Laughter is eternity
If joy is real

- U2

I was pretty worried that Micah was not going to make it. When I first saw him in the AMPATH HIV clinic, he was one of those children who made me angry about the injustice of one little body bearing so many burdens. Cerebral palsy and HIV and a reactivation of chicken pox infection that was crippling one of his eyes.  To make matters worse (if you can imagine worse), his father had died a few months before and his mother was having a terrible time scraping together enough food for her family of three to eat. Micah’s already-burdened body was frail and weak because he was lucky to get one meal a day.

Micah’s little body exposed the limits of what we can do. We cannot take away his HIV or his cerebral palsy. We cannot restore his sight in that eye. And, of course, we cannot bring back his father. I hate all of that.

But we fight within our limits: Medicines to make his virus sleep.  Therapy to help him get closer and closer to walking. Food rations to let him and his family grow strong enough that his mother could return to work and he could sleep without an aching belly.

Even when we bang against our limits with angry fists, there is beauty if you look for it.

When I dropped by Micah’s house this weekend for a visit, my eyes filled with tears as he hugged me with a big smile and managed to say, “Daktari Rachel!” A neighbor in their shanty compound was playing loud lingala music, and Micah laughed and laughed and laughed as I danced him around the yard.

Joy.

Housemate, from other room: That is not what you want to hear from the kitchen.

Me: That is what I always say in the kitchen!

….. a few minutes later….

Me, looking with concern at the stove top and my eggs: Wow, that is a lot of flames!

Housemate: That is REALLY what you do not want to hear from the kitchen.

Me: That is what I always say in the kitchen!

Most of the children who I saw in the pediatric HIV clinic today came with their parents or with the adults who have stepped into the hole left by the death of the children’s parents. Two came all by themselves.

Two solo adolescents, a 13-year-old and a 14-year-old, navigating the trip to clinic — the waiting to see the doctor, the questions and exam, the trip for a chest x-ray, the waiting for prescriptions — all by themselves. In many ways, they were quite similar to each other. Both have been infected with HIV since birth. Both have lost their mothers in the last year to this same virus. Both have been taking the medicines to keep HIV at bay in their bodies for about 5 years.

And yet, they were so different.

Worry.

Simon has not been told that he has HIV. Although he is entrusted with the responsibility of walking for almost an hour to get to the clinic all by himself, he is not entrusted with this secret. And Simon is full of worry. When I ask him how he is, the first time he says he is fine except for his cough. But when I ask him a second time, after we have talked about the challenge of remembering to take his medicines every day, he tells me that his “mind is sometimes full of worries.”

“What are you worried about?” I ask softly. And he replies that he is worried that something is wrong with him and that he worries about the death of his mother. Without his father or another guardian to give me permission to talk with him freely about HIV, I cannot do what he wants, what he needs. I cannot tell him what it is that is wrong. I cannot talk about his absent mother, palpably missing from the chair next to him.

I try to reassure him that the medicines are keeping his body strong, that he is healthy and that he can continue to be healthy and strong if he takes the medicines. I tell him that his body is catching up after a spell last fall where he was quite sick. I tell him how sorry I am that his mother is not here. I tell him that I am planning to see him graduate from high school in four years and that he will need to make good plans for what he wants to do next. I tell him as much as I can without what he really needs – disclosure that he has HIV and frank discussion about what that means.

Simon leaves the clinic with his worries.

Confidence.

Sylvia knows that she has HIV. She was told last year by her mother, with the help of one of the nurses in the clinic. When I ask her more about it, she confesses that she suspected for some time that she had the virus, and that it was a relief to finally hear the words from her mother.

Her mother told her only a week before she died from this same virus. Naturally, Sylvia worried that she would die too. She has a grandmother, though, who gathered up Sylvia in the midst of her grief and whispered to her the words that she needed.

“You will live. You must have hope. You are strong.” Whispers of love. Whispers that healed a broken heart. Sylvia realized that, with the medicines, she is indeed strong. “With these medicines, I will live.” She said.

Sylvia is in Form One, the equivalent of being a freshman in high school. When I asked her what she wanted to do after high school, she answered confidently, “I will go to university.” Not, I want to go, but I WILL go.

“You will,” I told her with a smile. “We will keep you healthy.”

Sylvia walks to the lab to get her blood drawn with her head held high and a smile still on her face.

My team and I are putting in many, many hours to train disclosure counselors for the clinics, to develop useful materials for counseling, and to follow and support families through this process of disclosure to their children. Simon and Sylvia remind me exactly why we need to do this. Worry vs. Confidence.

Doctor V in the HIV clinic this morning, as photographed by a cute 8-year-old who was very keen on using my phone.

It is a lovely morning. The sun is shining. I am at a pediatric HIV clinic in a tiny town called Webuye that is in western Kenya on the bumpy highway that leads west to Uganda.

I am in Webuye, and I am locked in the latrine. Yes, in the latrine.

I have been working in Kenya for half of the year since 2006, and my toileting habits have adjusted themselves accordingly. I no longer expect toilet seats or toilet paper as I rarely find those things in Kenya. I have learned to squat. I always carry my own tissue. I know how to hold my long skirts so as to prevent unfortunate accidents.

And I can use the bathroom anywhere. I will use a pit behind someone’s tiny mud house. I can pee in the bushes along the road (although I did get my hair massively tangled in thorns while peeing in the bushes last week – so much so that I almost had to call my machine-gun-totting armed guards to come free me.) And, I will go into the most slimy, dark latrine.

But now, I am locked in one of those.

The floor is slippery and dark with substances that I would rather not put a name too. Mosquitoes are swarming slowly out of the hole in the floor. There is no light in a latrine like this, but the rickety wooden walls leave enough gaps that the sunshine peeks in just enough to get a sense for where the important things in the latrine are (namely, the hole.) Someone locked the outside door, and I am left banging on the slimy door and calling for help. (I do not know the precise Swahili words for “I am locked in the latrine”, but my desperate cries translated well enough.)

You would think this would be the toilet story that makes me long for the US. You would think that being locked in the nasty latrine rises to the top when I think about toilet frustrations in this country. But you would be wrong.

Being stuck inside with the mosquitoes and the stinky, dark filth may be my grossest toilet story from Kenya, but somehow it goes with the territory. (Says the girl who has been locked in bathrooms in Kenya before — not to mention locked in and out of her house in various states of dress and undress.)

What I hate the most, what I have not been able to adjust to, what makes me long for the glorious public restrooms of America with their ample supplies of soft toilet paper and their non-broken toilet seats, is being locked OUT of the bathrooms in Kenya.

That’s right, locked out. Oh, what I would give to be able to walk right into the bathrooms of Kenya…. The latrines, the toilets — even the toilets in the hospital and in the clinic building where I work — are always locked. The keys are hidden away with a select and powerful group of people that I am generally unable to identify.  The urge to use the toilet (which happens often because of my small bladder highly efficient kidneys) is followed by an increasingly desperate search for someone, somewhere with a key to the bathroom. The frustration of not having easy access to the bathroom just down the hall from my office is a frustration to which I have not been able to resign myself. For SEVEN years I have worked in this place without easy access to the bathroom.

Yesterday was one of my most exciting days at work, not because of the children’s lives saved (although I do love that), but because, at long last, I GOT MY OWN KEY TO THE BATHROOM. I cannot tell you how this brightened my entire outlook on life. Ridiculous, but true.

I can use the bathroom whenever I want! No more combing the halls for an unlocked toilet on a different floor! No desperate search for someone, somewhere with the magical power! No more begging! I will probably be traveling to Eldoret from miles away just so I can use this toilet that I can unlock WHENEVER I WANT. (Can you tell how excited I am?) Very excited. This may be the most capital letters I have ever used in a blog post.

But here is the thing that would make me even more excited: I wish I could give every girl in the world her own key to a toilet.

The truth is, safe and accessible toilet facilities keep girls in school. Girls who stay in school are significantly healthier and they have dramatically more possibilities open to them. They have fewer babies and their babies are much more likely to live and to grow. Education is one of the most effective weapons against poverty and for economic empowerment. Girls who stay in school can change the world.

But girls need toilets to stay in school. Seriously. In many parts of the world, girls stay home from school every day that they are menstruating — several days a month — because their schools do not have hygienic, private latrines where they can change and clean themselves. When girls miss that much school, they often stop going altogether. In India, almost a quarter of girls drop out of school when they reach puberty, and this is one of the reasons. Girls may not need an actual toilet, but they do need bathroom facilities!

Now that I do not have mounting rage and frustration every time I am attempting to access the bathroom in my building, I’m going to try to channel some part of that energy into this idea of bathrooms for the other girls of the world, the ones who need them much more than me. Here’s a start — the World Toilet Day petition to remind the world leaders of their commitments to sanitation Sign on behalf of all the girls locked out of (or inside) the latrine. Sign in shared celebration of access to the toilet.

Another idea? Make sure that girls have sanitary pads. Our Orphans and Vulnerable Children program does that, and it can make all the difference too. $15 is enough for what a girl needs for the entire year. Stay in school. Stay in school.

• Bask in bliss of first warm shower in 7 days. Attempt to warm hands and feet after another freezing-cold shower.
• Practice gratitude for running water.
• Apply hydrocortisone cream to eleven mosquito bites sustained during night.
• Take malaria prophylaxis.
• Curse wiliness of mosquitoes. Practice gratitude for malaria prophylaxis.
• Identify foul, biting insects identified in bedsheets on two occasions in middle of night. Convince self that said-creatures are not bed bugs.
• Avoid accidentally stepping on giant grasshoppers invading house.
• Related, start wearing socks around house.
• Investigate whether giant grasshopper invasion of house could be subverted for good to combat mosquito invasion specific to my bedroom.
• Attempt to remove laundry from clothesline before 3^rd day of rain-soaking.
• Look up how to remove lizard poop stains from clothing.
• Explore whether diversion of lizard from clothesline perch would be more effective against mosquito invasion than swarm of giant grasshoppers.
• Double-check whether lizard vs. giant grasshopper green zombie apocalypse has ever been documented in living situation. Also check whether any mosquitoes survived.
• Practice gratitude that snake, rat, bat, and slug invasions are all behind us.
• Learn how to make oatmeal without electricity. Eat delicious oatmeal chocolate chip cookie delivered by friend.
• Jumpstart housemate’s car without creating fiery inferno.
• Related, figure out how to determine which pole of car battery is which without any red/black or +/- markings.
• Practice gratitude for my functional car and for avoidance of death.
• Drive to hospital.

Morning To-Do List, Work-Related

• Add item: Practice gratitude for best job in the entire world.

Of course, the advantage to wild adventures through the hills and over the savannah is all the NEW stuff to do or see or try to sort out. (Who needs all that internet and hot shower stuff?)

6 novelties for the week:

1. The amazing toughness of my car. 24 hours of driving over 3 days. And only ONE HOUR of it on reasonable paved roads. Mud, rocks, broken paths, high grasses. My car can make it through everything! Here is how a guidebook describes one of the roads we spent a day on: “The main road is known as the Cherangani Highway, and is one of the most terrifying and challenging roads in Kenya.” Yep.

Our best road! (Nice mud)

A girl and her car in the bush.

2. How nice it is to sometimes ride in the car and not drive it. I have a great guy working for me this year, and he also thinks it is fun to drive in terrible conditions. How convenient! As much as I love my car, I also loved breathing in the mountains and the plains and the lack-of-roads in complete confidence from the passenger’s side of the car.

3. Armed escorts. I had to traverse a part of the country where two ethnic groups are in frequent conflict with each other and where armed bandits often attack solitary cars. So, I had to arrange for armed military or police escorts. Traveling with two men with machine guns in the car was quite a new experience.

I also never thought I would spend a lot of time with this view – bumping along a non-existent road with even more armed guards picking their way through the bush ahead of us.

4. Way off the grid. No phone reception. No email. No electricity. Driving or walking to the police station or to the clinic to figure out what was going on. I had no problems with this. At least for a few days.

5. Livestock of the hills. Living with your animals is the way of life for the families here. Goats and cows are your treasure, your children, your livelihood.

We couldn’t even find a restaurant without a goat inside of it!

6. The endlessly diverse beauty of this country. Over and over, it makes me gasp with its beauty. Misty mountains. Wild, thickly forested hills. Golden plains across the valley basins. Banks of clouds rolling across the savannah. A million stars dancing their way out each night. Deep breaths of beauty.

The road to Chulaimbo is bumpy, twisty, pocked with huge holes in the blacktop, and rolling up and down in a challenge to even the most motion-tough stomach. And in the rains, the unpaved portions become a slippery quicksand challenge.

The road is terrible, but the scenery is gorgeous. Green, green hills with bright red squares of farm plots.  Tea fields of the unparalleled glossy green.

Along the road, women walk with large woven baskets on their heads, mostly filled with bunches of bananas or freshly picked tea leaves. Anything can be carried on the head — plastic jerry cans of water, stacks of books. Once, I saw a woman and her daughter, both carrying large, athletic-style backpacks on their heads.

Beatrice is 12, and every day she walks for almost 30 minutes to get to the river where she collects water for herself and for her grandmother. She walks back with the water balanced on her head in a plastic basin.

Beatrice is a good walker; she walks almost 2 hours to come to the clinic all by herself each month. Beatrice lost her mother and her father to the HIV virus. Her grandmother, with whom she lives, is too frail to make the journey to the clinic with her.  Even though she is very small for a 12-year-old, Beatrice walks those two hours to the clinic each month, carrying a woven basket with her boxes of medicines, to see the doctors and to get more medicines.

On the days that Beatrice walks to the clinic, she cannot go to school.  She tells me that she loves school; she loves history and she loves reading.  They do not have any books in her house, but at school she gets to read books. Her eyes light up when she tells me about the new books her teacher purchased for her classroom this year.

Beatrice is a smart girl, who quietly takes responsibility for her medicines, for collecting water, for gathering firewood, for getting herself to school… for all the big and little tasks that make up her daily life. In the midst of all of her responsibility, I was horrified to learn that Beatrice has never been told why she takes the medicines. She doesn’t know what is making her sick. She does not know why she has to walk to the clinic each month – only that she needs these medicines to stay alive.

I think Beatrice must know her diagnosis on some level, but no one has ever explained it to her. No one has ever said, “You have HIV.” For this smart girl, who loves history and loves reading and who has lost both of her parents, I know we need to talk to her about her sickness. She has already made so much of the journey into adulthood on her on; we need to help her with the next big steps.

This week, we have put a counselor into Beatrice’s clinic, a disclosure counselor who can begin to explain her HIV infection to her – slowly, carefully and over as much time is needed.

I hope it will be a way to support Beatrice in her long walk.

Yes, Doctor V is heading back over the sea once again. And with just a few items….

One of my friends has a plan to create a book featuring the things we carry across the continents in our bags and trunks and the stories — of work, of friendship, of random insanity — that those items convey. I think it is an excellent idea.

I am sure I will accomplish some good work in Kenya as we get things up and running at 8 clinics to implement our major counseling effort around pediatric HIV disclosure. My main accomplishment, though, may be my delivery of everything the clinics need to make this project run — computers, portable DVD players, special medication bottles that record electronically whenever they are opened and more. Yes, that’s what is in those trunks.

To top off the pack horse insanity, I am carrying on a cooler filled with dry ice and chemo medicines for a friend’s dad who has cancer. How they love me at the security check points with my ice and my chemo and my strange devices for measuring medicines and my gazillion laptops.

See you in Kenya in about 30 hours.