ignorance

    
     This week coming up may or may not be exciting.  I got permission, when I was in Colombo last week, to hire a translator for sessions I want to have with the staff.  I sort of got permission, it's not quite as easy as that, I have to find one, get prices and then in two weeks when I am back in Colombo I present what I have found out etc. etc.  I choose to try to find a translator, pay for her or him and risk being reimbursed by VSO.  Of course finding a translator is not easy, if however I do find one, I am going to start a weekly session with the support staff, most of whom are totally new and have no experience, and a bimonthly meeting with the nursing staff.  It is a beginning and I am keeping my fingers crossed. 
     I have continued to feel disturbed by the lack of knowledge the Sri Lankan have.  I was sharing with one of the doctors the other day about the Tajikistan group that was here visiting VSO.  He asked me where Tajikistan was; OK, lot's of people wouldn't know that.  I explained about how when the USSR broke up all these countries reemerged and so forth.  He asked me about the USSR and why they broke up!  I keep trying to ask about Hitler, 2nd world War, Jews, no one knows.  I asked a 19 year old studying for A level exams to get into University.  He said they had some world history and social studies in school but very little.  Mostly they study only about Sri Lanka.  I asked someone about the Dalai Lama (this is a very Buddhist country), he said he had heard of him but knew nothing about him.  Now I would have more understanding of this if we were in the hinterlands of Africa where it is still quite tribal and there is very little access to the outside world.  This country makes a choice to not know.  Perhaps as more people get computers, more will know more.  The newspapers here have very, very little about anything besides Sri Lanka.  There is joy, dancing, yelling, firecracker lighting etc. for every event including the nominations yesterday for Parliament, the excitement was over the nominations of people who are aligned with the president who had disbanded the Parliament that existed a week or two ago.  Now please, I have no desire to be unfair, oh no. I read the Sunday NY Times editorials each week.  No the ignorance of the the Americans certainly rivals that of the SLs.  Two articles jumped out at me today, Al Gore's on climate change and how we are heading for disaster, it get's worse and worse because we know more and more and everyone, the government, individuals just keep buying anything they want without a care about the future of the planet or their own future kin for that matter.  The other article by Frank Rich about the  guy who killed himself and someone else in an IRS office in Texas, the Tea Party Party and where that is all headed really made ignorance  neck and neck in the two countries. So here I am, feeling upset about the state of the worlds I live in so what to do?  I set up the ironing board, put in my ipod ear plugs, listened first to one of my favorite musicals "Dear World" which hardly anyone remembers but is filled with wonderful music sung by Angela Lansbury and is about fighting the big bad guys to save the world from ecological destruction!! (I cannot figure out why this show has not been revived, it is so timely).   I sang my heart out and then, still not finished ironing!!! I put on Essential Women in Blues and danced my heart out..then I decided to write this although I am sure anyone reading this would have been happier if I just kept dancing and didn't sit down at my computer!
     I am pretty sure I have referred to my landlady and her husband as Charlotte and Caru.  Ancy has repeatedly asked where I got the names.  When I arrived those were the names I heard.  Well their names are Salgadu and Rajapasksa.  No wonder they never turn around when I call to them as Charlotte or Caru!  Speaking of Sal as I now refer to her, yesterday she gave me a present of an oven..yes an oven.  The picture is next to this.  It was actually the oven of Hannie who is the person I took over from here.  It looks bizarre but actually it works.  You put it on one of your two gas grills and it bakes.  I haven't mastered getting the temperature right but I did make chicken last night with my own concoction of SL spices and no oil and it was great.
     Some of you have been concerned  that I have given up my collecting of beautiful things like chickens and folk art paintings.  Be assured, I have not.  Last week I bought a rooster plate and at an outdoor art show a folk art painting by an 89 year old who sold it to me..he was amazing.
     I have not been wallowing in rumination on the state of the world this week. I have actually been much too busy since  discovering a green algae type substance was growing all over the two filters in my water purifier.  It was a great decision for me whether to find out how to get rid of it and if the water would again be pure or keeping the pretty green stuff and adding the fish I have been wanting for a fishtank!

mostly work..

      I am so funny.  I am chuckling to myself as I realize, here I am saying I am being in the moment, well yes being here in Sri Lanka and not in the US in my head, but what am I thinking about when I become conscious?  I am thinking about how I can't wait to go to Colombo tomorrow!  Those who have been reading the blog might remember that I couldn't wait to leave Colombo to get to Badulla.  Then, my perspective was let me start my wonderful new experience in Badulla, now my perspective is I can't wait to buy a decent set of sheets and meet my friends at the shops!  I think that is so funny to realize (again).  What have I missed of my life in these last few days?!
     Today most of the nurses, the OT, SWs, the attendant staff, Ancy and me, went to the home of Mahendra, the nurse who is leaving, to bring a baby gift for his 4 month old!  So we all arrive, it is a tiny rented house, not much different then the houses of a lot of patients we go to on home visits.  So we take off our shoes and go into his living room.  Everyone sits down, chats a bit, food is put out, we all get up and help ourselves, we all eat, some people outside or in the bedroom.  After eating everyone gets in a line to get to the sink and wash their own dish.  Then dessert is served in similar fashion.  Meanwhile, I have been taking pictures here and there and say when we are finished we can take a group photo. No one says anything. After dessert, rapidly after dessert, one, two then almost all the staff stand up and leave!  No gift has been presented, no chit chat, coffee or tea, hanging out..no, the Sri Lankan way is: come, eat and leave!
     I don't know if I have talked about the houses here.  I shall in greater detail some other time but for now I can say the walls don't come up as far as the roof and the roof is usually tin. There are few doors on openings.  almost everyone has a two burner stove top, few have ovens.  Sometimes there are windows but then there is an opening at the top which let's the mosquitos in.
     For the last month I have been going weekly with Mahendra and another nurse on home visits.  This is for patients who don't come to the clinic to get their medication so we go to them and give them Modicate (Prolixin injections) and whatever other medications.  I did talk about this before.  It is actually wonderful that this is done.  Most of the patients live on the tea estates.  Tea is grown on steep hills and mountains and has to be picked regularly; very, very hard work.  There is a lot of poverty, alcoholism, spousal abuse, suicide.  Ancy has an idea to train the few health workers who are on the estates in clinics to know a bit more about mental health so this is something we shall work on.  What I wanted to share though is a bit of what it is like to get to some of these people.  The other day we drove (we now use an ambulance for transport) to a location, we walked up a hill to the railroad tracks, we walked for some time on the railroad tracks, we got off them and walked down into someones backyard.  These lovely people live with a 90yo mother, her daughter, sister, kids etc.  These people served us tea and cookies. need I tell you were the store might be.  We then walked back up to the train tracks, back along them, walked up hill to another home with a 90 year old father and the rest.  I thought we should fix the two 90 year olds up, they were so lovely and so young and vibrant.  The problem is that one is Buddhist and the other Hindu.  oh well...  We then tried to get to another woman who I have met before on the estate and couldn't get to her because every lousy dirt road on that estate is being fixed at the same time and we couldn't get to the top where she lives.  This means that she will have no medication for a month...
     I am just telling you everything that comes into my mind because I shall be away almost a week and shall not have an opportunity to write.  Also obviously I feel better and am overwhelmed with projects to do having just found out that most of the attendants on the ward asked to leave and we got 6 new ones, never worked in psych before, the one attendant who is staying is the one that pushes and shoves patients so I am anxious to get them together in a group and talk before too much influence happens the wrong way.  By the way, I cannot thank you who read my blog enough, for all your wonderful ministrations to me and have saved them all should I need choochkeying(?)  again!  Anyway what I wanted to tell you is a continuation of telling you how frustrating it is to never know what is being said and I get so annoyed.  So I now know that the nurses are frequently talking about me, if they like what I am wearing, the fact that I have 2 earrings in one ear and one in the other, what I should do with my hair etc.  So several times I have asked what they are talking about and they vaguely say something about my smile or face or something.  Today I said in my tell me already fashion to let me know what else is said about me and Laxmi said essentially to stop worrying because they are talking about how pretty I am, my smile.  So I know this is just a stage they have to go thru, getting to know me and pick me apart until there is trust but I think they should just take their time about it!!!
     

continuation of the last one...

     I don't know if I shall ever post this, but I am getting myself more fully right now so had to write it down.  I might as well do it here.  I am feeling this sick feeling inside, sickness that I feel when if I cry  it will release it, sometimes it stays with me and I get depressed but I won't let that happen at this point in my life.  What I think it is is a giant temper tantrum!  I still seem to hold onto grandiose ideas about who I am and what I should be doing.  I can feel like a fraud knowing that I really don't know a lot of actual, factual stuff.  I bluster a lot.  People are telling me how brave I am, how I am doing this and that but in my heart I know that I am protesting being here at this placement in Badulla because I do not feel qualified to write and present trainings and make slide shows and things like that. I actually think that my suggestions to the VSO office that people who have written wonderful trainings  be allowed to publish them and we all use the same ones throughout the country is a great idea.  I think we are all reinventing the wheel over and over but I also know I am a good talker but not an educator and my mind goes blank when trying to think of things that should be said in such a forum and I therefore want out of being seen as inadequate, and honestly I don't want to do it!  I have always said I am lazy.  On the other hand I can't seem to let myself just sit around observing and seeing where my input, in my way, may be useful which is what I have been advised to do. On the other hand I really do think one volunteer is quite enough for Badulla.  I volunteered to feel like I might be of some service and that would be better served in a place like Jaffna where all these poor refugees from the war are still suffering.  On the other hand I am probably just being grandiose again as a defense against feeling inadequate!  It is somewhat confusing but I think I get it.  I felt much better a few minutes ago when I got an email from one of the other volunteers who is in Cameroon who appreciated something I did and I thought, yes, that is who I am, that is what I can do by example is truly hear and care about what people are trying to say only I can't understand them because I don't speak their language!  I am going to publish this because it is honest and where I truly am.

My funk...

     I have had a bit of a funk this week.  I think it is partly feeling  some confusion at work or around work for VSO, feeling lonely, and just the time. I decided I could hang out and feel really shitty which I did a little or I could try to take some action.  I of course have my little Buddhist and other sayings up on my wall that tend to get me back on track and I also decided to call some of the contacts Hannie, the person who I replaced, had made.  So I called Shabby who was one of her friends from the Lions Club.  It so happened that that night was the annual Lions Club dinner and ironically she had met Hannie exactly two years earlier at this event!  So despite the fact that I was to meet her at 7:45pm (practically my bed time),  I put on my prettiest outfit (thank goodness because it was practically a formal affair), called a tuk tuk and met Shabby, Kevin and their two kids at this do.  It didn't take me out of my sadness but it was quite an exposure to the richer side of Badulla.  The saris where unbelievably beautiful.  Have I mentioned that women here do not wear makeup, don't shave their legs,  that almost all women wear their hair long and pulled back?  Anyway, I was glad I went.  I feel better now, somehow just letting each day be what it is.  I find I must plan something for the future, a trip even if for a day, it helps.  
     In the last two days I found out that the Consulting psychiatrist Dr. K is leaving to go back to Australia.  Also Mahendra the only trained psychiatric nurse who also is the main translator for me is leaving to move home to Galle.  This is huge because everything depends on the support and approval of the psychiatrist in this system and I am already at a huge disadvantage not being able to speak the language to the staff, now it will be even harder. The nurses are really trying to use as much of their english as they can and we have been doing not too badly.  Dr. K said to expect only little changes and that over 2 years it has improved. Oh well, this is minor compared to so much in the world that is really awful.
     What do you think of this font?  My cousin sent  an email in it and I thought, wow, I can do that.  Today I was supposed to have my hair henna' d.  I don't particularly care but one of the nurses insists it will take years off so we headed out looking for a beauty parlor that could do it.  We couldn't find one actually.  It was odd but they only have black henna or tint, neither of which I wanted.  I did decide a few days ago however that I needed to make some food I could have in the fridge for whenever and so I made pickled beets and onions and was able to share this american dish with my landlady who is always sending up food and with one of the nurses who also made me my favorite dish, Sambol.  So my beets are called beet curry and served with the other curries at breakfast, lunch or dinner..who knows.
     Here is one of the issues here, aside from feeling terrible because I never know what anyone is saying and those who know me know that would drive me up a wall since I want to know everything, all the time; people don't quite tell you the truth, they don't lie but they sort of tell part of a story or maybe they accidentally get a tense wrong and so they say something is going to happen and it doesn't or they think maybe they will do it a week from yesterday or whatever.  It drives me mad.  I have a feeling it is an Asian thing because even Ancy who tells me she doesn't like this does it!  We all laugh a lot though, Mahendra says terrible about almost everything from a very minor event to a major trauma so of course we all walk around saying terrible, terrible all the time.
     My camera is almost fixed, it was fixed and then unfixed but hopefully tomorrow it will be fixed.  I can't wait, there are so many great pictures I see as I walk around.  Did I tell you that this is the noisiest place I have ever tried to sleep.  I am not bothered by a baby crying or usual night noises.  I have barking dogs that can go on all night, various religious recordings, seems to be a combination of Buddhist chanting, Hindi and Muslim chanting, other animals cavorting, and very early on the birds, dogs, chanting and other varieties of things.  Sometimes it is deafening, no kidding and I am practically surrounded by king coconut trees, papaya trees and other glorious things!
     It's Saturday morning here and I got an email from my sister letting me know that Margaret DeP., probably the last of my parents really old friends (Rudy DeP and my father were friends since they were 10 years old in Roxbury, Ma.) had died at the age of 99.  I feel very sad.  There are many reasons to feel sad, the loss of someone I truly loved (my favorite childhood memories are of going to Rudy and Margaret's and their twins, little Rudy and Margaret and Uncle Brother (Rudy's brother, the priest), cooking lobsters, eating great meals, getting presents like giant pink piggy banks, but mostly the amount of love in that house and when we were there it extended to us.  So, that is a reason to feel sad, I kept saying I was going to visit Margaret and little Margaret, the only ones left, for the last several years, and I didn't.  I think her passing represents so much in terms of my parents and my life, so many reasons for sadness.  I started wondering, what do people here in Sri Lanka do with feelings like this?  Do they acknowledge them, do they talk about them?  Do they get depressed,  hospitalized or what.   An interesting thing happened on Ward 12 this week.  A patient who was admitted with mania several weeks ago and discharged in good shape a couple of weeks ago, was readmitted.  She seemed fine to me.  I kept asking various staff why she was back.  They answered me but not real answers, they said her husband was an alcoholic and abusive and she was here for that reason.  I kept saying he should be here, not her.  I must have asked 4 staff before one of the doctors finally explained that she has been admitted at her request so that our social worker can go to the home and talk to the husband and let her separate.  They are doing this to help her socially live a better life!  I think that is amazing.  So what am I here for, I can't improve on something we wouldn't even do at home.  I know similar cases in the US and people, family, got no help from the system we have!
     While I have been writing this a friend Skyped me and then my landlady and her husband came to the door to offer me food tomorrow night and ask for a favor, meanwhile I am soaking my clothes I am washing and then my other neighbor came up to see my home and my friend was no longer on Skype!  Life can be so different from moment to moment as can moods.  I can only be in the moment, sometimes it's terrible, sometimes it's fine, it always is something.

I am always doing something wrong...

     I am always doing something wrong here around eating.  The hospital staff I work with, particularly the nurses but also the OT are usually finding something wrong with the way I eat.  As I told you, I was using the wrong hand (BTW, at home, by myself, I use my left hand), I was not gathering my food properly, I held a banana in my hand instead of holding from the peel on the outside, I did not wash my hands immediately before eating (this I find hilarious considering there is hardly any soap anywhere and they don't wash from patient to patient!)  The latest faux pas was yesterday when we were all sharing a meal and Laxmi, a nurse I am very fond of, said as I licked my fingers, "in our culture, we do not lick our fingers!"
     Many years ago, in the 60s, I saw a film and later read the book, "Woman in the Dunes".  It is Japanese, very slow moving and at first viewing, frightening.  I think about that film a lot.  It was very existential at the time (still is I'm sure) but at some point I realized how well it fits into a Buddhist philosophy of mindfulness, of being present wherever you are.  I wrote that I am were I am and that is true, I am not thinking about my home and my things, films or theater.  I feel I am fully living here.  That doesn't mean I am always were I am though!  I still struggle with my mind about people and life and go off in my head just like everybody else. I really miss my Sangha, my meditation group that I went to every Tuesday eve.  It's weird, this is a Buddhist country but Buddhism is so ritualized here that it is like a form of religion and I haven't had time to investigate places I might go to sit that would feel ok to me.  However, very weird, the monks have cell phones and the average person does not meditate!!!!
     Today is a holiday here.  There are many holidays in Sri Lanka.  People tell you laughingly how many holidays there are and how they enjoy them.  I guess I was thinking about the film because I am home today just being home.  I do think a lot about work.  I was feeling bad because things they need, I don't really know how to do like writing a training program.  I think I could carry one out with the help of others.  I did contact some other mental health volunteers and one of them had an entire program so she sent it to me.  I also got lots of great material from friends who teach in the US.  What I really can offer is the years of experience with patients and other ways of treating them.  Someone asked what I meant about people here wouldn't even be admitted in the states.  I did exaggerate a little in that patients here would be in our clinics or with private practitioners but many of them wouldn't be admitted to our hospitals because they are not really suicidal, homicidal or dangerous to themselves or others because of how psychotic they are.  They would be managed with medication and some kind of therapy.  Here many families take care of the mentally ill and that is wonderful.  When the person is more acutely ill than is normal for them, they are brought in.  I have been reading these articles by Ethan Watters which have been in the NYTimes lately about how drug companies market to countries to get them to need their products.  This has not happened here yet.  They can't even get most more modern drugs and run out of needed drugs periodically.  What I can unequivocally say is that the ward is unsafe for patients.  There are parts of windows missing so glass shards are just sticking up in windows.  It is wonderful that patients take care of each other, it is not wonderful how they are not taken care of by those that should protect them.  on the other hand, in the US people would have tried to commit suicide with the glass, here no one seems to notice it!  xI think it is not OK that patients are ignored sometimes and conversations continue while patients sit patiently waiting to be interviewed. This is part of their culture though and our culture is to get all blown up and huffy and annoyed at having to wait.  We are angry a lot, they are not.  They seem a much happier culture in general.  People smile, they are helpful.  Do you know I don't see baby carriages in Sri Lanka!  Babies until about 1 year old are carried.  Sri Lankan people love their children.  Yes most cultures love their children but here the children are so special it seems.  They are held constantly.  Maybe that's why there is less anger in the culture.
 

thoughts and reflections

Sociologically this is a very different place from the west.  Very little seems to be done individually here.  Much is done and expected in groups.  Patients think nothing of lining up and waiting for hours, they are obedient and don't get upset while waiting in huge groups at the clinic.  People are usually with family and on inpatient, sometimes, family sleeps there with them in their beds or come back with food several times a day.  Patients are in a huge room with 20 beds, no curtains, no privacy.  Baths are together in this outside bathing area that I have shown you and patients help each other to wash their hair if needed.  They are very helpful in general with each other, really taking care of each other on the ward and comforting each other.  Little seems expected of the staff.  It is as if the patients have now become a group, a patient group.  Patients here, and I think this is in general not just in psychiatry, are totally obedient unless they are a little manic.  The patients here who get admitted as acutely ill would barely have made it to a clinic or psychotherapy in the states.  It is a very, very polite non individualistic society.  The exception is that people do not step out of the way to let you pass, they just plow into you, it is so impolite and opposite everything else!!!!  Because of this, unusual behavior is really not tolerated, they label it.  Patients here I think get identified as schizophrenic and Bipolar who may not be so, who may be going thru something and could use some talking help.
 I took the train to Kandy last week to meet a friend and see the town.  The train ride is spectacular but extremely long.  I took the bus home, a very interesting experience because it was an old, very dirty, smelly bus.  They crowd as many people in as possible so there was standing room only by the time we left. The trip is 3 1/2 to four hours,  I was on a seat where my tocks where on the seat but my but was off the seat.  We were 3 in one longish seat.  People were very polite and respectful of the little space they could give.  Throughout the first half of the journey I kept thinking how grateful I was that I wasn't squished in the middle of the other two.  Half way thru the ride we stopped for a tea and pee break.  People get off and know to get back on 15 minutes later.  I was surprised when the woman by the window told the guy in the middle he could have the window, then she looked at me and said would I please get into the middle.  We all moved one place over!  No one was carrying on on this crowded bus, it was a very orderly group.
 People don't like to say no so thay will indicate yes or shake their head but the norm of society is to not say no.  This is normal here.  This can be a problem.  The other day a trishaw driver I know said yes to picking me up for the train.  He didn't show up, I called him, he said he was on the way, he didn't come while I was there.  He probably couldn't come at that time but wouldn't say no.  also people ask you what you want to buy, you tell them, they invite you into their shop and start offering everything else.  They don't have what you want.  I don't think they are trying to fool you they are hoping you will find something else in their shop.
Many people have commented (well many, maybe two) on how easily I seem to have adjusted to being here and I think that is true.  I am able to be where I am.  I think this is a blessing.  My head is here, not in the USA.  I am where I am.  That doesn't mean I don't miss people.  I miss talking.  I miss telling someone the things that excite me and the things that are hurting or upsetting me.  I love living in my home, it is ironically very similar to my NYC apartment, I love the orderliness of it, how clean it stays, I like the way I've set it up.  My life is simple and now I have discovered thanks to my cousin Lyn that I can get summaries of Jon Stewart on my computer!  What could complete my day more!  It's weird, until she sent me this link, I hadn't really thought much about TV or movies although I have some with me.  I read a lot .  Right now I am in Olive Kittridge land, it's a fascinating land in it's everydayness  and yet it's uniqueness.  Just like life, the life most of us live no matter where we are.
So I have done further research into the toilet and soap situation.  It is true that they do not use toilet paper here.  They rinse off in one fashion or another (either with a pitcher of water or a sprayer that comes out of the wall) and drip dry.  There should be soap at the sink in the toilets but in the hospital the government allocates very little soap, it get's used up before the next shipment comes or people take it.  There is supposed to be something to dry your hands with but usually there isn't.
My Belgian friend Lieve who is also a volunteer, and I had a long talk about about our experiences in this country, their huge bureaucracy which is very cumbersome and works poorly.   Sri Lanka was controlled  by the British and it continues doing things the way the Brits did .  The thing is that they don't seem to know why they do what they do.  It is a country that was controlled by others and when they took over their own control they continued what they had  seen.  Unfortunately they never learned why they did what they did, making a request to do something differently near impossible.  Lieve lived in Mozambique for a while and said it was a very similar dynamic.  I shall keep studying this.