Tuesday, May 17, 2011

The Ugly Cry

18 days until we leave our home...
     The house is mostly packed and cleaned.  The children and I have had check-ups and shots.  The pets (three cats and a dog) have been freshly vaccinated and groomed.  The house has been readied for the renters (new shower, new deck, newly insulated walls).  We have saved as much money as we will be able to before leaving.  In truth, our family and our home have never been in better shape.  If nothing else, preparing for this adventure has helped us to get our acts together, at least temporarily.
     There are still some fairly overwhelming hurdles.  The three cats do not yet have foster homes (anyone? anyone?).  Malawi (our daughter) does not yet have US citizenship or a US passport, as the readoption process has, of course, taken much longer than we'd anticipated. We do not yet have a house to rent in Lilongwe.  Most significantly, I recently discovered that the children may not be able to attend the International school which I have been describing in romantic detail for them for the last few months.
I discovered this development a few days ago, when I finally received a response to one of the many e-mails I had been sending to the school since February.  I was politely informed that there is not sufficient space at this time, but we could certainly put our names on the waiting list. 
     Having read this e-mail on my i-phone in line at Starbucks, I had an immediate and uncontrollable emotional reaction, and began sobbing as I stood waiting for my Americano.  It was a visceral, hiccuping Ugly Cry, as humiliating as it was undeniable, and I could only nod apologetically at the Starbucks employee who warily handed me my bagel as tears streamed down my face.  It was the culmination of weeks of stress and anxiety, unleashed and unbidden. 
     My kids have been struggling as our departure date approaches, and I have comforted them as they faced leaving the things they love (school, friends, sports) by assuring them that the new school they will be attending has all that they are used to and more.  Poor little Aine was bereft at the idea that she could not advance in "Flip" (gymnastics) this autumn, and was only placated by the prospect of continuing Flip in Lilongwe.  Eamonn is a very shy child, who does not like having to make new friends, and the similarities between the International school and his current school gave us both peace and comfort that he would be able to transition gracefully.  Their attendance at Bishop Mackenzie was one of the foundations upon which we had been planning to build our new life, and their rejection felt like my emotional undoing.
That morning, after I wiped the snot off my face and gathered myself together, Dave and I skyped the director of the school and sent frantic e-mails with their records and application, as well as an imploring letter from me, begging them to accept my kids.  Now we wait.
     We have since discovered that, according to the experts at UNC whom Dave e-mailed, malaria is prevelant in Lilongwe, and the vast majority of the infections are with the most deadly form of the parasite, p.falciparum.  We were informed that we should strongly consider giving our children anti-malarial medicines for the duration of the year we are there.  We are therefore faced with the unenviable choice between trying to convince my three stubborn children (who think bubblegum flavored Tylenol is gross) to take a daily pill (which costs $7/day per person, for those of you who are good at math), and giving them a weekly pill that is known for causing hallucinogenic nightmares (I've had them.  They are horrible).
     Since that first Ugly Cry, I have had two more significant sobfests, including a second at Starbucks on my lunchbreak today.  (If I wasn't such a caffeine freak I might start avoiding the place).  I think my emotionality stems from fear, as much as the sadness I expected to feel about the move.  I am not afraid for myself.  I'm adaptable, I love to travel, and I am committed to our goal of working in the developing world.  I welcome the challenges and changes of our move. I am overwhelmed by angst and fear because it goes against every cell in my body as a mother to take my children away from their home, away from their safe, secure, familiar environment to one that is statistically more dangerous, completely foreign to them, and far away from the people they know and love.  I am so afraid that they will be scared, or lonely, or sick, and that I will have failed in my job to protect them and keep them from harm. 
Tonight while I cried over my Thai yellow curry,(for the third, and hopefully final, time of the day), Dave held my hand and told me to have faith.  He told me to remember my belief that if your motives are pure, and your intentions are good, then your success is certain. I never expected this to be easy, I just don't want it to be hard on them

Tuesday, April 12, 2011

Black Mamba

And still, the anxiety mounts.  Finally, FINALLY I have actually reached the level of anxiety ( No... not panic...not yet...) that has motivated me to attempt some of the tasks on the ever-expanding To Do list Dave and I have created.  For weeks we have spent date nights drinking wine and writing lists (well, we are usually drunk by the time we get to list-making, and realize we do not have a pen or paper, so the lists are often theoretical).  This last week when Dave suggested that we spend a romantic Saturday evening sitting at a bar with the computer making lists I broke down, suggesting testily that perhaps it was time to stop theorizing and planning and start DOING, as we have only 55 days until we have to be ready to leave the house. 
This forces me to confess that I have:
1. Begun counting down the days until we leave (which is harder than it sounds, as it involves counting backwards by 7's).
2. Become very testy lately about a lot of things.
I think that the testiness is because I have so many emotions, that sometimes it is simply overwhelming.  I asked the kids at the table the other day how they felt about our upcoming adventure, and Eamonn said "Happy, but sad", which I think really sums it up for me, too.  For weeks now in clinic I have had to say goodbye to families, give farewell hugs to children whom I have truly grown to love, and begin to unravel the tapestry that has intertwined my life with theirs.  Tonight, after a weekend of packing, I walked through the downstairs of our house and saw bare walls where family pictures had hung, saw boxes of belongings stacked neatly by the door, and felt a dizzying wave of unpreventable, inescapable, impending change.  The thought of taking my children away from their extended family (grandmas and grandpa, aunts, uncles, and cousins) breaks my heart.  I have truly been aware, almost constantly lately, of all that we will be leaving behind, all that I am giving up, and all that I am asking my children to give up. 
I'm not saying that I am bitter or resentful, and only sometimes am I even sad. Often I am excited.  There is a class at UNC on Malawian culture and language which Dave and I signed up for.  I went to my first class last week, and have been teaching the kids how to greet each other and ask someone's name in Chichewa.  We walk through the house bowing or curtsying to each other (as is the custom in Milawi) and saying "Moni!"  "Zikomo!"  I have been sneaking away to study in the morning sometimes, and am 200 pages into a manual on TB and HIV in kids in the developing world.  I am very worried about how much I am actually retaining, as much of it is completely foreign to anything I currently do or have done, but I am hopeful that some will stick, and looking forward to being trained in Houston in July by Baylor.
They say that every physician has a closetful of ghosts that they carry with them, and (spoiler alert) I'm about to share a particularly tragic one with you.  When we lived in Belize (some of you may remember my writings from that year, and may have already read about this) I took care of a little boy who ended up dying of malnutrition and dehydration after having a diarrheal illness.  In an effort to save him I had driven two hours into the village to try to help refeed him, as the parents refused to take him to the hospital (I did not entirely blame them, as it was often less safe to be hospitalized).  I returned to town only to learn about 36 hours later that the baby was dying in the hospital.  After a long, impossible attempt to resuscitate him and a longer voyage overnight to Belize city, he died.  I was faced with the task of driving his body back home in a tiny wooden coffin, sliding in the back of my pickup truck for 4 hours, with his bereft mother wailing in the arms of her husband, sobbing the child's name the entire way.  I am still tortured by the thought of all that I could have done differently.  This regret, which I have carried with me for years, is part of my motivation for reading and trying to educate myself.  I am so thrilled for the opportunity I will have to learn, and to be mentored, and to have knowledgeable colleagues.  Dave and I often felt very alone in Belize, and frequently faced situations where we felt unprepared and inadequate.  I do not want any new ghosts...
On the lighter side, I recently got up the courage to Google "snakes and malawi", and instantly regretted it.  It turns out to be the home of the deadliest and fastest snake in the world, the Black Mamba.  The bite of the Black Mamba injects enough venom to kill 144 men in an hour, and requires that anti-venom be administered within 20 minutes in order to prevent excruciating death.  Given that there is no Emergency Response team to speak of and given the scarcity of medical resources, I am fairly certain that a Black Mamba bite would mean certain demise.
 I often gauge my emotional response to new information by comparing it with Dave's.  Dave is, for the most part, a pretty level-headed guy.  If something stresses him out, then it is definitely something that I feel justified being terrified of.  After I shared my knowledge of the Black Mamba with Dave, he made the mistake of doing further Google searches, and discovered the story of an unfortunate gentleman who came across a Black Mamba in his dryer.  That night Dave had a horrible nightmare that the snakes were coming in every door and window, attacking him and our family. 
I have begun shopping fervently for all-weather knee-high boots for every member of our family.
I still haven't found the nerve to Google "bugs and Malawi".

Saturday, March 12, 2011

So much anxiety, so little time...

My obsession with our move continues.  My relentless thoughts range from the mundane (comparing the costs of airline flights) to the ridiculous (how will I get my eyebrows waxed in the middle of rural Africa??!?). Some details have been worked out, somewhat.
We have found a nanny!  Her name is Laura, and she is the daughter of a good friend of mine from the ED.  She is a college graduate, with a degree in Commuinty Health Education (which I am hoping will somehow translate to effective childcare skills), who is interested in living and working in Africa.  She is bright and enthusiastic, although she has not yet met my children, and for some reason she believes that living with my nutty family in a foreign country for approximately $2/hour is a great opportunity.  In fact, I have had to ask her to please stop saying "You don't even have to pay me", lest the prospect of free labor becomes overwhelming, and I have to take her up on it.
I have decided on the international school for the older two.  After looking at it more closely, it seems to have some hippy tendencies, and I am starting to feel a little more hopeful that it will be similar enough to what the kids are used to that it won't be a devestating change.  Plus, it has a pool.
I will have Laura stay home with Malawi, as she would only have a 5 hour day for her $10,000/year, and she is not even in Kindergarden yet.  I am hoping that we can rent a house in the neighborhood of the school, so that Laura can walk them there and back.  Their school day, unfortunately, begins at 7:15...in the morning. Considering that we already cannot get everyone to school by 8:15 without several large glasses of Diet Coke and multiple melt downs, this has me concerned, but I will deal with it as it comes up.
Dave has been unofficially offered a (paying!) job, which is exciting, but it has not yet been finalized, so I am waiting anxiously for that minor detail to be settled.
Preparing for the trip is beginning to feel surreal.  Even as the date approaches I feel as though time is not moving, as though I am in a dream where I am nearly paralyzed and trying so hard to move forward but cannot.  I have begun to study HIV in the morning before work or on the weekends, and already I feel that slow fury growing inside of me.  I look at pictures of children with wasted limbs or toddlers with open sores in their mouths or faces covered with warty lesions, and I am afraid.  Angry and afraid.  I go to work and play with clear-eyed cherubs and make sympathetic sounds about rashes I cannot see and imagine how soon I will be faced with dying children and have to say "I'm sorry" and "I can't" to their broken-hearted mothers. 
Every moment of my day I am aware of all that is about to change, and I have to force myself to live in the moment, to notice the beauty of the impending spring and see the joy in my children's faces.  I do not understand why I have been so lucky, and I feel a superstitious dread at even mentioning my gratitude for the gift that is my life.  It is so easy to forget that people are suffering needlessly.  It is so easy to become complacent or even to start to believe that the challenges that I face (high gas prices, dirty dishes in the sink, squabbling siblings) are worthy of complaint.  The average Malawian earns 80 cents per day. Per day.  The standard HIV medication combinations that children need to survive in the developing world do not exist. Why?  Because children in the rich countries (like ours) do not use them, so there is no profitable market, so the drug companies have not produced them. 
Soon I will be unable to forget the disparity, the inequity that, for whatever reason, exists in our world.  Soon I will try, to the best of my ability, to give thanks for all that I have been given by serving those who have nothing.  If I may quote Spiderman, "To whom much is given, much is expected."  I pray that I have strength of heart and courage.  I pray that I can help make childrens' lives better and bring peace to the families of those whom I cannot help.  I pray that my children are not afraid, and that they remain safe and strong.  And I pray, most of all, that there are not a lot of snakes or gross bugs.

Saturday, January 29, 2011

The Logistics

The logistics of moving a family of five halfway around the world are daunting, to say the least.  It requires months of lists and questions.  First, we worked on finding me a job, as I am the "weak link" of the two of us. David is an ID doctor with interest in HIV and TB coinfection, and I am a pediatrician, who has seen pediatric HIV twice.  Miraculously, I have been offered a position with the Texas Children's Hospital Pediatric Global Health Service Corps (say that ten times fast). Now, we are trying to find Dave work in Lilongwe. 
Financially, there are so many open questions to be answered that it is exremely frustrating trying to plan.  Will he find a job?  Will it be paid?  If so, how much?  What will our taxes be?  Will we be taxed at our current tax rate of nearly 40%?  How much does it cost to rent a house?  How much does it cost to send children to school (X three)?  How much does it cost to buy a car?  We have been told we may need 2!  How much does it cost to fly a family of five to Linlongwe, Malawi? (Answer to that one: About $10,000)
That's enough to keep me up nights, and then there's food...we are vegetarians, and live on veggie burgers and vegetarian chicken products and tofu and soymilk.  My middle child is a whisp of a thing, and here she has almost unlimited choice.  What in the world am I going to feed her?  I worry she will disappear, or that I will be reduced to submitting to her pleas for candy, in a desperate effort to get calories in her.  When we lived in Belize I made reasonable Seitan, and we were fortunate enough to have met Gomier, a tall, Bob-Marley-channeling gentleman from St. Lucia.  I was able to keep my kids from starving, but we ate an embarassing amount of Ramen soup.  Perhaps Lilongwe will have some magical vegetarian restaurant, but endless Google searches and hours pouring through guidebooks have not left me hopeful.
I have thought about trying to make soymilk, but I do not know if there are soybeans in Lilongwe.  I have begun to think like a refugee, overcome by my maternal drive to feed my children well. I find myself buying two of each of the items that we use every day that I do not  imagine we can survive without (quinoa, tvp), and mentally calculating how many pounds of high-protein whole wheat bread flour I can stuff into my 5 ft long duffle bag. The trouble is, we only get two bags, each weighing no more than 50 lbs, before we begin paying to bring things with us.  I have to admit, this fact has helped protect me from the fugue state that usually overtakes me the moment I walk into Target.  We already have way too much.
The shots we should be OK on, as we were vaccinated before we brought Malawi home from Ethiopia last year.  She has asthma, which seems to improve only when she takes Singulair, which has a $50 copay in the US, and I imagine is unavailable in Lilonwe.  So I am thinking of asking a drug rep to bring me a year's worth, or else I will be forced to take samples from our closet each week until we leave...
School for the children worries me. My kids are all at Montessori, which believes in "following the child", and working things out at "the peace table", and the schoolwide Spiral Dance, where everyone holds hands outside.  In Malawi it appears that we have two choices for international schools. One is a conservative Christian school.  It is regimented,  has required biblical courses, and (I'm pretty sure) lacks the Spiral Dance.  I have a very strong belief in God, but I am not Christian.  I really don't want to be the religious outcast in my own home, and I can't think of a more opposite approach to teaching from where he is now.   The second follows the Bristish curriculum (better, but definitely NOT Montessori), and is $10,000 per kid per year.  That is approximately my salary for the upcoming year. So we have considered homeschooling, but this is not realistic, as both of us will likely work full-time and more.
Another concern.  Here, I am part-time, and am available to tuck my kids into bed each night and bake chocolate-chip cookies and play Moose in the House (great game).  There I know I will feel compelled to work as much as possible, in order to do as much as I can.  And so I obsess that my children will suffer for our absence, alone in a  new and strange country.
So many worries, so little time...

The beginning (well, not really...)

And so I am beginning the process of telling our story.  Our story actually probably began about 15 years ago, when I first left the comfort of the Western world and travelled to India.  Anyone who knows me has heard me talk about the absolute hearbreak that I felt walking off the plane into the filth of Bombay airport, where I was greeted by a tiny boy, maybe 4 years old, alone and trying to sell me a newspaper at 4 am.  The bus ride into the city took my breath away.  I had never been so close to poverty.  Miles and miles of towns with houses made of cardboard or corrugated metal, groups of dirty children playing with old tires and mangy-looking dogs stretched on as far as I could see.  A seed was planted in my heart on that trip that has grown and developed into this need to try to make some difference, no matter how small.
Our year spent in Central America was an enlightening one.  Dave and I learned that our intentions were grandiose in the face of the reality of poverty.  The scope of what we were able to do was so pitifully small: buy groceries for one family, drive the baby with the anencephaly (missing brain) to the city and pay for the CT scan with our credit card, buy the coffin and transport the body of the toddler who had died of diarrhea.  I was often despondent, and felt so helpless and overwhelmed.
And here we are again, planning to go abroad to try to "help".  Mostly, I am afraid.
I am afraid of all that I will not be able to do.  I am afraid of looking into the eyes of another mama and telling her that I cannot  save her baby.  I am afraid of the anger and pain of the inequality that I will see, and of the gap that will grow between myself and my friends and family back home who are not faced daily with this inequity, and so do nothing. Having done this before, I harbor fewer illusions.
There is some excitement.  I love travel, and I am looking forward to exploring Malawi and the surrounding countries.  I love the challenge of trying to live without the "essentials" of home, and already walk around with long lists of things I need to start hoarding before we go (face cream, Melatonin, Reeses peanut butter cups).  I look forward to sharing more of this beautiful planet with my family, and to having the opportunity to plant the seed of service in their hearts. 
I will try to keep posts to let people know what we are seeing and feeling.  I hope that they are not depressing to people, but I hope that they are affecting.  I hope that more seeds will be planted, and I hope they grow.  Anyone can do what we are doing.  We are not special, just determined.