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Letters from Ann Evans, Old Fangak.New Year’s Eve in Old Fangak-2009 Twelve hours from the close of one year and the start of another—not usually a significant event in my life where the years are like a river that keeps flowing; and where I usually sleep through the magical mystical changing hour and date. Nor am I one to make a set of New Year’s resolutions, ones I’m confident I won’t keep anyway. This year I pause, reflecting on both the recent and more distant months, looking for new understandings, new meanings to life—a life to use, to enjoy, to waste, to give—so many options stretch out before us—can do some of each; all of some; none of others. Life in balance? How to strike that balance? The 2009 year started for me in Sand Point, Alaska, in the Aleutian Islands, working in an Alaska Native health care clinic. In November of 2008 the gloomy economic scene with plummeting stock prices and retirement accounts caused many to make drastic changes. My good fortune was to have a profession in which I could choose to work, and to have many options of where and for whom. For much of the year I travelled to new places in one of the most beautiful areas of the United States, areas that are not often visited, except by local people or seasonal fishing workers. Each place had its special beauty and appeal, also its challenges; each was interesting to explore; and it was a fully paid adventure! After Sand Point, there was Adak, Cold Bay, and Whittier, where a clinic is operated by Eastern Aleutian Tribes, even though it is not in the Aleutians. Earnest, sometimes desperate, pleas to provide medical coverage led to working more than I intended, more than I wanted. The result was less time with friends and family, and being home in Bethel. But, the BIG wake-up was a two-week period of time when I saw only a handful of patients, and asked myself why--why was I doing what I was doing? Why was I willing to accept a salary, be apart from friends and family, and provide so little to others? As important as it may be to have medical coverage available there, if needed, I couldn’t justify the expenditure of these days of my life; not now, not when there is so much need in the world, so many ways to give, if one can just find the right options. And not now, when time and circumstances allow me so many other choices. “What to do,” cry the morning doves. Where does one go when the destination is unclear? In 2007, immediately after retiring the first time, the ‘what to do’ question led me to the Physicians for Peace gathering in Virginia where brilliant, passionate, and actively engaged professionals spoke of the profoundly desperate situations in much of the developing world, a world where so many live on less than $3 a day, where starvation is common, where war leads to displaced persons and families, if they are lucky enough to survive the war. I had previously thought that some international volunteer work—few weeks a year-- in Central America, a reasonably close area, with some fine vacation options too, would be a good choice—serving others and serving self….. But as I listened to the speakers, I kept hearing about the needs of Africa. Africa hadn’t even been on my radar screen—so far away, so culturally different, so very under developed, so ‘not’ what I had in mind. At the conference I met a lovely woman from Project Hope. After we had talked for a while, she asked, “What would you like to do?” What a question! I had absolutely no idea, and no answer, except, “What do you need me to do?” The idea to ‘give back’ from my years of extensive and diverse studies and experience created more confusion than clarity. A surgeon can go do surgery; a teacher can teach; a nurse can nurse; but is there a way to weave nearly 50 years of education and experience together? Can a decent fabric be made by strands of practice as a nurse and a nurse practitioner, as a teacher, supervisor, director of education; a way to use public health training, policy analysis, and research skills; a way not to leave anything out that might be useful? Or was I still trying to make up for being kicked out of kindergarten? Without a clear answer, I took my usual route and went back to school; this time travelling to England to take a course on International Health Consultancy, put on by the Liverpool Associates in Tropical Health, an arm of the Liverpool School of Tropical Medicine. In the late months of 2008 and early months of 2009 I was short listed and waited for a decision on whether I would be added to a team to assess the health care system of Sudan—at the Federal, State, and District levels. In the final cut the appointment went to an African who had worked in the area—a reasonable decision and likely the right one. I was told it was a ‘difficult decision’, which was very kind, whether true or not true. Just before going to the Aleutians I received a call from Jill, from Sudan, asking if I could come help her, because she was alone and the NGO was no longer there. But I couldn’t come, because I was already committed. It was hard to say no to someone I respect so much and admire for her years of dedicated work, her well earned competency in tropical diseases, her courage to strike out on her own to treat TB in Sudan when others said it couldn’t be done, and because she is a very dear friend with a heart of gold and was asking for my help. The ‘no’ answer was heart breaking for me, and I vowed the next year would be different. This year, not wanting to get a plea for help when I couldn’t respond, I preempted that possibility by calling Jill in September, saying I had some time in January or February 2010; but Jill said, “I need you now.” I said January or February would be fine; Jill responded again with ‘now’. The decision wasn’t hard; if one really wants to help, one goes when and where the help is needed. I replied that I could travel after the funeral for my Father and Aunt, and after the family beach gathering with our two ‘children’, now grown of course. The earliest, even remotely possible, date to travel was October 15th. Jill said the 15th would be fine… so the family left the beach on October 15th and dropped me at the closest major airport that afternoon. By the 16th I was in Nairobi, en-route to Sudan. The original plan to do some teaching with the national staff was adjusted to respond to the surging epidemic of kala-azar and the greater need for clinical skills. Much of the rest of the year has been addressed in the previous letters, including a “Night Before Christmas” poem. With the new year-2010- arriving within hours, and my departure from Sudan in just 8 days, I am all but overwhelmed reflecting on these past few months. I reread my Old Fangak letters, refreshing my memory, that fails me with increasing frequency. I found descriptions of events and reflections, some funny, poignant, sad, revealing, educational, begging—quite a varied list. Today I received an update on the round-the-fire-pit-discussion that took place after I chose sleep as the better option last night. Part of the discussion centered on what purpose is served by being here? By providing treatment? A drop in an endless bucket? A waste of resources? The questioners are newly arrived youths, with hearts set on serving, but not here long enough yet to find their places to be of use or to receive the gifts that come through service; it may not even happen before they depart on Monday. And almost assuredly, they won’t experience the satisfaction of saving lives, the sense of shared humanity with patients—with parents who see you lovingly caring for their child, while looking so strikingly different from themselves. They will also miss the playfulness of the children, who moved past their fears of the fabled ‘white people who eat children’, and now find them playful and loving. They will miss the genuine depth of appreciation and acceptance from the national staff that find there is no job that we won’t do from picking up trash, to cleaning up incontinence, to carrying heavy weights, to holding the frightened, febrile, naked child, comforting them with song. They will miss the anxious question that I received, about whether I was leaving on the next flight, and the relieved reply that they hoped I would be here a long time. Yesterday evening, as patients gathered on the ground, waiting their turns to be seen, I heard a stressed cry from a baby and slipped in beside the mother to check the temperature, then pulled them out to do a malaria test; it was positive. In a short time the baby was appropriately treated and the grateful mother and baby were on their way home. Just a few months ago I couldn’t have provided that. What purpose has this journey served? This journey, unplanned by me, other than to respond to my friend’s plea and to hope to ‘make a difference’, without concern for weaving all the strands of education and experience into one grand fabric, one large bandage to apply—this has been a journey beyond expectation with rewards that fill and enrich my life, that will leave me processing for months to come, that give a reality to at least one village in Africa, a ‘knowing’ that transcends pictures and books, however scholarly or revealing. When the elections occur in Sudan next year I will be acutely interested, knowing the results can mean a more enduring peace, as tenuous as it has been; or mean more years of war in a country that is so much in need of peace. It means there will be faces and names to people who will be affected. Doesn’t that make a difference? Couldn’t we have more peace in the world if we knew the people as people, people like ourselves, all ‘made of one blood’, regardless of physical appearances? Isn’t every life a precious life? In addition, so many friends have travelled with me in spirit, relating their appreciation for the letters that provide glimpses into that experience and that open them to the opportunities to financially participate in saving lives. At this point we have admitted over 1100 kala-azar patients into treatment, more than 1000 of those since I arrived in late October; another 45 to 50 enter each week. More than 95% will survive this deadly disease, because we are here and you are there; each of us doing what we can do to help; please keep spreading the word, long after I’ve gone. In too few days I will be leaving here, to allow room for others to follow, to be of use, to make a difference, to find their places. I wish for them the great rewards that I have known, for I am quite confident I’ve received at least as much as I have given and probably more. For those who may be receiving one of these letters for the first time and want to know how to help in this wonderful and ongoing project: Make checks out to CCI with notation on the lower left line for the Sudan Medical Project and mail checks to: Consider using your on-line banking to make continuing donations on a monthly basis—such a painless way to keep the necessary funds available. We expats and administrative people in the US and abroad are volunteers who pay our own way so that 100% of donations go to support the project. Personally, I’ve never been happier knowing where my own donations are going and the difference they make. Want to know more? Go to crosscurrentsinstitute.org for information and a wonderful video that gives a great glimpse of Dr. Jill Seaman, whose heart is big and beautiful. Also, go to sudanmedicalproject.org for more information as well as previous letters. |
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