Cameroon letter #6 - negotiating limits in my short-term nursing role

Dear Ruthanna and Sarah,

Mom sent me a picture of you today, Sarah – long-legged, already summer-blonde, smiling between the sleek-trunked bamboo. I’ve missed that smile. I’ve missed how it appears gradually, with your face waking up – eyes nose forehead cheeks – to welcome it like a much-anticipated sunbreak. I miss your heavy hugs – no holding back, so much trust, we will both fall if I don’t hug you back just as hard.

The past week has been busy, as I’m both finding a routine on the wards and struggling to find a sleep schedule. I’ve never had trouble adjusting my circadian rhythm to travel before. But this time it seems that subconsciously my body knows I’m five hours ahead of usual, because I’m often awake until 2 a.m. I wish I could say I spent the time responsibly, but in the half-daze of wanting to sleep and not quite getting there I’ve done a lot of scrolling through Pinterest for African outfit ideas, drowsily browsing an easy-read book, or just wishing my bunkmate Jill was awake so I could talk to her. Our schedules are so different that we rarely see each other awake.

what you do here when your ladder doesn't reach, apparently

In fact, it’s odd how rarely I see any of my roommates – Mica, Danita, Melissa, and Bonita. Mica is a tall, sporty, gentle brunette from Texas with bold blue eyes in a face full of freckles I envy – the freckles gene skipped me and picked you and Ruthanna instead. Hurtful. :-P  Danita is quiet, funny, and thoughtful; she wears tee shirts with nerdy jokes and references on them, and I love it. I don’t see her as often as Mica, who often works in D Ward with me. I almost never see Bonita. Melissa is a physical therapist and mom from the US who has bright red curly hair, a smile that takes over her whole face, an easy laugh, and a couple kids in the States that she calls often. She actually lived on the ship before, and it’s neat to see how easily she has slipped back into the routine. She’s so lighthearted, but she’s deep too, and extremely observant. My roommates are a wonderful, kind, fun group – people I look forward to seeing, people I am refreshed to be with. A little family of our own, and oh I am so thankful for it whenever I get to see them. I so much value the relief of having “my people” around me when I get back from work, because working on D Ward presents challenges I either haven’t encountered before, or never figured out how to navigate.

     taxi ride with some of my new friends

My ability to speak multiple languages has created one of my biggest challenges. Counter-intuitive, I know. But also, not. It’s funny how one of my most precious possessions – languages – is becoming something difficult to work with, just because of limitations. I deal with 1) moving beyond my limits, and 2) trying to stay within them too. Here's what I mean: 

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 1) Moving beyond my limits – I feel the boundaries of my vocabulary, expression, ability to translate even when I understand what is being said, so often. I miss a switch and put the wrong language in the wrong sentence. I miss a conjunction or misconjugate verbs. I speak conversational Fulfulde, not medical Fulfulde. I speak Hausa more fluently, but there are so many idioms I don’t know. And languages themselves, the options of expression they offer, create different concepts of illness. How do I translate that? I can translate having a white stomach – the lightness-inside of how joy replaces the black stomach, the darknesses we carry, these are ideas that feel like gifts to my mind, beautiful ways to trace across the mundane with color and art as we speak it – but how do I best explain the nuance, the vagueness of having your stomach dance, of your intestines turning over, or pounding-pounding? To explain it is to teach the hearer to feel something new, to imagine through their own experience a feeling they have never expressed that way. To explain it is to discover another side of compassion, I think. And my spirit is willing, but my tongue, my brain – they are weak. I’d like to say yes every time I’m needed, but I really physically – or neurologically/physiologically – can’t.

man taking a nap on his motorcycle - photo cred, my friend Ivan

2) Staying within my limits – I’m struggling with my ability to translate. Not just, when is it adequate for the conversation, but, when is appropriate to use it? I didn’t come here to translate, I came here to be a nurse. We have translators already – the day crew. But the patients and staff now know I speak multiple languages. Although my Fulfulde is limited, it’s more than some of the day crew can speak. And I haven’t met a day crew member that speaks Hausa yet, although we’ve had some Hausa-speaking patients. Many of the day crew we work with are from the southern part of Cameroon, where other languages are dominant. So when staff nurses or doctors ask me to translate, of course, yes, I’ll try. And when the patients all know my name and consequently are constantly calling me to do things for them because they want to be able to easily explain what they need, yes, I’ll try. But at the same time, we need order and boundaries that fit the limits – limits of our staff, limits of our roles, limits of what I can actually do and what I should actually do.  And so when do I say no?

my friend Debra browses paintings for sale in Douala

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I’d forgotten about this struggle I carried through adolescence into college – the balance of responsibility and appropriateness. Just because I can do it doesn’t mean I should do it – or does it? In what cases, under what conditions, is capacity de facto responsibility? When we talk about keeping order, what order are we talking about? The order of the relational cultures that surround us, or the order of empirical Western medicine, or the order of the more-time-bound and achieving societies from which most of our staff come? What does making someone well mean? How much do we prioritize making them feel well in the process? What is realistic and what isn’t?

What about when I translate, and consequently the day crew don’t have anything to do? Or when I don’t translate, and the patient feels like I am shrugging them off as I call the people whose job it is to translate so that they can stay busy and I can keep up with my own tasks? The Western mind in me says, call the day crew. The African part of me says, ouch my Hausa sister, I’m so sorry, you still matter. Is there a language that effectively explains all of this?

on clear evenings Mount Cameroon is visible across the inlet

One of the other nurses told me, “I think you are finding that your greatest strength is your greatest weakness,” and I agreed with her, because I think that is true in general about everything. About any strength we have – we carry its flipside weakness, and the stronger it is, the heavier is the weakness.

Because I could sit down on this bed and chat with this patient. I actually can do that. It would make them so happy. But if I did that, I would run late on other people’s meds. I would be spending time with that patient in a ward of other patients who all sit and watch which patient I felt was most worth my time today. And would I just be setting the bar unfairly higher for the other nurses, who learned to drive, date, use a smart phone and ATM years before I did, during the years that I was learning to bargain in Hausa and sing in French? 

Or I could just act like I don’t speak enough French today. But by this time, people know I understand a lot of what they’re saying. The patients talk with each other and listen to the day crew talk. Many of the patients have been with us for over a week, so they recognize the nurses. And when I watch a fellow nurse looking around anxiously for a translator while a patient groans or tries to climb out of bed or stares imploringly at them, it hurts me to just stand there. So when does capacity become responsibility, and how do I hold that balance with kindness and humility?

I miss you, Ruthanna, as often as these questions run through my mind. I know you’d have an opinion, a firmer one than mine and maybe one more clear. Sometimes your black-and-whiteness hurts you, but sometimes it saves you hurt, and sometimes I almost envy you the ability to draw a firm line somewhere and actually believe in it, not look at it from four other sides through different media and watch it shift, shimmer, deflect light rays confusingly like I do.

a somewhat frightening sign in one of Douala's commercial districts - I thought you'd laugh too

I miss you both, I miss your firm ideas and your ability to just be lackadaisical sometimes, I miss how you engage with questions or don’t care about them, I miss sitting down at the counter across from you cooking something and just letting my day at work fade away from me, drowned out by your music and your vibrancy and your heavy hugs. Oh, how much I miss your hugs.

Love, Tab