Tuesday, June 22, 2010

Really?..a Cobra...

    Today Laxmi RN and Manikay RN where talking about Manikay leaving the house for work and a Cobra sitting on her welcome mat outside the house!  This was TMI for me..I didn't need to know about how many Cobras live around here.
     This morning I saw a couple, they are only in their twenties and have been married for 5 years.  She is a nursery school teacher who is suffering a serious depression with psychotic features.  Part of it is psychological but a good deal of it is this society.  She and her husband have been unable to conceive for which there are medical reasons.  She lives in a village where she is really harassed and taunted for not having a baby.  She is buckling under the pressure, now convinced people spit when she passes.  Many people have told me that in this society people do gossip about their neighbors viscously and would do exactly what she is describing.  I cannot tell you how difficult it is to have to deal with this stuff without speaking the language.  I did the session with Nilantha, SW, and it was quite tedious to get thru but more, the frustration for me in not knowing what is truly said and how is, well, frustrating!  This is probably the major issue of every day..not knowing what is said, not being able to make myself understood.
     Two babies have now been born to staff members and I have noticed how freely everyone breast feeds.  Walking onto the maternity ward, visiting someone anywhere, in a store, on the sidewalk, it is the norm and as a matter of fact it is the law apparently.  You feed your baby this way for 2 years minimum..just like the USA right where people get arrested for breast feeding in public!
     In the last 2 weeks, 8 patients have been seen who tried to kill themselves..most by poison, one by hanging. She is 18 yo and this was her 2nd attempt. One had Bipolar disorder but the rest.. a major issue in SL is the lack of talking.  It is against the norm to talk about feelings.  I think people become desperate about their situations and it grows enormous inside of themselves, they see no way out.  It is a huge societal problem along with alcoholism.  There are hardly any trained counselors but people are reluctant to see them anyway.  I am encouraging people to use their counseling skills if they have been trained or go get trained.  The doctors have had minimal training in counseling/therapy but have no time to spend with patients beyond dealing with medications.  
     The last few weeks I was sort of, bored, alone, feeling like there just would not be enough worthwhile for me to do here for another year.  I have no intention of leaving but I just felt useless.  One day out of the blue the nurses said " We like you."  I said "any reason in particular?"  They said "You are always smiling, you are gentle and kind to patients and to us,  you have a good heart."  Of course this made me feel great, how could it not.  However, at the same time a few days later, I arranged for some work to be done with the AA members coming all the way from Colombo to help us, and one of the social workers, not Nilantha, promised 3 times to come help.  He just never showed up..also typical of Sri Lankans many of whom are government employees with no sense of the importance of following thru or keeping a commitment. I felt awful about it and was really pissed.  The point is one event was wonderful and took me out of my doldrums, the other was terrible and had me obsessing about what to do to this person for a few hours...but all that is about other people, not me..I need to work on Equanimity, I think what I mean is, if I was just being inside myself I would roll with the kisses and the punches, it would all be the same because inside of me would be the same.  This is not new information but I saw it so plainly over the last few days.  
     None the less, I did get over my few low days.  We got wonderful news that one of our nursing staff would be trained to become a Community Mental Health Nurse which means they really hope to create change in this archaic system.  I was so excited, of course I had a hand in choosing the nurse, helping her apply, I practically ripped the phone out of her hands when she was consulting with her husband before hearing the yes!  These moments of joy help me. 
     Speaking of Joy, I am off for vacation until July 20.  I am meeting  my sister Bobbie and cousin Helene in China.  I am very excited and particularly to see them. I am sending you all kisses.
      
     

Sunday, June 6, 2010

The Nurses Have Never Danced..



The nurses have never danced, never drank alcohol, even a taste.  It is a very conservative society but they will bluntly say things like your fat; boys will ask for money, which I hate; the staff ask me when I am giving them a party with American food!  I said I'd give a party for my big birthday coming up in August, they said no it should be much before that! I told them everyone will have to dance at my party and I told Laxmi RN she will come to my house and we will put on rock and roll and dance, then I demonstrated how dancing is meditation, you just listen to the music and your body starts to sway, she blushed.  Some of the other nurses think this is hysterical and now when we see each other we start to dance..speaking of hysterical, some of you may remember my laugh which is .. robust..well Ancy has told me not to laugh out loud. In Asia, people don't do that it disrupts other people...so yes that is hysterical..I laughed a lot over that one. 
    When I was leaving Laxmi the other day to go to Colombo for a week, I felt such a rush of warm, loving feeling for her I said, "I feel like hugging you".  She leaned back with a look of horror on her face and said "no, please we don't do that in our culture!"  I asked some others and they agreed but then I noticed that some of the nurses did hug me and I realized Laxmi is a very inhibited person but gets great joy out of watching me.  Yesterday a patient kept referring to me affectionately as white, she kept saying a word, I repeated the word, everyone laughed.  Then they said the word, I said it again, laughing.  When I was alone with the nurses they said the word I was saying was a naughty word.  So the word for white has a "d", the same word with a "t" is a naughty word for vagina and the word with "tha" is a penis.  So I repeated all this to Laxmi and as I did I pointed to my "you know what".g I thought she would faint but she couldn't stop laughing.  You can imagine the amount of ridicule I go through because of my inability to hear this language correctly and to not understand very much.  Fortunately, people with a sense of humor are international. The staff find it very funny also that I am frequently making lists, jotting things down, they write nothing down which is probably why things aren't remembered and followed through on.  But Nilantha SW noticed, asked why, listened and went out and got himself a notebook to write down things he needs to remember..ah, an OC in the making! 
I was very concerned over not being around  the  Sunday morning of the first AA meeting but the nurses wanted me to stop worrying and calm down..they said "it's a good program, we will help you"..I almost fell over..that is a first..that is capacity building in action and guess what? Ms. control freak here was having trouble trusting that it would all really get taken care of (of course this is Sri Lanka and I have yet to have regularly scheduled meetings with the staff so....). When I got back I found out that the nurses had gone to the meeting and taken everyone's name to register them for the new Alcoholics Anonymous Clinic!  I almost had apoplexy.  I had explained over and over about anonymity and that we were only using the space, it is not a hospital program etc.  Finally after the charge nurse said that the nurse has to be there because they were responsible for the inventory of the place (!!), we got our new Consultant to write a letter to the new Director about the situation and it's hopefully OK.  The charge nurse now will not be responsible if a pencil is missing and all are relieved.
I've been noticing how competitive I am. I always denied I was competitive but I am very competitive. I also really like being liked and I like feeling respected.  I can't avoid seeing myself here.
   Through my interest in the tea estates and AA, I have formed alliances with several priests and nuns here.  They are real Christians, they give heart and soul and really give to the people in a very loving way. I also have formed closer relationships with a couple, muslims who tend to have a more worldly view and more education.  Rumaisa, the woman in the couple also dresses as an obvious muslim woman.  I had a long talk with her about it and it is she in the couple who insists on being covered although she doesn't wear a veil over her face.  2 of her sisters do.  She gave up work when she got married (arranged marriage) and will not go out alone. She is 31 years old. Her father is very liberal, upset that his daughters essentially gave up their freedom and wishes my friend would learn from me.  He wants to meet me.
    Several weeks ago was International Nurses Day. I was invited to the ceremony and all the nurses and students where there and the new director of the hospital who I know because he used to have a different job and I would go and meet with him.  So here I was at this ceremony and then I was asked to light a wick of oil for the Buddha which is an honor. (there is no separation of church and state here so everything has a monk present and Buddhist rituals and the rest of the population just have to bare it.)  Then I saw the whole thing is dedicated to Florence Nightingale who died one hundred years ago (who knew?).  They had pictures of her and put flowers on her picture like a necklace and put flowers on the alter in front of her and then they asked me to speak!  I have no idea what I said or why I was up there except my opening joke went nowhere so I have no idea if anyone even understood me.
     I have learned the way to get things done is to not talk directly to people about what I need or want, work behind the scenes and let other people work their magic making sure my name not associated..
     This is finally the week that we put on the teaching series for the tea estate health workers.  My hours went very well and I promised to make them fun.  I think they were.  I however, didn't feel competent to be telling these people anything.  We talked a lot about the stress for them and the people who work on the tea plantations.  It is terrible.  It actually sounds like slavery in the 1860s.The bosses care only about production.  The conditions are terrible, the pay is terrible, the education and health care are terrible, the people spend their money on alcohol, they send their kids to work instead of school, women drink a lot of poison...I taught relaxation techniques...yes I did do more then that but that's how inadequate compared to the hugeness of the problem it felt.
     Teeth are an interesting subject. About half the Sri Lankan people have beautiful teeth, the others VERY buck teeth.  Teeth that fall out are not replaced. I have seen only a few people with braces which are just being introduced here, probably because of the cost.  The other problem is that many people chew beetle nuts and tobacco, making their teeth orange and rot.. 
      The issue of cost and available supplies, I haven't talked about much but this is not first world, people are still surprised when I say I am scrubbing my towels in a bucket or they don't have things like pepper grinders here that we take for granted. After going to many stores looking for a pepper grinder I was told to go to the grinding mill where they do it for you or to use a mortar and pestle to grind my pepper corns.
     I have so much control of my bladder now I can go for hours without using a toilet.  No one seems to use them and I can't find them!  Buses don't have them, so as my friend Samanta RN says: "what to do?" Finally I have to say I feel so young, I cannot believe I am my age.  people here retire at 57!  I am blown away because I feel like I am a contemporary of the doctors and Ancy who are in their 30s..of course I never grew up really..