Thursday, July 5, 2012

A recounting of an event

It's been a while since I wrote about any little reflections on living in Kenya - the challenges we've faced have made it difficult to separate out the causes for our heightened stress level and subsequently, it's been a challenge to differentiate how difficult Nairobi is vs how difficult other aspects of life are. It feels as if there is some change on the horizon, as the hecticness abates and we've given pause for reflection. This morning, as I was sitting in the back of a taxi holding my two babies (since our car, with carseats inside, is in the shop again; and there are no laws requiring children to be in seatbelts - absurd in a country where I've been told road accidents are the leading cause of death - above poverty, illness, and crime {doubly absurd if you consider 51% unemployment, one of the highest rates of malaria in the world, and security checks at the entrance to any major public place}), I looked out the window and thought  "oh, there's the Kenya I fell in love with as a child."

The sun was shining through the clouds, the air seemed fresher than usual, and people walked unassumingly past on their way to work, to home, to school, to nothing...I met a friend for a cup of delicious coffee at a coffee house with an amazing playground, and enjoyed the indie rock music playing in the background. Sometimes, Kenya is incredibly comfortable. Sometimes, Kenya is incredibly challenging. Always - Kenya surprises.

As I mentioned, the Handsome Man had surgery about a week ago. And I must recount our day at the hospital. Important foreward: we went to one of the less developed hospitals in the country for one reason: it is the hospital where the majority of American surgeons visit for weeks - months at a time. Subsequently, while the hospital services and staffing are not the best we could find, the quality of surgeons is much more reliable (and largely much more comfortable for us as Americans). While the human body is largely the same from culture to culture - communication styles and cultural norms differ just as widely in daily life as they do in approach to medicine. For example, we visited one orthopedic surgeon who looked at the Handsome Man's scans and said "this is massive...I mean, a lot of small problems which make this a massive problem", and then proposed to do surgery immediately, as in, within an hour. We spoke with a visiting American doctor who said "this isn't as bad as I expected, I can do surgery in two days so you just know it's taken care of - why don't you take a day and call me back, just let me know what you want to do. Can I take some more time and talk to you about your different options?" Never underestimate the importance of cultural competency in medicine.

Anyway - we arrived at the hospital early in the morning, before the staff had finished their devotions and the clouds were still clinging to the side of the mountain we were on. We arrived 20 min later than we had been told to, due to massive traffic, and surprisingly (in a culture where things often run more slowly) were chastised for being late. In less than 15 mins, the Handsome Man was rushed back to "theater" and I was left holding his shoes and wedding ring. I went to wait with a friend for the 1 hour surgery...45 min later I was asked to shuttle his x-rays from the waiting room to the surgery unit. I was then sent to admissions to pay a deposit for his operation.

When I arrived, the admissions clerk sent me to the cashier. The cashier asked how much I would pay for my deposit - confused, I said "well, don't you have a standard amount or a percentage of the estimated total cost?" He sent me back to admissions - the admissions clerk began throwing out numbers, close to $1000 (note - this would have to be paid in cash). Looking around me, it was immediately apparent I was the only white person in sight and that the majority of those in the room were working class or rural Kenyans. The fact that it was within the realm of reason for me to have that much cash on hand was brutally offensive - and I was offended by the lackadaisical manner in which the clerk threw out obscenely large numbers: "why don't you just pay a $1500 deposit? No? Ok, how about $1200? No, ok, how about $1000?" - as if health care was a bargaining event. In a not so shining moment of non-glory, I drew attention to my skin color and requested I be approached like everyone around me. He was offended, and after receiving a mini-lecture on "there being no discrimination in this place", I was allowed to pay a deposit half the amount of his proposed figures...I returned to waiting.

 2 hours later I had been told nothing. 3 hours later I just happened to encounter the doctor coming out of surgery, telling me all had gone well, my husband had never been put under general anesthesia, and should be able to go home in 1-2 hours.  1 1/2 hours later, when I inquired again, I was told my husband was just waking up and would need another hour to recover. I was also told I couldn't see him. An hour later, after inquiring again, I was sent to pay the remaining amount for his bill - I was told sit and wait for my name to be called.

While I was waiting, reading on a bench with ample space around me, an old woman came and sat down next to me. And by next to me, I mean, practically in my lap. Her weight leaned against me, and her arm rested on top of mine. She stared unabashedly at my book, then at my face, then at my book, then at my face. Still not satisfied, she gave me a once over - head to toe. And another. I refused to flinch. In a room of over 60 people, all watching (literally, because there was nothing else to do...), I refused to flinch, to look more different than I already was. Here's a truth of life - racism (defined in this context as "an assumption about a person based on their skin color") goes every direction - up, down, backwards, forwards, and inside out. And at that moment the room was full of it - and much of it was directed at me - it felt as is every person in the room was internally wondering "will she flinch? will she lose her temper? will she move away? she's gonna react - white people don't sit that close to each other." After about 5 minutes of scrutiny, my bench partner decided she was satisfied and settled back into her seat - about 1/2 an inch away from me.

25 minutes later, I went to the counter to inquire into my husband's bill. I had attempted waiting patiently, as I was told, trusting the system would work....the clerk found my husband's paperwork siting haphazardly in a nondescript corner; discarded by someone who decided it shouldn't have been where it was and moved it to where it shouldn't have been. After some quick calculations, I was told my balance -  it was less than $5. I paid. I was then sent to the opposite end of the hospital to collect an itemized receipt. The woman behind the counter practically glared at me (please keep in mind I was on the verge of a nervous breakdown, with my husband out of surgery but not allowed to see him, having endured the most difficult 6 months of my life which were culminating the most difficult 3 weeks of my life, which appeared to be culminating in one of the most emotionally difficult moments of my life), took the papers given to me by the cashier, and told me to wait. 20 min later, I approached the counter to inquire about my receipt - it was sitting on the counter and she hadn't called me....there were only 3 other people in the room. Amazed by the insurmountable passive aggressiveness I was facing, I collected my receipt and returned to the collect my husband from surgery (as I had been directed to do). The nurses questioned my paperwork, then accepted it.

I waited. In a room full of people reminding me how much I had to be grateful for - babies with breathing tubes down their preciously small noses, being clutched to their father's chest by an arm crippled by polio; a young man with a bandaged stump in place of a foot, followed by a line of relatives who looked so much like funeral mourners it forced the realization this man would no longer be able to provide for his family through the manual labor they all relied on; dozens of people crowding around, the sick and the well blurring together and the smell of the reality of the human race permeating the room. I counted my many eases in life repeatedly, and thought thanks.

After 15 minutes, the nurses told me my paper work was unacceptable and sent me back to the cashier, but assured me my husband would be ready "for collection" upon my return. I did as I was told and returned with the new paperwork. A brusque nurse informed me my husband was not ready. When I asked why, she told me was not recovering well and had begun vomiting (which I was later told by him was not true) - I could hear his voice down the hall but was not allowed to go see him. When I questioned whether he'd been given anything to eat or drink, she told me "you can do that when I release him" - I suggested he may feel ill because he hadn't eaten of drank anything since the night before. She assured me that wasn't the case...and stared me down. I questioned whether he was still connected to an IV, she assured me he was (which I was later told by the Handsome Man was not true)...and stared me down harder. I asked how long I should wait, in the room filled with heartache and silent faces, she told me 30 minutes. I wanted to demand to see my husband, to demand she give him something to eat or drink. And I knew if I demanded she would keep him longer, in this absurd power play I had no hope of winning.

So I fled. I admit it, I did. I walked out of the hospital as fast I could - past the hundreds of people. Waiting people. With little to do but watch the freckled, red-cheeked white woman hurry past - chin as high in the air as it could go, searching for anywhere to cry. Kenyans don't cry in public. Almost ever. I state this with confidence and 18 years of experience living here. And they don't know what to do when I do. So I fled. And I hid. And I cried. And I cried. And I cried. It was as if that nurse, in all her blatant aggression and lack of sympathy, embodied everything that has slowly beaten me to the ground over the past 6 months. The false information I'd been given, the desire to just take care of those I love in the way I thought best blocked by immoveable forces, the lack of response when I asked questions, the assumption I was being impertinent when I asked questions, and the bottom line of "you can fix it when we release it to you."

Waiting is perhaps the most difficult thing to do - it starts the minute we're born. We're hungry, we aren't fed, we have to wait, and we immediately begin screaming. And it continues through the rest of our adult lives - though most of us learn how to quiet the external screaming.

After a 20 minute cry I returned. My husband was released to me, almost falling over from being so faint and nauseous. Pale as a sheet. After 5 minutes and 2 glasses of water his color came back and the nausea left. We drove away from the hospital, satisfied with the quality of surgery, but starkly reminded of the fact we weren't anywhere close to Pasadena, CA, graham crackers, health insurance, or recovery rooms.

The Handsome Man is mending, and we feel encouraged things are on the edge of improving. I share this story mostly just to share it, because it seems like a good glimpse and another "moment worth sharing." What I walked away with was the reminder that I have options (defined here as "the ability to control external circumstances contributing to or detracting from one's quality of life") - and that is a humbling thought, and a privilege I don't think should be taken lightly. Of course, there are always aspects of life where we have no choice, but for many of us there are options (basically, if you're reading this you have access to a computer, know how to use the internet, and are literate - you have options). I was reminded I have options to health care, I have options to where I live, I have the option to work or to stay home with my babies, I have the option to eat out, I have the option to choose what I want for dinner, I have the option to vacation, I have the option to read, to go back to school - all of the things about Nairobi that are difficult? I have the option to leave - not that it would be the best or most mature option, but it's an option. The millions and millions of people in refugee camps? No option. The millions and millions of people living below the poverty line? Very few options. Kids with terrible parents? Almost no options. I have options.

So, while waiting is difficult, and while something about life will always be out of my control, and something (many things) will always be difficult - I have options. And, because I have the option to choose my response - I choose to be grateful, to see others suffering as a reminder to be grateful for my eases and to formulate a response to the inevitable presence of suffering - in my life and in the lives of others.

Happy choosing.

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