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.

Mogadishu

I’m finally back in Somalia after a break for the holidays (and a couple of breaks of my bones). It’s been good to be back. I’m always torn about coming here. I don’t like being away from family but I enjoy being with the team here.

This trip as been limited to just Mogadishu. I needed to get my visa renewed and attend to a few things at our main office. It’s likely that, security permitting, I’ll venture out to field sites on the next trip. I was informed that one of the major media outlets is interested in possibly visiting to cover the drought so that may end up being the focus.

With the complexities of Covid, some challenges with immigration, flight irregularities, insecurity, etc., heading out on a trip such as this is usually fraught with uncertainty. In the end, the travel went relatively smoothly. Admittedly expectations are quite low.

As is my luck, while we were chatting just outside the airport compound, a car hit me from behind. The rear bumper hit me just above the back of the knees and I fell backwards onto the trunk/boot of the vehicle. I rolled to my left and proceeded to land back on my feet, still facing my colleagues. I don’t know what it looked like to others but to me the whole thing felt sort of smooth. That may have been the case since the fixer leaned over, slammed the back of the car with his hand, giving the driver a dirty look, and the conversation continued unabated by the incident. Not a word was said about it.

* * *

view of the ocean, modest as it is

Once in the vehicle, we proceeded to exit the airport compound and head to the office. For the first time in five and a half years, I wouldn’t be returning to the office/guesthouse where I’ve spent so much time. A couple of months ago, we initiated a switch to a new office. The former one sat adjacent to the compound of a former president – someone currently active in Somali politics. As such, over the years he kept beefing up security on our road to the point that it became impractical for us to continue staying there. The property was also uncomfortably close one of the most attacked checkpoints in the city. After considerable search, we finally found a new building. The move happened a few of weeks ago and now I would be seeing it for the first time.

After a short drive on the main road, we turned down a dirt side street. It reminds me a bit of downtown Dar es Salaam many years ago when only the main arteries were tarmac (only Dar didn’t have the excuse of years of civil war to blame). As we made our way, we had to weave through about a half dozen cows munching on some roadside rubbish. No boom gates, cement barriers or young guys armed with AK47s. Just cows. I liked it already.

There was, however, a gate, boom gate and armed guards to enter the compound. That’s standard in Mogadishu.

The compound looked clean and nice. Some of my team were waiting in the courtyard when we arrived. I was provided an immediate tour of the place. Similar to our previous building, the facility consists of two main floors of offices with a guesthouse above. What’s cool is that there’s another room on the roof that is destined to be a workout space (with possibly other uses). Best of all is that there’s a view of the Indian Ocean – something that was missing in our previous building. It’s not a massive view but it’s not bad. You can even see waves crashing up against the rocks. Never underestimate something like that for one’s mental health, particularly here.

* * *

Most of the meetings have taken place at the office. I’ve been away for a while so there seems to be a lot of interest in small or individual meetings to sort out issues. I sort of feel like a village elder sitting under a mango tree receiving villagers as they present their various requests. There’s a part of me that would prefer to be out under a mango tree rather than in our guesthouse living room. Don’t get me wrong, it’s a nice space, but I would love to be outdoors.

The caveat to that is that it’s hot here. It’s not so bad in the shade and there’s quite a bit of wind which helps make it bearable. But the wind has its downside. Because so few roads are tarmac and you have quite a few unbuilt spaces, you get loads of dust and sand in the air this time of year. Directly above, the sky is bright blue but as you shift towards the horizon, it become a dark beige color. It stays that way the whole day, even throughout the night. I cleaned my laptop screen this morning and a couple of hours later I can already see a dusty layer has already accumulated again.

* * *

Usually when I come, I can get away to a restaurant, like the one at Lido beach. It doesn’t make sense this week, both because of limited time and insecurity has been an issue. It may need to wait until the elections are over. I did get out for a meeting with our lawyer followed by a short visit to a nearby café. This place is located near the airport and has good security. Being in the office/guesthouse after a while can be claustrophobic. Heading to the roof and seeing the view is nice but it’s even better to go someplace different. I sat with a colleague and we had a Somali tea. I don’t have it every day. I tend to prefer a traditional English tea mid-afternoon but Somali tea is quite good. It’s basically crushed ginger, cardamon and cloves boiled in the water for about a half hour until the flavor is fully extracted.

The bit where I often draw the line is with the milk. Somalis generally prefer camel milk in the tea whereas I tend to go with cow’s milk (though I think camel is healthier). The difference is partly flavor (camel milk is stronger and has a somewhat musty taste) and partly intestinal. The less you’re accustomed to camel milk, the greater chance of it working as a laxative. I’ve seen visitors power down a glass of camel milk with the smug I’ve-been-around bravado only to see them end up frequenting the loo over the next few hours. Proceed with caution.

* * *

One thing that strikes me about meeting after meeting after meeting with staff is how this mosaic of conversations begins to form an overall image as to what is going on. I do a tremendous amount of reading about the Somalia context from people of different clans and different socioeconomic backgrounds. Prior to the internet, it was generally the upper strata of society that could get published or be included in publications. Nowadays you can get yourself heard on Twitter or other platforms with limited resources. I dedicate a certain amount of time each day/week to perusing all these news sources. I find that the divergence of opinions in the virtual world is reflected in these conversations with staff. One might express with considerable certainty the reason such and such happened. On the heels of that conversation, someone else will say, with as much certainty, that something else was the cause. If you keep asking the same questions, with all the various nuances, the mosaic of answers seems to create a more reliable image of the overall situation. The challenge is that it takes a considerable time investment. 

 

* * *

Back to work. Nice to take a break and do something besides meetings and emails. But now, duty calls.

Space Invaders

The new year has begun and we’re more or less back to our routines. The drought is worsening in the Horn of Africa and I’m in the thick of work on humanitarian response. The girls are back in school. The cast that was on my right arm is now gone and I’m on the slow path to recovering my mobility and strength. I’ve done this several times before but it seems a bit slower at this phase of my life. It’s okay. I don’t mind the challenge.

* * *

After successfully traveling back to Kenya, we shifted quickly to the work of getting over jet lag and preparing for work/school. The former hasn’t gone so well. I’m not a good sleeper even in the best of times so when faced with jet lag, it’s often a question of whether the lying awake is caused by my normal insomnia or if it’s a matter of adjusting to the time zones. Added to that, almost immediately after arriving I came down with a bad cold/congestion. For me, sickness always exacerbates jet lag.

As with a lot of sicknesses these days, it always raises a yellow flag as to whether or not it might be Covid. The symptoms I was dealing with were more or less consistent with those communicated as being common with the Omicron variant. Though we were all PCR tested the day we left the US, according to the CDC, it can take a couple days before someone will test positive. So I could have contracted it, for example, at the Louisville basketball game or passing through a store (even though I have been masked whenever out and about). Even though everything seems to be sped up with Omicron, it’s unlikely that I would be symptomatic from picking it up during the US travel, where PCR tests and/or vaccines are not mandated, given that it was too recent.

We did a couple antigen tests over the span of a few days and they were negative. So it appears to be a common cold. I was almost hoping it would be Covid given that the symptoms are manageable, it might build me some antibodies and it would go away after a while.

* * *

Given all the dramas with the current new variant, the girls’ school has been in hot debates about starting off the year in class or online. Given the success of the school’s pivot towards online education in 2020, I was a bit puzzled to see the pushback from some parents about they possibility of going online for a couple weeks or so. Apparently some teachers are impacted by related travel complications (canceled flights trying to get back to Kenya) or have contracted Covid and are not able to travel. This whole thing is inconvenient for everyone but, as Priya told the school Whatsapp group, people need to exercise a bit more grace during times like this.

In any case, the girls are back to online school for now. There’s an upside to living where we do when normal school is happening. But our urban apartment is less attractive when the pandemic flares up.

Kiran and a classmate are using our dining table and Kinaya took the office. My office is on work from home status so Priya and I ended up being pushed a bit to the margins. I opted to spend a few hours here and there in cafes to carve out some space which isn’t terrible. There are loads of good coffee shops in Nairobi. It wasn’t the end of the world but thankfully school returned to “normal” and I have my office again.