Sunday Morning ~ Johannesburg

January 27, 2019

Hi Everyone,

I’m back in Africa and it feels good. Even after fifteen hours in the air from Atlanta. Even after having my flight cancelled from Bar Harbor and having to jump in the car and race to Boston, catching my flight there with seven minutes to spare. Even after being cramped into the middle seat, the trip always seems so worth it. I haven’t gotten to Malawi yet as the plane arrived too late yesterday in Johannesburg to make the Malawi connection, which meant a night to adjust to this time zone and hemisphere and get my blog written. All good so far. Now I’ll just have to deal with the internet or lack thereof. We landed here yesterday amid a show of lightening, thunder, and pouring rain. I caught the shuttle to my hotel and immediately went to the gym to run on a treadmill hoping to alleviate the bloating that goes along with having my feet dangling for a whole day. I watched the storm spectacle out the gym window on the fourth floor, a perfect location with the hazy city lights below it all.

The trip came together well, though the approval was only two weeks before and the departure date dependent on a talk I was doing at our library in Bar Harbor.  The original flight had me leaving Bar Harbor Thursday but I said I couldn’t because of this talk which had been planned, advertised, and set for Thursday night. The weather in Maine that day was dramatic: pouring rain that turned icy and 60 mph winds that made me ever so glad those trees had been taken down at my house. I was sure no one would venture out that night to hear my talk, but then I thought if only two people came that’d be fine with me; I’ll tell this story to anyone who will listen. But a lot of people came! I was stunned as I saw people enter dressed in full foul weather gear having walked through that tempest! Wow! That’s dedication! 

I was actually a little nervous when I started, something I haven’t felt in a long time. I knew most, if not all, of the people there, and was a little worried my message wouldn’t be engaging enough, given all that’s going on in our country right now. The women’s march we’d had on Saturday put forth so many critical issues, I was hoping this would live up to that kind of urgency. In the end it all melded together. Women’s plights around the world are not all that much different. And though I could only refer to three of them, Malawi, Congo, and the USA, there are lots of similarities.

At the end of our contracts in June we had a close of service physical exam. Any health issues resulting from our service are the responsibility of Peace Corps so they are identified before we leave. I’d been very healthy for the two years aside from the diarrheal episodes that are expected and transient. But at the exam in June, they found some blood in my urine that wasn’t associated with any infection. A month later it was still there and it was mildly concerning, cancer being the potential creepy monster, but a parasite being more likely. I took the treatment for the parasite, and was given a voucher to have it followed up when I got home. In September, it was still there. Damn! I was sure the treatment for Schistosomiasis would have taken care of it. So then I got a little more nervous, not because I thought I was going to die from bladder cancer, but because if that’s what it was, I’d probably need surgery. I got a referral for a urology consult. I waited a month for them to call me with an appointment but never heard from them. I followed up and they finally scheduled me to see the urologist three months later. Three months. I thought, ok, I guess they aren’t too worried that this might be cancer. I was distracted with training for the marathon anyway and went into denial. I felt fine. I felt great, in fact. George was worried about going away in case it was something serious, but I really wasn’t. That said, I did want cancer ruled out, again, not because I was worried about dying, but didn’t relish the thought of having an organ removed and a bag attached. Not how I saw myself. I always said I’d never do chemo but started wondering if that opinion would change if I were really faced with it.

My much anticipated consultation arrived on a snowy day in December and George and I trekked up to Bangor for the appointment. I’d received a lengthy questionnaire in the mail about my health history and had sent that back immediately, thinking someone would have actually read it by the time I arrived. After all, they’d had nine weeks to do that. I checked in at the reception desk and was asked to sign a black pad on the outside of the window, consenting to care. Just a blank black pad. I said, “Excuse me, what am I signing here?” The receptionist replied, “A consent to care.” as if I should have already known that. I asked if I could see what I was signing and she turned the computer screen toward me and it had a signature page with a sentence at the top I couldn’t read and for some reason I was afraid to ask for a closer look. She seemed annoyed I was asking. I asked, “Am I the only one who asks to see that?” She didn’t answer and I signed the black pad even though I didn’t want to. I thought, how strange this is. I am a health professional and I am afraid to question a practice here because I’m afraid to be labeled a problem patient before I even get seen. I let it go. Well, not really, but I went and sat down to read a TIME magazine.

I was called in and my vital signs were taken by a medical assistant who was looking at a computer screen while she asked me my name and date of birth and if I had any allergies. Then she told me the chair was going to rise up to get my weight. I was wearing boots and layers of weather-appropriate clothes, was holding my jacket with keys in the pocket, and was being weighed? With all that? I asked if I was supposed to wear all the same clothes when I came back for my follow up visit? She didn’t laugh. I’m not even sure she got my point. I thought of my students in Malawi and how I emphasized getting an accurate weight on patients. I thought of how appalled I was when midwives there didn’t take an accurate weight seriously. And then I thought, I waited three months for this.

Well, it turns out the specialist, who I waited three months to see, was in surgery that day and I would see her nurse practitioner, who was very nice. She asked me all the same questions I had answered on the questionnaire I’d filled out nine weeks before, and because she was so nice, I didn’t ask sarcastically if she’d read it. I kept thinking, “Three months for this.” Then she nicely told me she’d have to ask the doctor about my case and since she wasn’t in the office that day, she’d ask her the next day and get back to me. I said,”You are kidding me! I waited three months for this appointment and my own nurse practitioner at home could have done the same thing. She could have called the doctor and asked what the next step was!” This, of course, flustered her and she told me she’d call me right away and I’d be first on a cancellation list to get in to see the elusive specialist. I said, “I’ve already been on that list and I waited three months and I thought I was seeing her!” By the way the blood was still there and I asked about the possibility of cancer. She wasn’t sure, but told me if it was cancer, this particular doctor doesn’t care for cancer patients and I’d have to be referred to someone down the hall. This, I thought incredulously, is our great, expensive medical system? The system that is always worried about getting sued and blames patients for that? Medical providers need to be patients once in awhile just to experience this.

I left, steaming, and thought I would never go back to that office. I’d call my friends and get a decent referral, then I realized this was demonstrating incredible privilege. I know people who work in various specialties and could get some strings pulled and I was ashamed that I was actually thinking of using it. 

The urologist called me the next day, obviously having been briefed about my discontent, and was incredibly defensive and condescending. She told me there was no control over the amount of time I had to wait for the appointment (fair, maybe) and she was the most qualified person to care for me. I said that was fine, but she wasn’t caring for me was she? I hadn’t seen her. I had two approved visits and one was already spent and I was no further along in the process of diagnosing the problem. She softened a tad. She declared that because I’d been living overseas it was most likely a parasitic problem (which I’d told her I’d already treated), and I’d need a CT scan and a cystoscopy. I already figured that, standard, and could have done those months ago. I said I could get the CT scan done at my own hospital, and she said she wasn’t comfortable with that. I asked, “Why?” She said it was because she wanted to see very specific findings and was more comfortable with me having it done at her facility. She’d get me in within a few weeks. I said, “No. I will have it done in Bar Harbor. They are quite capable of doing the procedure and sending you the results.” She reluctantly agreed to that, with a “Now. Are you going to cooperate? Should we proceed with this?” Scolding tone. Bitch. 

Why is this so difficult? I may have gone in there with an attitude, but I can’t tolerate the idea that women don’t deserve respect or even consideration, that women should be grateful anyone is even giving her time for their very expensive care, that they should put up and shut up, that if they question anything that seems a bit off, well how dare they? 

It was another three months before I could get an appointment for the cystoscopy with this arrogant provider. I would have gone to someone else, but found out it would not have been covered under the previously approved agreement with Peace Corps. So much for choices. (I tell you, if I hear anyone criticize universal health care because of how long you have to wait to see a specialist, I will lose my shit.) I sucked it up and subjected myself to more attitude. I tried to be open about it and evaluated whether my own attitude was the problem. And I guess it is if I am to be  critical of expensive care that is demeaning and inappropriate. The problem is that most women don’t speak up. Those who do are a problem. It’s another form of suppression and control of a vulnerable population. If you are worried you have cancer, you are being silly since the great and powerful specialist (who hasn’t even seen you) doesn’t think so. And in some perverted way, I found that reassuring.

There was a cancellation and I got in this past week for the cystoscopy. Again I was asked to sign the black pad. This time I asked for a printed copy of what I was signing. It was a two page document with tiny writing. I thought of the paper in Malawi that women are asked to sign before surgery that says, “I give permission for the doctor to do an operation on my body.” and how shocking I thought that was. How it gives permission for about anything and is a farce. And I looked at the consent form in front of me that most people sign and never see, that requires at least a secondary school education or higher to understand, and think, there is no difference here.

A very sweet medical assistant explained the procedure to me very thoroughly. She then handed me a consent form to sign saying the procedure had been explained to me. There was a blank for the name of the person explaining the procedure. I started to fill in her name. She said, “No, the doctor will put her name there.” I said, “But you are the one who explained the procedure to me.” and continued to sign my name. Well. The doctor came in, not pleased with me, took the form, crossed out the medical assistant’s name and asked me to initial where she crossed it out. She looked at me, very 1984ish, and said, “I am the one explaining the procedure.” I said, “Fine.” and then she continued on without explaining anything. Whoa. That was creepy. She filled in I don’t know what on the computer screen, put on non-sterile gloves, picked up the scope and started to proceed. I said, “Wait, isn’t that supposed to be sterile?” And with exasperation looked at me and said, “Look, you know, I don’t HAVE to do this.” I said, “I know you don’t, but I need it done and I have the right to ask.” I felt like asking her infection rate, but honestly, just wanted to get it done and out of there and was tired of being treated like a fly to be swatted. This is such crap. I thought of all the times patients of mine related stories like this one. I always told them to write a letter. Providers get away with this kind of behavior because they don’t get called on it. But few women do write. They don’t want to anger a provider they may depend on for care, so tolerate being treated badly. And, yes, it does seem futile, but still, if I’m going to encourage women to speak up, then I have to do the same. But it is intimidating. I am intimidated. And I was not in pain and I know what my rights are, and still, I felt bullied into accepting to be treated in a disrespectful way. Not ok. I’m starting by writing here, but it will go to some administrator as soon as I can find one. I’ll be curious to see if I get a satisfaction survey from that office.

I asked for a copy of the consent form I signed. They gave it to me, but warily. I can feel them on the defensive. I wondered how bullied the staff there feels? If she treats her patients this way, how does she treat her employees? 

Ok, my rant is done. I’m off to catch my flight to Malawi.

Love to all,

Linda

Sunday Morning ~  Home Ec Lessons

January 20, 2019

It was junior high and home ec was not optional. The boys took shop and the girls took home ec with Mrs. Burke. She wore boring skirts and sweaters and seemed to have very little job satisfaction. We started in September with cooking and we learned to measure exact volumes of ingredients resulting in uninspiring products. I remember the day we learned to bake a potato (seriously!) and Kathy forgot to turn the oven on. We went to test for doneness and found the potato still hard as a rock. By then class was over so we didn’t get to eat it and I remember being mad at Kathy thinking it would certainly affect our grade. This is the problem with working in groups. I think I overreacted. It may have been our first fight. 

In the spring we moved on to sewing. I’d been sewing Barbie clothes as well as my own for a few years before I got to seventh grade and didn’t like having to go back to basics. Measuring out darts and making aprons bored me and I wanted to show off how much I could already do. I wanted to get it done quickly and I was reprimanded for not following the appropriate sequence of steps. It was excruciating. And, adding insult to injury, my showmanship was punished with a poor grade and I couldn’t even blame Kathy for that. Instead, I blamed Mrs Burke for being so unreasonable. I’d heard my aunt tell my mother that I was going to do well in home ec because I already knew how to sew! I remember being proud and was looking forward to finally being good at something. Well, I didn’t do well in home ec. I hated measuring stuff and hated pinning darts. I had my own system and Burke was cramping my style. She told us we were the worst class she’d ever had, the same praise she heaped on other classes. Honestly, how any of us came away with any shred of creativity after that was miraculous. The gym bag we made was too small for our gym stuff. Poor design, though the lime green and pink print I’d picked out was pretty. I wonder what ever happened to that bag? It’d probably be quite trendy now, for a lunch or something. Not for the big sneakers, white socks, and kelly green jumpsuit we had to wear for gym. Good God. The crosses we had to bear. And all that was before the sexual harassment and discrimination to come! This was intro to Inferiority Complex 101. 

My school chums and I spent a lot of time talking about all this over the past few days. It’s our annual school girls reunion weekend, our tenth. That means our classmate Mike has been gone for ten years. Hard to believe. We appreciate how he brought us together and toast to him each year. You’d think we’d run out of things to talk about after ten years, but there’s no end to the reminiscing. Each year brings new stories and revelations and now that our memories are fading we can tell them over and over and still find them hilarious! We just crack ourselves up.  

On Saturday we made signs for the women’s march in Bar Harbor, (a bit slapdash since we were rushed after lingering over coffee and more storytelling), then stomped our feet with others in solidarity on the village green. Young and not-so-young women inspired us before we came home to thaw out and eat again before we got down to chores. Three volunteered for kitchen clean up and five of us ventured into the woods to get branches for kindling and fill the wood boxes. A storm was coming and we wanted to be sure we had enough firewood for a full day of cozying. We all work so well together. I turned from the load of wood I’d just deposited and saw everyone hauling and stacking and working together like a well oiled machine. I remarked about how seamless this all seemed and wondered if it was because we all took home ec together? I remarked that maybe we should consider living together in a small village when we are old, infirm widows. We could share chores and keep each other company. We do it so well. There were exclamations of “Yes! I’ve always thought that would be neat!” Then one said with the utmost sincerity, “As long as everyone knows I can do pee and poop but not blood or broken bones.” 

By Sunday morning it was snowing hard and though I had every intention of getting this blog done by afternoon, the Prosecco we drank at brunch and the two coffee and Bailey’s that followed sent that intention down the freezing drain. The snow and ice kept up all day and the fire we lit at seven in the morning burned until midnight and we never even got dressed. We looked though old photos of escapades that we would have forbade our children to even consider and shivered as we considered what could have happened. We are so lucky to be alive. We went through the yearbook and wondered what happened to classmates and teachers. We wondered how different our lives would be if we had computers and iPhones back then. What if bullying wasn’t tolerated? What if those who got pregnant weren’t sent away? Would we be sitting here, cherishing our friendship, filling in missing details of weddings and boyfriends, singing our alma mater and marveling that we remember the words? We acknowledged all we were grateful for: decent wine, micro fibers, warm pajamas, jewelry we love, forgiveness for dumb things we did that hurt each other. We could put off shoveling until we felt like it, we could meet next year in Puerto Rico, we could dance to oldies if we wanted, and we did. We drank lemon water and tea all afternoon and remarked how this must be some sign of getting old. In years past that would have been a sign of weakness. The girls remarked that I’d furnished the bathrooms with better quality toilet paper than usual and though I could have taken credit for that, I had to admit it was George who’s upgraded that department and stocked up before he left. Some of them had even brought their own, knowing what their previous experience was here. Such sweethearts. I love these women. We’ve held each other up, kept each other safe, held each other’s hands while we laughed, cried into strong shoulders over a cheating boyfriend or husband, been there when our parents died, or husbands, or classmates. We’ve believed in each other and celebrated our various talents, which, despite our high school experience, managed to stay lit until there was enough oxygen to fan the flame. 

Sunday Morning ~ Boosts

January 13, 2019

Hi Everyone,

I’ve kind of put my life on hold for the year hoping to be able to go back to Malawi to push this midwifery ward a little further toward the goal post. I believe in this. I have a fantasy that it will take hold and be a model for all over the world. I said exactly that when I was presenting it to a class of interior design students at Jefferson University in Philadelphia this week. I started out saying it is a model that could easily be replicated, and someone asked, “Where? Africa?” I said, “The World!” at which point there was a little twittering about my delusion of grandeur. But it could! It should!

I’ve been waiting to hear about returning to Blantyre and was getting very discouraged about it’s chances of becoming reality. It seems our country’s plight right now is overshadowing everything that could be done to improve life on a global stage. I was starting to lose hope and steam. As I was driving to the University with my friend on Friday morning I said, “I woke up this morning thinking, ‘What the fuck am I doing?’ I’m not getting a salary running around the country pitching this. I’m having fun, but at some point I need to get a little compensation to pay my bills and see something tangible come out of it. I was starting to think I should just go find a job and say I tried. I was also feeling like the energy surrounding the book had run it’s course and maybe I should think of some other place to set my focus. 

Then I had a conference call that was productive and encouraging. I AM going back to Blantyre for two weeks and will see what we can get accomplished as far as writing up policies and procedures, finding a project manager who will be responsible for making the wheels turn, and set some goals for the rest of the year. It was a little booster shot. Then I met with the students and got a huge injection of boost. Their response to the project about picked me up out of my seat. It’s thrilling for me to see a new generation of responsible citizens who want to use their talents and energy for the good of mankind. I felt totally energized again. I am going to give this everything I’ve got and reevaluate after this trip. Two weeks away! Yikes! It’s so often like this, wait wait wait, then hurry up and go!

I left Philadelphia and headed toward Reading, Pennsylvania where a book group consisting of four couples read my book and invited me to come to their discussion. Another booster shot was waiting for me there! It makes me so happy to hear someone say, “I felt like I knew all these people by the end of your book. I cared about what happened to them.” That is the absolute pinnacle of what I’d hoped for. The book group consisted of people in all walks of life, varied professions, both male and female, and had similar feelings about reading it. A couple of them said they could see it as a movie, which, of course, I’ve already mentally cast. I’ve got my dress picked out for the academy awards (the author gets a ticket, right?), and I’ll finally meet Meryl Streep when she plays me!  Ok, let me reel this in a bit, and think of a few more ways to get book groups to read it and recommend it to others. Back to earth.

My hosts were over the top with hospitality: introducing me to people, showing me the surroundings, taking me on two hikes and one run, a wine tasting, dancing, dinner in a castle, and great conversations. I’m exhausted! For me there is much more reward in all this than money or fame…but I’d still like Oprah to get her chops into it.

Now I’ve got to get my shit together to be ready to head out in two weeks. Packing should be pretty simple, hopefully the weather cooperates so my little plane leaves Bar Harbor on time, then back to a place that pulls at me, though I have some trepidation about “you can’t go home again” syndrome. I’ll try to be realistic, try to achieve some goals, try to help midwifery take one more step up the mountain, and pray that women’s lives improve because of it. I’m giving it a try. It feels right. Plus, I can’t wait to see my colleagues again! I love those women!

And in the meantime, I’ve got lots of women friend energy coming my way this week and I’m going to soak up every bit of it. 

Love to all,

Linda

Sunday Morning ~ Epiphany Sunday

January 6, 2019

Hi Everyone,

Epiphany. Revelation. Twelfth night. I love the way that sounds. Shakespearean. Another holiday, a celebration, a remembrance of three kings arriving across a desert to honor a hopeful future and promise of redemption. I think of the story in a literal sense and acknowledge this probably did not happen exactly as the story is told, but I love the symbolism. I love the idea that a star guided people of means on an honorable mission. They brought gold as the symbol of majesty, frankincense for spirituality, and myrrh as it was used in embalming the dead–– probably a useful gift at the time.

Epiphany Sunday for me is the day to take down the tree and put away most of the decorations. I scrolled around the internet to see what special customs were common around the world for this day and I came across one I rather like. In Ireland, Epiphany Sunday is known as “Women’s Christmas” where women get the day off and men do all the housework and cooking. They might gather together in a pub and have a meal with friends and drink wine. (Ok, for lots of us that’s like…Thursday, but I like it being official.) I’m not sure how old this tradition is or how it started, but it seems very fitting this week.

Women’s Christmas strikes a chord as this week feels so much like the best Christmas ever. Our first woman governor was sworn into office at a ceremony that took my breath away. I sat at my kitchen table, painting my Christmas cards, focused on chickadees and pine boughs, listening to the event on the radio. As the announcers were describing the scene I started trembling and had to see it. I ran for my phone and figured out how to watch it live (such a modern miracle!). I liked listening to the radio description, so muted the video and listened to them describe what I was watching. (I thought of my father who used to do this with the Celtics games because he hated the TV announcers.) My heart was racing with, what can only be described as, joy.  Alone in my kitchen, I actually stood up and cheered. I squelched the feelings of envy I had for those who’d been invited to the event, but felt a wonderful bond with those who were posting about watching at home and expressing the same emotions I felt. This is Maine! A fairly homogenous state, and the celebration seemed as diverse and inclusive as possible! I was overwhelmed with pride and excitement. My state! Hooray! It gives me such pleasure to be proud of my state again. Eight years of apologizing for our governor is behind us! Hope for the future! This light seems even brighter because the eight-year tunnel we’ve been living in was so dark. Please God let this be a sign of the future for the country. Two young immigrant girls sang to the absolute heavens “This Girl is on Fire”. It just doesn’t get better than that. 

My women’s writing group met here yesterday. I feel like the house is being rechristened with their energy. It felt wonderful, like a Women’s Christmas. The living room was a bit crowded, especially with the tree still up, but I wanted to leave it, the hot colorful bulbs warm up the room and make it feel even cozier. Dear George made sure all the firewood was split before he left so I have ample atmosphere and as we sat, and wrote, and read aloud, I reflected on the bond I have with these women. We’ve gotten to know each other mostly through our writing and reading. Some of it raw and painful, much of it funny, lots of it full of simple detail that comes out as poetry when read aloud. One of the group had been invited to the governor’s inaugural celebration the previous night. I was green with envy, hanging on her every word. She wrote of the event and the feeling of being part of such a joyful celebration. She described the outfits, the music, the smile on Janet Mill’s face, the dancing, the camaraderie. I feel like we’re entering the age of reason and we all have a chance to be a part of it. It feels like a lingering sickness is starting to resolve: the cough is diminishing, the breaths are a little easier to take, and the fever is gone. It’s like when you know you’re still sick, but have turned the corner and can see now you really are going to get better. You couldn’t see it before, but as you improve each day you get more and more sure you’ll be right as rain again. Patience. Good food, plenty of fluids, moderate exercise, and soon you’ll be running again. That’s what this feels like. 

So, Happy Women’s Christmas, everyone! The Irish really have so many good ideas!

Love to all,

Linda