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I suppose it's time.

I've been avoiding writing this one last post out of denial—if I write it, it means it's true. It means the year is over, Africa is over, and the "real" world is real again.

But, these last two weeks have forced itself upon my psyche, with a stubbornness surpassing that of Macarthur's promise to the Philippines. The real world has returned. And it bears a striking resemblance to what it was when I left.

It is strange to think that, just twelve days ago, I was sitting on a ramshackle dock in an impoverished country in West Africa, debating whether the rainy season had actually started or whether it was just being coy. People warned that returning to the west would make you feel like what had happened to you in Africa was just a dream.

And it's true. It's amazing how easy it is to slip back into western culture, to slip back into home. But it's home, redefined, and it's western culture seen through a pair of changed lenses.

Here's hoping those lenses remain changed.

How did they find us?

The Hindustan Times?

Really?

Reformed curmudgeons

We're officially into our last week in Liberia, the last week in a year away from what used to be reality. Sunday, we'll be on our way back home, retracing the steps we took nearly five months ago when we came here. Monrovia. Abidjan. Brussels. New York.

There will, I predict, be plenty of things that we'll have to get used to. Grocery stores (though you could make an argument against that in New York City). Restaurants. Traffic. Sushi. The lack of ready beaches. The ability to take showers that last more than two minutes. Cold weather. And cheese.

But, most of all, I think it will be exiting communal life that will be the hardest.

This surprises me. Acculturated to the fierce individualism of my generation, I figured that being stuck on a boat with 400 other people would frighten me. It had all the makings of immense claustrophobia. I've never been one for small-town living. The blessed, communal anonymity that NYC offers—of running into a thousand people just leaving your apartment for shrivelled hot dog and faux papaya juice, each of whom would avoid your gaze with a studied detachment—that was the sort of community I was all about.

So, my impressions of communal living were uninformed and—I hate to admit it—stereotypical. Unwashed. Militantly utopian. Dandelions and dirty fingernails. Greasy-gray ponytails and socks the color of day-old guacamole. It's hard even to write these descriptors now. Because, see, now I know it's different.

Practicing medicine in Africa has been spectacular. I'm going to miss it. This country itself is gorgeous. I'm going to miss it, too. But missing those pales in comparison with missing community. Community isn't about Esperanto or people who think that the word ganja is anti-establishment verlan.

No. Community is about sitting on a dock, watching the sun take its final spectacular breaths for the day, cheering loudly, with ten people whom you met only a few months ago but who have become your family, as the quickly descending globe scatters its golds and reds and baby blues and ominous greens across the sky with the abandon of a reformed, Dickensian curmudgeon. Community is about watching massive jellyfish over the side of the ship, embroiled in a two-hour-long conversation about the merits of marmite, millenialism, or post-racial presidential candidates. Community is a Scottish dance on a West African pier. It's learning how rubber is made from a man with one eye. It's four Koreans and a Norwegian performing English songs. It's a Canadian, a Swiss guy, an American, and two West Africans dancing to the victory of a British football club. Community is having spontaneous gatherings of music, with people whose voices blend like only the voices of strangers can.

And I'm going to miss it. I'll confess. Maybe there's room for one more reformed, Dickensian curmudgeon in this world.

Bookworm

My sister Ingrid is a year older than I am. While growing up, the most significant privilege of her seniority to me was her access to books that I could not read. Throughout elementary school, I would beg and borrow her required textbooks for English class so I could race through the stories. My jealousy intensified when Ingrid made it to middle school and I was still in elementary school. Suddenly she had access to the middle school library, which was combined with the high school library and had roughly ten times the number of books. I began to resort to desperate measures when Ingrid started getting annoyed at my constant pestering. When we went to bed at night, I would sneak into her bag and pilfer her books. I would scuttle back to my bed where I would fling the covers over my head and read by flashlight. Even though we shared a room, my parents had the foresight to put us in bunkbeds. Ingrid luckily preferred the top bunk, leaving me free to my nighttime scavenging. I remember finding out one day that Charlie, the weird kid in my first grade, frequently read in the bathroom while his parents were sleeping. I felt a sudden kinship with him knowing that someone else was sitting on a plastic toilet seat in the middle of the night flipping through the adventures of Nancy Drew (or, I suppose, the Hardy Boys).

This is why I found it unbelievably tragic today when 24-year-old Bendu came to be admitted. On March 14th, she curled up in bed with a book, as was her habit, and probably fell asleep. Her kerosene lamp got knocked over, and set the mattress on fire. Bendu was overcome by the carbon monoxide fumes, and when her mother rushed into the room, Bendu's face and right arm were already burned beyond recognition. Although Bendu spent the next two months convalescing at St. Joseph's Catholic Hospital, the burns on her face started to form contractures such that she could no longer close her eyes. When she came to Mercy Ships today she was starting to have blurred vision. Her cornea had begun to ulcerate from exposure. Bendu's mother sat across from her, lips compressed, arms crossed, as I tried to explain that all we were able to do was to put a skin graft on her face such that she could close her eyes and preserve her vision. There was no hope of restoring her face back to a semblance of normal, not here, not even on Mercy Ships, where the goal of burn contracture surgery is to restore function, not form. I was at a complete loss for words.

Faith

Augustus was dressed in black when he walked into the admissions tent. Odd, since we were not in New York City, but then who am I to comment on Monrovian fashion? I had made a remark to a patient several weeks ago about his slick black outfit, only to be reprimanded that it was actually navy blue and his metrosexual digs were appropriate to his profession as a tailor. So I let the observation slide.

Augustus's story was fairly typical of the patients we see. In 2003, he was a passenger in a motor vehicle accident. After the accident, he went to JFK, Monrovia's biggest hospital, and was given only tylenol for a right humerus that had snapped in half. He did not get an x-ray nor was he casted, and fortunately for him it was a closed fracture, meaning that the broken bone had not pierced the skin. His arm healed, although the bone had healed unfused, in what we term "non-union of the humerus." He was lucky in that he was neither a farmer nor a mason but rather an economist, which meant that despite having a permanently broken arm he could still write and therefore he could work.

As we chatted about his medical problems and such, I began to ask him if there was any history of illnesses in his family. "My son died yesterday, and I am in mourning," he said. Augustus Jr. was in the 10th grade, a miracle by any measure in Liberia, where I have only met a handful of people who have progressed beyond the 6th grade. On Friday, Augustus Jr. stepped on a nail on the way to school. He was brought to the local hospital and given some antibiotics and had his wound cleaned out. On Sunday, August Jr. was dead. "Tetanus," Augustus told me. Because of the war, vaccination programs had ground to a halt and many children had fallen through the cracks.

As Augustus spoke to me, tears welling in his eyes, I was struck by something. He was neither bitter, though he had every right to be, nor was he emotionally detached. He firmly believed in a benevolent God, who was watching out for him and who knew what was best. It occurred to me that perhaps faith is just as important as clean water or a bed to sleep on, because faith makes the intolerable tolerable. Western donors are never going to have pockets deep enough to fix the problems caused by civil war or natural disasters. Furthermore, even though foreign aid workers like to throw around terms like "sustainability" and "cost-effectiveness," very few projects ultimately are. If, however, we can offer the sort of faith that Augustus had, faith that on the one hand costs nil in terms of resources yet is also impossible to purchase with any earthly currency, then perhaps we have made a lasting difference.

I read recently a quote from Martin Luther:
"Faith is a living, well-founded confidence in the faith of God, so perfectly certain that it would die a thousand times rather than surrender its conviction. Such confidence and personal knowledge of divine grace makes its possessor joyful, bold, and full of warm affection toward God and all created things—all of which the Holy Spirit works in faith. Hence, such a man becomes without constraint, willing and eager to do good to everyone, to serve everyone, to suffer all manner of ills, in order to please and glorify God, who has shown toward him such grace."

Augustus had this sort of faith that Luther describes, and I thought rather wistfully that I would like to have it too.