The True Test of Civilization

 “A decent provision for the poor is the true test of civilization.” -Samuel Johnson, lexicographer (1709-1784)

 

I’m back in Nairobi. The six weeks in the US seem like a distant memory as my work has been intensifying. The situation in Somalia continues to worsen. The figures are staggering:

•        451,000 drought-related displacements in the past 90 days (people seeking aid); 760K overall displaced.

•        Of the locations where the displaced have congregated, only about a third have water.

•        6.1 million in IPC 3&4 (serious need of assistance); 81,000 in IPC 5 (catastrophic situation)

•        Over a hundred schools closed as children and/or teachers have been displaced.

•        90% of the country’s water sources have dried up.

•        Livestock herds and crops have been decimated, likely impacting food security for years to come.

It’s hard to describe what’s going on. It’s hard to make it matter for people who would be able to share a bit of what they have for those in need. I was interviewed two days ago by ABC News and the guy asked me how I could make a compelling description for people to understand the disaster that continues to unfold in the Horn of Africa. I realize that the data can make people’s eyes glaze over. I told him that a million and a half children are suffering from acute malnutrition, many of whom are going to die. Sometimes focusing on children will get a rise out of people. But so far, with about 5% of the funding received compared to what is needed, even the idea of children needlessly suffering doesn’t seem to jar people enough to refrain from upgrading their lawnmowers or dumping money into clothes they don’t need. People don’t necessarily need to change their lifestyles, skip vacations, etc. (though cutting back on food wouldn’t hurt some people). The world would be a lot better off if people just shared a bit of their surplus, particularly the millionaires and billionaires.

It might be helpful to shed some light on what people are experiencing right now. The main concerns are starvation, dehydration, waterborne illnesses (from drinking contaminated water) and malnutrition. Measles and other diseases are also on the rise. Just to home in on one. What does dehydration look like?

Water makes up about 55 to 65% of your body. It’s a crucial ingredient in the chemistry that helps your brain think, your blood flow and your muscles move. When thirst kicks in, your body clings to all remaining moisture. As time goes by, your kidneys send less water to your bladder, darkening your urine. As you sweat less, your body temperature rises. Your blood becomes thicker and sluggish. To maintain oxygen levels, your heart rate increases. Your blood is so concentrated that the resulting decrease in blood flow makes your skin shrivel. Eventually, your blood pressure drops, making you prone to fainting. You’ve basically stopped sweating, and without this coolant, you start to overheat. Your body is having trouble maintaining blood pressure. To survive, it slows blood flow to non-vital organs, such as your kidneys and gut, causing damage. Without your kidneys filtering your blood, cellular waste quickly builds up. Your uncontrollable body temperature means your vital organs risk overheating; liver failure will probably kill you. But if conditions are mild, toxic sludge builds up in your blood and the thing that will do you in is likely to be kidney failure. It's an unpleasant way to go.

The last question the journalist asked me was to provide a final comment: if you had 15 seconds, what you would like the American audience to know about the situation in the Horn of Africa – something to stick with the viewers. I thought back to the severe drought in Somalia in 2017. I referred to something that the UN Secretary General (who I had a glass of wine with many years ago in Dar es Salaam, Tanzania) said at the time. With climate change, severe droughts are unavoidable. They will come and go. However famine is preventable. Famine is the result of the lack of response to the severe drought. The path we’re on is currently leading us in the direction of famine, though we’re not there yet. If we get there, it’s on us. We could have avoided it had we responded sooner.

Back Across the Pond

"We live in a world in which we need to share responsibility. It's easy to say, 'It's not my child, not my community, not my world, not my problem.' Then there are those who see the need and respond. I consider those people my heroes." -Fred Rogers, television host and author (20 Mar 1928-2003)

 

The moment I fell from my bicycle back in November, I knew it was broken. Even then as I got to my feet, I was aware that my right wrist was broken and probably my left thumb. However the implications of that break were something that I could not have imagined at the time. I anticipated that I would be in a cast for a period of time. I anticipated that there would be a long period of healing. But I never would have guessed that it would require a trip to the US, surgery, a re-breaking of the bone, six weeks away from my family, etc. It’s a very good thing that we don’t know the future.

Departing solo

Other than the medical appointments and work mentioned in the previous post, I did do a number of other things in my spare time. It was a challenge since I wanted to take advantage of time with family based in Idaho, at the same time I was trying to make it clear that my priority was to get my wrist taken care of and stay on top of things at work. This would not be vacation.

Happy it's done. Not enjoying the pain.

For the most part, it worked well and I was able to balance everything. The part that took the biggest hit was my sleep. I felt that for the full six weeks, I probably averaged 4-5 hours of sleep per night and almost constantly felt tired. Even on mornings which technically were considered a weekend, I wasn’t able to get extra sleep for some reason. I toughed it out knowing that it was only going to be for a few weeks.

* * *

One project that has been on my mind for some time has been the need to digitize my parents’ pre-digital era photography. I knew it would be a daunting task but it wasn’t clear to me what we were talking about in terms of volume. But once I knew I was going to the US, and I would have a period of time where I wouldn’t be able to be that active, this seemed like the ideal opportunity.

Thousand Springs (though nowadays it's more like a dozen)

Not too long after arriving in country, I made my way to visit my parents and began digging around the boxes of media. There were boxes of reel-to-reel audio, VHS tapes, slides, negatives and some photos (though the majority of the photos were elsewhere in albums). I homed in on the slides for a few reasons. One is that for a period from the late 1950s to the mid-70s, my parents seemed to have predominately maintained slide film in their camera. It was the thing to do at the time and gathering around a screen to view projected photos was a nice way to re-visit one’s experiences, particularly as a group.

I know slide shows got a bad rap over time as a boring thing your father did, but for some reason I always enjoyed them. It was like movie night at home (since we didn’t have Netflix back then). My dad (or grandfather when we were at their house) would break out the projection screen. The lights would be dimmed and the kids would assemble on the floor. The grown-ups would sit in chairs around the perimeter. As the round slide carousel would be loaded (or changed), the kids would often take advantage of the white projection screen and make shadow puppets. One by one the photos would click by, often times upside down or inverted. If it was an interesting photo, it would be corrected. Otherwise, we’d just continue on. There was no photo editing at the time for the layperson. If the lighting was bad, you’d squint to try to make out what the photos was but that was it. If the photo would be better cropped, oh well.

One of the precious scanned images; me on the left

The second reason that I focused on slides was that, given the way slides were shared, if you didn’t see it projected, you generally didn’t see it. With photos, you could casually browse through an album sitting on the coffee table and frequently tap into them on occasion for reference. As such, the slides provide some images of a couple decades that, at least for our family, haven’t otherwise seen the light of day.

I had previously owned a slide/negative scanner but after several attempts to resurrect it, I gave up and bought a new one. I looked into outsourcing the scanning but, in addition to the expense, I realized that I sort of enjoyed the browsing of the past and it could be done while watching the NCAA college basketball tournament and/or chatting with family.

* * *

Given that it was still the waning days of winter, one thing I wanted to do during the window that I had prior to the scheduled surgery was go skiing. It’s not really a recommended activity for someone with a jacked-up wrist, and it would have been a precarious thing to do to fall on my nearly constantly painful wrist, but I rarely fall when I ski and I convinced myself that I would make a special effort to reel in my often aggressive approach to skiing.

Amazing day on the mountain

It’s an activity that is of deeper importance to me than simply sliding down a mountain on a couple of boards. I’ve been skiing since my youth, throughout my eight years in Switzerland, and off and on since. It’s almost as much the connection to an incredibly beautiful slice of nature, on a snowy mountain, as much as it is the act of skiing itself. There are very few activities that resonate with me quite like it. I knew I had one chance to go before my operation and it would not be possible thereafter. I wasn’t able to use my poles due to my wrist, but I really didn’t need them. The day that I was able to go was gorgeous. The snow was great. The weather was sunny. I was surprised how good I felt given how rarely I get to ski these days. It was a wonderful gift for which I am immensely thankful.

* * *

Allegedly Ben Franklin used to say that guests are like fish in that they begin to stink after three days. As such, I sort of kept on the move. It was also to make sure I fit into people’s schedules along the way. I would stay a few days with a family member and then move on to the next.

Soon after surgery I headed up to the mountains to hang out with family up there. Once again, it was a time of year that I haven’t seen in Idaho for many years. When I first arrived, there was still considerable snow on the ground. But over the span of just a couple weeks, it changed radically. The weather warmed and the valleys became green. Massive temperature swings from one day to the next. Lots of unsettled weather, which I like.

One of my many work spaces

I was able to stay at both my brother and sister’s houses. I checked on the construction of our house, which is moving at a snail’s pace. But it is moving forward. It could be worse given the demands on contractors these days.

* * *

After almost a week in the mountains, I headed south to return to the flatlands with a planned stop to see my brother on the way. However, soon after leaving my sister’s place, I had a flat tire. It’s been years since I’ve had a flat. Apparently I had hit a rock that had come loose on the hillside due to the spring thawing. Its jagged edge punctured the sidewall and I was now stranded on the side of the road. I grabbed my phone to notify by brother who lives another fifteen minutes or so down the road. Unfortunately there was no cell reception – not uncommon on a windy, mountain road in Idaho. But it was created a dilemma for me on this occasion.

My next thought was to simply expedite the tire change so as to limit the delay. I don’t like people waiting on me. I got out of the car, went back to the trunk and noticed that there was no spare tire and no tools!? When I was in my twenties, I worked at a car rental agency and we always made sure vehicles had spare tires and tools. Apparently, things have changed.

As I got back in the car to warm up and sort out my next move, it occurred to me that with my broken forearm, I likely wouldn’t have been able to use the jack anyway. As I began to take in my setting, I noticed to my left that across the river and through some trees there was a pick-up and trailer. I could also see what appeared to be someone walking nearby. It looked like my best chance to get out of my current mess.

I grabbed my coat and headed up the road to a small bridge that allowed me to cross over and backtrack towards the pick-up. The man, likely in his late 60s, seemed a bit startled to see me, understandably since he likely doesn’t get too many visitors, certainly those arriving on foot. I greeted him and explained my situation. He didn’t make much eye contact and carried on loading things in the back of his pick-up as I talked. He eventually stopped working and offered to let me use his landline at his house up the hill. He let his dog out of the pick-up and the three of us walked about a quarter mile up to his small cabin. It was impressive how quickly he launched into his political leanings. I just smiled and kept walking. I’ve always considered myself mostly in the political center but some of my home state, particularly in these more remote areas, seem to have wandered to the extreme right. I just kept my mouth shut. I wanted to make sure I accessed his phone before any possibility of him changing his mind.

The cabin had a fire going in the fireplace and I was comforted by the warmth and the likelihood that I was going to sort this out. Soon my brother was on his way and the man, the dog and I made our way back down the hill. I thanked him for being so gracious to drop what he was doing and take the time for me to use his phone. I headed back to the car to wait for my brother.  

Broken wrist; making my brother do the work

When he arrived, we rolled the car down the hill a ways to get it further off the road. We removed the tire and proceeded to head towards the town of Council. On top of the other challenges, this was a Sunday and nothing was open – no chance of getting the tire fixed until at least the following day. As such, we headed to the local pub for a drink and to hang out with the gang.

Cabin with a fire - few things I like better

After spending the night at my brother’s place, we headed to the town of McCall to get the tire fixed. With amazing efficiency, it was repaired before we finished our breakfast. We ended up buying some cook-at-home pizza and headed back to his mountainside cabin for the evening, binging on James Dean movies, hanging out and enjoying my last day in the woods.

* * *

I was also able to spend quite a bit of time with my parents and do a bit of exploring around the Magic Valley. The “magic” refers to the transformation of the valley into farmland as a result of the construction of dams and an extensive canal system in the early 1900s. It is the phenomenon that lured my grandparents’ families out West. Over time, however, this amazingly productive farmland is being covered by concrete and houses. Hard to say if builders stop to appreciate the backbreaking efforts of early farmers (including my grandparents) in removing rocks and unknowingly making it easier for construction rather than agriculture (there’s no shortage of land that is poor quality for farming but suitable for housing). In any case, this permanent loss of arable lands is continuing unabated and I do wonder if it will be to our regret one day as the world increasingly struggles to feed itself. In the meantime, the “magic” is sadly becoming less magical.

Shoshone Falls from afar

* * *

After returning to Boise, we were hit with a decent snowstorm which covered the spring blossoms. After a front-loaded day of work, my sister and I took a 40-minute break to quickly build snow people. It had to be fast not only because we still had more work to do, but the spring snow quickly began to melt. Parts would fall to the ground soon after attaching them. 

My delicate construction lasted about as long as it took to build it. My sister’s fared better, but nonetheless face-planted by the following day.

He was an inspiration to us all...

One first for me was attending a lacrosse game. My brother-in-law’s son was coaching and my sister and I thought it might be a fun way to spend a couple hours. I grew up around sports but lacrosse wasn’t one of them. I knew very little about it and, to be honest, I still don’t know that much. I get the overall objective of launching a little ball into a net with a stick with a small basket on the end, but most of the stuff that leads up to that point isn’t very clear. I see the appeal though. It’s pretty fast. There’s a bit of roughing each other up. What’s not to like?

We were late getting to the game and missed the first quarter blizzard. But by the second half, the weather was mostly sunny. The pleasant weather didn’t help our team’s cause and they lost by one point. It was in the stadium which accentuated the sparse crowds. I played on artificial turf several decades ago and the technology has clearly improved over the years. We were able to go out on the field briefly after the game and it feel nothing like turf in the old days.

Another first was attending a comedy club. Quite fun actually. I'm not even sure they existed in Boise when I lived there. Maybe. But I didn't have much money back then and I likely wouldn't have used what little I had on going to a club.

* * *

On Wednesday, April 13, I had my final doctor appointment. It was sort of like passing an exam to be able to fly home to Nairobi to see my family. But pass it I did. Doctors are good at looking at gross things and saying, “That looks really good!”. I’ll take his word for it. I put on my arm brace that Friday and headed to the airport. The longest time being away from my wife and children was coming to an end.

 

I wouldn’t be home until Sunday morning, flying directly over the North Pole from Seattle to Dubai, but it was all worth it. My arm was more or less fixed. I was able to keep up with my work. Spend time with my parents and siblings. Scan a couple thousand slides of family history. Mission accomplished.

After a Break

After some time away, it’s time to begin writing again. I have several excuses for not writing – the two most prominent being a broken wrist (which had to be re-broken) and excessive travel and work.

While the wrist is on the mend, travel and work continue unabated. As I often do when I’m behind with the blog, I will commit to methodically catching up. Given that this is a general account of my experiences, I don’t really enjoy skipping things. Life tends to come at me fast and hard and lots of things happen that should be recorded.

the shorter left forearm bone (radius); tilted wrist

As mentioned previously, my wrist that was broken last November and it didn’t heal properly. But a cast was put on it in the hopes that it would. When the cast was removed in late December, it just didn’t feel right. As much as I invested time and energy to rehabilitate it, it just didn’t get better. Not only did it feel wrong, it looked wrong.

After I returned from my previously mentioned trip to Mogadishu, I booked a follow-up appointment with my doctor in Nairobi. He confirmed that indeed I needed surgery. While he refrained from speaking negatively of surgical care in Kenya, he did discuss with me the complexity of the break and hint at the need for me to explore options outside the country. In my case, that meant the US. He also said it needed to be done urgently to avoid further complications.

I immediately began to look at my options. I haven’t had much medical care in the US over the past several decades so I wasn’t sure where to start. I contacted my sister and brother-in-law who pointed me in the direction of the sports medicine facility at my alma mater. They, after grasping the complexity of the break, pointed me in the direction of a clinic that specializes in hands. That’s all they do. I didn’t even know that existed in my home state. But I figured that if they could take me in as a patient, that would be fantastic. I just wanted it fixed. So I sent them my information and doctor’s referral, including a scan of the x-ray, and, thankfully, they booked me an appointment.

The frustrating part was that they were reluctant to let me know how this was going to unfold exactly. Apparently, until the doctor had a chance to see me, there would be no determination of a surgery or anything else. I needed to book a ticket to the US and just guess how this might play out. I was very much in the dark as to what was going to happen. The only thing I knew was that I had an appointment the first week of March.

I proceeded to go online to try to find the lowest fare to the US, regardless of my mileage program allegiance, and I randomly guessed that the whole process would take about six weeks, hoping that it would be less, all the while fearing that it could be longer (in the end, it turned out to be exactly the duration needed).

While I was sad about being away from family that long, I was tired of being in pain and knowing that something wasn’t right about my wrist. There was a steely resolve that helped me maintain a focus on doing what was necessary to get it done. I booked a flight on Emirates the same day I secured my appointment and things were set in motion. I would leave the following week.

* * *

The next thing was to figure out how this was going to work for my job. I knew I wouldn’t have enough sick leave to be out that long. And besides, with my deputy director out on extended medical leave (and some other leadership out for other reasons, including maternity leave), I was backed into a corner. I would need to work throughout the time that was away. That would mean managing a 10-hour time difference six days a week (the Somalia week runs Sunday-Thursday; Kenya/NY runs Monday-Friday; only Saturday is really off). I’m used to working six days a week but the thought of managing that with the time difference over a long period of time made me sick to my stomach.

I left on a Friday night to avoid the need for a vacation day due to travel and to get there in time for my appointment on Monday. By the time I arrived in the US, it would be Saturday night and I would be able to work the next morning (albeit jet lagged). Before I knew it, I was at my all-important initial appointment. The doctor pulled up the x-ray that I had sent him (actually, a phone photo I took of the x-ray hard copy since I was told the clinic in Nairobi couldn’t send x-rays via email). He more or less confirmed the diagnosis of my Nairobi doctor. My interior forearm bone (radius) had been crushed at the wrist and had healed shorter than the exterior forearm bone (ulna). As a result, my hand was dislocated from its normal position and thus causing the constant pain and the lack of mobility.

What needed to be done was to re-break the radius (saw it into two pieces), extend it out to its normal length about 2 cm. such that it’s even with the ulna, add a plate and some screws to hold it in place, and then bone graft in between so that the two parts of the radius bone are able to fuse. Simple as that. I could see very quickly that the doctor was intrigued by the complexity before him. I was glad to see his interest in my case. I was hoping it would translate to a successful surgery.

He did leave the door open to the possibility that things may not go as planned for a couple of reasons. One was simply the complexity of the break, something he’d never seen before. The other was the fact that there had been previous injuries in that area (about six previous fractures to my forearm, wrist and hand) that added to the complication. But at least we had a plan. Surgery would be in ten days. Not bad given that operating rooms were backlogged due to the pandemic.

* * *

While I waited for surgery, I proceeded to continue working and spending my time with family. For the former, drought has been raging in Somalia. Moreover, my management team has been short-staffed. On top of this, Mr. Putin decided to invade Ukraine on Feb. 24, not only devastating the lives of millions, but also sucking valuable aid resources away from East Africa. While I was happy to see the international response to a crisis in Eastern Europe, I was sad to think that a crisis of similar magnitude in Africa never generates the same kind of visceral response in the Western world. It’s not surprising. It’s just sad that the world seems to value some lives more than others.

I was also getting up in the wee hours to attend meetings, respond to emails, provide approvals, etc. The earliest critical meeting so far has been 2am Idaho time though it has been averaging between 3am and 6am. I’ve been doing my best to keep up but I’m not sleeping well (i.e. not enough) and it’s difficult to keep up with everyone’s schedule here. I’m trying to go to bed early though often circumstances don’t permit it. I do think people here have been understanding. I just don’t think they get how hard this is. It’s not only keeping up with a job in a different time zone. It’s keeping up with my particular job – helping get aid to thousands of people are in dire circumstances at this time. 

* * *

The day of the surgery, my dear sister took me to the hospital in the dark of the early morning. Despite the complexities, the surgery would be outpatient. I would be provided necessary anesthetic but I would be able to leave that afternoon. It’s pretty amazing, really. I’ve had a couple surgeries before, years ago, possibly even less invasive than this one, and both involved a night or two in the hospital. It’s good because it keeps costs down and allows people to go home to their families. It is weird, though. After all the cutting and digging around in your body, they just sew you up and get you home by tea time. No medical professionals hanging around to make sure you’re okay.

The surgery prep was pretty straight forward, except for the fact that you’re in a room with a few others also heading into surgery. You’re only separated by a curtain. You can hear the prep conversations with other patients and it’s less than comforting. You can sense the anxieties others are experiencing. I was already looking forward to a sedative.

A nurse came in and shaved my forearm. Another doctor came in and explained how the anesthetics were going to work. Someone else came in, jabbed my arm and hooked up my IV. Things were getting real.

After only about 20 minutes, they began wheeling my gurney towards the operating room. On the way I asked the nurse if indeed I would pass out during the surgery. She said normally, yes. It was that word “normally” that bugged me. I didn’t want to hear/see, bits of my forearm bone flying across the room as they sawed it in half.

Once in the operating room, they started hooking me up to equipment and putting all the tools in place. The last thing I remember was the clanking of the metal instruments on the tray next to me. After that, my next memory would be waking up in the same place where they did the surgery prep. It felt like five minutes but it had actually been about two hours. As I was coming to my senses, nurses immediately began talking to me as if they expected me to be coherent. I did my best to get it together and speak in complete sentences. One asked me if I felt pain. Another asked me if I was nauseous. My right arm, from the shoulder down, had a block and I could feel nothing at all. They pulled my IV out of my left arm, which I did feel. They said I would lie still for about an hour or so and then I’d be ready to be escorted home by my sister. She had apparently been briefed by the doctor so that she would know how to look after me, particularly for the first 24 hours.

Sure enough, after about an hour I was helped to my feet and I was able to walk out, into the sunshine, with my surgery finally behind me. I’m still amazed how all that works, but I was thankful to be done with it and have the ability to go home, or at least my sister’s home.

post surgery: on the left, the metal plate; side view on the right shows the six screws

I'll refrain from showing the post surgery non-x-ray photo. It was pretty gross.

* * *

Once at my sister’s house, I planted my butt on one of the sofa’s and didn’t move much. My arm was bleeding quite a bit and I was trying to keep it elevated as much as possible. As well as I was prepped for the surgery and recovery, the continued bleeding was unfortunately not discussed. I wasn’t sure if it was normal. I was also feeling the block begin to wear off. You’re supposed to begin the pain killers before that happens. I was a bit more delayed than I should have been and I was able to have a sense of the seriousness of the pain I would be masking.

When I woke up the next morning, I had a pool of blood on my chest where my arm had been resting. By Sunday, two days after surgery, it was still bleeding quite a bit and we decided to seek support from an urgent care facility. For reasons I don’t understand, I was turned away from two different facilities (connected to the same hospital where the surgery was done). Both said that it was the type of urgent care that they didn’t care for (??). Both said yes, I should probably have it looked at but it didn’t meet their criteria. The one even mistakenly referred me to the other. It was basically, go to the ER or wait until Monday and go see the doctor who operated on you. Seriously. How can two urgent care facilities see a patient with blood oozing from a surgical incision 48 hours after surgery and not even offer to re-dress the wound with some clean bandages.

I honestly don’t understand the American health care system. I went from praising the system for the amazing outpatient repair of my forearm to the realization that there are gaping holes in how the system really works.

Anyway, the bleeding stopped after about 8 days. As for the pain, I was off meds after the first 48 hours. There was still pain but I preferred to monitor how things were going. It’s hard to do when it’s masked. I would occasionally take an ibuprofen but I avoided the prescription stuff. The Wednesday after surgery, I had my first follow-up visit. They removed the bloody bandages that were put on post surgery. It was disgusting, needless to say. The forearm was Frankenstein-ish with the metal clips, discoloration, dried blood, etc. The technician wiped it with antiseptic and proceeded to fit me with a brace that was supposed to be my companion for the next few weeks. In the end I used it a little over a week.

Two weeks later they removed the metal clips and I was told I would have one more appointment before I could head back to Nairobi. The timing of my return flight, booked well in advance of knowing how all this would play out, was, according to the doctor, ideal to allow for the last check-in appointment.

* * *

Little by little I’m gaining my movement back. I was given exercises to do to slowly improve my mobility. It will be a long road but, again, I’m happy to be where I am. I have been in pain since November and now, a little over a month from the surgery, it’s the best I’ve felt since the accident. I can’t do anything heavy with it until the 8-week point but that’s fine with me. It likely will never be like it was, but I'll be happy if I get back all my basic functionality. Time to move on from this break.