one day soon

one day soon

for shwe

one day soon
i would like
to lie in an open plain of grass
with you
and watch the open sky above

on that particular day
i would like
to do nothing but that.

in silence
with you next to me.

the clouds
full puffed up boats of gray
or
wisps of near disappear
make their way across the blue canvas

the yellow light whispers
sings loudly off key
stretches like a yawn
blue into sleepy yellow
at midday
then

slowly

birds chaperone
the light off to the west
orange
like
a fire in the hillside
a flame panting then
falling into a manageable
breath

each passing hour
subtle marking of time
until finally
light drips
off
the ledge of our viewing

darkness
like a blanket
pulled over a head

all of my days
going forward
(like we watch the sky)

i would
like to watch the
landscape of your face
as laugh lines form slowly at the corners of your lips
or
soft creases form at edges of your eyes
the marking
of the passing
of our time together.

ss
7/12/2010

burundi to sargur(rural karnataka)

burundi on top, rural karnataka below.

Eventually Burundi spills into Karnataka spills into Haiti which spills into so many places where people crouch next to roofs slightly higher than than their head and come out of the darkness into the Sun. A Sun that blares belligerent onto any forehead but can’t seem to get into the space inside the house. The house is for lizards or rainwater to drip in damp but not the sun. The deeper into the forest of southern Karnataka the more it looks like Sub Saharan Africa. There are a good amount of tribal folks here. In the hospital all the patients have a weather worn appearance. A spine that protrudes. Skin like it is slapped in between ribs like paper mache, skin like chappati dough roled too thin that a hole is going to emerge if stretched a centimeter more. The diseases are the same. The malnutrition is less here, especially among children. And there are far more doctors in India, but they are still overwhelmed.

I am currently in rural South India with a local NGO trying to support the organization by seeing patients and going into the field, connecting the social-economic impacts of health with classic biomedical treatment of diseases of poverty.

The thing I find impressive about this organization is that in a mortality conference when someone dies, they look at why they died, ie if all medical decisions were timely and appropriate. But they don’t stop there. They ask if a community health worker could have identified the 6 year old girl with malnourishment long before she developed disseminated TB. They look at potential government policies that are not being implemented and could be a source of intervention. The root cause, the root cause is the mantra. So simple, but so far different than most of us docs have been trained.

brecht and prof hayes

Strangely enough, I have been thinking alot about health care lately. I am out of school and finished with training next year and thinking about what I am going to do. I think most of in the doctor world are not agitators so many times there are very few mentors who are excellent physicians and at the same time asking hard questions about race and class and poverty and gender. And big money and pharma. I came across this poem that is so right on and obvious but strikes me as really profound because we don't really get trained to think on these terms. Check it out.

A Worker's Speech To A Doctor

We know what makes us ill.
When we are ill we are told
That it's you who will heal us.

For ten years, we are told
You learned healing in fine schools
Built at the people's expense
And to get your knowledge
Spent a fortune.
So you must be able to heal.

Are you able to heal?

When we come to you
Our rags are torn off us
And you listen all over our naked body.
As to the cause of our illness
One glance at our rags would
Tell you more. It is the same cause that wears out
Our bodies and our clothes.

The pain in our shoulder comes
You say, from the damp; and this is also the reason
For the stain on the wall of our flat.
So tell us:
Where does the damp come from?

Too much work and too little food
Makes us feeble and thin.
Your prescription says:
Put on more weight.
You might as well tell a bullrush
Not to get wet.

How much time can you give us?
We see: one carpet in your flat costs
The fees you earn from
Five thousand consultations.

You'll no doubt say
You are innocent. The damp patch
On the wall of our flat
Tells the same story.

- Bertolt Brecht

There is this prof at UC Berkeley, Dr. Tyrone Hayes who has studied a particular pesticide, atrazine and its effects on amphibians. And his findings have shown that a very small amount,(a smaller amount than is allowed to be in the water by the EPA) effects amphibians sex organs drastically. And he was attacked by the big pesticide company Syngenta who sells atrazine to farmers at a considerable profit. And he was villified. He is a black man tenured at 32 and an excellent scientist and he could not be bought. His work and story is testimony to the lenghths industry can go if your work, your science becomes a threat. http://www.mindfully.org/Pesticide/2003/Syngenta-Tyrone-Hayes31oct03.htm

And I wonder what would happen if doctors in addition to studying AICD's (Automatic Implantable Cardioverter Defibrillators) studied the damp. What would happen if we spoke out, in mass, about the damp? It dawned on me, so late in my training that evidence for what we do and why we do it as doctors is often based on who puts up the money.

and there is no money in studying the particular toxins that may be linked to black women and cancer, for example. There is no money in studying the damp, or treating the damp. But those who do, and there are some.. like Dr. Tyrone Hayes can maybe lead the way for us clinicians who have a ways to go.

on silence and medicine

At Vipassana:

I recently spent 10 days in silence. Absolute silence. With 30 other folks. no glances. no speaking. 12 hours of meditation a day. until your leg aches and your ability to be even minded is broken. I was a little scared to spend my short vactation in residency with hours rolled out long as a airplane runway. Waking up at 4 am. And I had just come off 80 some odd work weeks and dying people. The wards in a county hospital. Six of my patients had died over the last month and no emotion really came through until ten days of silence. It wasn't that I sobbed or broke down or anything but I realized at some level my absence of any emotion was not respectful of those lives. I got to thinking that maybe why the American health care system spends so much money on end of life care, is that most of us aren't very comfortable with death. And for someone to become DNR(do not resuscitate) has something to do with their world view and the way they see life and death.
And moving from death, there are so many things American medicine gets wrong or not quite right.
In those meditation hours I got pumped about Cure this. I want to feel after I leave a long day at the hospital and walk into Whole Foods(on those super bourgeois days) that the person behind the counter doesn't have more to do with health and healing than I do. All those startups in the tech world because of their littleness and creativity on the fringes can innovate and come up with new paradigm solutions for old problems. Or charter schools dealing with super low income kids and really breaking ground. What is possible on the fringes of medicine that can be creative and radical? Simple and successful. small or big
A new American medicine. Or international medicine. Can we organize off this website, brainstorm, redefine ourselves, our direction? What we came to the table for as doctors or nurses and what piece of the pie we expect as patients.

As JJ says:
Its on. you and me, the both of us. the all of us. We're on.
It was wierd how many things come up in 10 days of silence. One sit, I heard JJ's laugh clear as a bell. over and over. so many things stored up inside all of our heads.

baby boy born at dawn

the three of us traveling made a deal to come up with a poem by the end of the World Social Forum in Nairobi. still working on one inspired by the WSF but here is one from working in a rural clinic in tanzania. The mother died of AIDS and even though we got together money for formula for her five month old son, he died right before we left. Me and Monica saw the grandmother and grandson in clinic and payed the 7 dollars a week to get him along for a bit. he is pictured above. he was swimming in those shorts. We didn't even find out his name. A poem seems so useless but it was a long plane ride after finding out the son had died too.


On AIDS in Tanzania
(Loose emulation of JJ's "Focus in Real Time")


Something as simple as a pill in the palm of her hand

This Tanzanian woman
Sings as she breast feeds

They say it was the rain
But it was always my tears and sweat
Which brought up the maize

They said the railroads
Will bring a new day
But it was always diamonds going
with the sunset
The other way

And now she dies and is dying

Something as simple as a pill in the palm of her hand
This Tanzanian woman
Brilliant orange head wrap
Red African mud between her toes
Any pill
Anything close to healing
She does not hold in the palm of her hand.
her left breast sags in
the sun.
ribs exposed
continuum with the spine of her too large wooden chair
she resembles the chair
both of them frail
twigs
ready to snap

a pill
something as simple as a pill in the palm of her hand

her hands scathed
rough as maize husk

she dies and is dying
her 5 month old
baby boy born at dawn
suckles at her dry left breast

he suckles ashes from her left breast

something as simple as a pill in the palm of her hand

Who owns this pill?
What plant or human genome extract gave birth to it?
Who cut the compound, packaged
into compact cure?
In which boardroom, what lawyers patented it?
Blue suits and leather suitcases
tucking death into the space between fine print

Who keeps the cash?
Which markets rose while she fell?
Which corporate graph will track her demise?
Who will clench their fists one over the other as she opens her hand?

This Tanzanian woman
Her baby boy born at dawn

Who will began to ask for a moratorium on their death penalty?

Something as simple
as a pill in the palm of her hand

Who will join this standing up?
A reach to claim the pill
demand the pill
And place it in her hand
Something as simple
And good
As healing
A pill in the palm of her hand

Sri
2/10/07

from east africa:

in tanzania the children refer to their elders with the greeting "shikamoo." It means "I will hold your feet while you are shackled" or "may you not be beaten too severely" The kids say it lightly and with lots of energy. Most of the folks don't remember the literal meaning. Alot of Tanzania is like that, intensity and struggle which is so woven into everything that folks deal and smile and are so warm and keep going.

We were in a little town near Lake Victoria called Sota. A village. One red mud dirt road. Huts and Huts and people that make their lives outside and migrate inside only to sleep or fetch something. There is this doctor trained in the US that has lived there for 25 years- married a Tanzanian. She just opened a little clinic and our job was to try to survey the community. Try to hit up a thousand hut households, walking from house to house. We had a swahili translator nurse come with us. The kids in each house would set up little chairs for us to sit in and when we went to the next house they would pick up the wooden chairs and follow us. So many children curiously peering at us. We would get a list from the head of the household of everyone that lived in the house. Some men had up to 8 wives. And 16 kids with some of the wives. Most had 2 or 3 wives. And once you started getting the list of kids and 6 of 10 have died of malaria or 4 of 11 you realize this is where your medical school textbook is talking about when it says flippantly 1.5 million folks die of malaria each year.

The survey punched a bunch of holes into so many taken for granted kind of things. The water had schistosomiasis and families didn't boil their water. then you figured out that two days wage is the cost to boil water.

We organized a day for vaccines since so many of the kids don't have their vaccines up to date. All the mothers lined up, but the maternal-fetal health folks did not.

You realize that poor health is the outcome of poverty. They needed roads and jobs and clean water and then maybe we wouldn't see all the end results of the lack there of.

between a clinic and a well, you gotta choose a well. but of course there should not be that choice.

after working i went to climb kilimanjaro(which was amazing!!!) and headed to the world social forum in Nairobi and river rafting in uganda. it is amazing how the world is carved up by race as you go to the tourist things. Kili only had australians and white south africans and canadians and europeans and americans. the brown folks were immigrants from these rich countries and maybe some koreans and folks from japan.

Slowly, slowly i am trying to write to remember for myself and keep myself committed.



Sri
Sri

Sri

diagnosis

i read this women describe a potential devastating diagnosis like this:


it is either
a maniac with a knife
or the wind


David Jewell