Post-Int'l Health Project Musings

I just got back from a whirlwind trip to Chiapas to "finish up" a public health project I and three of my classmates at UCI "carried out" over the past six months in three Tzotzil communities. We were first there this past July, but for so many reasons, it was especially difficult to go back this time. We have our own collective blog.

We went to Chiapas to bring ecological stoves to 40 families in the highlands and to measure changes in pulmonary function (via spirometry) and air quality (via PM measurements) after 5 months of stove use. The project was messy in and of itself because that's how international health projects are. We went back to Chiapas to measure (hopefully) a reduction in particulate matter; however, we did not expect that open fires would be blazing all day long (worse than in the summer when we took pre-stove installment measurements) because of the cold season. Oops. We also could not have predicted vast political changes in Las Abejas, the civil society that we are partnering with to carry out the project. The social climate had changed dramatically, and it affected relationships among the health promoters, families and communities we worked with, as well as our relationship to all of them as outsiders.

Also troubling is the notion of us "executing" a "project". I hate it when people write in quotation marks as if the punctuation alone imbues your words with the hidden meaning you hope to convey. I hesitate to say we have finished our project because completing a finite project with a beginning, middle and end was never my intention. In fact, having done similar things in the past, that was exactly what I wanted to avoid. As a future public health professional (God willing), I'm looking to establish relationships and make lifelong investments in international health. I want to lay down roots. When I signed up for Chiapas, I saw that potential. Looking back on our interactions with the communities, however, I don't think we built relationships so much as we completed a study.

Why do I say that? Months ago, I would have said that we were doing a good job building the relationship with Las Abejas health promoters. We were building bridges, hanging particulate matter machines in homes, making stoves together, making people breathe into tubes over and over again...together. We went to a health promoter meeting to announce our arrival and plan, went to church to introduce ourselves to communities, dined with families, celebrated a local festival. We bathed with rainwater, used the latrine, ate twice a day, walked up and down mountains.

But we also called all the shots. We brought these mysterious machines and collected all the filters to take back to our fancy laboratory with our fancy weighing machine to run sophisticated statistical tests to come up with Significant Data to publish in a fancy journal that the health promoters and their families will never see or understand or care about, it's that irrelevant to their daily existence. If that is true, did we truly collaborate the way we set out to do? It was a big part of our project's self-image that we had community buy-in to ensure the sustainability of our project. True, it's a huge challenge to achieve true collaboration, but if we don't have that, then what do we have? Yes, we installed 40 stoves. But do they like them? Did they make a positive impact on their health? Their quality of life? Did we gain their trust in a way that makes future cooperation likely? My head is full of these questions.

Whether they use the stoves we installed or not is a fair, honest question that deserves our evaluation, and I think that we did justice to that problem by carrying out a follow-up study of past stove recipients (last year's UCI-Chiapas cohort also installed stoves in similar communities). Whether or not the stoves improve health outcomes is another fair question we have and are continuing to evaluate through our study. But whether or not we and the health promoters of Las Abejas (and the communities they represent) have invested in a truly collaborative relationship working toward the betterment of health and quality of life in the highlands of Chiapas is another question that I don't think we gave enough thought to. And in the long run, I think it's a far more important facet of our "project" than the simple delivery of 40 ecological stoves that may (or may not) improve respiratory health.

I was talking to John Rose, the founder of UCI's relationship with Las Abejas, on the way back to San Cristobal from the community one day when we thought of a way to really work on the collaborative relationship aspect of our project versus the service aspect. The service aspect is undoubtedly important, but it gets in the way of the collaboration and two-way learning, as it did in our case. When you're running around trying to get a spirometer donated to you, designing a study, writing grants and stretching money, worrying about how to pay for 40 stoves and endless other logistical details, it's hard to concentrate on the philosophy of health promotion, the rich history of indigenous rights and resistance in Chiapas, and the intricacies of binational communication as it applies to international public health projects. We need to strike a balance between service and learning.

What we came up with is an idea that may or may not end up happening: a series of workshops next summer in which students work with health promoters to design comprehensive projects addressing their top five or so community health concerns. They can learn how to define a health problem, write a grant, gather data, and present findings. We med students can learn how health promotion works and focus more on building relationships and communicating ideas. At the end of it, UCI med students will come out having had a fulfilling experience a) learning about how health promotion works in Chiapas, and b) having shared knowledge and know-how regarding how to go about convincing the people with the money to give you funding to carry out a health project. The health promoters will be invested, too, because they will pick the health problems that will be addressed in the workshops. At the end of it, they will have several of their biggest health concerns fleshed out in a language that funding organizations understand, and whether it is in collaboration with UCI or independently, they (or together, we?) will be primed and ready to present a convincing case to attract funds.

It's an exciting prospect. I only hope I can be a part of it next year, too. Because as much as I love stoves and my experience in Chiapas this year, the idea of investing further in our relationship excites me even more.

Happy holidays!

Prop 4: Abortion Waiting Period and Parental Notification Initiative

For those of you who haven't read up on the propositions yet, Proposition 4 is on the ballot this year in California.

The initiative prohibits abortion for unemancipated minors until 48 hours after physician notifies minor’s parent, legal guardian or, if parental abuse has been reported, an alternative adult family member.

It's also called "Sarah's Law" after a 13-year-old girl who passed away from a botched abortion after having a relationship with a 39-year-old sexual predator, Gary Cross. When she became pregnant, he took her to an abortion clinic and then resumed sexual relations with her, all without her parents' knowledge. Sarah's mom found out about the abortion after coming across related paperwork in her daughter's room.

Anti-Prop 4 arguments include the very realistic fear that more minors will opt for illegal and dangerous abortions. Communication between minors and their parents/guardians is never uncomplicated; teens probably fear that their parents would react irrationally and/or hurt them. Whether that fear is real or perceived, it affects a minor's behavior at such a crucial, traumatic moment. Another argument cited is that no law can mandate family communication; rather, it's something that has to come naturally. And what if it doesn't? Then take the lesser evil, because a safe abortion is better than an illegal one.

I am against abortion. I think it's killing an innocent being that was meant for life, if not for our intervention (ie, abortive procedure). Does this mean that I don't care about the poor minor in this traumatic situation?

Of course I care. But I think instead of figuring out ways to deal with the symptom of the problem, such as rules regarding abortion among minors, we need to concentrate really hard on figuring out ways to reduce unwanted pregnancies. Of course, they will still happen. But when they do, we need a plan. A plan that supports life--both the life of the baby and the life of its young parents (who are kids themselves). Two wrongs don't make a right; there's no real way to undo a pregnancy. Does having an abortion make a minor whose had a sexual relationship mentally sound and "over it"? I don't think so, having been through a pretty rocky decade myself at that age. It's short term relief, but the emotional wounds leave big scars you have to deal with sooner or later.

I don't have a real answer. I just know that what needs to be done is to focus on prevention, and on building a society where support systems are in place for minors who would be at risk for this kind of behavior. And when sex and unwanted pregnancy happen, there should be support for that, too. There are plenty of young people who DO choose to carry their babies to term. What makes them different? Probably less hopelessness, more of a support system, more emotional maturity. Doesn't every minor deserve that, pregnant or not?

In a way, maybe Prop 4 will help some families. I agree that it will backfire in many ways, particularly in families where communication isn't possible. I know in my own family, when I was a minor, communication definitely didn't feel AT ALL possible, so I can only imagine what it's like in families with more diverse challenges. But in those families where parents or guardians are ready to reach out and help their minor, maybe it will force-foster some needed healing. Because when a teen is pregnant and wants an abortion, clearly something isn't going right.

Ramblings, on becoming a doctor

“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. Tis the same cause that wears out
Our bodies and our clothes”

From Bertoit Brecht's A Worker's Speech to a Doctor

I'm visiting home this weekend and am fascinated watching my sister interact with her newborn child. He is such a helpless little thing. As my sister said, anyone can do anything to him, and all he can do is cry. It's an obvious point, but I guess that degree of fragility is something we don't often encounter in daily life.

It got me thinking about the above excerpt from Brecht's poem. One of the reasons I love medicine as a profession is that people come to you with their problems, and you get to fix them. Anyone reading this will probably immediately think, "Oh yeah? Is that how it works? Because that isn't how it's been working!" Nevertheless, it is that idea(l) that attracts me to the field.

It's a scary thought, not to be taken lightly. As a physician, you are asking someone to come to you in their most vulnerable state, helpless as a baby (let's leave litigiousness aside for the moment). You have powerful drugs at your disposal, compounds that can wreak havoc on the body, or fix it instantly, or some compromise thereof.

Small things make a huge difference. Maybe your marriage is in trouble, or your teenager is a nightmare. Maybe you're depressed. Maybe your finances are suffering. Maybe you don't want to talk about it. Maybe you do. Maybe you shouldn't, but maybe you should.

How will I know if I don't ask?

Sometimes I frankly cannot believe that they let me into medical school. That assuming all goes according to plan, I will be a doctor and I will have this huge responsibility of someone's life in my hands. That I will have a pad on which I write treatments that could do a lot of damage to another human being. Or if I become a surgeon, that I will be fiddling around inside a fellow person.

But wasn't that the dream? Isn't this what I've been striving for, that very responsibility? Didn't I write in my medical school applications that there was nothing I wanted more than to be in this position?

And it's true, it is still true. There's nothing I want more. I don't know how this sounds, but I want to be a resource, a beacon for people. I want to be a giver like a tree that bears fruit. You pluck the fruit and it grows more, no problem, no questions asked. It bears so much fruit, in fact, that sometimes the tree bends over with the weight of its bounty. I want to be like that, if God wills it.

I pray I never forget what Brecht is referring to. The exquisite vulnerability of that moment with a patient. Eventually, it will be up to me: I can treat their symptoms (or what I perceive to be their symptoms), or I can treat them whole.

I'm sure I have no idea what I'm talking about right now, but I'm also sure that what I'm saying is true.

Food for thought from Infidel

I’ve read quite a few novels this summer, but Ayaan Hirsi Ali’s Infidel has probably been the most provocative. While I oppose with her fundamental conclusions about Islam, I do agree with some of her injunctions against traditional Muslim culture.

That fundamental point of disagreement is this: I think she fatally misinterprets Islamic tradition as being part of the Quran—the word of God is NOT the same as what your imam or Quran school teacher tells you, necessarily, nor is the word of the Prophet in Hadith. She’s had some seriously crooked people/institutions rear her in their seriously crooked (mis)interpretation of Islam.

Anyway, while I think she takes her frustration out on the Quran when she should be directing that energy against opportunist, backwards interpreters of the scripture, I found her account of refugee camp life and her criticism of faith-based schools particularly interesting, especially as I was interacting with kids who had been through this unfathomable experience. I wanted to share some excerpts:

“The UN began to distribute food; basically they handed rations to people who claimed to be clan leaders, and these people either kept it for their own families or sold it.”

“It began happening al the time: Kenyan soldiers came at night to rape Somali women who were alone without protectors. And then all these women would be shunned and left to die.

This is what my grandmother had meant when she warned me: if you are a Somali woman alone, you are like a piece of sheep fat in the sun. Ants and insects crawl all over you, and you cannot move or hide; you will be eaten and melted until nothing is left but a thin smear of grease. And she also warned us that if this happened, it would be our fault.

It was horrible. Everyone in the camp called themselves Muslims and yet nobody helped these women in the name of Allah. Everyone was praying…but no one showed compassion.”

And on Muslim schools (this is the author’s opinion; I personally know nothing about Muslim schools but imagine it’s similar to Islamic tradition/culture):

“Muslim schools reject the values of universal human rights. All humans are not equal in a Muslim school. Moreover, there can be no freedom of expression or conscience. These schools fail to develop creativity—art, drama, music—and they suppress the critical faculties that can lead children to question their beliefs. They neglect subjects that conflict with Islamic teachings, such as evolution and sexuality. They teach by rote, not question, and they instill subservience in girls. They also fail to socialize children to the wider community.”

I believe strongly in gender equity, like Hirsi Ali, but I also think men and women were created to fill different roles in life (I’m thinking particularly about family life). Different, but equal. I also believe in creationism—to me, evolution is an undeniable truth, but within a species—but I agree with the author in that whether you believe it’s true or not, children need to be educated about the ideas that exist in the world they’re living in. That’s the only way they can make real choices and be intellectually and spiritually strong enough to believe in something worth standing up for.

A new outlook on my future in global health

Yesterday I had lunch with my dad, and we got to talking about global health. He's not against aid to Africa; on the contrary, he was the one who accompanied my mom to Kenya last year, when the project was in its incipient stages. But he always seems to ask, "Why not India?" Considering that we are definitely Indian, and speak Indian languages, and eat Indian food, and know Indian culture, and have family there, it's a more than legitimate question. Why Africa?

Until I really got to know all these students and delve into their personal histories and, more importantly, the history of their place of origin (Southern Sudan, specifically Bor Town), this was my question too. I love India. I may not speak the languages my parents do, but something happens to me when I go there, oddly: I feel at home.

Anyway, if it's language we're talking about, why not Mexico? I speak pretty good Spanish and have grown up around Latino culture. Why not the urban poor of San Francisco, for that matter? The needy communities of Santa Ana?

Those are all legitimate questions, no doubt. How did we become all about Southern Sudan?

Sudan is not a cause (if I can momentarily reduce it to that) that we sought out, it's something that just happened. We weren't looking to work in this particular part of the world, necessarily. Most of my global health experience is in Central and South America. And last year I did a project in India.

But there's something about Africa's need that is staggering right now. I know well that the indigenous in Chiapas have suffered unspeakable violence in the highlands--I'm thinking of the 1994 Acteal Massacre that earned the Pillar of Shame. I know that Hindus, Muslims and castes and subcastes (the Gujjars and Meenas, when I was last there) have been at it for centuries.

But right now, I feel that Africa is in a crisis mode we as members of the human race cannot ignore. Particularly, Sudan right now is in crisis. A whole nation is utterly torn apart, and at its heels are Ethiopia and Somalia and Rwanda. The instability is staggering. This extent of civil upheaval, of human cost, is among the greatest of international atrocities. Yes, the Acteal Massacre was horrific. It almost took our breath away to hear Manuelito's account of it (a survivor who lost both parents and several family members, including babies). But what about the 1991 Bor Massacre no one talks about? Yes, the social and political drivers are not comparable. But I'm talking about human suffering and consequent human need. So for me, and for my mom, that is why Africa.

(Banner from the film "Not Lost" on the Lost Boys of Sudan)

Faith-based schooling in East Africa

State House Girl's High School in Nairobi


Osama bin Laden once said, “You are either with the Crusade, or Islam.” This summer, that definitely seems true—in Mexico, it was the Crusade, and in East Africa, it’s Islam (and the Crusades, too).

In my two-week crash course on Kenyan secondary schools, I learned that almost all (if not all) schools incorporate religious education as a required part of the curriculum. There simply are no secular secondary schools (or so few that choosing to go to one is not an option for most students). In the fee structure for each term or year (3 terms in a year, 4 years total), the Bible is included as a necessary expense. Masses are held, and religious classes are mandatory. You even get a grade that factors into your point total. A part of the national exam administered at the end of high school, called the KCSE (Kenyan certificate of secondary education), is devoted to religion—if you are Muslim, you take the Muslim version, if Christian, likewise. You have two or three choices—I think Hindu is now a choice, according to Kwai, What if you decline? It is rare, but possible. Most people don’t decline—they already have their tidy social designation.

Anyone who knows me can predict where I’m going with this: why not let people think for themselves? Why make religion part of the curriculum at all? What are you going to teach, anyway? Piety 101? Charity, modesty, honoring your parents? Those are life lessons. You have to choose them all by yourself.

But there’s more to it than that. Everyone is so neatly categorized. In Southern Sudan there’s the Dinka, the Nuer and the Murlee, and more that I don’t know about. In Kenya there are clear lines between Somalis, Ethiopians, and other expatriates. Within each nationality, clans and subclans exist. You should know your family’s ancestry; it’ll help you in case you need to stay at a distant relative’s home, or if your people are at war. A relative won’t turn you down or leave you hanging; it would look bad. Clan/tribe/family ties are so strong in places like East Africa (eg Sudan, Somalia, Rwanda)—no coincidence that these are nations utterly torn apart by civil war.

Of course, they’ve had help from outsiders, no doubt about that. Khartoum in Northern Sudan is the #1 slave trade spot. Egyptians have historically come there to steal human beings—particular Southern Sudanese—for bondage. The discovery of oil has drawn often destructive, purely self-interested international attention (like China’s). But the fact remains that the Hutus and the Tutsis tore each other apart on their own, as did the Hawiye and Darod in Ethiopia, and the Nuer and Dinka in the Bor Massacre in Southern Sudan (in 1991). They didn’t need any help.

Nor did they receive any. Yeah, it’s true that civil strive had to do with internal tribal/clan conflict, but it’s much more complex and much larger than I’m pretending for the purpose of this post. And regardless, for wealthy nations to stand by when the chips are down, and step in when they eye something shiny, is in some ways more abominable than the civil unrest itself.

If You Knew

If you knew what my life has been like, you wouldn’t look at me this way when I ask you for a thousand more shillings, call you three times to see if you got my email, take up half an hour of your time outside your hotel even though I wasn’t on the list of “accepted students” you posted outside the office. With the note saying how hard it was to choose, how you wished us all well with our pursuit of education.

If you knew I only eat a meal a day, and that’s why I called you to ask for more money, after you’d already made a check out to my school to pay my fees, you wouldn’t lose your patience with me.

If you knew my only motivator growing up was fear, maybe you would understand why I didn’t tell you in the interview I had an outstanding balance at my school.

If you knew this scholarship means I’ll finally be able to go to boarding school and get out of my uncle’s house where I work all day to earn my keep, with no time to study, maybe you’d pick me even though I get C’s and D’s.

If you knew I could get 3 masters degrees for the price of your 1, maybe you’d see it’s worth it to put me through medical school.

If you knew I have no idea where my parents are, whether they’re dead or alive, maybe you’d be as shocked as I am to see how you talk to your mom sometimes.

If you knew I’ve seen a man almost shot over a jerry can of water in the refugee camp, you’d see that it’s not just a bottle of water to me.

If you knew that my features are typical Southern Sudanese, and that this fact is grounds for a life of discrimination, both in Kenya and in my own country, you’d understand how much more fighting needs to be done to be able to say that “everyone is equal”.

If you knew I’ve seen hyenas too, eating dead bodies while I was fleeing civil war, you’d realize wild animals are not just “beautiful” and “peaceful” they way they look on safari.


If you knew the only reason I showed up to your hotel was to say it’s okay you didn’t pick me, I’m happy for those you did pick—they’re my brothers.

If you knew that if you don’t pay my school fees now, my mom says I have to go back to the cattle camp in Sudan next month.

If you knew my ulcers make it impossible to eat whatever food is available to me, let alone study.

If you knew I look nice and presentable because I wore my very best clothes to come to meet you.

If you knew this chance to study means the difference between a wasted life and a future full of hope.

If you knew. If you knew. If you knew.

Tutaonana!

It's our last day in Nairobi and I'm really sad to leave, for so many reasons. Hence the title; tutaonana means goodbye/we'll see each other again in Kiswahili. One of the reasons I'm sad involves the fact that I'm two and a half weeks away from life in med school in Irvine. It has it's positives, but I'd much rather be here in Kenya talking to kids about how to complete their education and get ahead in life. But God has a plan and I can't be anything less than excited about it, because it always ends up better than I ever could have imagined. And that's the truth.

Anyway, there's so much to write, but the last week has been a whirlwind of paperwork and phone calls and haggling over school fees (yes, haggling, my mom is a genius by God's grace) and tying up loose ends. Running to the bank to make out banker's cheques to pay term fees for the upcoming school term. Converting between kenyan shillings and dollars, and withdrawing from the ATM, which is very stingy with letting us access our own money. We've also met with all the students, and had a real, delicious Sudanese meal at Kwai's house. That was probably one of my favorite things that happened here, actually. To eat traditional Sudanese food with some of the accepted students who we've been working with to sort out all their school and personal information was really nice. We'd been all business before, but this was purely a social event. It was a definite highlight. Even some of the very gracious applicants who weren't accepted came to share the meal, which I appreciated so much.

We are in the process of scanning all the life histories and photos of the students who applied but were not accepted this year, so that we can put them up on a yet-to-be-created website. God willing, the plan is to connect these students with donors other than the ones already involved in Universal Unity, Kiva-style. We'll keep everyone posted as this unfolds; there were a LOT of applicants so it will take a few weeks to sort everything out online.

There's so much to write about and think about, thankfully I have a whole 24 hour journey ahead of me to do all of that :).

More later.

A Few Photos

The first day in Nakuru, introducing ourselves. Mario is to my left, Panchol to my right. We held the interviews in a church at an orphanage.

At the Sudanese community office discussing applications today.

Agou Jon and Mayen. I really love working with them!

Mom and Kwai. Indispensable!

Eliza and me after an interview. She is just starting secondary school and is disabled. She was so shy, but put her arm around me for the photo. A very sweet, determined girl.

We finally have our list!

Today was another crazy work day in Nairobi. We had finalized the students we picked for the scholarships for university, pre-university (certificates, diplomas) and high school (boys and girls) last night in another long meeting with lots of good-natured arguing. This morning, we did more of the same, and then went to the community office to meet with the many students who were, sure enough, waiting for us. (They often show up to the hotel we are staying at, too. In fact, today we had to deal with that and it was unpleasant).

Anyway, so we got to the office and met with the students, finally able to give them the news of whether they’d been accepted or not. It was really difficult and I have to admit to shedding a few private tears (no one noticed, otherwise it would have been mortifying). It was a lot harder than I expected, partly because there have been so many logistical things to take care of, that I didn’t dwell on this particular moment, aside from the practical aspects like explaining exactly how we decided. I didn’t prepare for how they’d react, the raw emotion of it all. For instance, the first guy we had to let down said that he didn’t have any bad feeling, because even though he really wanted the scholarship, he was happy we were helping Sudanese, because they were all his brothers. Another person apologized for his low grades (I explained that even though his mean grade of B- was decent, we had no choice but to pick others with higher grades like A or B+), but told us that it was life was really hard and there were other circumstances that got in the way. Ulcers? Fatherlessness? Lack of food? Being chased away from school because of arrears? Ten students to a textbook in Kakuma refugee camp? Yeah, I bet. Life is hard.

Anyway, so we had some good meetings and some tough ones. Thank God we are working in a team. Because we are all working together and we want to fight for the truth and pick the absolute best students (we have to defend the fairness of our choices, to ourselves, to each other, to the students, and to a higher power), it’s great that there are so many eyes looking at all the applications. This morning, Mayen fished out an application that my mom had looked over, and asked us why this boy was not on the finalized high school list. Indeed, he had better grades than a couple of boys we’d chosen. We had had reasons for picking other students, but in the end, we felt we had to swap another with him. It was an important decision. Two similar other decisions were made through the course of the day. Imagine, because of God’s help and our due diligence, three people who otherwise would not have gotten funded, finally did.

At the end of a long, lunchless day (sadly, one or two meals per day is how too many people usually operate here), we finally left the community office to eat. We ended up at an Ethiopian restaurant where we had a delicious, buttery, meat-filled meal, eating injera and curry with our hands. It was amazing!

Tomorrow, we are going to the Nairobi museum in the morning with Mayen. In the afternoon, we’ll meet with Kwai and Jon to discuss strategy since not all the students who were accepted showed up to the office today. We have to call them all and get all their official school documents together to start making payments. A few don’t have schools to go to yet, so we have to place them. We also have to open a bank account here in Nairobi to deal with all our new financial commitments. But that will have to wait until Monday.

Takwenyo/Sopa! Backlog from Masai Mara.

Last weekend my mom and I got back from a short trip to Masai Mara, the southern part of the Serengeti here in Kenya. Masai refers to the Masai tribe (more on that later) and Mara refers to the Masai tribe (more on that later!). Takwenyo and Sopa are Masai greetings for females and males, respectively. If someone greets you in this manner, you say Iko or Ipa. Other words in my paltry Masai vocabulary: Asheoling means thank you; Ijo a means how are you; and Olesere means goodbye.

Masai Mara comprises 1/50 of the Serengeti, and features one of the highest concentrations of natural wildlife on the planet. Now is the season for the famed migration of the wildebeest, so we saw a lot of wildebeests crossing the Mara river. The animals start migrating from Tanzania to Kenya in June, so by August, the highest concentrations can be found. There are between 1.6 and 2 million of them! We saw lots of lions, elephants, giraffes, crocodiles, gazelles, antelopes (diktiks, topis, and elands), and a few buffalo, warthogs and hyenas. Cheetahs, hippos and finally, a rhino. Evidence of a leopard in the form of a baby wildebeest carcass strung on a tree branch.

I learned a lot from Samuel, our guide who seems to love offroading in his Jeep and watching animals do their thing. He excitedly taught us about the difference between giraffe "horns" and real horns (like male antelopes have)--horns are bony, and "horns" are keratinous. He also taught us some anthropology: lions engage in community breastfeeding; male wildebeests have harems (they are forever running around defending their females and babies from being stolen, or pursuing other males' "property"); hyenas are predators of lion cubs; cheetahs can jump 10 feet high and 30 feet long; and elephants live up to 60 or 70 years old and are dangerous predators of Masai people (as are buffalos). Samuel is also a fan of The Lion King and the circle of life/the food chain. As thousands of wildebeests risked their lives crossing the river full of crocodiles, he told us, "So many wildebeests! No wonder the crocs and lions eat them up! If not, there would be no grass left, even the roots would be eaten." The man makes a point.

The whole thing was amazing. I'd never seen anything like it, it was right out of the Discovery Channel or National Geographic. The only thing I didn't like at all was how close up we got to the animals. Tour guide jeeps were so eager to get up close to the wildebeests crossing the river that they'd park on the banks, with tourists getting out of the car or sitting on top of it. It throws the animals off; when this happens, the wildebeests wait or turn back, unable to cross in the presence of people on foot (they are ok with people inside the cars, apparently). We also drove right up to the lions, so close we didn't need to zoom in to get an incredible photo. Yeah, it was amazing to be that close, but it was also very disconcerting, especially when you see eight Jeeps surrounding cubs and their mother, eating the morning kill. Kind of like watching a movie scene being filmed, rather than nature unfolding itself.

It made me reflect: 1) how different are we from animals, and 2) what right do we have to be so intrusively curious about them? and 3) what gives us the ability to pursue that curiosity? I bet wildebeests don't have maps they've drawn up of our migrations, or hold tours showing their fellow beests how we mate in social groups. Something from our trip to Masai Mara tells me, in a way that is distinct from my other ways of knowing (faith, logic, scripture) that I am not just any other animal "evolved" from natural history. The height of my emotions; my ability to reason, to calculate; my capacity for guilt, remorse, shame; and even just the mere fact that I was sitting in that Jeep watching a pride of lions eat a zebra carcass, taking pictures and learning about their way of life as we humans have discerned it, reinforce my intuition that I have a deeper purpose in my existence, and that is to uphold good and stand up against bad, to be grateful to whatever awesome Power made me what I am right now, and to correct myself when I misstep, because I will be called to account for it. This is really inarticulate (and with extremely poor grammar) but it was just a fleeting moment of profound clarity.

Anyway, we also went on a nature walk. Our guide was Daniel (that’s his Christian name, I forgot his Masai name). Daniel taught us about the history of the Masai tribe’s relationship with the Kenyan government since the 1940s. It was at that time that the government independently decided to make Masai Mara a national conservatory (a part of the Serengeti where the Masai live—Mara means spotted in Masai, referring to the spots of bush dotting the flatlands). They drove the Masai out with excess force, as Daniel put it. The Masai retaliated indirectly by burning grassland (endangering herbivores) and killing wild animals, particularly endangered species. Finally, the government called a meeting with the Masai chief to reach some sort of accord. After almost two years of talks, an agreement was reached whereby the government would lease the Masai Mara land from the tribe, and give 19% of park entrance fee profits to the Masai people. With their profit, the 300,000 Masai here in the south Serengeti do things to benefit their villages, like build water dams to ensure their cows have enough water in case of drought. Interesting.

Some other things about Masai Mara I found intriguing/worrisome: the Jeeps drive over croton bushes and through herds of wildebeests, which I thought was really disruptive and disrespectful of the natural habitat. Rangers carry out controlled burning of grassland for the gazelles--they like flatland because they're able to see prey more easily, but burning grassland is bad for trees and birds that nest on the ground. (Do they do this for the tourists, because tourists will find gazelles more pleasing to the eye than birds/trees? You gotta wonder.) There are also excavations in certain places, and the introduction of (I think man-made) gravel so the dirt roads are less slippery for tourist vehicles. And tour guides regularly off-road, and allow tourists to step outside their cars. Sure, off-roading sometimes allows you to see that amazing animal you would not have otherwise reached, but the fact remains, you're an intrusion.

I'll post pictures when I can!

A random thought on 'charity'

One of the dilemmas we’re running into with the high school applicants—particularly the girls—is that many of them, as orphans, are staying with benefactors or distant relatives. These guardians often strike a deal with their charges: clean the house, and we’ll take you in (and sometimes also pay for school). Of the girls we interviewed, several were concerned that going to day school rather than boarding school, and relying on the kindness of benefactors, would result in their spending too much time doing housework and chores to focus adequately on their studies.

This is problematic for the students, but it’s also a symptom of a larger social issue. Sure, that benefactor wants to spread around his/her good fortune to the needy orphan. Yet, he/she still wants to get something out of the deal—perhaps to keep the orphan accountable, or perhaps because he/she has unmet needs that a poor girl with few options in life could fulfill. (What is an unmet need, anyway? A cleaner toilet? Fresh cut fruit for breakfast?) Perhaps this benefactor would hire a real servant otherwise, if not this orphan Sudanese refugee student. He/she might think, I’m helping this child change her life. And it’s partly true, no? But not if she can’t get good grades because she is doing chores with the greater part of her free time, in order to earn her keep.

Why is this problematic on a social level? Because while many of the haves will always be ready to give charity to the have-nots, it’s also true that many of those same charitable haves (the so-called well-off) will also always want there to be a ready pool of people to hire for menial jobs like cooking, cleaning, and raising their kids. They want this workforce to be readily available for them while they do other things with their time: travel, make money, or do whatever. They want this workforce to work long and hard, sometimes for fair compensation, sometimes for a bargain. So how can these well-off, well-meaning individuals expect to bring up the poor classes who they profess to want to educate? How can they give them a hand up in life while simultaneously requesting that they stand at attention, ready to sweep the floor or cook the family’s evening meal? By supporting the idea of the orphan girl’s education while (perhaps) resenting the notion of her spending the greater part of her time and energy not in polishing wood banisters but in learning English and math?

I don’t hold the well-meaning well-off in contempt for their wealth, or for their desire to help the needy. I have no right. I think our Creator has a good reason for providing each of us with whatever means we have; I believe in a divine plan. But at some point, I think we all need to look around and take stock of where we are and what got us to where we are. And then I think we need to think about how we can be part of affording others the luxury and the freedom of making the choices we are able to make as a result of what has been afforded to us.

Meet the Team...pictures soon!

I've mentioned in earlier posts the names of team members I'm working with on this refugee scholarship project, but I wanted to introduce them properly, because theyare phenomenally capable people whose dedication astounds me as much as the hardship they have survived and continue to overcome every day.

It is approprate to start with Mario, as he is the first of the so-called Lost Boys we came to know back in California. Mario is a graduate of University of San Francisco, and my mom was introduced to him by a Christian missionary, Ursula. My mom traveled to Somalia and Haiti with Ursula before realizing that she could accomplish more on humanitarian trips if she ventured out on her own, unfettered by organized religious/bureaucratic organizations. She continued to keep in touch with Mario and his Sudanese friends-Deng, Mamer, and a lot of others who knew each other either from refugee camps or after coming to the US. They were almost all involved in NGO work for Sudan, so my mom and I got involved through them. Last year, she went to Kenya with my dad to meet some of the students who she was introduced to by Mario and who she now sponsors. As I wrote before, this year, our aim is to expand the program, God willing. We haven't gotten any outside funding yet (grants, etc) but to continue to see the project grow (and there is a desperate need for that!), we plan to actively pursue other sources of funding.

Anyway, another member of the team is Deng, also studying in the US. Deng is a softspoken but adamantly just man who plans to get his masters in public health at Touro Univ. in Vallejo, CA. He is a college graduate. He is with us in Kenya right now, but just returned from his marriage in Sudan to a young woman he met in Kakuma refugee camp. They have two kids. He is forever arguing for us to make the most fair decisions regarding students: for instance, not discriminating against Ugandan applicants just because they are in Uganda (and thus harder to keep track of), and not discriminating against students who seem to look better off (what, do we need them to look dirty and bad to sponsor them? he asked last Sunday).

Kwai is another member, but I think I devoted plenty of time to him in my last post. A blessing to the project and more importantly, to SUdanese refugees in Kenya, period.

Then there's Mayen. He's also a refugee who was kidnapped by the SPLA but escaped with Chol, another one in Sudan right now for a school project (Chol did a lot of the organizational work for the project here in Nairobi while me and my mom were in Mexico and at home in CA, respectively). Mayen has two brothers, both of whom are in the US/Canada. They won the lottery like Mario did. He should have gone too, but his paperwork was lost. He's studying catering in college. He's a loyal, hardworking, resourceful, honest, accountable guy, always ready to help his people and their cause. As he told us in Nakuru: I don't care if I have to sleep under a tree, as long as the work gets done. I am learning from his example. He also likes rap music, so I'm going to make him some CD's once I have access to my laptop again.

And finally, there’s Agou Jon. He goes by Agou but I’ve only known him as Jon. I met him over email last year when he wrote to me, telling me about his studies. He had gotten admission to Moi University to study medicine. Moi is a prestigious public university here in Kenya. It’s even harder to get into med school here than in the US, which is saying a LOT (trust me). But he had no money to pay (like everywhere else in the world, studying to be an MD is extremely costly). So he gave it up, and decided to study communications instead. Of course, he excels at it, and USAID is doing creative projects using the radio to bring education to Sudanese, but I can’t help thinking that he would be of much greater service to his people as a doctor. And at least equally as importantly, I believe he’d get more satisfaction from it. Just my .02. Personally, I hope he finishes his current degree and then pursues funding (maybe a Universal Unity scholarship?) next year for medicine. The cost is $7,000 per year for four years. Anyone have any ideas? He is just so capable and dedicated. For instance, on Sunday in Nakuru, we divided up the labor of drawing up cost estimates for each candidate we’d narrowed the list down to. He took university students and I did high school boys and girls. He had class on Monday, but still came at 6pm with a neat Excel spreadsheet detailing everything. Knowing how prepared he would be, I did the same by hand (no laptop), calling all the schools I could in order to find out term costs in each school (each term is priced differently, and there are four forms in high school, three terms per form). I am inspired by his work ethic, as I am by Chol’s, Mayen’s, Kwai’s and Deng’s.

As I mentioned before, some of these students knew each other long before we got to know them as individuals. Mayen told us about how they all knew each other before this, back in Ethiopia and Sudan. Apparently, Chol snuck Mayen out of the SPLA camp at one point, and then himself escaped. In Kenya, Mayen met Mario. They were refugees trying to survive. Mario would bring food, Mayen and others would search for water, and still others would bring firewood back to the bush. Everyone knew Mario because he would bring the food and then distribute it, first to the little ones (like Mayen, back then) and then to the adults. Hearing this made me realize that there’s a whole history I know nothing about, and I have to be humble and keep my eyes, ears and brain wide open to learn as much as possible as I insert myself into this social network.

Back in Nairobi!

It occurred to me that I didn't exactly introduce what me and my mom are here in Kenya to do. Basically, we have accrued through my mom's non-profit organization a sum of money that we would like to now invest in Sudanese refugee children's education here in Kenya. My mom got to know some of the "Lost Boys of Sudan"; students who won a lottery established in the U.S. to bring Sudanese boys living in refugee camps to study in American universities. She developed a relationship with them and as they graduated from universities like San Jose State and University of San Francisco, she realized that they were determined to go back to Kenya and work for change for Sudan. And she wanted to be a part of it. She is already sponsoring 5 or so Sudanese students going to college in Kenya, so this was an extension of a network that was already in place, by God's grace.

So Mario, Deng, and other students from the U.S. (who come back to Kenya when grant money and other means are available) put the word out to the Sudanese refugees studying here, some of whom are my mom's students. They were happy to put up fliers in refugee camps like Kakuma, and schools where Sudanese refugees study. In this way, by the time we got here on Thursday, there were over a hundred secondary school and university students (or hopeful students) waiting for us with their biographies, life stories, and copies of their grades and other documents that might help us make a decision.

Over the weekend, we were in Nakuru, a two hour drive from Nairobi. There are lots of Sudanese refugee students there and we had an even longer day of interviewing than we had in Nairobi the day before. But it was great to meet all the students. My heart broke for the ones who were very nervous, as well as for the ones who had lost a parent (or both). So many have no idea where their parents are. So many have lost their parents to the war. So many woke up from hiding in the bushes from bombs at night, to find that family members were missing in the morning.

So many walked to Ethiopia, then out of Ethiopia and back to Sudan when war broke out in 1991, and then Kenya when life in Sudan became too dangerous to continue. They didn't know they were en route to Kenya. They were just following the masses of refugees.

We spoke more with Kwai, who I mentioned in my first post: he's the coordinator of the donated Sudanese community office in Nairobi. It's called PARAD: Penkyou Agency for Relief and Development. He's an awesome guy, and a great resource for the students. He went with us to Nakuru and was one of our greatest assets. We didn't know much about him until we finally shared a couple of meals together. He was a former SPLA fighter (Sudanese People's Liberation Army; we met others who were kidnapped as children by the SPLA and then taken to Ethiopia before the Ethiopian war, and fed and clothed until they were old enough to either escape or be sent out to fight with AK-47's). He fought for the SPLA and then somehow got to Kenya as a refugee, where he was a teacher in Kakuma camp. Then he got to this post at PARAD, where he helps anyone and everyone in the Sudanese community.

Kwai was deployed by the U.N. (last year? can't remember) on a peace mission tothe Murlee tribe of Sudan. I am finding from interviewing students that one of the most commmon reasons for poverty and refugee status is the Murlee warriors. The Dinka and the Nueri tribes are frequently attacked by the Murlees, who steal children and cattle. Apparently, they suffer from STD's and some of them are left barren; Kwai says he hasn't seen any Murlee boys in their community, only Dinka and Nueri (perhaps stolen or bought). They even wanted to buy him when he was a young boy!

Anyway, so he was deployed with a team of 7 other Dinka and 2 Kenyans to Sudan. Their mission was public health: they didn't want to hold the Murlee accountable, they only wanted to give them what they obviously lacked: food and water (probably the reason for their reliance on thievery to subsist). They came expressing their desire to help with finding water, and drilled holes to 100 meters searching for a water source, with no luck. The Murlee got angry, starting to mistrust the team, and Kwai said he was truly afraid they'd attack. So he called the U.N. and got permission to drill to 120 meters, and a plane dropped more supplies so that they could continue their mission. They found water and drilled a lot of holes, and the Murlee celebrated with their tribal dances and by smearing cow dung, blood and saliva on Kwai and his team.

Despite their portrayal as guerrilla warriors and terrorists (as far as I know), the SPLA doesn't seem to be held in contempt by the Sudanese people I've been talking to. They steal kids and give them AK-47's, but I think in Sudan, where you have the Murlee and the Arabs terrorizing peaceful tribes, the SPLA stands against them, and is probably not too badly received. In fact, they seem to be somewhat well-received; in another moment of danger, when leaving the Murlees, Kwai had to call for emergency protection and the SPLA came to his rescue, surrounding the area with troops while a U.N. plane came to airlift his team out of Sudan.

Yesterday and today were devoted to compiling all the students’ information, including grades, schools, family status (Which is an indication of need…orphan? One parent? Father or mother? Who currently pays school fees, if anyone?), how many terms they have left (there are three terms per year for a high school student), and all sorts of other helpful information. We also narrowed down the list to about 12 university candidates, 12 high school boys, and 10 high school girls. It was definitely a two-day job, with me on the phone to all the high schools I could reach to confirm fees, and Jon making an excel sheet of estimated costs for all the university candidates. Yesterday, we also visited three girls’ schools, as educating girls is a priority of ours. We were not impressed with any, but got a lot of insight into what life is like for a student. You’re not allowed to go to your room anytime you want (as a boarder); they lock the rooms from 6am to 9pm because otherwise people steal from the rooms. Crime is such a danger in schools that you can’t even keep any pocket money with you; you have to leave it in the main office and take it out as you need it.

Today, we had two more last minute interviews, one for high school and one for college. One of the candidates was a 17 year old boy whose mom currently works for the SPLA and earns $100USD a month (the reason for her joining). She tries to support her son, but she has four kids. They are all in Kakuma refugee camp, and she is back in Sudan. Their father was killed. He is a straight-A student. The only hindrance to his studies is his ulcers. I think he’s so afraid to eat because of the grinding pain that he simply doesn’t eat except for the sake of survival (in fact, most Sudanese I meet only eat twice a day, or even just once, just something to keep them alive, even in Kenya). He is so thin! I talked to him at length about food at schools, and it’s hard because the schools have a set menu and his ulcers make it impossible to eat some of what they give. I asked him to buy bread with some money, but he can’t take any outside food to his boarding school; if he does, the administration will search him and take it away! Why? For fear of stealing. Yes, even a loaf of bread.

Sudanese are definitely treated differently in society. Today I was reminded of this fact yet again. We had borrowed a stapler at the motel we did most of our work at yesterday. Today, we borrowed another stapler. It looked very similar to the one we were using yesterday, and I wondered if one of us had mistakenly taken it from the motel in Nakuru. It turned out that we hadn’t, it was just a very similar-looking stapler (broken in the same way). But Mayen, one of the boys on our team, then mentioned to us that yesterday, someone called the police and told them that two Sudanese boys had stolen a stapler from the front desk. The truth is, we were all using that stapler! I had borrowed it earlier in the morning and returned it; he had come back because we needed it again. I was so angry…how unfair. The things they have to deal with in terms of discrimination, on top of lack of food and having gone through so much.

Ok this is the longest blog ever, so I’ll have to save some of this for later.

Kenya, so far

so we had a whilrwind first two days in kenya, starting early morning friday to see all the college students we had lined up to select for scholarships. lots of students came to the donated sudanese "office" in nairobi, and we ended up splitting up into two teams with me and mom working separately, so we could see everyone in a timely fashion both for the students' sake and ours. some of these kids came from really far so we had to see them, no matter whether they were promising or not.

to hear them describe what they go through as you try to figure out how they live, how they study, what their plans are, is really something else. another post.

after a hectic first day, this morning we woke up super early (like 2am) because we couldn't sleep. late night i had been compiling all the student information into one coherent master list, so at 3 or 4 mom and i decided to work on it together as neither of us could sleep anyway. so we ate the emergency quaker granola bars and finished the list, two separate ones, one for college and one for high school candidates.

then at 6 we started to get ready to check out of the hotel already for nakuru, where we are now. nakuru is a couple hours away from nairobi, and it is where a lot of high school candidates are. so we came here. there were lots more high school students waiting for us than college. we ended up seeing 35 yesterday, not sure yet how many today. we just got done and went to eat food, and then came here. we are restless but zombielike because of the jet lag.

on the way to nakuru we were told we'd have to stop and vacate the car and be inspected by police because there have been recent cases of people with guns in buses like ours, but it didn't happen.

the sudanese are definitely treated differently here. you can tell they are different by their facial features and they are a lot blacker than kenyans. we don't understand swahili but we understand they are called by their nationality "sudanese" sometimes and this evening one of the students claimed he needed 3,000 kenyan shillings (conversion: 67 KSh = 1 dollar) to get home because the police stop him and take money from him, and he's in trouble if he doesn't have the cash.

there are lots of stories like this going around. i tend to believe them despite how awful they sound because they are so alike among sudanese refugees, and because they tell you the truth even when they don't have to (for instance we ask, what are your grades? they will tell you B- or whatever they are even when they didn't bring their documents. they could just say A, right?). anyway.

i am surprised to find who i like working with and who i almost cannot tolerate. i really like john agou, and deng, and chol, and mayen. i am on a short string with mario, who is from the US and got 8,000 through Univ Unity to check things out in Sudan. i just lost my patience after awhile. and after the 30th interview you're just like please...but mayen is really honest and hardworking, and chol always has a smile on his face, and john has a cool head but he notices a lot of things, and kwai is another one who is coordinating everything behind the scenes. we couldn't do this without them. they made the lists and told everyone when and where to come, and had staplers to staple documents, and gave us the applications as the students came in to ensure steady flow to get things done efficiently, etc. etc. we really have to be grateful.

now we have the even more daunting task of going through all this information and selecting the students. we wanted 5 girls and 5 boys for college and 15 high school students in roughly the same gender proportions. it's tough to find college girls, easier to find female high school candidates. but we have so much information on so many candidates, and because we split up into two groups over two full interview days, we have to communicate so everyone is up to date on every candidate and we can all make a fair, informed decision. not to mention that we haven't done proper justice to the essays of each applicant, so we have to do that.

we are also taking photos of each applicant to put together with their scanned autobiographies and other school documents, to create a profile online of each of these students, so that their efforts in applying to Universal Unity scholarships will not be in vain, God willing. our hope is to put each of their profiles up on the internet, and publicize it so that donors can be connected with these students and can put money toward their tuition, kind of like kiva.org. this was reshma's idea and i think it is an excellent one. we want to show appreciation for the fact that they came all this way and overcame so much hardship to pursue their desire to study, jumping through our hoops of paperwork, essay, and face-to-face interview. none of this could have been easy.

tomorrow we are going to see lake nakuru, apparently there are flamingoes there so we will hopefully visit for awhile. nakuru is not a big city, but it is definitely a town and not a village, so there is a lot of commerce and traffic here. i want to walk the streets more and get more of a feel of what life is like here before we leave on monday morning. and of course, we have a LOT to talk about regarding the candidates we have interviewed!

Liberation Theology

I'm writing this post fresh off the beginning of what I hope will be a lifelong commitment to the betterment of public health in the rural highlands of Chiapas, Mexico. Sounds like a lofty statement. That's probably because it is.

Anyway, it was an amazing experience, meriting its own blog (estufasenchiapas.blogspot.com). I got back a couple days ago, ate my weight in junk food, and am leaving for Kenya tonight. Hey, they said it was our last summer and I believed them, so I figured I better do it big.

Chiapas was about getting stoves to families that cook with open fires, and Kenya is about educating Sudanese refugee kids. Disparate projects, but they seem to have one disturbing theme in common, the topic of which is this blog entry: liberation theology.

It's no surprise that religious groups are doing good work in resource-poor areas. After all, one of the basic tenets of any religious faith is to help those in need. It's not disturbing to me that Christians (or Muslims or Jews, for that matter) are putting Sudanese orphans through school or contributing to the empowerment of native Mexicans in Chiapas. What is disturbing (to me, that is) is that an undeniable byproduct of their aid is the conversion of the disenfranchised to the faith of their benefactors.

Now, it may well be the case that I am the only one bothered by this observation. Perhaps the recipients of faith-based organizational aid are unfettered by, or even grateful for, the importation of institutional religion into their cultures and communities. That's not for me to say, and there has been such a profound interweaving of ideas since as far back as the 16th century that the complexities are pretty great.

I believe in God, but inseparable from my faith is my conviction that everyone should use their own eyes, ears and brains to figure out what makes sense for themselves. For some reason, the disenfranchised of this world have endured the structural violence of hegemonic relationships for so long now that some of them seem more apt to accept what they are told (even by those who created those hegemonies) than to think for themselves. As Jaime from Medicos del Mundo told me and my crew in Chiapas a couple weeks ago, if you tell an indigenous man that this piece of paper is worth $1,000 pesos, he will believe you. This observation, to me, is potentially almost as disturbing and destructive as Hernan Cortes was to the Aztecs, or as NAFTA has been to the campesino. I'm exaggerating, but you get the idea.

So how do we empower the have-nots to think for themselves? How do we get to the point where as we objectify them by talking about them as the "have-nots", they too are creating social constructs in which we are pinned as the "haves", creating a way of seeing the world that makes sense to them and in which they have agency and can affect change?

Health and education are the only things I can come up with.

Health + education = agency. Health and education = object --> subject.

This post was supposed to be about liberation theology, so I guess I should say things about that now.

Mainly, I am concerned about the mixing of charitable work and religion. I think it's perfectly fine to share your religious beliefs with others. I definitely do. But sharing beliefs is different from building a church in the local community and tying aid (whether it's education, medicines, housing) to evangelism. In my opinion, it creates in people an unnecessary association between a hand up in life, and a particular way of thinking about the world (ie, Christ is going to save me). It creates in someone whose needs are so great that they don't have the luxury of choice, particular ideas about reality that ought to be his or her decision to make. And in fact, in many of these communities, despite big churches and crosses, people maintain their native ideas about life. And they are often in direct conflict with European religious constructs.

Case in point: I receive emails from Sudanese refugees living in Kenya trying to scrape money together to go to university. One of them wrote to me addressing me as his "sister in Christ". I don't believe that Christ is going to save me, I just believe in God alone, so I mentioned that to him. He wrote me back, and it was a worried email in which he apologized for having "misspoken" and written about Christ. He reassured me that he believed in God alone. And then he asked me again about school fees.

Am I to hold him in contempt for verbally conforming to my own beliefs in the hopes that it will secure some financial stability for his schooling? Definitely not. But I know that there is a strong Christian presence in Sudanese refugee aid efforts, and I am frankly suspicious that it has directly resulted in a large number of "Christian" refugees. What they want/need is a hand up in life, and there isn't much they are not willing to say or do to get it. I would, too, in their shoes.

Nor, however, do I hold religious NGOs in contempt. They are not force-feeding their beneficiaries with their own brand of theology. One can even see the conversion of native Mexicans to Christianity during aid efforts (ie, liberation theology) as an inevitable byproduct of such charitable projects. But I strongly believe that those spearheading these projects should be aware that instead of urging their own religious beliefs (voice them, yes, but voicing is different from evangelizing), they should exhort their charges to use their brains and think for themselves, and then give them the freedom to make their own choices.

And what is freedom? How do you give it to a person? By fighting to increase their access to health and education, I think.

Last night, after a week of studying for a couple of brutal national exams (whose sole purpose was evidently to convince us first-years that we still know nothing about medicine), I went to the Santa Ana armory to see patients with doctors, residents and other medical students. It was a good experience, as it made me reflect on my choice of profession more than anything else had in a long time.

First, some background: the armory is a seasonal night-time shelter in Santa Ana, California that runs only during the winter months. It opens its doors every evening around 6pm, and closes at 5am (the homeless are woken up at 4:30am to gather their belongings). It is located in a big warehouse stocked with 200+ four-by-six mattresses that accommodate its nightly patrons.

However, despite the lack of a kitchen, a child-care area, and other basic necessities of a shelter for people who have nothing (such as being open year-round, perhaps), the armory is generally well-run. It does its best to provide the services its clients need most: health care, legal aid, toiletries, and a hot meal.

My experience, of course, was in the clinic. MD's, DO's, residents, nurses, social workers and students are all part of the team providing care for 24-30 patients in a two hour time slot--no small feat. I've seen a lot of volunteer clinics, and this one worked well. Everyone had a role to play (even us first-years!) and things went fairly smoothly, the only worry (and it's a big one) being that homelessness is a disease too complex to cure in a twenty-minute visit. No matter how good a triage system you have.

I was paired with a family physician from Kaiser, a soft-spoken guy who (thankfully) was happy to have me around. He seemed like a natural teacher, and was eager to explain the intricacies of each case and field my endless string of questions. He was impressed that I knew what Barrett's esophagus was (he didn't know it might be the only thing I learned in histology) and that I was able to come up with differential diagnoses (even though much of the time, my differentials were longshots). In short, he was a kind man.

We saw several patients, and all of them reminded me of how my interests in literature, doctoring and people are the very reason I sit on my butt all day reading about the human body. I met an elderly German who shared his name with a film star from his country and chastised me for my poor geography. A Santa Ana native who came in for infected abscesses from heroine use and told us he spoke three languages: "English, Spanish and obscene." A jittery lady who "got out of prison on February 28th and lost all my teeth by the first of March." (I didn't ask how, despite wanting to know, because her chronic acid reflux was a much more pressing concern). "This homeless thing really gets in the way of eating properly and not stressing out," she told us. No kidding. We met a slight African American gentleman who hobbled into our station so fatigued he spoke in a whisper and had to rest on a cane. He was suffering from congestive heart failure, high blood pressure, peripheral neuropathy, and a really bad case of athlete's foot (which I noticed!). "Try to keep your feet as dry as possible, buddy," the doctor advised, despite all three of us knowing that his feet were the least of his worries. It was hard not to feel a little overwhelmed by the daily struggles the patients obviously face.

The night reminded me that everyone has a story. Not just homeless people, for that matter, but everyone. When we see standardized patients with our teachers and peers at school, or even when we practice interviewing with community doctors, I never get the feeling that I'm truly listening to a patient. I'm worried about whether my history-taking is orderly, or whether I'm asking all the right questions, or whether I'm projecting professionalism. But last night, in a real clinical setting, I felt more natural than ever before. And it didn't make me a worse clinician-in-training...in fact, I think it made me a better one. I was truly listening to the patients, trying to understand the evolution of their chief complaint from their point of view. Questions popped up in their logical progression; their answers led me down various paths. Some were right, others were clearly wrong. Either way, I felt a true connection with the patients, and I can't wait to volunteer again. Being a doctor is bearing witness to people's private life stories, and there is nothing I'd rather do than be the person who gets to hear them (and hopefully, one day, do something about it).