We were introduced in hurried passing, two fish-out-of-water Americans orienting to a bustling African healthcare office.  But unlike me, she exuded grace and comfort in an unfamiliar situation.  I was impressed.  And I was practically gleeful when my work-issued cell phone rang that night and I heard to a soothing voice say, “Hi, it’s Karen.  Do you want to get together for dinner tomorrow night?”

We shared a taxi from the office to an Ethiopian restaurant just outside of the city.  Wafting in through open cab windows, sharp scents of burning brush competed with the almost edible fragrance of plumeria trees.  We shouted at each other over Kiswahili hip-hop as our cheerful cab driver tapped the beat into the steering wheel’s torn leather.

Karen is a women’s health Nurse Practitioner who has spent the last twenty years implementing family planning programs overseas.  Recently, she’d shifted from living abroad to conducting short-term consultancies.  As a relatively recent entrant into the world of global nursing, I had the sense that I was talking to exactly the kind of woman I hoped to someday become.

We passed two animated hours over Tusker beers, our fingers sticky with chickpea sauce and spicy red snapper.  Karen supplied invaluable insight into how I could think about my upcoming work with nurses in a rural hospital.  “Observe, observe, observe.  Lay low.  Ask loads of questions but keep your opinions to yourself.  They are usually good reasons things are done the way they’re done, even if they don’t make immediate sense to you,” she advised. 

We were approaching our nursing careers from opposite angles, Karen and I.  Mine was just getting going, while hers was beginning to wind down.  As dinner progressed, Karen expressed candid reservations about moving back to the US and adopting a semi-retired lifestyle as a single woman.  As she eased into that transition, she’d taken up hospice and VNA work.  The isolation and loneliness of her new, homebound patients affected her deeply. 

The treatment of the elderly, their integration and involvement in society, differs markedly between our native country and this sub-Saharan one.  In addition to Karen’s shock at discovering the number of Americans taking anti-depressants, she was semi-horrified by the reality of older Americans’ lives.  This fun-loving, energetic health expert felt increasingly worried that she was headed in the same direction, that she would not sustain vital personal ties into her later years. 

Her fears hit home.  Over the course of the past year my grandmother has lost the ability to drive and to live independently.  She is no longer consistently oriented to person, place, and time.  I have watched my mom’s interest in crossword puzzles, done expressly for their cognitive benefits, grow in direct proportion to the degree of her mother’s deterioration. 

It was a relief to distance myself from this process.  Yet, as I threw a tube of SPF 45 inside a piece of sturdy black luggage, I briefly reconsidered my decision to vacate the premises.  Quickly, I shelved the inconvenient thought.  Next time, perhaps, the decision-making, risk-benefit-ratio will play out differently.  But this time I followed my individualist, utterly American, leanings, got on an airplane, and hop-scotched over eight time zones. 

No question, there are aspects of care that must change in this still-developing place, where yesterday I watched a man, scurrying on padded knees, scoop brackish water from a smelly puddle before bringing the liquid thirstily to his lips.  But I hadn’t expected to arrive in Africa only to be reminded of the struggles I quite deliberately left at home.   

             

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