The myth of rural silence.

One of the funny parts of being in a remote tropical location is the lack of silence. I think I have grown accustomed to the silence of my home, my car, my life in general that I take for granted the lack of sounds. Here there is no lack of noise.

The symphony of sounds in a typical 24-hour cycle include:
_ungodly loud animals at night. so loud it can be difficult to fall asleep. frogs, crickets, unknown night creatures.
_the generator coming on, or going off - depending.
_the fan in our room rotating its blade and then clanging side to side.
_buzzing of mosquitos and flies.
_cell phones ringing
_swish-swishing of brooms made of palm trees brushing the leaves off the dirt paths and sweeping the veranda
_roosters crowing on the porch in the morning and from under yam leaves in the middle of rain storms
_the rain pounding
_the thunder clapping
_the power of the wind rustling through the leaves
_motors of boats whirring by
_okadas (motorbikes) chugging along the pedestrian path
_kids playing, sometimes laughing sometimes crying
_voices yelling, sometimes friendly, sometimes not so friendly
_wheelbarrows full of sand and tools bouncing along the gullies in the muddy path
...and today: the deafening sound of a chainsaw outside the glass doors of our makeshift studio space preventing me from even being able to read.

Perhaps I should invest in earplugs. Or just be grateful that I know what silence sounds like. And laugh about the fact that many people think 'rural' and assume quiet.

Celebrations: mass, graduations, goats.

Waking up bright and early, I put on my Sunday best on to attend St. Augustine's Catholic Church in Umuoba-Amam Otuocha. Well, actually I borrowed a skirt, but same same. The nine o'clock mass, which lasted for three long hours and was in Igbo was quite a cultural experience. With drumming to our right, the voices of the church rose up to fill the large hall. There were mostly women in their Sunday finest filling the pews. I don't know if this is a reflection of the general dearth of men between the ages of 16 and 60 in these communities or if men are just generally less church-going. Regardless, there were lots of women and children. The children had their own wing of the church off to one side of the altar. It seemed like a genius design to accommodate the antsy nature of children being asked to sit still for hours on end. What is even harder to describe is that the children were unattended by adults. The older one tend the younger ones, as is generally common, but I had no idea how many children there were until I turned to face them when I was walking back to my seat after the offering. At first guess, I would say a thousand kids. Easily.

The church is focused on some development projects. They have a primary school. They are working on raising money to build a new church. The drawing of the new design hangs over the altar and I am not sure how much people want the actual design that is drawn, or just the newness and the expensive cars included in the drawing. They did manage to raise almost 50 000N in the service.

After the service, we went to Dr. Chife's brother's house for a graduation celebration for two of the fellows who we are working with: Simon and Fidelis. They both just completed their undergraduate studies in economics and biology at a school in Kumasi, Ghana. The celebration consisted of us drinking beer at 11am, talking, and then eating a flavorful goat stew. After chatting for a while, I decided to step out when the conversation turned to: do you want a Nigerian husband? (I decided that I am open to the possibility if I can also potentially have a American husband, but no one was open to the idea of a wife having two husbands despite the prevalence of men having two wives here.)

When I stepped outside, some of the boys and recent graduates were playing draught, which is like a complicated checkers where pieces can go back and forth, jumps are required, and kings can move along diagonals. I lost pretty badly. But through my mistakes, I did manage to learn the rules. After getting my butt kicked, Fidelis offered to defeat my competitor to avenge my loss. He played a much better game.

It was a fun day and I really enjoyed the moments when we weren't quite sure what the appropriate social grace was so we just floundered until someone took the lead.

Ologwulogwu.

Today we went on a hike to the sacred ologwulogwo, a sacred location where water stands year-round. It is said to be the home of a deity. This deity may appear to humans as a crocodile. Or as a hive of bees. These are warnings he gives to people who are nut pure in their heart when they enter this sacred place. Although we were not warned, the deity is very cautious about who is able to enter the mystery of this land.

Five of us started out with two guides, a site map, and handheld gps. The sky was blue, but dark clouds were not far off in the distance. Having been given this adventure by Stacy, we weren't really sure what to expect when we arrived. We walked for maybe an hour, through cassava farms, tall grasses, and waist-deep puddles that are filling in the path as the rains continue. As we walked through an extra-deep puddle, the sky opened up and water soaked us from from both directions. Just after emerging from this situation we entered a glade. The landscape was dramatically different from the farm land and tall grasses where we were coming from.

The trees enveloped us and vines hung down creating a network of nature that would make a great place for fairies and nymphs to play. Although the rain continued, we were protected by the dense overhead flora. I looked down and found a yellow plastic bracelet that looked like it belonged to a child. The silence and the peacefulness of this place was remarkable. Well worth the wading and the cold pelting of rain.

Walking back Boniface, one of our guides, sang a Nigerian folk song to us the whole way. The melody was about a how a son should listen to his father and how no one should ever tell a lie. His voice was hypnotic. By the time we returned home I was mesmerized by the experience. I am not sure whether it was the deity or the singing or the walking in the cold water, but I felt a deep calm in my soul.

The concept of the deity in the ologwulogwu makes me wonder how these traditions arise. I have no doubt that the place we went is connected to something deep and mysterious. You could feel it. The air was warmer, and things got quieter. Sometimes I think that people set up shrines to honor great mystery. Other times I think the shrines alert you to natural phenomenon that warrants caution: beehives, crocodile homes. These things are indeed a source of great mystery, but there is also a social need to protect people from potential dangers. It seems that many traditions and cultures develop spiritual beliefs that protect people, such as health laws in judeo-christian beliefs which seem outdated when we have things like running water and sewage or food handling practices that are outdated with modern technology. Protection in this way is a practical form of spirituality. I wonder how these traditions will be incorporated or modified to adapt to the new city that will be built in these locations.

Oguwuyo Community Event

Today we had an open forum for people from the community to come and see the site and discuss ideas for development. The boat brought about 20 people from Otuocha in the morning. After a tour of the fish farm and brick factory, which are the first of the two seed projects that are underway, we broke up into groups to discuss various topics.

As part of the health group, we discussed our visions for the overall health of the future Anam City and asked people what they believed were the most pressing health concerns and their hopes for the future health centre. I was grateful to have such a strong group of presenters and moderators with me: Nuzrat, Nkiru, Fidelis, and Michael. They each explained their understandings and contributions and translated between Igbo and English. I was very inspired and took some wonderful video clips that hopefully I will be able to post when I return. After rotating through the three different groups, we all gathered to plant an Iroko tree and take group photos. Then, it was lunch time. Everyone returned to the Chife estate where we drank malta, ate jollof rice and fried chicken, and generally mingled. Afterwards, we watched a video and then broke into small groups to again focus on various activities. In the health group, we acted out the most important features of going to a clinic: 'what does it look like to get loving, personal care from a practitioner?' It was funny to see people act like they had malaria, and they did a convincing job that mimicked almost exact presentations we had seen earlier.

Overall, the event went well and it was really inspiring to get such great input from the community.

Nothing is Routine in Nigeria.

I have started to settle into a a pattern here, well at least a daily pseudo-routine. I wake up sometime before eight to eat breakfast of oatmeal, eggs, and toast before we start work at nine. I do some form of work or group discussion until lunch, work some more until evening, then dinner, followed by more work or a presentation or a movie, then I go to bed sometime before two.

Okay its not much of a pattern. It involves a lot of sitting in the studio, sitting at the dining room table, and being at a computer.

The weekly schedule follows something like this: Mondays we pow-wow and get a clear schedule of what we are doing or discuss any events, strategies, goals and assignments for the week. We have pin-ups on Wednesdays and Fridays, which is fun to get to see what everyone is working on. Various fellows usually come on Tuesdays, Wednesdays, and Fridays. Then Saturday we take a tour of an Anam region.

This all being said, everything must be decided in the moment depending on factors that change frequently: the weather, who is around, the boat's availability, security, etc. I am having lots of opportunities to practice flexibility and adaptability to the timing and scheduling of Nigeria.

Esteemed Elders.

I am constantly humbled by the health and status of the elders in Anam.

Every culture relates to their elders differently. In Anam, as is true in most of Nigeria, and probably most of Africa, the elders are revered for their wisdom of experience and are cared for by younger members of their family if they are not able to live alone. Children are like the insurance plan to make sure that someone will care for you in the future. For many of the elders in the community, they never need to cash in on this insurance plan as they are healthy and independent well into old age.

The elders make all of the most important decisions in the community. Anam has an elder council that is composed of the oldest men from the eight different Anam communities. This egalitarian system has a long history of consensus making and democratic process to make decisions. They advise and endorse plans by younger members of the community. They bring justice in a culture where it is hard to imagine life without corruption and lack of legal recourse. They are the authority that everyone must be accountable to and the voice that has the final say.

While I think that generally American culture could learn to embrace the wisdom of elders more, the thing that amazes me most is the health and vitality of the elders that I meet. In Abegbu, where we met with the elders, one man was 97 - almost 98 - living alone with most of his visible teeth still in his mouth. He could recite the history of his community with all the names and dates from the time of his birth when we asked him about the history of his people. In his house, a 'younger woman' carried a bench in from the veranda. She was 89. In Otuocha, I met a woman who was 82 had malaria and was boiling leaves to treat it. She didn't want her photo taken because she was sick, but she had the most amazing smile. Two other men that we greeted were in their upper 80s and looked vital as they sat watching people pass by for the market. These are not isolated occurrences: meeting healthy, even vigorous, elders in the community. In a community where poverty and disease are rampant, where clean drinking water and proper sanitation are hard to comeby, we must ask: what are these elders doing that allows them to live such long healthy lives?

And further, how can we recreate this in the New City?

Children.

I am continuously struck by the children in Anam: the number of them, their distended abdomens, their curiosity to learn and the lack of opportunity to support their potential.

Everywhere we go, children gather. Partly the children gather because we are a spectacle of foreigners and they are curious. Partly they gather because they seem to roam in packs. One of the first days we arrived in Ebenebe we were on a site tour. There were only two children at the school because the teacher had not come that day, so they joined our walk. Then at one house there were 21 children under the age of 5 and maybe 3 women. I thought that was a lot, until we went on a trip to Iyiora where 70 kids plodded along behind us as we walked from house to house.

The kids are thrilled with the novelty of our presence and they want to be involved in what we are doing. They want to be in photos and ask for a 'snap.' They jump when the camera flashes and celebrate the completion of the photo with squeals of excitement or shy glances from behind older siblings. The older ones carry the younger ones on their backs wrapped in vibrant West African fabrics and knit caps. Their toys consist of old bicycle tires that they push with stick or the newest toy is a version of pushing a stick with two bucket lids attached like a wheel at the end. The latter reminds me of the Fisher Price push popcorn vacuum toys popular when I was a child. They smile and laugh and remind me that the joy children exude is universal and appears to exist independent of life conditions.

When surveying a 24 year old woman, she sat with 6 children, 3 of whom were hers. After the older kids got bored of watching us asking healthcare questions, they ran to a neighboring hut to play. Only her 7 month old was left playing on an empty rice bag next to her. The infant was content chewing on a leaf for a while; then she moved onto handfuls of dirt. After a few fistfuls, her mother picked her up and bounced her on her knee until she breastfed the little girl. After getting her fill and smiling the milk-drunk smiles of contentment, the girl peed her pants while sitting on the edge of her mother's lap. Unable to crawl, she simply sat there unphased by the bodily function. At another house, I met a two year old who was able to eat well with a spoon when he was fed. His abdomen was distended and his hair was beginning to thin and had a reddish hue, indicating kwashiorkor. He was able to stand with support, but he could not walk and he crawled to follow his other siblings until they picked him up to play. It is this kind of scene that devastates and motivates me. What will become of these children's futures? Will they grow up to be strong contributing members of their families? Will they grow up at all? What can we do to make this better?

In Otuocha at the chemist's office, a woman from Ebenebe came to see Juliette after her three week old had been sick for the last week. The woman reported that the baby had suffered with diarrhea and vomiting for the whole week. When the chemist listened with her stethoscope, which was lacking a membrane on the bell, she said, 'There is no heart beat', which explained the stillness and silence of the swaddled child. The worst part was that they simply wrapped the child up again and left.

Who knows why they waited a week? Perhaps they were trying herbal remedies that were not effective. Perhaps they did not understand the risk of dehydration in an infant. Perhaps they could not sacrifice the day in the field to paddle the boat for over an hour to get there. Or perhaps they came on a market day because they had to sell something before they could afford to consider getting medication for this child that was alive for such a brief time.

Unfortunately this is not an isolated situation. The chemist told me that she sees approximately five children per month who have died. Generally they come from Ebenebe or Iyiora where they have no access to health services. Usually they are the poorest in the community. Farmers living in remote areas. And they just don't have the resources they need. She told me that in April, 14 children died because there was a measles outbreak. Since then the health centre made a big push to vaccinate for measles and the numbers hover in the single digits. But the fact is that she is only one of twenty chemists, separate from the health centre, and this does not account any of the traditional doctors from the area. I am working to get an idea of the actual number through the surveys, but what is the impact that this is having on the people?

The hardest part of this experience for me was the matter-of-factness of children dying for completely preventable reasons. How many of these deaths could have been avoided with simple treatments? How many families must suffer the grief of losing a child due to malnutrition or dehydration? This should never have to be a regular part of life.

After this visit to Otuocha, I immediately began to wrestle with questions: Are we doing enough? and Are we doing it fast enough? At the same time, I know for sure that what we are doing will dramatically improve the life and the health of this community. Providing access, providing care for children, providing health education. This will insure a better, healthier future.

Otuocha Eke Day!

On Saturday we continued our weekly explorations of the Anam communities. This week: Otuocha on Eke. Eke is market day and it occurs every four days. This week it coincided with a Saturday, which means that the market was even more populous.

Otuocha is the largest of the populated areas and, per local reports, it used to be somewhat of an urban oasis for people to visit. However, in 1999, there was a conflict over land. The Umuleri and the Aguleri are the primary groups that settled there. At some point long ago, the Umoba-Anam purchased land from both groups giving them rights to settle and live in the more urban area. When the conflict grew and crisis occurred in 1999, the Umoba-Anam were caught in the middle and basically trapped in their ghetto and this forced development to become more dense in their section of the city.

The majority of the development in Otuocha is in the low land abutting the river. There are pros and cons to this. The main advantage is the river access that provides trade routes for farmers and peddlers. The main disadvantage is that this is also along the flood plane.

We arrived on a boat from Ebenebe. On the ride, we briefly noted that this was exactly how people in the US were celebrating the fourth of July too: on boats, in hot sun, with an armed guard wearing a shirt with trout and american flags on it. So patriotic we are!

As the boat pulled up to the shore of the ferry landing, we could see the layers of the market. Women selling vegetables under umbrellas along the earthen slope between the river and the high ground. Paths between waste that creates a fabric over the sandy shore. Bustling streets full of pedestrians and salesmen. Shops

Women sold most of the vegetables from the farms: okro, tomatoes, bitter leaf, etc. Men were higher up in more permanent stands selling yams and goods. There is a section of stalls for juju, where you can buy skulls and feathers for talismen. There is a whole rice processing area where the local rice is dried on mats in the street where cars drive over it occasionally. There is an area for fabrics with seamstresses and tailors, where I hope to have some clothes made on our next visit! It was quite a busy hub of activity.

Oh, and there were men selling herbal medicines out of their cars! I spoke with ‘Dr.’ Dixon for a moment about his miracle powder. He claimed it could clear up any infection. When pressed, he wasn’t really sure what an infection was, but he was quite charismatic as a salesperson. He also didn’t know what exactly the creator’s degree stood for; these credentials supposedly made him a doctor. What does FNAHM stand for? Who knows?! I suggested it was something about herbal medicine. Anyhow, based on the label and the posters this powder is mostly good for reproductive issues, ranging from getting HIV from a dog to having children that are half-goat, or things like “veneral infections, weakness of male genital, virginal discharge, and pile.” We bought one for N100 (~$0.60). The instructions are to take one packet in lime orange or Sprite every three days until symptoms clear up. Yikes!

So while half of our group stayed to study the market, three of us went to explore the layout of housing. I was more interested in seeing how the conditions of this more urban setting helped/hindered health. Did people have more access to clean water or sewage treatment? Was there better ventilation? How available was health care?

Luckily for me, one of the new fellows that we met in the city, Fidelis, was really interested in collaborating on health care. He said he had wanted to be a doctor, but most recently he had been studying biochemistry in Ghana. Excited to have someone who was eager to follow a similar line of thinking, I gushed about all the programs we have been discussing. After the brief orientation, he took me to a chemist shop nearby.

Leaving the architects to measure footprints and rooms of houses, we walked a couple blocks to a chemist shop where I interviewed Juliette. She runs one of the twenty chemist shops in Otuocha in addition to catching babies. Juliette has no formal training, which is the standard for chemists. She apprenticed with a doctor and now she is teaching nine young women how to do what she does. As far as I can tell, chemists form the back bone of health care in this area. Their services are accessible, relatively affordable, and fairly comprehensive. She sells everything from nutrients to antibiotics to phenobartitol. While we were there a couple of people came in, so I also got to see her in action. It was an extremely informative visit, which perhaps I will write about at some point in the future. After the interview, I feel like I have more of a pulse of general health needs in the area now.

After we left her shop, we headed to the health centre. It is a four room health clinic, which was unfortunately closed on Saturday. I tried to peer into the rooms, but the bars and mirrored windows obscured most of my vision. I did get to see some of the posters aimed at the health of children and women mostly. They were posters for condom use, immunizations for children, and guinea worm (which only occurs in areas that lack clean water sources). We tried to find a nurse or two, but they were all out of town, so I will have to return on a weekday to visit the clinic.

By this point, the afternoon storm was visible, so we headed back towards the central meeting location, stopping along the way to greet a few of the traditional doctors and women who specialize in herbal medicine. We reconvened as a group at the catholic church to head back to the boat. I was excited to hear about the exploits and adventures of the other teams, and grateful for my relatively raw and singular experience of the health of Otuocha. I think that I half expected my experience in Nigeria to be more like this town than the rural think-tank where we are and so it was extremely satisfying to touch the feeling that Otuocha inspired. I really enjoyed the bustle of the city mixed with the warmth and welcome of everyone we met.

And the rains fall.

Last night, I woke up tossing and turning, hot and sweaty, to hear a thunderstorm announce its presence in the sky. At one point around four am, a thunderclap shook the earth and was closely followed by a flash of flaming lightning that left me wondering for a moment if I had just been struck. I think that there were flames following the strike and while I tried to orient myself in the night, I went over the electronics in our house trying to remember if anything was plugged in before recognizing that the power was off anyhow. Then, as I realized we were not in a state of emergency, my thoughts drifted to all the inhabitants of the nearby settlements in their clay waddle-and-daub huts with thatched or tin roofs, knowing that the structures were no match for nature in all her glory. My thoughts and prayers stayed with them until I drifted back to sleep.

Surveys Begin.

Health surveys are one of the many pieces of gathering information that will help to best inform the development of the health care system. I have been working on designing a survey that will give us a clear profile of what people want from local health care and what challenges people are currently facing so that we can move forward with programs and applying for strategic partnerships, ie funding. Today we began the process.

It is really an honor to go to someone's home and sit with them for 30 minutes or so while they share their family history and hopes for the future of health in the New City. Even though I cannot understand most of it until a fellow translates for me, there is a lot to be gleaned from the animated tones and gesturing of the dialogue. Here is the order of operations: We go and introduce ourselves. Usually there is a fellow who leads the conversation in Igbo and I chime in with words like Dalu and Naan, which are standard greetings. After giving a brief overview of where we are in the project design, we offer to give them a family photo if they are willing to answer our questions. In this process, benches appear out of nowhere. They are long smooth wooden benches made from a single long plank with keyhole-type joints (no nails or screws). The children will carry them inside from outside if we are invited in. Or the adults will magically produce benches and stools to sit in the area of swept dirt outside the front door of their waddle-and-daub hut. The benches are dusted off and we sit.

The eight page survey takes about 30-minutes. When a man asked why we were asking all these questions because he thought I should know these things as a doctor, the fellow replied in Igbo that we have different diseases where I come from and so it is important to know what people here go through. It was a delicate situation handled well, although the statement is only partially true. Some of the diseases are different than what people experience at home, malaria typhoid guinea worm, but many of the diseases are the same, hypertension diabetes back pain. The conditions that produce the disease are different, but the human body has a limited set of responses that link us no matter where we are in the world. We are all human after all.

After going through the myriad questions, many of the families are pleased with the opportunity to have their photo taken. 'A snap' is the proper Nigerian term for the snapshot we take. To have a photo properly printed, one must trave 90 minutes to Onitsha and I can only imagine the hassle of actually locating a place that will print photos once you arrive there. This doesn't account for the fact that very few people have cameras. Almost everyone has a cell phone though, and many cellphones have cameras so the concept is not foreign. People get excited and dress up for the photos, and the photos are honest. They show families sitting in front of thatched roofs, women holding their children, and beautiful austere faces of people who are all hoping for a future that will provide relief from some of life's challenges.

Groundnut Soup on a Rainy Sunday.

After a day of staying inside due to the heavy rains, we feasted with a delicious Ghanian Groundnut soup prepared by Nuzrat Ngyamah-Poku, who is a Ghanian architecture student that I get to work with designing the health care program and facility. (Nuzrat, I am sorry your photo ended up sideways, but it took 75 minutes to load, so that is the situation.)

Nuzrat's famous Ghanian groundnut soup recipe (serves 12)
1 bottle groundnuts (aka raw/lightly roasted peanuts)
Fresh ginger, about 3 inches
Salt, be generous
Maggi (Knorr Chicken Bouillon is same thing)
Meat: we used 1lb of beef, cut in cubes. Shrimp, chicken, or tofu would also be delicious.
8 tomatoes the size of roma tomatoes, whole with skin
2 purple onions, quartered
1-5 fresh chili peppers, roughly chopped and seeded depending on spice preference
1/4 medium head of cabbage, shredded

Blend with water, ginger, salt until smooth. Add only enough water to make everything smooth. Should be about the consistency of Tahini.
Pour mixture into a saucepan, add 12oz water and chili peppers. Bring to a boil, then simmer for 30 minutes.
While this mixture simmers, combine desired meat (chicken, beef, shrimp, tofu), salt, maggi, roma tomatoes, onions, and 16 ounces of water in a separate large soup-pot. Bring to a boil and simmer, adding water as needed.
Now, combine the two pots together by adding the peanut mixture to the larger of the two pans containing the meat. Again add water as needed. We are cooking on kerosene burners that are hard to control, so the amount of water may need to be adjusted to your cookware. The final consistency should be like a thick creamy soup.
Allow this to simmer for 15 minutes.
Then remove all the larger pieces of vegetable: tomato, onion, pepper. Place these in a blender with enough liquid from soup to effectively blend. Once the mixture is smooth, pour back into the soup-pan.
Simmer for 45 minutes.
Serve hot over rice and with shredded cabbage.
Personal opinion: peanuts should always be sold in recycled liquor bottles.

The Abandoned Government Hospital. Notes.

I am posting my notes from the Hospital. I will formalize it later, but if you have any feedback I would love to know your thoughts/impressions.

Tour of Vacant Government hospital:
(With Cecelia’s husband)
Closed since strike in February 2011.
Operating room. Working last year. 2-3 procedures performed.
Doctor brings medications with him when he comes.
No utilization of National Service Youth Corp.
Cost of delivering a baby is 5000N. This can be pain in increments.
Staff: 1 MD, 6 Nurse, 1 sister (Mary Paulette), 1 midwife. The latter two are from the church. There is no system for pregnant women to get care in their own homes.
Observations: mold growing in saline bag. Used needles hanging in operating rooms. Supplies for sutures are available and look new.
Chart notes are sitting out in entrance from 1994. Kids with diarrhea, 1yearold with fever.
No mosquito nets or fans in the wards.

(CECLIA nurse: was working in the farm prior to coming over. Kids ages: 9,8,5,2y7mos)
There is no water available in the hospital. How can you care for people when there is no water?!
Card costs 200N for each person or child.
No one has been coming here since the strike started in February. The doctor comes weekly on Wednesday.
When he comes, he sees 2-5 patients per day.
Cecelia now sees and treats what she can. She mostly treats malaria. She also delivers babies when it is not an emergency. Usually there are about 2-3 deliveries per month. If it is an emergency, she calls the doctor and he comes from Onitisha and usually takes these women away to his private hospital there.


REFLECTIONS AND OBSERVATIONS
Emphasize short community trainings. Better professional training.
Provide home services.
People think the clinic in Aboebgu is too far away to get there. (It is a short walk).
Who are the local leaders that could promote health training for the general public?
What are the best ways to educate people about basic health care needs?
What are ways to provide transportation and home visits?
Motos equipped with basic supplies for home visits (DM, HTN, rheumatism, malaria, diarrhea, etc) Nurses come to health center in morning, then go door-to-door during the day. At end of day, return moto and lock up equipment.
Shuttle from each settlement to hospital once per week.

How do we ensure that the medicines are getting to the patients and not going to the doctor’s private hospital?
Provide scholarship for agreement that the doctor will return to Ebenebe for 5 years to practice. Same thing for nurses. Health educators. Provide salary and transportation while working. As part of the agreement, they go site to site.
How do we communicate with public?
Promote classes.
Spread word about services.
Reminders about antenatal care.

Basic Health Topics:
CPR
Hemorrhage
Malaria
Diabetes
High Blood Pressure


Would the current nurses be interested in teaching/mobilizing to educate women and groups?
Topics: infectious disease, antenatal care, nutrition, ‘


Can we make it cost effective to go to people’s houses?
How do we create abundance mentality for employees, patients, community?
How do we make sure that they think there is enough?


Feeling of hospital: the wards feel terrible - tight and cramped. 12 beds in a room, no circulation. The outpatient facility was comfortable. I think starting with one consulting room is a good idea. Administration? Interesting.

Abegbu, phase one.

On Saturday, we walked along the road to reach Abegbu. People in Anam speak about it like it is a ghost town that was abandoned when the market town of Otoucha grew and inhabitants left to live in a more urban environment. After visiting the intimate and organized Iyora community last week, I wasn't really sure what to expect.

We walked for maybe 30 minutes on the road, which is beginning to fill with water in the parts that have already worn away. Along the walk, we were passed by approximately seven Okadas (motorbikes). It was almost comical to see people stop their bike with multiple passengers on it before a small pond in the road and try to figure out how to drive along the 2-3 inches of hardened earth. I think walking was easier.

Once we arrived in Abegbu, we were welcomed into the Elder most man's home. His two story home was immaculately swept and organized with large photos of individual family members framed and hung neatly around the top of each wall. After welcoming us to Abegbu, he offered his support for the project and the planning of the new city in Anam. Then he told us the story of people in the area as far back as he could remember, which was his age: 97 - almost 98. I would like to repeat: he is 97, almost 98! He lives alone, has most of his teeth, stood to shake each of our hands, and remembered the story of his down since his childhood.

It is refreshing to be in a community that so deeply reveres the wisdom and experience of the elders.

After leaving his home, we toured the sprawling town. This was quite the opposite of a ghost town, but there was a large generational gap present. This is becoming a theme in the rural Anam communities. There are abundant children under 12. I counted 70 at one point when we were standing together. Their mothers and grandmothers can also be found, usually cooking in the kitchen or tending to the farm. And there are elders. But where are the Youth? Where are the able bodied 13-40 year olds? Answer: They have gone somewhere to search for better economic opportunities. So how can we design a city that will constantly have an abundance of employment and opportunity for growth? Let me know if you have any answers. I think there are some great ideas in the works here. Another time, I will discuss these projects and goals.

Anyhow, after we left we were invited into the pastor's compound to speak with his father, where he provided the universal sign of welcome: warm Coke in glass bottles. He used to work as a general contractor and he answered many of questions about the cost and process of building in Anam and even some of his impressions about health care. From there, we left and measured a number of houses. At one point while the architects were measuring a house and store front, we met with the women to discuss health care. They offered many helpful taking points and contacts. Here are some of my notes from the conversation:

There is a chemist shop in town that people go to. And a hospital that people can go to buy drugs or for antenatal visits. Currently there are no home visits, but this would be welcomed. Other services that people have to go use are in Miata and Otochua or Onitisha. There is a Sister that comes around. Sister Mary Paulette. The doctor who works at the hospital comes every Tuesday. Or you can call for an emergency. He comes from Onishita and can come in 2-3 hours. There are nurses. The facilities lack manpower. Yesterday a woman almost died in childbirth because the nurse was busy helping another woman. No one reported hearing of an Anam woman who lost a baby in childbirth. The young pregnant woman says that the gods have been kind to them. The older woman has rheumatism and she wants help. She wants services. She suggested free services for support - medical counseling and psychological services. She would like these to be provided by a trained medical professional ideally. It would be okay if these were by semi-trained people in the community. Just to provide psychological support for people.

My head was swirling with further questions and ideas that I look forward to asking in future visits. Their requests are reasonable, and unfortunately not unique. Now the task is to identify how to provide these services in a way that can be supported in the new city. The highlight of the trip for me was the amount of information I learned about available health care and desired services that people wanted to receive. On the walk home, we stopped at the abandoned government hospital that was built in 1988. This topic deserves its own post, however, and I promise to finish it soon because it highlighted the importance of my work here along with the added challenges that are specific to Nigeria.

We left Abegbu with more of a feeling of what happens in a sprawling Anam town. There were probably one to two thousand people living there, and yet the number of abandoned foundations or walls that had become gardens or just overgrown with the power of nature here. It was a strange mix; not quite a ghost town, but not quite organized or planned either.

Thirty!

Today I celebrated turning thirty! In Nigeria!

It was a really wonderful day. I woke up to my roommates crooning happy birthday to me while I lay ensconced in my mosquito net. Throughout the day, I received wonderful emails and messages from people all over the world, and I celebrated with two birthday cake surprises and a group of visionary experts with whom I work.

Let me explain the extraordinariness of the cakes. First, all our cooking is usually done on three kerosene burners outdoors. Secondly, one of the interns has been working on building a solar oven, but we lack certain reflective materials (enough beer cans), so the plans and skeleton of the solar oven live on the floor of our studio work space. Thirdly, the only sweets that we have access to are digestives, which are more accurately described on the label as 'wheatflour coasters.' Fourthly, chocolate is loosely interpreted as such in Nigeria.

So now, to the cakes themselves: a gluten-free chocolate-coconut-ginger cake ala Stacy and a frosted corn-muffin sponge cake decorated to say "Happy Birthday Julia" in pink frosting bought my a Nigerian architect, Deji, who transported it from Oniticha (the cake is more delicious than my description). I felt so loved and indulgent! I must give Stacy a little more credit for her feat of a cake. Having the forethought to bring gluten-free cake mix from New York, she steamed the cakes in a secret manner during the day using a double-boiler type system with kerosene burner, which is not the most consistent of flames. Then she made coconut-ginger icing and decorated the cake exquisitely. I would eat it again in a heartbeat!

Reflecting on the past year, it is amazing how much has changed. I celebrated my last birthday two days after graduating from naturopathic medical school in Seattle. Then, I passed board exams, completed an internship in Hawaii, decided that I was meant to be self-employed instead and moved to Austin in February, started a practice and network there, and then accepted a ten week public health internship to revolutionize the public health care model in rural Nigeria. What an amazing year! And I am pretty sure that the future only gets better.

I am looking forward to thirty - both this upcoming year and the decade. I like where I am headed. I love the people I have close to me in my life. And I sometimes, I cannot believe my fortune when I see how the pieces are all falling together.

The notion of exercise.

After work today, a few of us from the workshop went to help unload half a trip of gravel and sand from a boat at the dock. If you are not familiar with how much a 'trip of gravel' weighs, well, I cannot really tell you, but basically it is a boat load. A heavy boatload. We joined a number of the day laborers from the construction site and carried the bags up to 15 feet. My arms were exhausted after lifting possibly 35 of these gravel bags.

When we returned to the house, it was time for our daily workout regimen. Since June 13 we have been doing Beach-Body-Insanity Workout videos after our workday. I really enjoy the group cardio work the videos promote along with the luxury of working out inside to avoid the mosquitos. We have a fluctuating group of people who participate and they make it easier to motivate to exercise every day. After lifting the bags of gravel, I had a hard time lifting my water glass to my lips to drink. Inevitably this added to the intensity of the Insanity workout.

The contrast of the physical labor with the forced exercise video struck me as absurd. I am not sure yet what to make of the situation, but it is helpful for me to conceptualize the physical demands that people in the new Anam city currently face and will be facing so that we can cater services and programs to meet those needs. For example, it becomes more important to make sure that nutritional needs are met with proper food storage strategies, food access routes, and relevant nutritional education. How to effectively do that is the question...

Anam City Blog Post.

I wrote a post about Herbal Medicine in Anam City on the Anam City blog.
Check it out.
And then subscribe to the blog!

Sandflies, mosies, and no-see-ums.

How can feet possibly be so delicious to insects!?!?!!?


And why can't I stop scratching mine!


I heard an insult today: 'I feel sorry for your shoes (pause for dramatic effect) because your feet must really stink.' I think I could add 'AND ITCH!!!!'

Palm Wine + Kola Nut.

Friday we presented our workplans for the rest of the ten weeks. The scope of what everyone is trying to accomplish is humbling, ambitious, and extremely exciting! I managed to use clip art and colored arrows to present my timeline. I felt pretty proud of my attempt at graphics, considering I am working with people who are extremely talented with design softwares. Hopefully, someone will teach me how to use a snazzy program like Illustrator or InDesign.

After we presented our work programs, we celebrated! The fellows were thoughtful enough to bring palm wine and kola nuts with them in the morning, so we experienced the kola nut and palm wine ceremony with all its pomp and circumstance. The ceremony is a welcoming of guests, acknowledging that they are welcome any time. After the presentation of the kola nut and money from the male head of household to the guest, there is a five part call and response. One of the fellows translated everything from Igbo, the local dialect, to English so that we got the full effect.

Then the kola nut was broken and passed around. The bitter pink fruit is supposed to be extremely stimulating. One of the fellows said that students will use it to stay up for days. He also said that women will drink it to promote lactation. Then, he warned us not to eat more than a quarter of the fruit's flesh in this sitting.

Once we all had our kola nut, the palm wine was generously poured from a blue plastic gallon container that probably held some sort of fuel or oil prior to palm wine. Someone promised me it had been washed out. The palm wine tasted like a cross between coconut water mixed with pure fermentation. I helped myself to two generous glasses, which contributed to some extreme post-imbibing gastrointestinal bubbling. Someone told me that there was more alcohol in the palm wine than in a guinness. I doubt it. But it was delicious. And it was fun to just sit around and laugh together sharing in this tradition.

The Largest Market in Africa.

Today we went to Onitsha. It was part market-research, part cultural-shopping-adventure.

Anytime we leave our cloistered oasis, there are multiple steps involved. It is not arduous, so much as it requires a fair amount of organization. So sometime mid-morning, we boarded a wooden boat bound for Otocha where we docked at the ferry landing. The boat is best described as a long wooden canoe powered by a motor and bamboo pole. The captain drives the boat from the back with the first mate giving gestures and occasional verbal cues indicating upcoming obstacles - water hyacinth, fishing nets, driftwood. Once we docked at the landing, kids began to gather. White people are not a common sight, I suppose, and staring is socially acceptable. The kids were generally smiling and entertained by us, although only a few of them spoke english so communication was limited to body language and eye contact.

Otocha has a market that runs every day, with a large market rotating every four days. It is an interesting cycle based on the four days of the Anam calendar. You have to find out when the last big market was and calculate when the next one will be in order to figure out when to shop. Today was not one of the larger days so we got oriented while someone collected the cars and our vigalante escorts. The vehicles are now stored in Otocha since they cannot be stored at the site due to the wet, muddy road conditions.

We then drove for about an hour to Onitsha where we took in the market. We started with the food sections and then traveled to the heart of the market. It is said that if you cannot find it in Onitsha, you cannot find it in Africa. The scope of the market is expansive and quite ordered. There are separate sections for food, meat, clothing, books, electronics, construction goods, etc.  This gives you the opportunity to comparison shop as well as take in as much sensory stimulation as you can handle. We had wonderful escorts and trying to maneuver seven interns and a number of staff through narrow stalls of goods is an adventure on its own.

After an afternoon of shopping and exploring market organization in the hot sun, we piled back into the van for the drive back to Otocha. It started to rain as we were driving back, which is not optimal when you still have a significant boat ride home. We tried to wait it out for a short period, but between the sun setting and the rain clouds darkening the sky, we needed to collect all of our groceries that had been purchased and head home. For this we needed a bigger boat. One of my favorite things about the ferry is that you just park your wooden boat and it will stay there. There is no security, nor any patrol of the boats. People generally know who's boat is who's (they are also labeled) and it brings bad fortune to you if you steal someone's boat. So it just doesn't happen.

Anyhow, we made it home in the cold, dark rain with food to feed 12 people for a week - 4 chickens and 8-20L water jugs included.

Location, location, location.

We have been here for almost a week which is hard to believe.

Before arriving, I was under the impression that we would be staying in thatched huts on the site. As with most things construction, there were delays. The huts and the staff quarters are not finished. So instead we are bunking in the Chife's house. It is really more of a mansion, a Trasarco McMansion, and we are really more like squatters. The house is brand new, almost completely finished, with floors and fixtures from Ikea and romanesque columns everywhere, and absolutely huge. Someone said the other day, "Nigeria is like Texas. They like everything to be bigger."

It is common in Nigeria that when someone from a community makes it big, becoming a Big Man, they build a large house in their village. Right now this white semi-Mediterranean style house stands out amongst the waddle-and-daub huts that dapple the countryside. Dr Chife grew up near here and his community raised money to send him to college. In addition to the New City Project, he has created programs, such as scholarship programs, that help to repay their support by reinvigorating the future of Anam. He models the principles that many aspire towards: success, generosity, vision. I look forward to hopefully meeting him this summer.

Anyhow, as far as where we are...Ebenebe is one of the eight Anam Communities located in Anambra State near the Ezichi and Niger rivers. It is primarily a farming settlement and some people live here permanently, while others just live here when they are farming. The landscape can be described as a forest-mosaic. What this means really is that it is part jungle, part forest, part farmland, part flood plane.

I share a sleeping room with two other interns, one from Spain and the other from Oregon. We all have foam mattresses and that are draped in mosquito netting each night to protect us from the mosquitos and their potential diseases. The room is part of Dr Chife's future office for the times when he is here. My suitcase is my dresser and I am grateful to be able to hang my toiletry organizer. We take bucket showers because although there is indoor plumbing, the electricity goes off for about six hours per day. The state put up power lines in the area years ago, but there is no power coursing through the wires. Instead, everything is run by generator.

Our office is the future living room and we have three large tables with various models of computers available for usage. Everything is open and studio-esque. The ten-week program has been reframed as a workshop, which emphasizes the nature of our work and the collaboration of everyone here because certainly everyone here has a lot of insight and knowledge to share. There are seven other interns total, six of whom are here. Five of us are American, one spaniard, one ghanian. I am really grateful to be a part of such a visionary and educated group.

All in all, it is a pretty good set up. We sleep, work, and eat in the house. We are close to the river and it is easy to explore the site. Things are off to a good start.

Goat feast.

Today was the awaited Goat Feast.

Yesterday Mercy and Rose, our dutiful cooks, brought a goat back from the market. The goat was 2-3 years old, brown, and scared out of her mind after being transported in a car for a few hours. She cost about 150,000naira, which is approximately $100. I am not sure what the market rate is for goats at home, but for the amount of food that we are getting this seems like a deal!

Sparing the details of the processing, nothing from this goat is going to waste. Much of the meat was roasted over an open flame. Half of it was frozen. Some of it was stewed. (Goat head stew is a famous dish in northern Nigeria.) And some of it, I do not want to eat. It was quite delicious and more tender than I anticipated. I may not want to eat goat for a while after we finish everything, but for now I am really excited about this novel protein source.




One other note about today: A few of us went for an afternoon run and part way through a few kids began to follow us. There is a strange contrast to our need to go exercise and be physical after sitting most of our work days to the active lifestyle of the families in this area who are primarily farmers and laborers, but kids are a different story. They began to imitate us and we played along. We taught them some stretches and calisthenics and twirls for good measure and they practiced their new moves, laughing and smiling. Then we went down to the river for a quick swim and the kids watched us from the bank. One of their mates came along and we watched them explain what we were just doing, acting out the running and stretching and calisthenics. It was precious to see them laugh as they described what we did.

Also, my fingers are still burning from where I touched fresh chilis cooking last night. This is a true testament to the strength of the spiciness.

Site Tour and Context.

Day Two of Orientation focused on creating a context for the ideas of designing a new city. After arranging the tables and computers in our workspace, we began with a site tour after a hearty breakfast of eggs, oatmeal and nutella. (Mmmm...chocolate for breakfast.) We walked the 4km (~2.2 miles) from the north to the south end of the area designated for New City development. The site tour was helpful to develop an understanding of the land, its current uses, and to imagine the potential development of the city. We saw where the future hospital will go among a grove of mango trees; we stopped at the high grasses that are being cleared for the brick factory; we rested on the bamboo stoop of a neighboring family and counted 21 kids for the 4 women that were present. It is hard to explain what we are encountering. I wish I could post photos to highlight the natural beauty that surrounds us and the excitement of the people that we have spoken with. Even with photos, the kinesttic quality of being here is hard to describe. Everyone that I have encountered is fully committed and engaged in making sure that the New City is a success. They are passionate about making this a better place for their families to live and return to for generations and generations. There is palpable meaning in what we are here to contribute.

After concluding the three hour tour to the south end of Ebenebe, we took a boat back to our starting point. It was refreshing to see the land from a different perspective and it helped me understand the magnitude of how people here adapt to a changing landscape. For instance, farmland where yam and cassava are grown is dry right now, but soon will become flooded and the mounds of yam will be underwater. The tall grasses that border the river will be submerged in months time. It became easier to conceptualize that when the road gets flooded, people adapt. There is still access to neighboring communities by river. Essentially, the river becomes the road.

To celebrate the river, a few of us took a sunset swim in the murky waters at sunset. It was quite an adventure through someone's cassava mounds to get to the river, but we made it and had a glorious swim. It is hard to believe that we have only been here for two days as there is so much to see and comprehend. But I am beginning to see how things fit together and the specific possibilites of this collaborative project.

Ruban Workshop Begins.

After a full day of travel on Tuesday, we began our workshop on Wednesday.

I would like to start by describing our travel from Lagos to Ebenebe. Here's the plan: leave the hotel at 10am, fly from Lagos to Benin City at 11:40, drive for 2 hours to Anam, begin orientation. Sounds like a full day, but nothing too strenuous. I don't ask a lot of questions and I am up for anything, which is lucky. After breakfast at the hotel, we all load in the car and leave the hotel by 10:30am. Wondering if we are going to be late for check-in, we drive all of 100 yards to the airport. Realizing that we could have walked this far, we check in for our flight without showing any IDs. I wish I had taken a photo of the situation because well, it was unique. I have some photos from the arrival in Benin City (courtesy of Isabel). Anyhow, we make it through security with full water bottles. We were asked to take a drink from our bottles to make sure that it wasn't acid or something dangerous and then we proceeded to the boarding area. I think TSA could take a clue and follow this strategy instead of throwing out useful things all the time and banning water.

Inside the terminal, there were kiosks selling sundry goods from books to watches to edibles. Interestingly, the books mostly focused on bettering yourself in business, like focusing on management strategies or being a better consultant, or self-help/religious topics. I think I saw a medical dictionary too. We waited and our flight was delayed 30 minutes. Then 45 more minutes. When I asked our kind guardian and shepard Emmanuel if they gave a reason for the delays, he looked at me and laughed saying, "It is delayed because they are Nigerian!" I should point out, he is Nigerian and lives in Lagos. We eventually boarded the 40 minute flight and were greeted in Benin City by cars armed with police officers to take us to Ebenebe. The police officers are our security. They carry large personalized guns and scan the streets and onlookers for possible perceived threats. I feel extremely safe, but like a fish in a fish bowl.

Everyone I have encountered thus far is extremely nice and hospitable. It is hard for me to imagine anything going wrong. And at the same time, we drive for almost four hours and there are innumerable checkpoints where police stop cars and want money from vehicles that don't have security. So better safe than sorry. We stop at a market to pick up some mosquito nets and while a couple of people venture off, all of the new arrivals (the seven interns) stay in the van. We quickly become a spectacle. White people in a car in a town that may never have had a caucasian visitor. Kids run and tell other kids until there is a swarm of kids looking and watching. It is a little like we have paparazzi sans cameras. Thus the feeling of being in a fishbowl.

Our final destination is Ebenebe in the Anam region of Anambra state. We made it to our final destination after dark, perhaps around eight at night. This is one of the last days the road will be passable by car. Soon the rains will start and will flood the road making the river the only way to access the area. Already the road is rough and the vestiges of inadequately funded state road make themselves apparent as we pass from smooth developed road to mudholes that could swallow a car.

A feast awaited us upon arrival: greens, yam, casava, plantain, and fresh fruit for desert. We were exhausted and hungry after our day of travel and gratefully inhaled the deliciousness prepared for us. After dinner, we had brief introductions and watched an inspiring video from Dr and Mrs Chife welcoming us to the project. Then after settling into our rooms (which I may describe more later), we went to sleep.

The next day, the Rurban Workshop began.

When someone tells you that they are designing a new city that can serve as a model for African development, you know that it is going to be a big project. You assume that the project has immense potential to make a difference in the world and the lives of the individuals who will live there. But you don't really know how large the project is until you grapple with the master plan and the topics and concerns that have been discussed for years leading up to this moment in time. This project is especially wide in scope because it is so unique in evolution. The people in Ebenebe are building this city from the ground up, with every factor being weighed by the community elders. Our first day of orientation was all about understanding the Master Plan and the evolution of this project. After one day, I have a lot yet to understand.

Departures and Arrivals.

Life is good, and it only gets better.

The past few weeks in Austin have been fantastic. Not only do I feel like I am really starting to belong to the community here, but I am also learning how to utilize the resources and wealth of knowledge surrounding me. I went to a beekeeping class, kayaked on town lake, and tubed down the river in San Marcos. I have eaten some of the most delicious food on the planet. And I have enjoyed spending time with people I love. Needless to say, I am pretty glad that I made the move from Hawaii to Austin in February.

Timing is a funny thing. Just as I was starting to feel established and comfortable with my life in Austin, it was time for me to leave for the summer to go to Nigeria. I accepted a position working with the Chife Foundation to help develop a public health care system in a new city in Africa. This opportunity provides a chance to make a difference on a larger scale than a private practice while working with visionaries. The goal is to create a model for future African development. While I have lots of ideas about what I will be doing and what to expect, there are more unknowns than knowns. Here's what I do know:
-I will be living in rural Nigeria for two and a half months, doing a combination of surveying (health surveys, etc) and collaborating with other experts to make recommendations for the new city project.
-Stacy will be there. And seven other interns, whose names I have seen in an email.
-I will have a chance to work with other really amazing people (interns, Chife employees, Anam community members).
-I will get to learn about Nigeria and have to opportunity to make a contribution.

So on May 29, I boarded a plane bound for Lagos.

About an hour into the flight, there was an announcement over the loud speaker: "We are looking for a doctor or nurse to help with a medical situation. If you are a doctor or a nurse, please contact a flight attendant immediately." After a brief moment of hesitation, when I wondered if I was really prepared to declare myself so publicly on a plane, I made eye contact with a flight attendant who asked if I could help. After introducing myself as Dr. Strickler, I quickly felt that I had control of the situation and the moment of hesitation was long forgotten. Luckily we didn't need to reroute the plane, nor did I need to perform any drastic measures. A simple exam with questioning and some paperwork later, everything was in order. It was a good reminder of how comprehensively I was trained for myriad situations. It also made me wonder what was in store for me once we landed in Nigeria.

I made it safely to Lagos after 14 hours of travel. Before even making it through customs, I met four of the seven other interns, which only contributed to the excitement of arriving. After getting our luggage and yellow fever cards checked, we were swooped from the airport to a hotel, where we ate our first Nigerian meal. I managed to sleep the whole night through even with the time difference (Nigeria is six hours ahead of CST). And prepare for another day of travel before getting to Ebenebe, the site of the new Anam city.

okc marathon.

Following in the tradition of Pheidippides, I ran my first marathon yesterday. It was quite an experience to say the least.

Four months ago, I remembered a promise I made to myself when I was eighteen: I would run a marathon by the time I was thirty. That seemed reasonable when I was eighteen and thirty seemed like forever away. Plus, I was eighteen, resilient, and trail-running regularly. That was twelve years ago and I really had no idea what the impact of being somewhat sedentary through medical school would have on my body. Nonetheless, a commitment is a commitment. And now I had less than six months to follow through.

I trained with the Passmore Racing Team (Stacy and Paul) for the Austin Half Marathon in February. It was great to have the support and accountability of our 8-week training schedule. I think we each pushed ourselves a little harder knowing that we would be racing together. After finishing the half marathon, we all felt pretty good and it was motivation for me to continue training for the full marathon.

So I scripted my plan, laid out days that I would do my long runs and hoped that four months was enough preparation. Turns out, a stress fracture type injury is enough to derail training. Six weeks before the OKC marathon, my left foot started giving me trouble. I pretty much quit training at that point. The longest I'd run was 16 miles. Now I couldn't go more than a few miles without major pain. So I stuck to yoga and swimming and wore an ankle brace. I decided that I would still go to the marathon, and do the best that I could despite the injury.

So, on Sunday May 1st, I completed the Oklahoma City Memorial Marathon. I am not sure yet how to characterize my mixed emotions about the race. One one hand, I am humbled at the number of people who participate in such events and proud of my accomplishment, while at the same time I think we might all be CRAZY.

When I woke up on Sunday a cold front had blown in creating a thunderstorm that was predicted to last for the day. We went from sunny and 72 on Saturday evening to 42 with 25mph winds and rain on Sunday morning. Thank you Oklahoma weather. Still too excited to process the potential impact this weather may have on the race, I got dressed in warm layers I had luckily packed 'just in case.' The final layer was a 13-gallon trash bag over my clothes. Stylish, I know.

My mom graciously agreed to run with me at the start and finish of the race. So she and I were out on the course at 6:20am ready to go. Unfortunately, we didn't know that the race was delayed due to lightening. So we stood out in the cold rain waiting for the new start time to arrive. While standing there listening to announcements and runners chattering about the weather, feeling the excitement of everyone was energizing. Then, moments before the gun went off, we were all asked to observe 168 seconds of silence to honor the memory of the 168 people that were killed in the Oklahoma City bombing. The only sound around us was the raindrops falling. I cannot express the profundity of 25,000+ people standing in the rain before sunrise, totally silent.

One of the things that I appreciated about the OKC marathon was the emphasis on the victims of the Oklahoma City bombing. We started and ended at the memorial, with tributes to the 168 victims woven throughout the fanfare of the race. The announcer read this quote that is on the entrance to the memorial:
"We come here to remember those who were killed, those who survived and those changed forever. May all who leave here know the impact of violence. May this memorial offer comfort, strength, peace, hope and serenity." I like the sentiment.

As the shot rang out, we started running! (This is a photo of us finishing.) The course took us through some really great parts of the city. My mom ran with me for the first four miles and then Spenser was waiting at mile 11 to run the rest of the way with me. I ran with another racer for a while who was running the half. He told me that he and his girlfriend started training for the half-marathon together and then they broke up two months ago. He was running in the race and she was at home on the couch! Love it!

Overall, the weather was the most remarkable part of this race. The first half was cold and rainy, and then it got colder and rainier and windier, and then colder and windier with hail. During the second round of hail, a nearby racer said, "Seriously, what's next?! A tornado?!"

Seriously, who thinks it's a good idea to run a marathon in 40 degree weather with 25mph winds and hail?! I couldn't feel my hands after mile two, my feet were wet and numb, and I think I shivered for at least an hour after finishing the race. A warm bath, hot water bottles, three blankets and a comforter later, I was finally warm and feeling pretty good.

I definitely could not have finished the race without the all support I had. Spenser, mom and I crossed the finish line together. (Above is Spenser drinking a beer at mile 25.) We all got our hard-earned medals and I got my finisher t-shirt. At one point in the race, I wondered why I was doing this, and recognized that in addition to being stubborn, I wanted that medal and t-shirt. However, the emergency blanket they passed out at the end was a more valuable prize then the medal by the time I made it to the end.

I am so grateful to Dave and Janet who generously hosted us, to everyone that wished me luck and cheered for me, and to the people who stood out in the rain supporting the runners. And I am really glad that I will never have to do this again! Ever.