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11 septembre 2012


Today is September 11, 2012, the 11th anniversary of the attacks on the World Trade Center. It is also the day on which my Peace Corps service comes to an end. As of 12:01 this morning, I am officially medically separated and am therefore an RPCV (Returned Peace Corps Volunteer). In normal talk, this means that my seizures have not proven to be immediately curable, and I have therefore been given the Peace Corps equivalent of an honorable discharge. It’s sad, in that it means that my service is finished less than halfway through, but it’s happy in that at least I still get full access to the education and employment assistance that are two of the biggest perqs of service.

So what comes next?

To be honest, I’m not quite sure. As I’m having seizures, I can’t legally drive. As a car is absolutely necessary in Wilmington and more-or-less necessary in RDU, this means one of two things: either I will have to move someplace where a car isn’t so necessary (NYC, San Francisco, Boston, Montreal, etc), or I will have to bide my time here for at least a year in the hopes that the medication will stop my seizures. My money is on the former, but big moves are always hard to predict so I’m probably going to be in wait-and-see mode for awhile.

And how do I feel about this?

Well…I have my good moments and my bad ones. I’m not horribly depressed, but I’m definitely not enthused either. I’m glad that the limbo of medical evacuation is finished (it’s a rather opaque process), but the thought of going out and getting a part-time service job is just a bit more than my spirit can maintain right now. After almost a year of doing a job that really mattered, I don’t think I can go back to just paying the bills. Happily, once I have my DOS (Description of Service, a document that formally summarizes your service for prospective employers) in hand, there are lots of options out there; I genuinely hope that returning to such work might prove entirely unnecessary.

What does all of this mean for this blog?

Sadly, with my time in the Peace Corps being finished, this blog’s mandate and raison d’être is finished as well. I don’t have much patience with people who blog their daily lives, nor am I a big fan of the idea of adding yet another voice to the howling legions of political/economic/athletic/social blogs already out there. However, this isn’t quite the last post: at the moment, I’m writing a series of longer, more formal essays talking in part about my service, in part about my thoughts on development, and in part just about life. They should be coming out over the course of the next month or two according to the not-so-rigid timeframe of ‘as I feel like finishing them’. Check in for those, as I strongly feel that they will be the final necessary coda to my service, the analysis in which I sort out What It All Meant.


Gorée Island

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16 août 2012

Gorée Island

By far the largest tourist attraction in Dakar is a little island named Île de Gorée, a former French fortress and slave port turned tourist trap-cum air market. It is sited about a mile from the mouth of the old Dakar port, and is reached by an inexpensive ferry.

Since we were trapped in Dakar for two weeks anyway, a Guinean PCV on med evac and I decided to go see what all the fuss was about. These are the photos that I took during our trip.

Of US politics…from West Africa

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08 août 2012

Of US politics…from West Africa

Health update: as of yesterday, my status for the next ten (10) days will be the same – in Dakar, on medical hold and under observation, while the doctors wait to see what (if any) effect the anti-seizure medications will have. If they work as hoped, I will be sent home to the US next week. Whether I will still be medically separated or on medical hold at that point remains to be seen.

I should note, however, according to my doctor, it’s no longer a question of if I will be separated, so much as when: will I just be sent home, with no ongoing care or per diem, or will I receive the 30 days’ med hold and accompanying per diem first? Time will tell. This will likely be the last update this week, look for more information around the 14th.

Do you live in Ohio, Pennsylvania, Florida, or Iowa? Are you used to being a battleground state each and every Presidential election? Are you resigned to endless quadrennial panoplies of third-party attack ads, quasi-truthful billboards, and pandering candidates?

Well I’m not.

In fact, I hate Presidential elections. Not ‘hate’ as in ‘I hate the way my groin gets cold when I put on sopping wet underwear’, but ‘hate’ as in ‘I hate the way my mouth feels after I go to the dentist, and he tells me I have to get 25 fillings, 4 root canals, and 2 crowns…and his drill is broken, so he’s going to have to use a chisel…and he’s drunk…and he was just diagnosed with advanced Parkinson’s…and he’s out of anesthesia.’ In short, I hate them to the core of my being, and I would do almost anything to get out of having to deal with them.

Hell, I might even join the Peace Corps.

Oh, wait…

All hyperbole aside, I can truthfully say that missing out on the 2012 election season has been one of the biggest  perqs[1] of my service. This is especially true since my home state of North Carolina[2] has decided to get all wacky this year and morph into a battleground state. I’m not quite sure what motivated them to volunteer for such a masochistic status, but I’m quite sure that I’m glad to be missing out on the downstream results. According to horror stories from friends back home, yard signs are already copious, billboards are going up aplenty, and you see attack ads 24/7 on every channel – even on the highly coveted Cartoon Network/3am timeslot[3]. I can smell the desperation from here.

Here in Africa, however, the viewpoint on the election is far more casual. It goes something like this:

Random Person In The Street: “I like Obama, because he is African. You should vote for Obama.”

Me: “Do you even know who he is running against?”

RPITS: “Is he African?”

Me: “What if it’s a she?”

RPITS: “Is SHE African?”

Me: “Does it matter?”

RPITS: “Yes!”

Me: “Then point in fact…no, he’s not.”

RPITS: “Wait…you just said it was a woman!”

Me: “No…I said it could be a woman.”

RPITS: “Have you ever had a woman President? I know I am just a villager in Africa, and I am not an expert on US politics, but I feel like I would have heard about that.”

Me: “Um…no.”

RPITS: “Then why would you say it could be! It never has been…oh, nevermind. You should vote for Obama, because he’s African, and that means he’s awesome!”

Nor, to be fair to that random person in the street, are the PCVs or other expats really any better:

Random PCV/Expat: “WOOOO!!!!! SUCK IT WINGNUTS!!!! OBAMA RAWKS!!!!!!![4]

Me: “Is there even the slightest possibility that you would one day remotely think about thinking about considering the idea of debating the thought of pondering the potentiality of voting for someone else?”

Random PCV/Expat: “Well…now that you mention it, he is awfully right of center. If we don’t care about realistic election chances, I really like Stewart Alexander or Jill Stein.”

Me: “Excuse me…who??”

Random PCV/Expat: (sighing) “Southerners are so conservative.”

As you might expect, the insulation of being in West Africa is both a blessing and a curse. It’s a blessing in that you get just enough information to know what’s going on, but not so much that you feel like taking a shotgun to your TV just to get some peace and quiet. On the other hand, it’s a curse in that, if you are an undecided voter (not much of an issue in this election), you are genuinely going to have trouble getting the information that you need to make your decision.

For example, right now we know that Romney is the GOP contender, he hasn’t yet chosen a VP candidate, he’s a little behind in the polls, and he just did a trip to Europe. It’s an admirable précis of the situation, and when you think about it, that’s all we really need 3 months out. Yes, things should pick up after the conventions, but that’s to be expected. What wasn’t necessary was the eleven months of hype leading up to today. However, if all you knew was that you weren’t too thrilled with the current state of things and you maybe wanted a change, you could genuinely have trouble making an informed decision. The internet is slow or non-existent, the satellite TV channels are all in French (and subject to French political interpretation), and there are no print media to speak of. It could be rough.

At any rate, if nothing else it has been interesting to see how the developing world views our domestic political theater. They definitely pay attention, and it is definitely discussed in the streets in Burkina Faso and Senegal to an extent that would surprise many Americans[5].

I know it surprised me.



[1] No, I didn’t misspell that. ‘Perq’ is short for ‘perquisite’; ‘perk’ is a thing coffee does. I don’t care if Word doesn’t like my spelling. It’s my blog and my grammar rules, and everyone else can deal.

[2] NC is normally a very odd political blend: a state whose government is traditionally dominated by the Democrats, but which is reliably red when it comes to Presidential elections. This time around, we have our first Republican legislature since Reconstruction, but we voted for Obama in 08 and we very well may do so again in November.

[3] Which, when you think about it, really tells you just as much about the poor sleeping habits of my friends as it does about the candidates’ determination to carry the state.

[4] In fairness to PCVs, there are conservatives in the Peace Corps. I’ve even met one or two. But if there are currently, say, 10,000 PCVs serving, I would estimate that 9,500 of them are liberal, 420 of them could care less about politics, and the other 80 (about 2 per country) are some species or another of conservative. Yes, those numbers are wildly unscientific, but sadly they’re also more accurate than you might think. Suffice to say, there is a skew.

[5] But don’t feel too flattered; they do the same thing for France. Also, point in fact, many villageois think France and the US are somehow part of the same country, and that you can drive to both from West Africa; it’s an interesting phenomenon to hear them discussing French or US politics in detail, when you know their geographic knowledge is so spotty.

More photos from Dakar

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05 août 2012

More photos from Dakar

Health update: I have started my anti-seizure medication, and if I don’t have any adverse reactions, they’re going to send me home in 10 days or so. After that, it will be up to my neurosurgeon in the States to figure out what is wrong with me and to get me working again. In the meantime, I have naught to do but sit, wait, and go tour Dakar.

Since my previous photo post seemed to be a huge hit,  here’s a follow-up. Some of you complained that the previous photos weren’t labeled or organized very well, so I’ll try to do better this time.


It’s all about confidence


03 août 2012

It’s all about confidence

If you went to a restaurant and ordered a sandwich and then asked the server what was in it and they replied ‘Oh…I can’t tell you that, because if I did, you would never eat it. But trust me – it’s really good’, would you eat it?

Or if you bought a car, and you asked the guy selling it what sort of condition it was in, and he replied ‘Oh…I can’t tell you that, because if I did, you would never get in it, much less drive it. But trust me – it’s safe’, would you buy it[1]?

Yeah, I didn’t think so.

Yesterday, I went to see the neurologist to see what he thinks of my MRI and other test results. As I predicted, they were 100% normal. Which left the neurologist with the following information:

  1. I’m having episodes of some sort
  2. My CT scan and MRI are totally normal
  3. My EEG is only very slightly abnormal – and the existing abnormality is exactly to the degree you would expect to see in someone who had once had a brain surgery like I did

For me, this means that my problem isn’t neurological, and we should try something else[2].  However, for him, this just means that we need a longer observational period and more testing. I don’t blame him for this mindset – it’s only natural that a neurologist would see a problem as being neurological – but I find myself being…less than convinced by some of his approaches.

Case in point: during the meeting yesterday, he mentioned that he wants to put me on an anti-convulsant for at least a couple of weeks, to observe and see what happens. Basically, it’s a fishing expedition; he doesn’t have a clear idea of what’s wrong with me, but he wants to give me the medicine anyway, because hey – it might make my seizures go away. Normally, I wouldn’t fault him for this mindset – I like my physicians to be proactive, and at least he’s trying something – but then we had the following conversation:

Him: So…your tests aren’t strongly indicative of anything, but I want to start on you on the medicine anyway, to see if it helps with the seizures.

Me: Ok. That seems reasonable enough. What medicine, and for how long?

Him: (some French brand name that I instantly forgot – why I even bothered asking is beyond me). It’s the worldwide standard for situations like this. Basically, we’ll ease you into it over a couple of weeks, to see how you respond. And if the side effects are too bad, we’ll switch you to another.

Me: Um…what kind of side effects are we talking here?

Him: (laughing) Oh…if I tell you the side effects, you will never take this medication. But you do not need to worry. It is safe.

Me: (hoping the expression on my face mirrors my feeling of ‘that response did not imbue me with confidence)

Him: Normally, the major side effect is a feeling of tiredness during your first few days, and maybe some headaches and weight gain. There are other side effects too, but they are very, very rare.

Me: (nodding and making furious mental notes to Google that shit the instant I get out of his office)

Him: So…you probably will not feel well for the first day or two after you take this, so maybe you should not start until the weekend, hm?

Me: Uh…sure.

As you can imagine, this conversation left me feeling, shall we say, less than enthused. I don’t mind taking medication in the hopes that it might help, but I object mightily to taking a drug that can cause (among other things): motor coordination impairment, cardiac arrhythmia, blurry or double vision, aplastic anemia, and thyroid problems. And I REALLY object to taking a drug that can cause me to hear notes a semi-tone lower, develop serious adverse cognitive anomalies, develop potentially fatal skin reactions, and even give me lupus[3].

But Abraham, you ask…what is this wonder drug that could potentially kill you while doing absolutely zero good?

Well, friend, let me tell you: it’s called carbamazepine, and it’s a great drug – IF you have epilepsy. It’s been around since the 50’s, it has been in use for epilepsy since the 1970’s, and its chemical mechanisms are actually understood[4]. If you have epilepsy, it helps suppress your seizures, it offers minimal side effects, and it absolutely helps you get your life back.

There’s only one problem: I don’t think I have epilepsy. All of my tests were negative or inconclusive, none of my ‘episodes’ really resemble true seizures[5], and my neurologist flatly admitted that he’s just kind of fishing around at this point. Nor, to be honest, do I have a huge amount of confidence in my neurologist; yes, he is truly an excellent doctor – one of the finest in Africa, and absolutely up to US or European standards – but he just isn’t that familiar with my case. We’ve met exactly twice, his English is about on a par with my French, and there’s just enough of a cultural divide that I feel less than fully relaxed around him. I don’t doubt his competence, I just feel that a physician who comes from a cultural setting where ‘take this because I say so, and don’t worry about the potentially harmful side effects’ is appropriate may not be exactly the person I want rummaging around in my brain[6].

Consequently, it should come as no surprise that, when Peace Corps says that it’s starting to look like the best solution might be to send me home to my neurosurgeon, I tend to agree with them. No, I don’t want my service to end, and no, I don’t think my problem is neurological (I definitely want to talk with an endocrinologist as soon as I can), but if Peace Corps insists on me being cleared by a neurologist before I can  return, I know who I want doing the clearing and he isn’t in Dakar.

So here’s where I currently stand: right now, my neurologist wants to start me on this medication, then observe me for 10 – 14 days for adverse reactions, then release me to fly to the US. However, the Peace Corps doctor here didn’t actually start me on the medication yet (she said to give me time to see Dakar, but I think she wants to consult DC first), so I’m not actually certain that this will happen. And if/when the time comes, I’m not actually sure I’ll be willing to take it. We shall see.

I still don’t have any firm answers right now, but in short it would appear to no longer be a question of if I’m being sent to the US, but rather when and for how long. I don’t know if I’m going to be sent to my home of record for a consult, but still on per diem, or if I’m just going to be medically separated, or even if something else entirely will occur. All I know is that what can be done in Dakar has been done, and now I’m just waiting to see what DC says about my future.

And that’s likely all I’ll know until the weekend is over.

Look for lots of photos tomorrow!

[1] Although, in fairness, it occurs to me that this is basically what happens every time I get in a Ouaga taxi. The unspoken rule is, you don’t ask about the dents and broken glass and weird noise coming from under your seat, and they won’t tell you about it. This helps everyone sleep better at night.

[2] Like seeing an endocrinologist

[3] But at least my stumbling, blurry vision having, cognitively impaired, auto-immune compromised, skin-destroyed self will be free from phantom limb syndrome and intermittent explosive disorder…it actually helps cure those problems.

[4] A BIG deal for me. You know all those antidepressant commercials that say real fast ‘Zoloft is thought to work by…’ yeah, no. Not for me, thanks. You either know what it does, or you don’t put it in me.

[5] Although in fairness, there are many kinds of seizures, and it IS absolutely possible that my fit the bill. They just don’t have the corresponding EEG evidence to back it up.

[6] This is ironic, because I’m a big opponent of prescription drug advertising, and I honestly feel that you should never, ever say to your doctor ‘what? You’re giving me that? Could I maybe ask you about (insert drug name you saw on TV) instead?’ It smacks of self-diagnosis and is idiotic. Normally, I take what my doctor tells me, when he tells me, for as long as he tells me, and then I toss the bottle. That I would want a different doctor because of a disagreement over a prescription is definitely a new experience for me.

The last day?


2 août 2012

The last day?

Today – this morning, in fact – is potentially my last day as a PCV. See, up until now, I’ve been a (very bored) PCV on medical hold, and then a (very bored) PCV on med evac, but that’s because they didn’t know what was wrong with me. This afternoon, I meet with the RMO (Regional Medical Officer – the doctor who is shepherding me through the med evac process) and the neurologist to find out the results of all the tests that were done on me on Tuesday. Pending the outcome of those tests, I could be sent back to Burkina Faso, but right now it seems to me like the odds are very high that I will be medically separated.

It’s a problem of diagnosis and treatment. If I’m diagnosed with epilepsy (thus confirming the preliminary data), they can treat me, but not at site; if I’m diagnosed with some other condition – my personal suspicion is a heat- and carb-induced condition similar to hypoglycemia – it has to be immediately treatable, because most medicines and treatments aren’t available in Burkina; if they can’t find anything, they can’t just send me back, still having seizures for unknown reasons.

In fact, the only scenario that does involve me going back is if my problem has an immediate cause – say, a parasite or my brief exposure to mefloquine – and an immediate solution – a drug or surgery (God, let’s hope it’s not another surgery). However, since my current condition does not eo ipso seem to encompass the immediate…let’s just say I’m not hopeful.

If this is my last day, I think I’m ok with that. Burkina Faso was good to me, I did what I could for her in the time I had, and I have no regrets. If at all possible, I do in fact want to go back – or at the very least obtain a transfer to a country where epileptic volunteers can be accommodated – but if that just can’t happen, I think I can achieve some sort of closure.

But to be honest, right now I’m not even thinking about the emotional side of things: I just want to know what’s wrong with me. I don’t like having a broken brain, and I definitely don’t like the thought that there might be some sort of time bomb in my brain, just waiting for the day when *surprise! you now have an IQ of 73!* When I really sit down and start thinking about that, the sadness that accompanies any form of COS[1] just. doesn’t. compare.

So maybe this afternoon I’ll get some good news, and I’ll get to go back to Burkina. Or maybe I’ll get some bad news, and I won’t be a PCV anymore. But hopefully, I won’t get some really bad news, and find out I have an incurable condition, or I need brain surgery, or some other distressingly medical outcome.

It’s all about perspective.


[1] I might be wrong, but as I understand it, any PCV who is medically separated is de facto (I’m in a Latinate mood today) held to have COSed as well.

Photos from Dakar


1 août 2012

Photos from Dakar

Today, for almost the first time since I left the US, I find myself having the magical combination of a computer, photos, a fast internet connection, and the actual inclination to spend an hour uploading a large number of photos. I’ll also do this for Burkina Faso when I get home, but in the meantime, enjoy.

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