DEPRESSION

DEPRESSION

(Written Friday, July 25, 2008)

The lines continue to blur on what I should include in this little blog. It would be nice to write about 3 weeks of a perfect little heal the world trip, but sometimes, that’s just not how it is, and not how I feel about it. For the sake of telling this adventure in its entirety, I’ve decided to include the following:

Wednesday and Thursday, I got depressed.

Tuesday evening, I was all messed up. The kid’s death hit me like a big cement fist in the chest. Combined with the overwhelming stress of attending 20 something kids by myself, Tanzanian medicine had knocked out my emotions. I had nothing left—emotionally drained. In a couple days, it had felt like a month of medicine at county.

And then I found out that 2 more kids died. Not good, in so many ways, for so many reasons. Following guilt and anger, depression was inevitable.

Wednesday, I had planned to go in to the hospital early and then to an outside clinic for most of the day. I slept in, completely blowing off the hospital. After the clinic, I came home and took a nap, even though I had plenty of sleep the night before. I was irritable—tired of Tanzania and the third world. Sick of the same high carb spaghetti and rice meals, but not really hungry anyway. Tired of showering by dumping a pitcher of water over my head.

And I wasn’t very pleasant, not my normal Jambo-to-everyone-in-the-African-world self. I didn’t care to learn any more Swahili, and wished I could have a conversation in English where I didn’t have to repeat myself every third sentence.

I wanted my bed, my friends, my country, and my medicine.

Did I have malaria? Fatigue, but no fevers. I had been taking my prophylactic pills, although weeks late, and was not using a mosquito net over my bed. Now that I think about it, I did have a cough for a week—so I shouldn’t rule out tuberculosis so quickly either. Nothing like learning about disease first hand. And I have totally been drinking the water, so you can include schistosoma in the differential as well.

I was a wreck. I felt things spiraling down.

It didn’t help things that I thought I should be totally happy. This was supposed to be my dream existence, right? Doctoring in Africa, free from the first world bullshit that disconnects us from living. Instead, just as the high rolling into Tanzania was one of the highest in the last years, was the low almost equally as dark. Some of it, the responsibility for dying children, uncharted territory altogether.

Then I got news that the C.E.O. had denied me access to the motorcycle because he was afraid I would crash and kill myself.

Thankfully, I had experience with this cycle. Just about the time that the novelty of the new land wears off, the withdrawal pains of the homeland (and the friends and family therein) set in. As Tanzania was beginning to let down her guard, unashamedly revealing to me her painful realities, I began to miss my 62 inch HDTV and the people that know I love cheesy chick flicks (the worse they are, the more I like them). Add on the clinical experience of dying children and attending responsibility, and you’ve got a recipe for hard times to say the least.

I had hit rock bottom. For those of us that know this place, it’s somewhat reassuring because you know that once you’re there, you’re not going any lower, and in fact, things will soon enough get better.

This is where it gets difficult to understand: I love this stuff. This is what keeps me coming back to the poor parts of the world. Few things are harder. The challenge to survive (let alone thrive) in this place gets me high; perhaps like the challenges of climbing Kilimanjaro or running a marathon inspire. Or maybe this is more like Fight Club, where you respect yourself and others the more pain you endure.

In my times in the poor world, I’ve gotten stripped clean, down to the bone. The normal daily routines—internet, music, TV, driving wherever you want, people who know me—gone. Adios, kwa heri. It’s crazy how much these silly routines give comfort, and even define us sometimes. So you go to the African bush, and WHOOSH, it’s all gone. And then shit, what am I going to do now? And even scarier, who the fuck am I?

So I arrive in this space, this alternate universe almost. I mean, in my California USA life, how much do I really need? I’m surrounded by loving friends and family, meaningful work and I’m never hungry. Never. But here—I’m needy, I’m friendless, I’m bored—it’s extremely fertile spiritual land. It’s why, I suppose, Jesus directed his message to the poor and the losers—having nothing else, they were open, willing to listen, and really in need of what he had to give.

In this bizarro Lawrence Tanzanian reality, I can hear several things. The first—people and relationships are most important. More important that I make them on a daily basis. Too much crap cluttering my life. Too much facebooking on the internet, too much match.com (sorry ladies), too much sleeping. Well, I’m still in residency. Maybe not too much sleep. Too much paperwork for sure. But not enough moments with people. Drinking beer on the porch in Paraguay, playing cards at the kitchen table in Tanzania or a cup of tea on the deck watching the sunset in Berkeley…these kinds of simple moments with people.

What has impressed me most about my time here is how the people of Tanzania have treated me, a stranger. From my random bus friends looking out for me, to the hospital CEO making sure I have a bus ride to catch my plane, there is a value they collectively share that I am happy to adopt as my own. The greatest two teachers of this have been the two guys I’ve had the chance to live with, Masahi and Mgiri. They will get an entry all to themselves, but they way they have treated me—in this time when I was in need of both friends and food—was more than just a couple random acts of kindness. It is deeply woven into their character, their habits. They just are that way, for no other reason than it’s just them. Damn, that's impressive and inspiring.

Fertile land, finally, in terms of life dreams and goals. There is an enormous power, both politically and financially, the United States possesses more than any other country in the history of the world. A doctor in Tanzania, for example, might make $6,000 US a year and be doing quite well relatively in Africa. He could save up all his money, start a small business, whatever—and never come close to amassing $100,000 in a lifetime. Ever.

The Shirati hospital’s operating budget is around $150,000 annually, covering all operating expenses from doctors and nurses salaries to medicines, etc. I think they’re doing pretty well on that money. $150 K to us, however, really isn’t that much. You couldn’t fund a small clinic in the US for that. In fact, it’s as much as the average family practice doctor makes in the US. The average US family practice doctor’s annual salary = the annual operating budget of a Tanzanian hospital. Kinda crazy (kichá in Swahili).

You can see where I’m going with this. We have the ability, through that imperfect monster of capitalism, to do so much good for the world. The possibility to make money—generate money at your job (as a doc, eg), invest it, start a business, and then after 20 years have enough annual income to fund a hospital in Africa—that’s a fucking dream. The possibilities are endless. These kinds of dreams really are unique to America, to our time, and are such an amazing opportunity. It's the kind of thing I'm passionate about.

Yes, I've since recovered from my depression, as you can see. In the next blog, I'll talk more about it.