06 March 2016

The Poet-Doctor Returns to Africa

Disclaimer: This was written Feb 29-March 2, but I'm posting it on March 6th, from Uganda. I am currently in Kisoro, I've been in the hospital since Thursday, and there will be more regarding that, soon. There will be/are real time delays, as with internet.

*****

le 29 fevrier ->2 mars 2016

It’s been almost three years. And this is the first plane ticket I have personally paid for. Then again, it’s the first time going that I have a job. Then again, it’s the first time I’m going as a doctor. My (nascent) career trajectory has spanned this. Next time, I’ll be on my own, maybe with Peace Corps, maybe MSF. A friend in med school commented once, it was hard to imagine there was a time when I hadn’t been to Africa. It’s true. Now 1/3 of my life since that first moment. In first grade, so enamored of geography before I’d seen anything other than the country of my birth, my most native tongue, France, snd the country that has claimed most of my years and words. I named Africa my second-favorite continent (Europe was first), and Ouagadougou was my favorite capital (Burkina Faso). My favorite movie was Cheetah—a Disney movie in the 80s, two kids and their Maasai friend trekking across the Serengeti in search of a cheetah (duma) they had rescued from the poacher that killed its mother, taking this one for greyhound racing. And in 2008, before going to Kenya, I downloaded “Jambo Bwana,” from the movie’s soundtrack. I named the kitten who came with my house in Migori (as did hundreds of of bats under the eaves) Duma. I went on safari, overland, in Maasai Mara (the Kenyan side of the Serengeti). I saw a cheetah.

I wrote about this almost three years ago. What it feels like to return to Africa. The light. The Equatorial light, existing in the back of my eyes like uncapturable jungle greens, makes me ache. The Constant Gardener has it right. Paris has a light. So does Equatorial Africa.

I wonder if, in this direction, I´ll see the Sahara in the same way. I wonder if, descending, I’ll feel the rush of warm air into the plane. I wonder if, in landing, the plane will erupt into applause. Flying to Cameroon is that way.

*****

I wept the first time I flew away from Africa. I kissed my fingertips and touched the tarmac in Douala (…and our Kenya Airways plane turned around soon after take-off, we landed in Douala, and, 26 hours later, I left again). When I returned to Africa (Kenya) six months later, I kissed my fingertips and pressed them to the earth. A year after that, I was back in Cameroon. You can go home again. I have. But in the between times—Africa makes me ache. Everyone, everything I know there, wondering who will be alive, the next time. Or have died of what. It’s funny to think of it as a continent, in so many ways (though the country I consider home is called “Africa in miniature.”) Or anything unified, really, when even within countries borders are arbitrary, so being from one nationality means many divergent cultures, traditions.

It’s been almost three years. I’ve traveled to the developing/Southern/non-Western (not true, for Central America), Global South three times on vacation in the past three years. But the first time I went to Africa, first time I went anywhere but the US or Europe, I moved in. Comfortable, stubborn, familiar in a plaster and stone house in the equatorial rainforest, with mostly walls, five rooms, and in the annual migratory path of the biting ants that can kill a child (a swarm of hundreds of thousands acting as one organism, in through a living room window, out through the kitchen at the other end).

       In Cameroon in April 2013, my last time anywhere in Africa, I was such an almost-doctor that all I had left of med school upon my return was graduation. This time, I’m such an almost (terrifyingly so) – attending that upon my return, I have 2.5 months left of residency. But now. Now I refuse to tell my patients I’m leaving. Not yet. There’s a minuscule “maybe” in there. But really I wonder if they’ll forgive me, if they’ll believe I didn’t say it, couldn’t say it yet, I nodded dumbly to “few months follow-up,” because, well, maybe. I wonder if they’ll believe I didn’t say it because it hurt too much. And now. Now I tell my patients I’m going to Uganda, they tell me to be careful, they tell me to come back.

     In the years before personal TVs in seat-backs and interactive maps, I used to think that flying over the North Atlantic—icebergs visible, sometimes—was the most exciting thing. I’d look for the maps of the flight path, posted somewhere near the galley, back bathrooms. Now I’m breathless, flying over the Sahara. It defines and divides the continent—North, or Sub-Saharan. The anticipation of crossing it, majestic, immense, impossible so, is of what lies south. The scattered clouds. Most of the time, I fly to Africa during the day. It’s not my second-favorite continent anymore.

******

      In Brussels. Two hours until I leave for Africa. One hour before boarding the plane to Kigali. I’m not wearing pagne, not this time (on the way to Cameroon, I generally wear Eto'o Fils), but there is some pagne packed in a bag of mostly medical supplies. That bag, as I am, is en route to its 9th African country. Walking around the gates of this terminal closed off by customs, I chance upon one scheduled for Yaounde. It is Wednesday—I think the one from Brussels is the MWF flight. My heart, to be both blandly general and exquisitely specific—aches. Maybe it’s a mistake to not be going. Not this time. East Africa isn’t home, it isn’t as loud and chaotic and colorful and full of spice (literal and figurative). Even considering my friends in Kenya, where I too, promised I would be back to Migori, and hoped to mean it. But there is a sense of belonging in Africa. Both appearing so starkly Other...mzungu (ntangen…white…foreign) and feeling like I belong. One of the most difficult parts of reentry and readjustment after Peace Corps. But, as I’ve learned, you can go home.

From what I’ve heard and seen in pictures, this hospital, this town (Kisoro, Uganda, and also a district hospital like Mvangan was) is much more developed than Mvangan—thus also busier. And there is no French or Bulu to fall onto, but constant translation. I’ve been called “dokita” (Bulu) and “docteur” and “doctor” many times before in Africa. For this first time, it’s true. I wrote my applications to medical school from Cameroon, about Cameroon, I worked (though mostly in public health) in the hospital there. I returned to the US briefly, then on to Kenya to start tentative steps in medicine, the summer before I started school. Then again to Cameroon in 2009, summer between 1st and 2nd years of medical school, both doing research and doing consultations (precepted!) in the hospital in Yaounde. And then 4th year of med school, back to Cameroon, both in the ER and medicine wards in Yaounde and doing surgeries out en brousse. And now. At every step of my career, I've been back. This only guarantees that I will work in Africa...and in Cameroon...again.

******

I’m on the plane now, watching the countdown of minutes, miles on the screen. I can see the Sahara, though it’s unfortunately cloudy. You can just make out the color underneath.

       The temperature is warmer than it was, maybe, but it’s really in landing that I’ll be able to tell. Or not. There isn’t the same portentous humidity on the East side, though, as I’m going very close to the Equator in Uganda, and I lived at 2 degrees north in Mvangan, there are certain similarities. But as I saw in Kenya, there were some trees that were the same, patches, looked like vestiges of what is still rainforest on the other side and in the middle of the continent. But the light will be right. It’s rainy season, and the rain on the tin roof at night will be right. The clouds are lifting. I can see more of the Sahara. And now it’s the Nile, I’m on the East side of the plane. Few oases along the banks; the map notes Khartoum, and I can just make out a larger cluster. It grows dark before we reach the southern edge of the desert, the Sahel, the transitions.

It’s a tradition I learned in African dance. The drums speak. Dance is about doing what the drums tell you, listening, and then not listening but becoming part of the music. Your body being inside the music. If the drummers keep going, you do. If they switch abruptly, you do. They direct everything. It’s one of the things I love best about it. The complete abandon that is necessary. And becoming rhythm, music, speech. At the end, the dancers go in front of each drummer, pressing both hands together as if in prayer, lowering your head to kiss your fingertips, and pressing them to the ground in front of each drum. Each drummer. They are above human, they are to be respected and revered. They create you. That’s where I learned. Malian dance class. 2002. It’s an amazingly, incredibly diverse continent, with >200 languages and ethnicities in Cameroon alone, with every landscape imaginable and history from prior to it. I recognize it, but still, there is something intangible and specific about returning to the diverse, heterogenous continent.

I hope we land on the tarmac, I hope there is an external stair, I hope we descend immediately into African air and African soil.
Regardless, I know what to do. I know what I will do. It’s been almost three years.
Reverence.

~j
Disclaimer: This was written Feb 29-March 2, but I'm posting it on March 6th, from Uganda. I am currently in Kisoro, I've been in the hospital since Thursday, and there will be more regarding that, soon. There will be/are real time delays, as with internet.

*****

le 29 fevrier ->2 mars 2016

It’s been almost three years. And this is the first plane ticket I have personally paid for. Then again, it’s the first time going that I have a job. Then again, it’s the first time I’m going as a doctor. My (nascent) career trajectory has spanned this. Next time, I’ll be on my own, maybe with Peace Corps, maybe MSF. A friend in med school commented once, it was hard to imagine there was a time when I hadn’t been to Africa. It’s true. Now 1/3 of my life since that first moment. In first grade, so enamored of geography before I’d seen anything other than the country of my birth, my most native tongue, France, snd the country that has claimed most of my years and words. I named Africa my second-favorite continent (Europe was first), and Ouagadougou was my favorite capital (Burkina Faso). My favorite movie was Cheetah—a Disney movie in the 80s, two kids and their Maasai friend trekking across the Serengeti in search of a cheetah (duma) they had rescued from the poacher that killed its mother, taking this one for greyhound racing. And in 2008, before going to Kenya, I downloaded “Jambo Bwana,” from the movie’s soundtrack. I named the kitten who came with my house in Migori (as did hundreds of of bats under the eaves) Duma. I went on safari, overland, in Maasai Mara (the Kenyan side of the Serengeti). I saw a cheetah.

I wrote about this almost three years ago. What it feels like to return to Africa. The light. The Equatorial light, existing in the back of my eyes like uncapturable jungle greens, makes me ache. The Constant Gardener has it right. Paris has a light. So does Equatorial Africa.

I wonder if, in this direction, I´ll see the Sahara in the same way. I wonder if, descending, I’ll feel the rush of warm air into the plane. I wonder if, in landing, the plane will erupt into applause. Flying to Cameroon is that way.

*****

I wept the first time I flew away from Africa. I kissed my fingertips and touched the tarmac in Douala (…and our Kenya Airways plane turned around soon after take-off, we landed in Douala, and, 26 hours later, I left again). When I returned to Africa (Kenya) six months later, I kissed my fingertips and pressed them to the earth. A year after that, I was back in Cameroon. You can go home again. I have. But in the between times—Africa makes me ache. Everyone, everything I know there, wondering who will be alive, the next time. Or have died of what. It’s funny to think of it as a continent, in so many ways (though the country I consider home is called “Africa in miniature.”) Or anything unified, really, when even within countries borders are arbitrary, so being from one nationality means many divergent cultures, traditions.

It’s been almost three years. I’ve traveled to the developing/Southern/non-Western (not true, for Central America), Global South three times on vacation in the past three years. But the first time I went to Africa, first time I went anywhere but the US or Europe, I moved in. Comfortable, stubborn, familiar in a plaster and stone house in the equatorial rainforest, with mostly walls, five rooms, and in the annual migratory path of the biting ants that can kill a child (a swarm of hundreds of thousands acting as one organism, in through a living room window, out through the kitchen at the other end).

       In Cameroon in April 2013, my last time anywhere in Africa, I was such an almost-doctor that all I had left of med school upon my return was graduation. This time, I’m such an almost (terrifyingly so) – attending that upon my return, I have 2.5 months left of residency. But now. Now I refuse to tell my patients I’m leaving. Not yet. There’s a minuscule “maybe” in there. But really I wonder if they’ll forgive me, if they’ll believe I didn’t say it, couldn’t say it yet, I nodded dumbly to “few months follow-up,” because, well, maybe. I wonder if they’ll believe I didn’t say it because it hurt too much. And now. Now I tell my patients I’m going to Uganda, they tell me to be careful, they tell me to come back.

     In the years before personal TVs in seat-backs and interactive maps, I used to think that flying over the North Atlantic—icebergs visible, sometimes—was the most exciting thing. I’d look for the maps of the flight path, posted somewhere near the galley, back bathrooms. Now I’m breathless, flying over the Sahara. It defines and divides the continent—North, or Sub-Saharan. The anticipation of crossing it, majestic, immense, impossible so, is of what lies south. The scattered clouds. Most of the time, I fly to Africa during the day. It’s not my second-favorite continent anymore.

******

      In Brussels. Two hours until I leave for Africa. One hour before boarding the plane to Kigali. I’m not wearing pagne, not this time (on the way to Cameroon, I generally wear Eto'o Fils), but there is some pagne packed in a bag of mostly medical supplies. That bag, as I am, is en route to its 9th African country. Walking around the gates of this terminal closed off by customs, I chance upon one scheduled for Yaounde. It is Wednesday—I think the one from Brussels is the MWF flight. My heart, to be both blandly general and exquisitely specific—aches. Maybe it’s a mistake to not be going. Not this time. East Africa isn’t home, it isn’t as loud and chaotic and colorful and full of spice (literal and figurative). Even considering my friends in Kenya, where I too, promised I would be back to Migori, and hoped to mean it. But there is a sense of belonging in Africa. Both appearing so starkly Other...mzungu (ntangen…white…foreign) and feeling like I belong. One of the most difficult parts of reentry and readjustment after Peace Corps. But, as I’ve learned, you can go home.

From what I’ve heard and seen in pictures, this hospital, this town (Kisoro, Uganda, and also a district hospital like Mvangan was) is much more developed than Mvangan—thus also busier. And there is no French or Bulu to fall onto, but constant translation. I’ve been called “dokita” (Bulu) and “docteur” and “doctor” many times before in Africa. For this first time, it’s true. I wrote my applications to medical school from Cameroon, about Cameroon, I worked (though mostly in public health) in the hospital there. I returned to the US briefly, then on to Kenya to start tentative steps in medicine, the summer before I started school. Then again to Cameroon in 2009, summer between 1st and 2nd years of medical school, both doing research and doing consultations (precepted!) in the hospital in Yaounde. And then 4th year of med school, back to Cameroon, both in the ER and medicine wards in Yaounde and doing surgeries out en brousse. And now. At every step of my career, I've been back. This only guarantees that I will work in Africa...and in Cameroon...again.

******

I’m on the plane now, watching the countdown of minutes, miles on the screen. I can see the Sahara, though it’s unfortunately cloudy. You can just make out the color underneath.

       The temperature is warmer than it was, maybe, but it’s really in landing that I’ll be able to tell. Or not. There isn’t the same portentous humidity on the East side, though, as I’m going very close to the Equator in Uganda, and I lived at 2 degrees north in Mvangan, there are certain similarities. But as I saw in Kenya, there were some trees that were the same, patches, looked like vestiges of what is still rainforest on the other side and in the middle of the continent. But the light will be right. It’s rainy season, and the rain on the tin roof at night will be right. The clouds are lifting. I can see more of the Sahara. And now it’s the Nile, I’m on the East side of the plane. Few oases along the banks; the map notes Khartoum, and I can just make out a larger cluster. It grows dark before we reach the southern edge of the desert, the Sahel, the transitions.

It’s a tradition I learned in African dance. The drums speak. Dance is about doing what the drums tell you, listening, and then not listening but becoming part of the music. Your body being inside the music. If the drummers keep going, you do. If they switch abruptly, you do. They direct everything. It’s one of the things I love best about it. The complete abandon that is necessary. And becoming rhythm, music, speech. At the end, the dancers go in front of each drummer, pressing both hands together as if in prayer, lowering your head to kiss your fingertips, and pressing them to the ground in front of each drum. Each drummer. They are above human, they are to be respected and revered. They create you. That’s where I learned. Malian dance class. 2002. It’s an amazingly, incredibly diverse continent, with >200 languages and ethnicities in Cameroon alone, with every landscape imaginable and history from prior to it. I recognize it, but still, there is something intangible and specific about returning to the diverse, heterogenous continent.

I hope we land on the tarmac, I hope there is an external stair, I hope we descend immediately into African air and African soil.
Regardless, I know what to do. I know what I will do. It’s been almost three years.
Reverence.

~j

07 December 2015

Regarding the right to choice and Planned Parenthood...The Procedure

This represents a minority of what PP offers. Further writing on prevention to follow.

As a medical student or as a doctor, I have worked in California (San Francisco and Fresno), New York, Cameroon, and Kenya. In the US, I’ve worked in abortion clinics (sic: family planning clinics) in San Francisco and in New York. I’ve never had much to be afraid of.

The below was written in July of 2011, as a medical student in an abortion clinic in San Francisco. Reposted.

----------------------------------------------------------------------------------------------------------------------

Today I used sound waves and a plastic transducer to take moving photos of a fetus-squiggle. I was outside, it was inside, and now it doesn’t take long for me to find the uterus, to see the black-filled-collapsible bladder on top of the double-stripe collapsible uterus that now, in pregnancy, isn’t so collapsible (potential space). The black-fill is water, and there’s a tiny yolk sac (depending) and there’s a little squiggle (this early). And it turns and turns and turns on a stalk, and I have to move, patient, to capture it. Length-wise. Freeze. I measure. My machine converts that to weeks.

And I print the photo, attach it to the woman’s chart on which I’ve written LMP/Gs and Ps/prior c-section or surgery. Bleeding or pain? Prior ultrasound?
I’ve filled in provider (the attending), the clinic, the date, and the patient’s name, DOB, medical record number are stamped at the top of the carbon-copy page. White copy on top.
I write in the length I found (if it’s first trimester-early, it’s crown-rump length - descriptive, no?) and I write it in mm and I write the gestational age.
I mark: + IUP.  + FCM
Single, intra-uterine pregnancy
Fetal cardiac motion

Under “reason for exam” I write “dating – undesired pregnancy.”









Every day for the past month I have been working in an abortion clinic.
And three days a week for the past 4 weeks I have done abortions – yes, I, at least once on each of those days. And at times more (depending on patients – can the student doctor do it? Yes/no. Would I let me, if I were the patient? Yes/no).
On the other two days, I’ve been helping to prepare for other abortions.

These are TABs or VIPs – Termination-abortion (as opposed to SAB, Spontaneous-abortion, commonly known as miscarriage).
VIP. Voluntary Interruption of Pregnancy.

This is not a treatise on abortion. This is not political. This, simply, is.

***


I’ve been working in an abortion clinic – it’s part of my education. It’s my fourth year, now, so I chose this. I chose to work here. A clinic in a large-liberal city in the United States. Where we are, at this clinic, we don’t have to deal with protesters or laws forcing doctors to do things doctors shouldn’t have to do or say. Legalities interfering in even the conversation of the doctor-patient relationship.

There are legalities in every part of medicine. We learn medico-legal speak. We learn what to write, what not to write. How to cover yourself and everyone else.

And for billing purposes, I write “undesired pregnancy.” That is the reason for the ultrasound.

And I do ultrasounds.

***

It doesn’t matter what the stories are; I don’t need to tell them.
My patients have been mothers of 3, high school students, animal trainers, women with master’s degrees (spoke 5 languages) now "without a home; if I have one more child my family is going to ...." Another, talking on the phone to get furniture delivered and 4 kids picked up from school… taking a day off from school + 2 jobs.

Twenty, three kids, here on a bus alone (can’t tell anyone at home), wandering around all night..and that’s why she showed up so early, and why I didn’t want to let her into the clinic, yet, when I was the only one there (protocols? Liability? Who knows. Or my laziness and wanting to finish breakfast, studying, and work for the day before anyone came in whom I had to talk to).

then the other one whose entire family lives on the same street
or the one with a two year old and a six month old – she’s 18.
or the one whose mother is there to hold her hand
or the one whose partner is pacing, anxious, in the outside waiting room
or the one whose social work/case manager is the one in the clinic, in the ultrasound, in the procedure, holding her hand
it was a different one who came from the psychiatry floor
it was a different one and a different one and another one who didn’t know she was pregnant
it was another one who had had to cancel three appointments – mother-in-law sick, died, funeral, then she was sick, then something else happened… but today, she had a day off, and she could do it.
(same for another, who luckily didn’t have to miss one of her summer school class days).

This is what keeps my day and my job alive, vibrant, constant, and me invested in what I’m doing with fresh (tired, tired, tired, red) eyes and hands, again.

Otherwise, it doesn’t matter.

Some are there for fetal anomalies (abnormalities? wide, wide range), chromosomal abnormalities (from amniocentesis; some, we know exactly what they mean – Down’s syndrome, etc. Others, it’s not clear, exactly, just clear it would be bad. Bad). Fetal demise (died inside. Didn’t come out. Could be an incomplete miscarriage, could be…whatever. Something happened. And something inside is dead and has to come out). And then there is every other imaginable reason.

But it doesn’t matter, does it.

***

As a future physician who will specialize in HIV/infectious disease, I shouldn't feel differently about my patients with AIDS-by-blood-transfusion or AIDS-by-heroin-shooting-up.  Health care worker? (yes, I identify more here). Unprotected sex, bad luck, the traditional birth attendant in Cameroon, the wife of the husband who was with the teenager and all those other ones...man in the same situation. Teenager (young). Before HIV was known about and how to protect from it. After. 
The medical treatment is the same. The clinical treatment, patient in the clinic, my patient in front of me, should be the same in that moment. I'd like to hope that one-to-one, ceteris paribus, it will all be the same.

But it doesn't matter, does it. The how or the who.

If I feel differently about the ones with anomalies or chromosomal abnormalities
If I feel differently about the fetuses that were absolutely desired pregnancies but, for some reason, the pregnancy can’t be continued – health, health, dying, fetus dead, health .

But no one’s happy to be here.
No.
The staff are happy to be in this amazing clinic, to be working together, doing this work, helping – counseling for psychosocial, support where there might not be any other in this woman’s life. Doing something small. Having a positive impact. And in this clinic, at least, family planning and contraceptive options are a big, big part of the counseling. Looking toward the future. No one actually wants to do this again - the providers don't want to see the same patients again. The patients don't want to be here again.

No one is happy to be having or doing an abortion. That's not the word.

Nothing is easy about this. In the beginning, it felt different – believing in, supporting abortion rights – and being the one who performs it. Is it? If I weren't in medicine and had the same socioeconomicpoliticalhealthcare views, I wouldn't be on the side with the hands-in-gloves, the mask on, concentrating on the procedure. 
But I am in medicine, I want to be in medicine, and that's part of the views, anyway. Getting to enact - getting to be part of extending health care, of making that a more positive experience for people who might not have those in a power structure. Respect. Just...being there. Like Peace Corps. Being there with whatever skills you have, working to learn as much as possible, always learning, and working because you care so much about it and about what you're doing. Lucky to get to do that. Lucky to be there, on this side. And that's all.

***

Before I started medical school, there was one procedure I was looking forward to learning:

This one.

I didn’t want to be a surgeon; I wasn’t looking forward to learning about appendectomies or heart transplants or venous grafts. I had no conception, yet, of so many of the things I would come to love in medicine. I didn’t know.

This, though – I knew. It had nothing to do with the procedure itself. This is, again, the privilege of medicine to me – and the responsibility, or what I feel it as. I’ve worked in places where abortion is illegal (though I haven’t worked in any of those places in the US, where everything is an unbelievable barrier). I’ve seen the sequelae, actually, a few times. And I’ve read about it (who hasn’t?), even back to my John Irving days and The Cider House Rules (book. better than movie). I wanted to be able to provide safe abortions. Safe. I wanted to learn how to do that, not just a safe procedure but a safe space to come for it. I want to fill in the gaps, in medicine. The things where there aren’t enough people (just need to be filled) or any at all.

Here’s a gap, to me. It’s a place I can fit.

Nothing is easy about this, and I don’t think it ever will be.

Nothing is easy about this. I'm learning. I'm going to keep learning. The skills will build. It won't be easy.

~j


14 November 2015

# Porte Ouverte


le 14 novembre 2015
  

It was ten months ago that I wrote about freedom of speech, of words, of the privilege of pens, and of those were killed, in some ways, for that. #Je Suis Charlie. Today, yesterday, it’s freedom of assembly. A concert (could “death metal” become more ironic?). A soccer game. Restaurants. Freedom of movement, of passage. The borders are close to closed. Famously, in the 1830s (as also depicted in Les Misérables), Paris was barricaded, fighting from the inside. Seventy years ago, there was the Maginot line, there was “Free France” and my grandparents fighting in the Resistance, there was my old favorite movie, La Grande Vadrouille, with the propeller plane landing just over an invisible frontier and then escaping back to England.

I still don’t know how much we should take for granted. There is a UN declaration. But not even every country is counted in that.

I commented to a friend that this—ISIS, all of it—is like a terrible, blockbuster movie for July 4 weekend. Except I don’t know who the hero is. There isn’t one. In another friend’s village in Cameroon, he discovered that people believed that in action movies, those who die, die. Ebola was that. I have trouble truly conceiving of so much destruction I have not experienced except in fiction. I know personal tragic and tragedies. I’ve seen babies, so many babies (and so many adults) die of AIDS. And TB. And malaria. And diarrhea. And malnutrition. And tetanus (the most banal-sounding shot I give my patients to check off the 10-year mark) : a five-day old with lockjaw who died because he couldn’t feed. And there was nothing else to do. I’ve seen that. I’ve been in shantytowns. I was in Kenya six months after buildings and people were burned in the 2007 elections. I saw the burn marks. But I’ve never been in it.