Science! and Haitian history!

So, I've been here in Paris/Orsay for about a week! Things have been mostly great, and I've been kept plenty busy! So far, I've been into Paris every single day (although if this post gets too long, I might miss out on tonight's potential Parisian adventures!). I'm starting to think I'd better get to know Orsay and Bures-sur-Yvette a little, too - I hear there's a huge park of some sort not too far away, not that I'm feeling a lack of nature on my UCSC-esque campus. :)

Everyone in the lab is very nice, and I'm starting to settle in and wrap my head around everything that's being thrown at me. Every now and then, I get a story or little memory about the Haverford of Lenny's college days - always fun to hear about what was different/similar. As of this afternoon, I'm working on at least 3 or 4 different (although some are somewhat related) projects, so until I started my notebook and started writing down all the fly crosses and genotypes, I was floundering a bit. Now it's making more and more sense, and Lenny's really good about making sure I'm understanding things as he throws lots of info at me. I got to start playing in the lab today, rather than just doing lots of reading about flies and my protocols, so that was fun and made the time pass surprisingly fast!

Since I have a few different projects, I'll be doing a few different things as the summer progresses. I'll obviously have to do some crosses and maintain some fly populations that I'll be using, so I started to practice that today. I set up my first 7 crosses! I clearly have a ways to go in the technique area, as a couple of flies escaped from probably every other vial, but I'm not too concerned because it's my first time trying these things. My other protocols will involve dissecting larvae, removing their imaginal eye discs (the "organ" of sorts in the undeveloped larvae that will eventually become the eyes during metamorphosis), staining the eye discs with antibodies, and taking images of the fluorescence patterns. I got to start practicing dissection today, too! I tried 3 larvae and had success in 3 out of 3, without too much time! :D The thing that took the longest was just building up the will (and dexterity) to rip the poor thing apart - it's a pretty quick and easy death, but we don't kill them before yanking their brains out by their mouth hooks. (too gory? yeah, I kinda think so too. whoops!) But all in all, I feel like I'm going to get the hang of it, and if the antibodies work, we'll be in business!

Not much to say about Haiti this time; I'm almost done with the history book (I can't wait to move on to Paul Farmer!!), and things have finally calmed down a little bit in terms of corruption and violence (I'm up to about 2005), partly due to the more recent leaders being better educated than those of the past, and also due to foreign powers intervening in the name of democracy/stability etc etc. I don't know if it's the influence of the author's biases, or if it's because of the story and the facts, but I'm feeling pretty conflicted about Haiti's history and the current political attitudes. The only times that Haiti experienced any periods of (relative) peace and actual development of any kind of infrastructure were actually the times when foreign powers like the UN and/or the US were partially (or completely) in charge of government management. Even when a seemingly "good," well-educated Haitian takes over, each time, corruption always seems to end up getting the better of him. Each ruler was so concerned with eliminating all possible political enemies, that they forgot to focus on any real issues like poverty, child slavery (the restavek system), hunger, a dying (dead?) agricultural economy... the list goes on (unsurprisingly). Given all the things that have been tried by foreign powers to set Haiti on the right path, I hate to say it, but it just keeps looking hopeless! (Note: I have about 8 years left of history to get through, and this guy has yet to explain what he thinks of the earthquake etc. No idea what his ultimate conclusion will be yet.)

So this author has suggested many times that part of the problem today is the Haitians' attitude; apparently many of them take the view that their country's poverty and unfortunate situation stems from all the vile and evil actions taken by foreign powers over the years, so countries like Spain, France, and the USA "owe" them for all of our years of colonial occupation and extortion (and it's therefore not 100% Haiti's own responsibility to deal with everything and get themselves back on track in the world). That may have been true for Spain/France, albeit hundreds of years ago (plus, after declaring independence, Haitian leaders still ran the country poorly and didn't eliminate slavery for quite a long while), but this wasn't really true for the US, which occupied Haiti more recently (and very peacefully/benevolently) and carried out many more infrastructure improvements than during any other period of Haitian history. I don't know how widespread or accurate this perceived attitude is among Haitians today, but (after rambling my way here) this is the reason for my feeling conflicted. I want to go help them in whatever small way I can, and I want to respect and support them 100% if I can, but if this is the prevailing view, I hate to say this but it just seems like a bit of a cop-out! It's possibly/likely(?) that this stems in part from simple lack of education about the history and what really went on; it wouldn't be the first time that history books were skewed based on who they were written by and directed towards. (Also, there's apparently a huge reliance on foreign aid that skews the country's population to be extremely dependent on that aid, sometimes to the point that products or labor in Haiti aren't profitable, so people may end up being less productive or ambitious if the product of their work can't compete with the free/cheap items and services coming in from elsewhere. While I know there's a huge need for medical work, I'd hate to end up helping perpetuate these atmospheres of finger-pointing and lack of self-reliance; I guess and hope that the fact that I'll be helping with community health education will off-set that somewhat because the goal is to empower the locals by putting their health in their own hands? Another conflict/dilemma to think about...) I'll be very interested to have some conversations with the locals in and around Jacmel to get their side of the story straight from the source, not from Mr. Biased Philippe Girard. :) 

OK, so I guess I did have a lot to say about Haiti. Not sure if I expressed it the way I wanted to (or if it even totally makes sense); I'm still learning the language surrounding these kinds of issues and I am trying very hard not to imply the wrong things when it comes to sensitive issues like these. I'm still super excited about going, so don't wrongly interpret my saying that I'm conflicted. :) And it has also been reassuring to see the progression towards a (slightly) less violent atmosphere as I've moved into more modern times in the book.

**Mom and Dad, don't worry too much - most of the violence that I'm talking about has been targeted political violence, and I don't plan on running for president while I'm there, so I think I can avoid becoming a target. ;)

Alright I need to get out of here and into PARIS!! I'd be interested to hear what any of you readers have to say about the issues at hand here - opinions, fun facts that you already happen to know about Haiti, etc. :) (Doing my best to be as mentally prepared as possible before I go!!)

Bisous!

I'm in Paris! ...sort-of!

(I wrote this whole post on Saturday morning, but it wasn't posted until I got to the lab and connected to the internet this morning.)


Well, I've safely and successfully completed the trip and transition to France! There have been some unexpected bumps along the way, but... nothing I couldn't deal with (and I've been very lucky to have lots of help and generosity from my lab PI here at Université de Paris Sud). 


I arrived at CdG about an hour late, although they apparently posted online that we were on time, and my meeting time with my PI, Lenny, was based on my arrival time (and he was watching for any delays of my flight so we could recalculate based on that). After getting my bags, I enjoyed the walk from my terminal to the RER (Paris' commuter rail), stomping through CdG as if I owned the place and politely declining (in French) any offers for taxis and the like - it feels good to be one of the ones to know a place when, as a tourist, you're so clearly expected to be lost and confused and vulnerable. So there, France! :)


After a long and sweaty train ride (apparently I brought some hot Cali weather with me - it's been rainy and gross up until my arrival date), I got to the Orsay-Ville train station and waited for Lenny on the front steps... but apparently he had already waited for over half an hour and then left 15 minutes before I arrived! Which meant that I was walking to the lab - not very far, but up a hill and in the sun for some of it, with all my luggage. Oh la la la laa. (Although I did get a preview of the very outdoorsy/woodsy campus - my walk from my dorm to my lab every day will be 15-20 min walking along a river through a beautiful, lush forest. How great is that?? ^_^)


Eventually, we had everything sorted out and I was all taken care of and moved in, although it took some improvisation to get me to that point! This dorm room is fine, but the dorm apparently doesn't provide some essentials like towels (although they offer linens - apparently just for the bed), toilet paper (luckily I made a friend down the hall who gave me some for my first day), and a refrigerator... well... I'm still working on figuring that last one out. At this point I think I'll just be making daily (or almost daily) trips to the grocery store to buy very small amounts of the perishable things I want to eat. Interestingly, French eggs are SO fresh that you don't refrigerate them (you just eat them within a few days of purchasing). Also, milk is SO pasteurized that you don't refrigerate it... until you open it. at which point you drink it. all. if you don't have a fridge. ...haha....


So I'm still working out a few kinks. But things are good overall, and I'm figuring out my research/project plans with Lenny in the lab, and it's all wonderful and exciting! I finally got into Paris proper (about a 45 min ride on the RER) and activated my phone - it felt SO GOOD to be walking around those neighborhoods that I know and remember and love!! ^_^ It's also a bit strange to be back this time, because my last venture into Paris started with so much excitement of discovery, and I was with a big pack of mostly like-minded, francophile Americans. This time, it's just me, venturing out on my own, which feels new and strange, but I'm going back to a place that is very familiar and loved, which is good but also strange because the arrival is less about new discoveries and more about... rediscovery? connections? reinserting myself into a culture I came to love? Still figuring out how to put it into words. But it's great to be back!


My cousin Charlie arrived last night, a day and a half after I did - just enough time for me to get my bearings and get my feet under myself! We're going to have lots of adventures in Paris! Yay!


Also, tidbit about Haiti: I've started reading the first of my heavy stack of self-inflicted pre-departure summer reading! I picked the straight-up history book first (Haiti: The Tumultuous History - from Pearl of the Caribbean to Broken Nation, by Philippe Girard), thinking a good background in Haiti's story would be useful before I get into Paul Farmer's awesome stories and adventures. My other books are Pathologies of Power, Infections and Inequalities, Mountains Beyond Mountains, The Spirit Catches You and then You Fall Down, and Cutting for Stone. I've already read a couple of them, but not for a long time, and they all seemed like important, valuable additions to the pile. Meanwhile, I also have a Haitian Creole - English dictionary that I'm using while I practice my Creole phrases on a free download of a language program. I'm really trying to prepare myself mentally, emotionally, in whatever way I can.


Anyway, this history book about Haiti is pretty shocking at times. First of all, it's not exactly that well-written throughout, and the author randomly inserts "unfortunately"s and other similarly biased words, but he sometimes does it for both sides of each conflict he's describing... It's suddenly very clear to me why history textbooks are supposed to be written without any apparent opinions or bias. Not only does it present one side as better or worse than the other, but it just gets downright confusing! And second of all, the history of Haiti is far more intense than I ever realized! Granted, I've only made it up to 1850 so far, but it seems like every single ruler of Haiti, whether they were Spanish, French, or even a native Haitian that got to power by helping lead a revolt against the oppressive, "evil" whites, ends up corrupt and doesn't make any moves to actually make a positive change for his people! There were multiple examples of the leader of a revolt or revolution who then becomes the country's new leader and... ends up making virtually no changes in the slavery system, only to profit as much as possible from the rich sugar economy. Another shocking moment: after a triumphant Haitian Revolution against the French and a declaration of independence, the new Haitian leader declares that it's time to massacre every white person on the island, as revenge for all their past offenses. Not only does this seemingly reduce him (and others backing the decision) to nothing more than the same kind of people that the French were, but it eliminates all of the educated citizens from the island (and scares off any potential immigrants). The first of many "brain drains" to occur in Haiti.


I could go on and on. Very interesting stuff. (I thought I didn't like history?!) Anyway, I'm off to wake sleepy Charlie up and we'll go to a local market, in traditional French style! YAY! And then to Pareeeeee


À bientôt...

Seeing is Believing

Today's post is something of a look backward, but also a preview of more to come. I spent about a month and a half shadowing once a week at a hospital near Haverford, and I was extremely lucky... in a lot of ways. I got to shadow in a bunch of departments related to OB/GYN, which is perfect preparation for my Haiti adventures; I was placed with a couple of really friendly, open, warm mentors who were extremely generous with their time and to whom I am very grateful; I got to see such a wide variety of incredible, fascinating, inspiring things, to the point that I am absolutely convinced of my choice to enter the medical field! There is no going back. I'm hooked.

I spent my days between the OB/GYN clinic, the Perinatal Testing Center, an OB/GYN private practice, and the Labor and Delivery floor. Each had something unique and different to offer me, and I got to see really cool things each time! I sat in on a lot of annual check-ups, and it was interesting to learn that those appointments (at least in clinic) tended to include a fair amount of non-GYN-related doctoring, such as for asthma, allergies, colds, etc... I also got to see the cervix, which as it turns out is just a little donut! teehee. On my first day, I was super excited to get to use the Doppler once to measure a fetus' heartbeat! In the Perinatal Testing Center, I mostly just saw a ton of ultrasounds of 2nd and 3rd trimester babies, which was pretty incredible; I didn't expect to be able to see a live, moving image of the four chambers of a baby's beating heart! wow. Technology, the human body, and human development do not cease to amaze me.

Labor and Delivery, however, had the most to offer in terms of AMAZEMENT. One of the days I spent there, I watched (count 'em) three little babies come into the world! And not just any old babies - the first was a C-section (!!) and the second & third were twins (!!), born naturally. What a day! This was the day that really solidified my desire to be a doc. My first day in clinic (i.e. my first day shadowing anywhere in the hospital), I had a sense that I was where I was meant to be, and it all felt right, and I was excited and all that. But this day in Labor and Delivery blew my MIND, and this was when I had a feeling that there's no going back! I absolutely loved every minute of it, and could have stayed for hours more if only to see it all over again.

So... since I was so inspired and excited and interested by everything that happened in Labor and Delivery, I'm going to share the gory details, for those of you who are interested and for myself so I have a record of it later.


--PLEASE STOP READING HERE IF YOU DON'T DO WELL WITH DETAILS ABOUT SURGERY / BLOOD!--
Or keep reading if that's something that you find interesting! :)

I first had to get into full scrubs (yay!), complete with shirt/pants, booties, hair net, and face mask. I wasn't ever going to participate in anything (of course) but I had to suit up, even to just be a fly on the wall. First was the C-section, which was planned and scheduled ahead of time because the docs knew the woman had a vasa previa. That means that there were some larger blood vessels from the placenta blocking the cervix (detected ahead of time by ultrasound), so giving birth vaginally would probably result in rupture of those vessels and excessive bleeding. I'm proud to say that I didn't get even a little bit queasy or nauseated or nervous or grossed out! (Apparently some people faint when seeing their first open-abdominal surgery.)

First, they gave her an epidural, which looked like a pretty big needle was involved and appeared to be pretty painful (although she was also pretty scared at that point, so it was hard to tell what exactly the source of the tears was). Once she was all numbed-up and attached to the epidural catheter, then they inserted a urinary catheter, and everything had to be kept extremely sanitary from this point on. By the way, she was kept awake for the entire procedure (!!), with a curtain of sorts blocking her view of what was going on around her abdomen, and her husband sitting with her by her head. It was super interesting to see them cutting through each layer, one at a time - skin, fat (yellow and bulging), fascia (a thin, tough-looking, white-ish layer), muscle (they just pushed these to either side without cutting them), peritoneum (lining of the abdominal cavity), and then finally the uterus wall. It was pretty incredible how tough the human body is - they were able to stretch and pull pretty hard/roughly on the edges of their incision, without anything tearing! Another surprising thing was the size of the incision they made - I guess I was picturing a C-section as a big slice into the belly followed by a lifting-up-and-out of the baby, but the incision (made side-to-side) was actually only about the width of the baby's head. Anyway, once they hit the uterus and all the blood vessels involved in the pregnancy/placenta, there was suddenly a ton of blood gushing out. They seemed pretty unfazed and just kept moving (quickly), collecting expelled blood with a big grand-daddy version of the dentist's spit-sucking pipe. Before I knew it, the doc had his hand in the incision (i.e. in the uterus) and had the woman "PUSH", and after a little bit of maneuvering, there was the baby, "delivered" through the man-made hole that was, as it turned out, probably about the size of the natural birth canal but just in a different spot! Super cool and interesting and exciting!!!

I think this baby was about 34 weeks, and they took him and cleaned him up, and he cried pretty quickly, so that was all good and fine. (Yay!) Meanwhile, back at the new momma, the docs were cleaning her up. First, this involved pulling out (delivering) the placenta, and then they basically took some sponges/towels and reamed out the uterus! Apparently the human body is way tougher than I thought, because it's OK to be pretty rough with it. One of the most unexpected things during this whole procedure was that at some point during this clean-up process, they were able to just flip the uterus up and out of the body cavity, and set it on top of the woman's abdomen!!!!! It was still somewhat connected to her insides, but apparently it's fine to move it outside to help clean everything up! Whaaaat?!!?! After cleaning everything up (and counting every single sponge to make sure none were left behind!), the docs began suturing. They had to do each layer individually, although they didn't have to sew every single layer because some heal on their own just fine. So they sewed shut the uterus and tucked it back into its spot, and sewed up a few other layers, taking special care to make a neat and subtle line on the last layer of skin (for cosmetic purposes). And that was that! The doc showed me the placenta, where/how it connects to the uterus wall, and then flipped it inside-out so I could see how it interacts with the baby. The huge blood vessel of the vasa previa was also quite visible, and happened to be right next to the incision he made. Close call! So exciting. Everything was so cool to see, and so intense! I had questions the whole time, and an awesome NP stood with me and gave me an oral tour during the whole process. It was great.

So after that whole mind-blowing, amazing, inspiring, life-altering experience, about an hour later I found myself as a fly on the wall again, this time to see the natural delivery of a pair of twins!!! I LOVE MY LIFE. I joined the party after mom had already had an epidural, and once she was totally dilated (10 cm). They got her all set-up with these massive industrial-looking stirrups, and started doing practice pushes each time she had a contraction. But before I knew it (this was probably supposed to happen, but it snuck up on me), these sets of 3 "practice pushes" at a time had actually become real pushes! I could see a little hair from the top of baby's head! Surprise, surprise!! :D Also, at some point, her water broke in a big way, but they had a nifty cloth & plastic bag set up below her bum so that caught a lot of the mess. Mom didn't seem to be in too much pain (thanks to the epidural), but it was clear that she was struggling her hardest to push with all her might. An impressive sight, to be sure! They had her do 3 big, long pushes and then rest until the next contraction, and each time the head would crown more and more...! Finally, after a big strong set of pushes, she hadn't quite gotten the entire head out (although it was sooooo close to being past the widest point!), but she was pretty worn out... so the doc actually just very gently, bit by bit, slid the edges of the vagina back and back and back (ever so slightly at a time) until suddenly... pop! The head was completely out! Then there were a few more pushes and there was a BABY! I actually almost cried, cheesy/cliché as it is. :) SO overwhelmed. Snip-snip and they quickly whisked Baby A over to his clean-up/cozy-up station.

On to Baby B! It turns out that this baby's head was pointed a lot more towards the top of mom's body, with feet down towards the exit, which is bad, so there was a lot of reaching way up inside while feeling/poking/prodding/pushing from the outside in order to figure out how to maneuver this kid into the right orientation. Head-down was the ideal goal, but butt-down can be OK too, especially with a second twin (because Baby A stretched things out a bit for Baby B). At the same time, they were using a live ultrasound to try to put the puzzle together and identify where everything was. Eventually, after no success, they decided to let her keep laboring for a while; sometimes a baby will reorient itself on its own, given time. But about 5 minutes after setting mom up all comfy-like, sans stirrups and all that mess, they were back with another doc who wanted to give the maneuvering a shot himself. He actually managed to right things just enough so that the baby suddenly was on her way out (shortly after the water of amniotic sac #2 was broken) without too much more pushing, butt-first (called a breech)! Let me tell you what, as it comes out, a breech baby looks a lot less like a baby being born - since she was face-down and butt-first, she was just a big mass/blob of white until they turned her around to send her off to her clean-up station next to her twin brother. Baby A was already all wrapped up in a baby burrito by then. :) Back at mom, the docs were doing a fair amount of sponging and cleaning up of the uterus and birth canal (things were stretched enough to reach waaay up inside!!! - but nothing tore during the whole birthing process, amazingly!). The placenta came out, and was significantly larger than that of the C-section I saw earlier that day, which makes sense considering there were twice as many babies attached to it! After a bit more clean-up, that was that!

BABIES ARE AMAZING! AND MOMS ARE TOO! Every moment was such an incredible experience! The vaginal births were probably more emotionally exciting and wonder-inducing, while the C-section was a lot more interesting/fascinating (it's obviously much more of a window into the body), in its own way... but it was all SO mind-boggling and exciting and amazing!!!!! I also feel incredibly lucky because apparently all the things I saw today are rare in and of themselves, so it's very uncommon that I would get to see all of them in the course of 4 hours or so. Wow. :D What. A. Day. (What a world!) Now I just love babies and OB-everything and deliveries and and and... ALL THE THINGS!!!


Thanks for reading, hope you enjoyed it, and hope it wasn't too much gory detail for you! ^_^ I'm PUMPED for more! (Haiti's just around the corner...)

Dye mon, gen mon.

Apparently I'm starting a blog! Hooray! The things I'm about to get to do are just too exciting and special to not chronicle. I'm one week away from my college graduation, and I still have some work to finish before I'm officially DONE, but all I can think about is my quickly-approaching trip to Haiti this summer...

So first, a quick background: Haverford has this awesome thing called the CPGC (Center for Peace and Global Citizenship) that funds social-justice-oriented student and faculty trips all over the country and the world. I am fortunate enough to be doing what they call a "Senior Bridge", a 10 week international internship of some kind that begins to link my academic studies and interests with my grown-up, real-world life and future career. My project, in a nutshell, is to spend 10 weeks at this awesome maternity clinic called Olive Tree Projects in Jacmel, Haiti; I'll be doing some combination of volunteering in the clinic, helping with admin duties, teaching some community health education classes, and lending a hand wherever I'm needed!

Ever since my freshman year in college, I've been getting really into global/public health. It all started with my freshman writing seminar, Writing in Public Health, taught by Judy Owen (easily one of Haverford's most glorious professors!). We read Tracy Kidder's Mountains Beyond Mountains, and the tales of Paul Farmer and Partners in Health had me hooked instantly and forever. Paul Farmer quickly became one of my idols (my "hero", perhaps?), and I've been on the road to try to exemplify the work he does... basically, I just want to be him.

If you haven't guessed it by now, that's where the blog's title comes from, in part. I was looking up Haitian proverbs and found "Dye mon, gen mon", which means "Beyond the mountains, more mountains" - it's probably where Tracy Kidder's book title came from, now that I think about it. It's described as "a proverb of both patience and the recognition of how difficult life in Haiti is", which made it even more apropos for this blog. It seems appropriate because (a) it's a Haitian proverb, and this is the beginning of my learning about their culture and traditions; (b) in a way, it's a Haitian translation of the title of my own personal bible; and (c) it captures a glimpse of the struggles that Haitians deal with on a daily basis, which brings it back to global health and social justice.


Before I close my first post (!), here are a few quotes from Mountains Beyond Mountains / Paul Farmer that I came across while looking for inspiration for a blog title:

"Never underestimate the ability of a small group of committed individuals to change the world."
"I can't sleep. There's always somebody not getting treatment."
"That's when I feel most alive, when I'm helping people."
"Equity is the only acceptable goal."

"We're all human beings."

P.S. I'm not sure that I'll be posting here a whole lot over the course of the next 2 months, since I won't be to Haiti until July 22. So if it seems like the blog dies down between now and then, expect it to pick back up again in mid or late July! :) Thanks for reading!

P.P.S. HAPPY BIRTHDAY, DAD!!!! Love you forever!! xoxo