With Two Kids and a Smile

Her big black eyes stared straight up at me, smiling—the one thing she wouldn’t let anyone take away from her. The gratitude in those eyes pierced me with that smile, making me uncomfortable. I kept thinking to myself, “She should be angry at how her life turned out, angry at God, angry at man, angry at something.” But there was no anger at all in her stare. Just peace.

She had come to the clinic for a sore on her foot. With a small baby boy and young daughter in tow, she hiked all the way up the mountain to the clinic. She had almost no hope. She went through the process of getting her vitals taken, waiting with 75 other sick people for her turn to see a nurse or a doctor, and then finally being admitted to the children’s malnutrition ward—no room left in the main ward.

Now, after the long day, I had gone with Brad, one of the volunteer nurses, in to check on this woman and clean her wounds. She had waited patiently all day, carefully tending to her baby’s and daughter’s needs. She did so with so much organization and care you’d think she was at home. Maybe for her, she was.

For reasons unknown to me, this relatively young mother’s husband had left her and her children to fend for themselves. Now, she was left with nothing.

Sadly, this woman had more than just a foot wound to tend to. She was also in the final stages of breast cancer. Where once lie a source of nourishment for her children, now lie tough piece of resembling the texture of an orange peel, with an hollowed-out wound the size of a baseball. Her baby boy only had one breast to drink from.

In this country ravaged by civil war and lack of health infrastructure, there were no health professionals advising her to do a monthly breast exam, no uncomfortable mammogram to test for any lumps, and now no chemotherapy to treat this awful disease. All we could do was treat the flesh wound and make her as comfortable as possible. Literally a band-aid solution for a much deeper wound.

In America, we have so many opportunities for prevention and treatment of so many things. It seems there’s always a commercial for a new drug for a new malady—restless legs syndrome, for example—sometimes I think we make up sicknesses just to have something else to talk about, or for drug companies to make some more dollars.

Healthcare in America has become a hot topic in the last couple of years. We still have so far to go in advancing healthcare and curing diseases in this country and all over the world. And there are many valid concerns that have been raised by people on all sides of the issue. Regardless of how one feels, it does seem in this highly politicized discussion that we as a society have gotten a little carried away with how we think of ourselves. I’ve even heard some Americans argue in this debate that healthcare is a privilege, not a right. I don’t think any of those saying that have ever been in this woman’s position. If they had, they might have a different perspective.


We need to constantly be trying to advance healthcare in our country and improve it, but we also need to be thankful for how much we already have. If anyone had asked this woman how she felt about what the cost of healthcare should be, she’d probably say it was worth a two day hike up a mountain with a hurt foot. With all the problems and issues and opinions we have, I cannot help but be in awe at how wonderful it is to know that we have come so far in healthcare in our country in the last 100 years.

Just 60 years ago, for example, most premature babies died in our country for lack of treatment. That is almost unheard of today in our country. And while there are still places in the world that haven’t been as fortunate as we have to have access to so much technology and knowledge, I know they one day will. If corrupt and greedy politics got out of the way in so much of the world and let justice into people’s lives, many more people would have access to what we do in America.

I stood there holding the gauze and ointment for Brad as he helped to bring dignity and comfort to this woman, listening to the constant hum of crickets in the background and the cries of the few babies who had not yet fallen asleep. As I watched Brad do his magic, I was almost overcome with pity for this woman. But with her bright eyes and grateful spirit, she wouldn’t let me pity her. She would let me help her, but not pity her. What would my pity do, and who am I to think she needs my pity? Funny how those who deserve pity don’t actually want it. I’m not sure what it is about people who have been through great suffering, but they always make me feel like everything will be ok.

I, like so many of you, have been personally affected by breast cancer. I am so thankful that for those that I love who have had, or are still battling, this terrible pink ribbon disease, there has been treatment to comfort and often heal them. And I’m even more thankful they didn’t have to hike up a mountain in the rainy season to get a band-aid.

My hope is that one day, when this woman’s soon-to-be orphaned daughter grows up, she will have the privilege of complaining about having to go get another uncomfortable mammogram.

The Simple Life

The small room of the foreign exchange bureau was air-conditioned, but I could feel my skin getting hot. My friend Zoum and I had come into this small money changer in Bujumbura to change $20 into Burundian francs. It was my last $20, and I wanted to buy some coffee with it before leaving Burundi for a trip back to Burkina. One would think this was a straight-forward process—but not today.

Unfortunately for me, someone at some point had accidentally made a small highlighter mark on one of the corners.

The clerk had taken my bill, looked at it, then handed it back to me, saying it was ‘too dirty’ for the transaction.

“What are you talking about? I just got this bill from a bank in the U.S. a couple months ago. It’s real, valid. I promise,” I said.

“No, we can’t take it,” came the response. The clerk couldn’t have been less interested.

I continued to plead my case, but quickly found out that I was just simply not going to be able to change my money today. Their buyers, other Burundians, apparently only like crisp bills.

It was Sunday, and in this predominantly Christian society, I was lucky to have found this for-ex bureau open. All others were closed.

Zoum said, “Come on, let’s go.” So I forced my stubborn self to leave, having failed at this simple task. It was really quite frustrating. I began to vent to Zoum—here in this country, they use my American money for international transactions all the time because their currency is quite weak. Plus, their money is so old and dirty that it is hard to read the values on it, not an issue for me, but seems quite hypocritical. And they are going to refuse my $20 bill because of a little highlight mark?!? I couldn’t believe it.

Zoum, after patiently listening to my ranting, smiled and replied with his usual calm wisdom, “La vie est simple. C’est les gens qui sont complique. ”—Life is simple. It’s people that are complicated.

His response surprised me, and left me speechless as I took it in. How true were the words that he said. I began thinking how the woman had refused my money because people try to sometimes use counterfeit money, and that’s because they want a quick way to get money (complicated), because they for some reason feel that will make their lives better because we place importance on material things (complicated), and on and on and on. And truthfully, my life really wouldn’t end if I didn’t buy some coffee (even though Burundian coffee is quite extraordinaire if I do say so myself.)

So Zoum and I packed up our stuff, loaded the plane, and started our long 2-day journey to Burkina, with stops in Nairobi, Kenya; Addis-Ababa, Ethiopia; and Lome, Togo. Our flight from Bujumbura to Nairobi was nearly empty. We took off, and as it was the middle of the day, we were treated to superb views of the land below—something I didn’t get to see when I’d first arrived as it was dark. Small brown rivers and creeks raced through the green velvety mountains, carving through the land to feed the huge blue lake.

After a few minutes, the beverage cart came around and gave us drinks. As we were drinking our tomato juice, Zoum leaned over and whispered to me, “Give me your cup after you’re done, I want to keep it.”

With wide, almost mocking eyes, I laughed and looked at him and said, “We can’t do that, they’ll get mad.”

“Oh come on, they’re just going to throw them away anyway, and they’re durable plastic. Plastic like this is expensive in Burkina,” he said.

I laughed at him—obviously I was caring too much about what other people would think about me. But leave it to him to be resourceful with just about anything. He took the cups and stuffed them into the magazine rack, he covered them with a napkin—with the look of a mischievous child on his face. As he did this, I realized I had made him embarrassed about something simple. I was in fact, now the one ‘complicating’ the simple life that we had discussed earlier.

Bouncing back and forth between American culture and the simpler cultures I have been blessed to live in throughout the past few years has definitely been a challenge. Values are so different. In America, we as a society place a lot of value on things we buy. Our status in society is built upon what we own, regardless of how happy we are inside. We work so many hours, bypassing time with family and friends, to make enough money to have a certain brand of car or live in a certain size house. In Burkina, Uganda, Burundi, and countless other places, value is based on how you treat people. If you are good to people, you are accepted. If not, you are rejected. And you take care of whatever you have as best as you can. People still place values in things, but it doesn’t affect the way they treat each other. Sadly, in America as a whole, it has.

People often ask me if I get culture shock when I arrive in a new place. Truth is, I usually just get culture shock when I arrive back in America after being away.

We finally arrived in Burkina, and took a cab to the Hotel Delwende, our usual stop when we’re in Ouagadougou (the capital). We didn’t have a reservation, so we were hoping they had a room. We showed up at the front desk, and Jean Claude, the clerk, looked up and, with a surprised smile, said, “Feeesh, bon arrive!” Not only did he remember me, he remembered my name, despite it being over six months since either Zoum or I had been there. We exchanged greetings, and then I noticed the shirt he was wearing.

Two years ago, my younger brother Keenan came over to Burkina with our cousin Jason. Before the trip, someone (who will remain nameless, Nathan) had given Keenan a bright orange leaf-print button-up shirt. He’d worn it some during his three-week visit, but wasn’t exactly too keen on it. Despite it really fit in with the bright clothing the Burkinabe wear, he couldn’t see it fitting in too well in America. On their last day in Burkina, we’d stayed at this same hotel, and he decided to give this shirt to the hotel clerk who was there—Jean Claude. (Sorry Keenan, if you hadn’t yet told this nameless person that you had re-gifted his gift.)

Now, over 2 years later, Jean Claude still had that same shirt! The hot Burkina sun had bleached out a lot of the color, but it was clean and pressed, and looked very neat. The shirt would have been perceived as ‘out-of-style’ or ugly in America. (Truth is, I don’t have a clue where Keenan’s gift-giver even found such a shirt!) But Jean-Claude was simply honored. Someone thought enough of him to give him a shirt. No one would ever think it was ugly, as long as it was clean and neat. Life is simple, if we let it be.

When Zoum spoke those words to me in Burundi, he simply stated things as he saw them, trying to calm me down from my tantrum. But what he said seems to be such a truth for all of us, in any culture. We have so many problems because we try to complicate things. We often stress over things that we couldn’t possibly live without, even though we truly could. People in many places live without those things, and they are fine. We should be more thankful for what we have. If we have a safe place to sleep at night, our bellies are full of food and drink, and we have loving people around us, can we really complain about anything else? There’s obviously nothing wrong with having nice things, but we complicate things when we turn wants into needs.

I try to remember Zoum’s words anytime I’m in a frustrating situation. And, more importantly, I try to make sure that I am not the one doing the complicating.

That's bull crap, Whitney Houston!

The hot equatorial sun was beating down on my newly buzzed head as I raised my polo shirt collar. Say what you want, but I was trying to protect my neck, not make a fashion statement. I immediately regretted the decision to hop on the back of this huge dumb truck, as I had no sunscreen with me. One of the unfortunate perils of a white man choosing to live in a place meant for those with more melanin--the constant war with the sun.

But I didn't want to miss this opportunity, as my work doesn't often allow me the freedom to stretch my horizons beyond the confines of the clinic property. Our 22 member cultivating and landscape crew, along with our two volunteers from America and Burkina Faso, Will and Zoum, had already gone down the mountain to the town of Mugara earlier and loaded on one load of manure, and the truck had brought it back to the site. I was now with the truck on this return trip, the second of 4 it would make in the day.

I had originally tried to sit in the front of the truck with Zoum and Will, having been accustomed to always given preferential treatment due to my skin color and offending people by not accepting it. (Many of you will remember Zoum, he is my good friend from Burkina Faso, who has volunteered his time and knowledge to come help us with our food security program!) I then realized I had taken the place of someone else, and used that as an excuse to climb in the back of the dump truck, something I knew would make the ride down the mountain all the more exciting.

With my popped collar, I was standing in the front side of the 'dump' part of the truck, right behind the cab, holding onto a bar placed there for that purpose. Standing there, I was trying to maintain my footing on the now slippery surface of the bed due to its previous load. Despite everyone's efforts, most had some amount of manure on them, mainly on their feet and hands. I knew I would be no exception.

I was on the left edge, next to Jean Marie, one of our cultivators, and the only one who speaks French. Incidentally, he is currently our only cultivator I can communicate with, as the learning curve for Kirundi seems to be very high for native English speakers. This spot on the left edge gave me a great (and often too close) view of the steep 3000 foot slope down to Mugara to my side. It was an incredible view from this height. Although, my position on the truck, along with the way the truck was built, gave the eery illusion that we were seconds away from tumbling down the steep hill.

The view at this point is priceless, and I never tire of it. Velvety green mountains, with spots of small pine forests, reflecting the strong sunlight, leading down to forests of palm trees, which are often harvested for the vitamin-rich and very tasty palm oil. The green pine forests lead all the way to the nearby Lake Tanganyika, which casts a white glare from the sun onto the tall mountains of Congo on the other side.

Riding in the back of this dump truck requires a lot more skill than one would think. The dirt road is very crude, although its presence alone is very impressive. Its 4 miles were built in 4 days entirely by the many hands of the community to be able to bring building materials to the top of the mountain to build the clinic. The community had really come together to show how excited they were about having a clinic in their village! But 2 ½ years later, the road has succumbed to the bullying of the many rainstorms this tropical area invites each year, and is very bumpy. The bumps, rocks, potholes, and many other trademarks of this route cause the huge dump truck to wobble back and forth as it slowly climbs down the mountain.

With me and Jean Marie in the back were two other cultivators, one of the dump truck workers, and a police escort. Riding down, bump after bump, we all had a good time joking about the road. And you can imagine the many looks from the people tending their gardens as they looked at the huge dump truck passing with a short, goofy-looking white guy in the back, holding onto the bar for dear life and trying to look like it wasn't the first time he had done this.

After a few minutes, the sun decided to take a rest from beating the humid soil and took a little nap behind some clouds, something that I took as a little favor from God for my white, un-sunscreened skin. We continued to wind down the mountain till we got near the town and had to pass through the palm forest. From above, the densely planted palm trees look like a bed of soft green feathers. Up close, though, their spiky branches and rigid leaves reveal they're anything but.

As the dump truck was so tall, man of the branches kept coming at us with their death spikes trying to clothesline us. We would squat down behind the cab to keep from getting smacked. I quickly learned the Kirundi (language of Burundi) word for “Watch out!”--Orogaba!.

We kept yelling “Orogaba” as we went along. One time, out of sheer panic as I saw one of the crazy palm trees coming running straight at me, I yelled “Orogabo”, which, incidentally, means “man”, not “Watch out!”. Luckily they are very forgiving with their languages, but not without letting every one within a 5 mile radius know about my mistake. But it just added to the fun, because we just started yelling “Orogaba orogabo!”, or “Watch out, man!”. I was too busy watching out for my own life, but I am afraid to know how many people we scared as we rode by seemingly yelling at everyone to watch out. For what?, they must have wondered after diving out of the way.

So along we went—the truck on the road going up and down, up and down, and us in the back, going up and down, up and down. It felt like we were living a nursery rhyme. Finally we got to the home that we were buying the cow manure from. A huge team of our workers were standing by waiting for the truck's return, and as with usual Burundian custom, gave me a huge welcome, especially since my trip was spontaneous..

“Karibu Cory, karibu!!” (Welcome Cory, welcome!) There were many high fives and handshakes and hugs to go around, this culture loves greeting each other, something I love about living here. Although, there was no sympathy for my clean hands as they all embraced me and my hands, sharing the wonderful germs of their labor with me. No big deal, I was about to get my hands dirty as well.

We were all very excited about being able to buy the manure. The economy has had its effects on our clinic too, and money has been very tight for several months now. Because of this, we haven't been able to buy the things that we need. Luckily, we got a grant to buy things for our fields that we use to feed our patients and staff. So we are now able to buy all this cow excrement to fertilize our fields!

I'm not sure exactly where to jump in (pun intended), although everybody is looking at me to start. As this trip was spur of the moment, I happened to be free at the right time, I didn't exactly come dressed appropriately. My freshly washed corduroy pants and white linen shirt are probably the worst thing to be wearing when you're about to tackle a huge pile of manure (again, pun intended).

The work happens in kind of an assembly line, involving about 25 people. There are people that use hoes and pitchforks at the pile to pass it along to a smaller pile, where it is then put onto small little 'stretchers'. Then two men take these little stretchers of manure and carry them to the nearby truck, where a couple other people receive it and drop the load into the back of the truck. This process is continued over and over until the truck is full.

I start working with Zoum and Will at the pile, but am not used to using the type of hoe they have here, so I try to find somewhere else where I can be more useful. It's a tough situation to be in. I want to show them that I am helping them, while also appearing like I know what I'm doing (or rather appear as little of an idiot as possible), while at the same time trying to keep my clothes from getting dirty—a tough day's work.

One of the stretcher carriers calls me over to help him, which I gladly do.

Even though the small stretcher is only 1' x 2', the manure is quite heavy, surprisingly, and I have to really hold on tight to the corner of the old plastic rice sack we're using. We run quickly, shouting “Heeeeeeeeeeeey!” as we approach the vehicle, to let anyone in the way to move away quickly unless they want a face full of cow poop.

Because of the language barrier, we all use a lot of sign language, and there is a lot of miscommunication and laughing. And the carrying of the manure doesn't sound that difficult, I know, carrying one side of a bag 30 feet and then lifting it up to a dump truck. But the grass has become slippery due to the constant traffic, and manure is heavy. And every time I have to lift the stretcher over my head up to the dump truck, I close my eyes out of fear of a slipped hand and a face full of, well, you get the picture. I work with Louie, my partner, for quite a while, and it starts to wear me out. Suddenly I realize they have turned music on in the cab of the truck. And after a few minutes, Whitney Houston's new song “I Didn't Know My Own Strength” comes on—here in this French- and Kirundi- speaking country, even they like Whitney Houston! I love that woman! And hearing that song gives me my second wind!

Finally, the truck is full, and I climb in the back with Zoum and a couple others, this time being about 3 feet higher than before, and prepare for the trip back to the clinic to unload the load. Because we're so much higher than before, we now have to squat down twice as far every time we pass an orogaba branch.

As we go along, Zoum and I joke about the difficulty in riding in the back of the truck. He reminds me that this is the worst road he's ever seen, which is saying a lot considering everywhere on this wonderful continent he's been to. But at least there is a road, and many people use it to get care at the clinic. I keep an eye on the sky to see if the sun will wake up from its nap and come bully my skin again, as we climb back up the steep mountain to the clinic. But at least I know, with a dirty shirt, almost sun-burned skin, and stinky hands and feet, that all this work will provide enough fertilizer for this year, and will help many patients. And even Whitney Houston lent a hand.

It's a Matter of Life and Death

It's amazing how small this huge globe can feel, and how at the same time places can feel as inaccessible as the moon. It started with a news report: Haiti had suffered an earthquake. Little was known, bu t it was a strong earthquake, striking near Port-au-Prince, and severe enough that it made Burundian radio.

Tens of thousands injured, possibly hundreds, and millions of people affected. The news hit like an aftershock to the world. But to a doctor here at Village Health Works, it felt like the earth dropped out from underneath him right here in Burundi. Barry* (name changed), is from Haiti. Port-au-Prince to be exact. He made the decision several months ago to leave his lifestyle, and more importantly his family, to come help the people of rural Burundi with his knowledge.

Now, on the other side of the planet, he couldn't even help his own family.

News reports started popping up on the internet.

“Hundreds of Thousands Feared Dead.”

“Relief Not Coming Soon Enough.”

“Many Still Buried Under the Rubble”

This is the only news Barry was hearing. He tried to call his family, but communication to Haiti was cut off. The only news he heard was from the internet. He contacted friends and family all over North America, to try to find someone who had heard something. All that day, nothing.

Soon, the sun dipped into the still waters of Lake Tanganyika, and still no word from his family. As the rest of Burundi settled under their mosquito nets and blankets, Barry sat wide awake at his computer, hoping someone, just someone with some news, any news, would pop online, and possibly with news that his family was alive and well.

Worry never gave way to fatigue that night, and Barry never went to sleep, afraid of missing that important phone call or email that would tell him his family was alright.

The next morning, as people started creeping out of bed, starting their fires for coffee, tea, and porridge, Barry was already wide awake. Despite what was going on back home for him, he still had his mission here, to provide quality healthcare for those who usually can't afford it. The lines started to form at the waiting area, and family members brought their loved ones to be seen for malaria, TB, coughs, and stomachaches. And soon, Barry got back into doctor mode as he started making his rounds in our malnutrition ward. Putting away his own life-and-death family situation, Barry helped other people with theirs.

The day continued on and on. Rounds to do, patients to consult, medicines to prescribe. All the while, waiting for some news. More news reports came in, pictures and videos flooded the internet, slowly draining the little hope that we all were holding onto for Barry's family. The day stretched on—still no word from Haiti.

I was on my way back from a meeting in Bujumbura, the capital of Burundi. With me were two new volunteer nurses, Helen and Connie, who had just arrived, and a representative from the UN's World Food Program, who was coming to check out our clinic to see if they could provide some food for our malnutrition program. I asked Barry if he wanted me to give her the tour because of all he was going through. He said he could manage.

We gave the tour to the World Food Program representative. And Helen was excited to be back after a couple months away, which brought some joy to our sad situation. Connie was also taking in all the new sights, it was her first time to the clinic.

We solemnly ate dinner that night. Barry wasn't interested in eating, or even drinking the cup of coffee Brad, a volunteer nurse from Maryland, had brought him. The second day, with no news.

“In America, you say no news is good news,” Barry explained. “But right now, no news is the worst feeling ever.”

I remember a couple years ago, while living in rural Burkina Faso, I was listening to the BBC World Service news bulletin. They reported an earthquake in Kentucky, where my family was living. I tried to call from my cell phone under the mango tree with phone reception, with no avail, reception was too poor. I tried our village phone, but still nothing. I waited in agony for several hours, just hoping that they were ok. I finally got a hold of my family after a few hours, and found out it was only a minor earthquake. But I remember the dread and helplessness I felt from being so far away that I couldn't help. And I didn't know what had happened to my family, or the extent of the damage. And now Barry was faced with the same situation, and for two days now.

The next day came and went, still the same story. It was a quieter day here at the clinic, so it seemed that Barry had more time to focus on the communication, or lack thereof, with his family. He had called everyone he knew in all parts of the world who might have had some sort of contact with his family. He'd gotten a couple leads, but wasn't quite sure how true they were. Three days it had been since the earthquake, and still no word.

We all went to bed, and Barry hoped to get some sleep that night, after 2 nights without any. But around 2 am, there were some emergencies in our inpatient ward that needed a doctor's touch, regardless of his personal situation. So Barry spent the third night without much sleep.

The following morning, a patient that had come to our clinic with a chronic foot wound a few days earlier started to take a turn for the worse. He had come with an wound the size of a softball on his right foot. The doctors and nurses had been taking care of the wound, and the thought of sending him to a regional hospital for surgery was being talked about. But this morning, he started acting really funny, as if he was under the influence of something.

Connie, Helen, and I were eating lunch at our residence, when Hilarie, one of our nurses, came up to get some sugar and water and rushed back to the clinic. We followed her, and we found Barry leaning over the man's chest, giving him CPR. His heart had stopped, and he'd revived it. Now it had stopped again. His eyes went dead, he stopped breathing, and we all stood there in disbelief that this man who had seemed so healthy a few days before was now dead in front of us. Barry, despite all his fatigue, continued pumping his chest, forcing the blood through his heart to keep him alive.

The man's two sons had moved away and quietly started to grieve, their stifled snobs echoeing off the cement walls and tile floors of the room we were in. But Barry kept forcing the chest to work. All of a sudden, a small gasp from the dead man's mouth. His chest started to slowly rise. He blinked, a reflex of the dryness in his recently-dead eyes. He was still unconscious, but now alive.

Barry continued to help the man's body take back control of its blood flow, and after what seemed like an eternity, the man slowly came to. What we thought was a hopeless situation now became another life saved, by a man struggling in his own reality, not knowing if his own family had been spared from nature's death grip on that tiny island in the Caribbean.

It turns out the patient was diabetic, and the years of high blood sugar took their toll on his heart. But now, he was alive again, and he will receive the insulin he needs to keep his blood sugar down to good levels.

A short while after Barry revived the man, his phone rang. It was a cousin of his in Canada. He said he had news about Barry's family in Haiti. This was the moment Barry was waiting for, whether the news was good or bad, all he wanted was to be able to know, to have closure. His cousin said that he had talked to Barry's father, and that all of his family were alive and well! His younger brother had some minor injuries, but that was all. Everything was going to be alright! They have a long road of reconstruction ahead of them, but at least they are all alive!

We all rejoiced, and the joy in Barry's soul was infectious to all of us, as we all celebrated the good news with him.

Living far away from family can be very challenging, and in my opinion, is one of the hardest things about working internationally. Going through this ordeal with Barry made me miss my family even more than usual. But seeing that man revived back to life reminded me why I am here, and why I believe so much in the work that we are doing here. I feel privileged to be a part of this team.

For more information, check out Tracy Kidder's Strength in What Remains at your local bookstore, and/or go to villagehealthworks.org