by Rebecca Sills, SOM ’11
Second Prize 2009 Gerald F. Berlin Creative Writing Award
“You fell in love with Africa—I can see it in your eyes.” This is what a friend said to me after I finished telling him about the seven weeks I spent there, having returned two weeks earlier. Maybe that is why I now feel this hollow, this sense that my life as a student is not quite enough anymore, that something important is missing. Perhaps I did indeed fall in love.
I am in class and someone important, respected, knowledgeable is speaking. Is teaching. There are pictures of cells being shown. At least I think they are cells. For all I know it could be an abstract painting. Glancing around the room, most students are listening intently, taking notes, moving their eyes between their papers and the cell-pictures. They look focused, fascinated, like they would be perfectly happy to spend the rest of their days soaking up this knowledge about cells, staring at cells, relishing the presence of such expertise.
This is not what I wanted. Not what I imagined, not what I hoped for. These pictures look as meaningless the pattern the coffee made splashed across my kitchen floor when I spilled it this morning. I left without cleaning it up, already concerned about being late to look at pictures of cells.
Only a month earlier I was a world away in Africa, listening intently to dying women. I was searching for meaning in a community where a third of the population had HIV and where funerals ate up what little money families had. I was trying to help, and at least in some small way, I was helping. I was learning. I was relishing the expertise of a nurse who had the gift of teaching groups of women information that could save their lives.
In Africa the smiles seemed genuine, the tears real and the emptiness devastating. And now, here back in school, classmates smile at me as we pass each other. But the smiles look weak, faces covering what might be true emotion or what might be nothing at all. These smiles say, “I am confident, competent, together.” When practicing interviewing actors playing patients, our instructors tell us to “Show more empathy.” “I didn’t feel you were really sorry when you said that,” the patients scold. But how can I pretend to feel empathy for the death of a non-existent father, when a real person so recently showed true sorrow when telling me of a sick sister?
I was there, smelling, seeing, hearing and living it. But I left. I returned to the comforts of the U.S. and the ennui of cells. I have written emails, letters, sent photos and gifts but heard nothing in return. It is not surprising; they have almost no internet access, little money to spare on stamps. But sending these thoughts, and feelings into the world without any sign of return I sometimes feel that it never really existed. That the people in the post-office are smiling and nodding, taking my money and then tossing my letters into a bin filled with letters to Santa or the tooth fairy. I have the pictures; I brought home sculpted stone elephants. But it feels so incredibly far away.
Nicholas Mwila, a poet and the director of a small organization that helps disabled individuals who I got to know, gave me an African name before I left, a Bemba name: Chibesa. He told me it meant “fast-running mind.” I asked other Bemba-speakers I knew there and, depending on whom you ask, it seems to translate either to “intelligent one” or “one who suffers from attention deficit disorder.” But I fear that that person is gone, that she was left behind. Now my mind often feels slow moving, my thoughts seem sluggish. I simply cannot understand how these cell-pictures I continue to stare at, could make anyone’s mind fast-running.
Sometimes the pain and poverty overwhelmed me. The moment that haunts me the most is the home visit during which one of many women I met who was dying of AIDS. She could barely move and sat in front of her “house” looking down at the bowl of cornmeal porridge that she was stirring gently. I had already seen a great deal of sickness, pain and sadness and hopelessness and thought I was somewhat prepared for more of this on her face. But I was stunned when she finally lifted her head and met my gaze. Instead of the familiar emotions, looking into her eyes I saw nothing at all. It was a crushing emptiness, an overwhelming void. Whatever battle this woman had once waged against her illness, her hunger, her life, she had lost. Whoever she had once been, she was no longer that person—if she could be considered a person at all anymore. I feared she might die at any minute, leaving her two young, malnourished children to fend for themselves.
I feel grateful for my ability to experience joy and sorrow, even fear. One night I was told that I was breaking the law, violating a 10:00pm non-existent curfew. I was taken into the back of a police truck, restrained by men with AK-47s, interrogated. I was alone, had no phone, no defenses, no hope against the at least 10 armed men surrounding me. I sobbed and felt a terror I have never experienced before. But they let me go. Did not even take any money from me, did not harm me. They told me I was in their country now, that I had to abide by their laws just like everyone else. They were so angry and seemed to enjoy my fear. I have struggled to understand what happened that night and why. As they exacted no bribe, I can only assume they were simply attempting to prove a point: At least for that hour, in that country, they were more powerful than I.
Despite that terrifying night, I still feel tremendous love for that country. And I feel very grateful that I had the energy and life within me to experience those intense emotions, to answer their endless questions. I could spare the tears. But I was also grateful to have the luxury of leaving. I met at least a dozen people who within the first few minutes of meeting me begged me to bring them with me back to America. They offered to be my maid, my cook and my nanny (though I have no children, a fact that continually horrified them). They wanted so badly what I had: the funds to pay for the $1,000 plane ticket to the developed world.
I had expected this trip to give me renewed motivation to complete school so that I could return, or go somewhere new and truly be helpful. But instead I found myself shocked by how much I could do without any extra degrees. There is no real training needed to learn to dig a well, to teach caregivers about sexually transmitted infectious, to stock a clinic with condoms and contraceptives or empower a community to design a microloan program. So why am I sitting here trying to make sense of these slides, these cells?
Six months later, I am still here in school, still taking exams and looking at pictures of cells and still missing Africa. And I am still unable to find a friend or colleague who seems to truly understand what I am feeling, how this summer has changed me so profoundly. In my limited exposure to clinical medicine in these pre-clinical years, I now work with an infectious disease doctor who sees mostly HIV and Hepatitis C patients. These patients’ tell me stirring, sad stories of trusting a dishonest partner or becoming addicted to heroin. But with a culture much more accepting of being HIV positive and the resources to give the latest, most effective drugs, these patients are living normal lives, living longer even that the typical HIV negative Africans live. It continues to amaze and inspire me to see the power that medicine can have. I try to focus on these moments.
Yet when the time comes for payment, when my preceptor reminds me that the reimbursement depends on what questions I ask and what body parts I examine, I cannot help but recall the literally hundreds of home-based caregivers that I met, women and a few men who volunteer their time and energy to visit other members of their community and encourage sick individuals to seek help and to get tested for HIV and TB, who check in on children and send the malnourished ones to the clinic outposts for free Plumpy’nut, the high-protein peanut paste given to these starving children. These people are paid only in thank-yous or respect from their villages. How can it be that the same country that is filled with such kind, giving people, also has a police force that can and does arrest anyone they please? More importantly, what can I do to change things here or there, such that we can be more giving and committed to the health of our communities, and they can hold their armed men accountable? How can the status of women be changed so that there is even a prayer of decreasing the HIV rate?
In the end, I did return of my own accord. No one forced me to leave Africa, no one threatened me if I did not continue school. I did come back. And the question that haunts me when I see the nothingness in that dying woman’s eyes is, did I abandon her? Sometimes, I look in the mirror, just to check that there is life in my own eyes, to search for evidence of a “fast-running mind.” And no matter how adrift I feel, there always is.