In which I test your patience for my chickenscratch.

Some verses I enjoyed from reading through James:
4:7-8a Be subject therefore to God; but withstand the devil, and he will flee from you. Draw near to God, and He will draw near to you.
Who is near to us depends on our choice. God will reciprocate.
5:7b Behold, the farmer eagerly awaits the precious fruit of the earth, exercising long-suffering until it receives the early and late rain.
I was touched by this mental image of an expectant farmer. Unlike my impatient self, He doesn't give up after just the early rain. He waits even until the late rain has run its course to reap, and what He receives is precious to Him. Even my puny raisin-grapes are precious to God. Even if after the early rain, I wither and die in the heat of a dry summer, the Lord may wait and let the late rain resurrect a new shoot from latent roots.

6.6.18 We were brought on a four hour drive to Manacara to talk to the regional ministry of public health about our research. A doctor who worked for the UN in Cote D’ivoire came with us. As we were eating lunch, a stranger flashed by and snatched his unfinished food off his plate. In a wink, he was gone. The doctor seemed a little peeved. At this seaside city, I noticed that the beggars who thronged us afterwards asked equally for money from the foreigners as from the locals. I asked the doctor as our van pulled away from the scene of the crime what was the best way to deal with beggars, since he was from Madagascar. He said, "don’t be deceived by appearances. Some of these beggars have more money than you. Even though they have this money, because they are part of a begging social caste, they continue to beg. Others are children forced by their parents to beg. Some do not want to work, so they beg. You must make a distinction between the poor, the mentally ill, and the ones who will not work." He went on to explain how the Madagascar government had put in place many social programs to give property and jobs to the homeless, but within a few months how most of them abandoned their lands and returned to begging. "You can give 10,000 ariary, but you won’t help them." He also cautioned us about NGOs. He had experiences with one that fed and sheltered the families of the imprisoned, but because of that system, there were some heads of households who purposely committed crimes to be re-incarcerated so that their families could continue to be taken care of. So some aid, he concluded, though well intentioned, only feeds a cycle of behavior.
I hate assigning blame to the disenfranchised. Most of the time, I feel it’s the privileged’s cop-out from grappling with the responsibilities of privilege. But I’m a stranger in this strange land. What can I say?
In the same way, I came to Madagascar because I wanted to help. But I have to really be on my guard, to understand my contributions in the context of the system as a whole, to make sure my help is really in the best interests of those I’m helping. The last thing I want to do is to stampede into a foreign country with a project that screams "I I I my my my" and leave with lovingkindness-bragging rights. What if the best way to help is not to come at all?

We also talked about malaria, the number one cause of death in Madagascar. Families here with a malarious child, he said, will first go to a traditional healer who will consult their ancestors, or a sorcerer, before finally consulting a western doctor. With the rapid course of malaria, which is a medical emergency, usually by the time he saw a case it was too late. He was frustrated by the futility of it all. I asked, "is it because of the difference in price between the services?" "No, these traditional healers are more expensive than us. After their service, they ask for an ox." "But what if they can't afford an ox?" "These families will find any way to get an ox to pay."
Another conversation we had that shocked me. "Dr. —, I noticed that most homes have fires inside. Is that bad for people's lungs?" He thought about it for a few seconds. "Yes, but also people smoke so much, too." "Do you see lots of cases of lung cancer?" This gave him pause. He then explained: cancer is incredibly hard to detect without expensive imaging modalities. How can one distinguish between cachexia and malnourishment? Who would go to see a doctor for night sweats or get a blood test for ion imbalances or peeing too little? Plus, as a slow-onset disease, death from lung cancer would be far outpaced by other, deadlier entities like malaria, plague, or diarrheal illness that cut down life expectancy below the usual age of onset of symptomatic lung cancer. There's a lot of tolerance for the symptoms of lung cancer, and by the time symptoms manifest, it'd be too late.
The team told him about homelessness and begging in America, as well as our deadliest diseases—lung cancer, of cancers, and heart disease/obesity—and I was keenly aware of the difference in privilege in our countries. I felt ashamed to even speak of some of America's poor, the homeless huddled along the blocks of New York City with phones better than that of this doctor. How do I explain this poverty? It's no less real. These people can't afford housing and can't get a job or loans. Of course it makes sense that they have a smartphone, because it's cheaper to get one of those than it is to get an apartment. But the context is everything. And the fact that I thought about cancer, an incredibly low-priority illness in this tropical country, shows how inured I am to American standards of longevity and medical care.

Today's lunch came with a tiny banana. I broke mine in half and offered the other half to the doctor. He ate it, and while talking, slid open the window and tossed it out without missing a beat. I sneaked a furtive look at my teammates, then gleefully did the same with my peel. When in ranomafana...