread eruptions of laughter.  My two years of service was an experiment in my flexibility and adaptability.  It made most days exceedingly awkward, but I learned the most from always saying, “Yes!” and expanding my skill set each day.  Many days, I fell flat on my face with apparent failure.  (One day, I literally slipped flat on my butt in the mud in the middle of an inter-school netball and football tournament, in which most of the village had turned out to watch.)  Still, I grew as a teacher, a mentor, and a human being from being unafraid to try new things.

Medical school is no different - I have no idea how to assimilate the sea of facts in my head and become something that resembles a physician.  Still, the only thing I can do is to go with it, knowing that I'll ease in with time.

Each day is a new chapter.  I wish that all of us would have the courage to trust ourselves, to place our feet, and to jump into the great unknown.