Wednesday, July 14, 2010

Meno Bili, Tafadhali.

Inside the dental unit at Arusha’s St. Elizabeth Hospital I sit on the waiting room floor in a circle with three children. To my right, observing our proceedings with rapt attention, are six wide-eyed adults. Some of them lean so far out of their chair there’s room for another person to sit. I sense that some of them wish they were sitting where I am instead of just watching, which pleases but also perplexes me, because what has snared their attention for the past hour is a board game called Snakes n’ Ladders.

Snakes n’ Ladders is the fugazi version of the classic game Chutes n’ Ladders. If yours was a deprived childhood, allow me to explain: The game board features a hundred square spaces arranged ten by ten. Scattered across the board are pictures of twisty chutes (or snakes) and ladders of varying lengths. Players begin at the bottom of the board and take turns rolling a die, advancing their pieces the appropriate number of spaces in a zigzag pattern up toward the final space at the top. If your die roll lands you on a space that contains the foot of a ladder, you get to climb it and jump ahead to the space at the top of that ladder. If you land on a space that contains the top of a chute, you slide down to the space at the bottom of that chute, negating much of your progress. The first player to reach the final space wins the game.

Part of the magic of Snakes n’ Ladders is that it somehow excites delicious anticipation and fierce competition though there is no skill whatsoever involved in the playing. The winner is simply the player who has the most fortunate sequence of die rolls. But anyone who has played the game knows there is no thrill like climbing one of those especially long ladders and finding yourself suddenly at the front of the pack—and you don’t just place your piece at the top; you slide it up the length, guiding it like an ice cube across a narrow plate of warm glass. This person also knows the cathartic relief that comes from watching the leader take that sad, slow plunge halfway down the board on a cursed chute (unless of course that leader is you).

So yeah, I understand the appeal perfectly well. But the notice we’re attracting at St. Elizabeth’s seems extreme—we’re not performing open-heart surgery here. The adults are enjoying the watching even more than the kids are enjoying the playing. When one of the children stumbles onto a snake, mere spaces from the finish, it triggers a startling explosion of laughter and chatter and I have to wonder, is it merely the hours-long wait and lack of well-thumbed magazines that has allowed this little toy to become such a source of stimulation? Or is it more to do with the Tanzanian lifestyle, its simplicity and deprivations?

Physically speaking it is a sad little game—a thin square of cardboard with crude illustrations, four plastic colored tokens light as air and a die smaller than a pea. But it’s easily the best 1000 Tanzanian shillings (about 77 cents) I’ve spent so far on this trip. I had picked it up from the supermarket just hours before, knowing that trips to the doctor in Tanzania tend to be half- to full-day affairs. I am proud of myself for demonstrating such foresight.

I’m also proud of my boy—my man, Bahati, for his willingness to make our game inclusive and allowing it to develop into the public event it is now. Today, he alone is my charge, and since it is rare that a boy from CHISWEA has the sole attention of an adult, I naturally assumed his first instinct would be to hoard it. So when first we were arranging the pieces on the floor, and I noticed another boy looking on intently, it was only a sense of obligation and politeness that compelled me to ask him if he wanted to play too. The boy grinned, said no, and though it was obvious he was just being modest or shy, I was perfectly willing to accept his declination. After all, I may love Bahati and many of the other children at CHISWEA, but I don’t love children. Suffice it to say I’ve never bought into the notion that children are inherently fun and fascinating, so why the hell should I have to entertain some stranger’s kid? I’m already doing my good deed for the day.

But Bahati, sweetheart that he is, urges in Swahili that the kid get over his inhibitions and sit down with us. I’m so impressed, so proud, that I no longer resent having to play with both of them. Later, a little girl takes my place at the board and I take a break. I open up a pack of cookies and motion to Bahati that he should have a few. After taking two for himself, he wordlessly places two each at the feet of his gaming companions. Shucks.

Bahati at 14 years old is a rail, skinny like his peers but lacking the thin layer of adolescent muscle most of them pack. He’s modest in temperament but not shy; personable, and generally chipper like most of the CHISWEA stock. When excited he speaks very quickly and with a hint of helium in his voice, so that what is actually Swahili sounds more to me like some Gnomish dialect. He has a few inconvenient medical maladies, his eyes for instance. He looks with only one at a time while the unseeing eye tends to turn outward, a condition he shares with his younger brother. There’s also something going on with his left ear, which he frequently stuffs with cotton. When I ask him why, he points to it and says, “maji,” indicating there is water inside, but the chronic nature of this fluidic blockage makes me think there’s more to it. I wish I could ask him questions like, “Can you hear well out of it?” or “Does it ever hurt, get infected, etc?” but those conversations are beyond our mutual capacity to understand each other, as they would be with most of the boys at CHISWEA. At some point I’d like to get his eyes and ears looked at too.

But today we’re tending to his front teeth, or rather his lack of them. Two years ago a friendly Tae Kwon Do match resulted in his falling face first to the floor, knocking out his two most prominent choppers and leaving him with the gummy smile that is now his trademark. As an outside admirer I am reluctant to “fix” this adorable quirk, but for him it is an ongoing concern. A few days ago, while helping me and some of the other boys paint one of CHISWEA's bare cement walls, Bahati turned to me asking, “Jimmy. Jimmy. Tomorrow… you take me to hospital… and get me… teeth?” He grinned wide and pointed to the vacant space to make sure I understood.

The other boys had a hearty laugh (so did I). It wasn’t a cruel laugh, thank God. Still I know it must be difficult for him to have his face be the focus of attention in this way, a regular source of chuckles, cruel or not, for his friends and even for me.

Searching for words I thought he might understand, I tried to explain that it was probably a long process to have his teeth replaced, that I didn’t have much money and was spending a lot on other projects at CHISWEA, etc. Either I failed miserably or he’s just a tenacious son of bitch because he asked a second time with the exact same wording, gestures, and even the same pauses: “…and get me… teeth?”

Virtually every boy at CHISWEA, young and old, has asked me for something—chocolate, cookies, a bicycle, my hat, my shoes, my pants, my shirt, my UNO cards, my phone, money, money for clothes, money for shoes, money for school uniforms, etc. It was mildly insulting at first, as if my mere presence, my volunteered time, was not gift enough. But I’ve learned not to take it personally, and try to remember that all kids habitually ask for things they want. That’s where we start, crying out for milk or a diaper change and getting served. Manners are counterintuitive and come later. Besides, the boys rarely seem disappointed when I politely decline, and I’ve known them long enough to believe that they are, in fact, very grateful for my mere presence.

Due to my financial limitations, and that their requests rarely constitute a necessity, and that I’d be encouraging impolite behavior, I make a point of declining virtually every request. This is my initial reaction to Bahati’s wish for teeth but this is one of the few requests I’ve received that has seemed especially worthwhile and, hell, the kid is just so adorable. After asking his question a second time as if my first response had never happened, my defenses crumbled, and a few days later I told him we would visit the dentist together “just to ask him some questions.”

Truth be told, once my decision was made I was utterly grateful for the opportunity. As could easily be expected, my weeks in Tanzania are among the most exciting I’ve ever had, but no matter how far I travel the slick demon Boredom is never far away. He creeps in everywhere.

*     *     *

I’ve often wondered whether this is true for adults with Attention Deficit Disorder—and I’ve long considered myself borderline symptomatic—but for me, boredom is largely a physical condition. If I go understimulated for too long, my brain begins to slowly die. It is a painless death, but not without physical sensation. I can feel my head begin to swell, resulting in a dull pressure that builds and builds. I call it the “milkshake” effect because it feels like some contaminant has been introduced into the normally fluid mechanism of my brain and, acting as a deadly thickening agent, slows down every mental process beginning with the most developed cortical functions like analytical thought on down to motor functions, and, eventually, even primal medullar duties like breathing and heartbeat.

In real time I may experience this as, first, finding myself unable to understand what people are saying even though I sense, through my eyes and ears, that they are talking to me. The individual words may even seem familiar, but they no longer fit together in any meaningful way. If the boredom continues, it becomes more difficult to manipulate items with my hands, and I have a greater tendency to bobble and drop them. My coordination and depth perception also deteriorate, so that I’m more likely to walk into parking meters and door frames, causing my companions to say, “Ouch, that looks like it hurt.  Are you okay?  Jim?"

Huh? I think. Oh, yeah. No, wait—huh?

Now my boredom has become a social and interpersonal crisis, and though I am by this time at least aware of what is happening I am nearly powerless to reverse the process, since my addled brain now has a limited capacity to seek out and process the stimulation it requires. Someone could be telling me the most riveting story of a subway mugging he just witnessed, including drawn guns, a hail of bullets, an injured conductor, a derailed car, a shower of sparks in a pitch dark tunnel, screams, blood… but the story is beyond me.  “Hmm. Yeah. Hmm,” I reply automatically, and my vacant expression makes the storyteller wonder from which planet the aliens who body-snatched me came.

Around this time it becomes harder to breathe. And, irrational as it may seem, my last traces of awareness fixate on the possibility that my heart may stop beating. This is the pinnacle of a deeply, deeply internal panic. I’ve read accounts of people with ADD who experience a similar correlation between boredom and anxiety. They describe it as so intense they entertain acting upon outrageous impulses, like suddenly screaming out during a conversation or dumping their drink on the person speaking, just to reassure themselves that they are still a living, breathing human being.

And I do experience days, even weeks, when I indeed feel dead to the world, when my body is simply a shell of what I used to be. There is something that resembles a rudimentary sort of memory collectively contained within the cells of my flesh and bones, causing my body to mimic gestures and motions from my living past simply for their own sake. I am a machine that no longer serves a purpose, my treads turning nonstop as I bump, bump, bump into the same wall over and over. This is where attention-deficit and anxiety meets low-grade depression. I don’t necessarily need to have one of the aforementioned episodes of boredom attack to reach this dead zone, but I’m sure the two are loosely connected. I participate in the routine of daily life without knowing whym since I have no motivation to do so. I derive pleasure from little, look forward to nothing, and lament that I gain no satisfaction from what appears on paper to be a charmed life.

These are the intense sensations I hoped to escape, at least to some degree, by coming to Tanzania and immersing myself in an experience so foreign, in every sense of the word, that I would not have to work nearly so hard to find that stimulation my body craves. There’s a risk involved, because it’s easy to overstimulate and overwhelm myself, producing an equal but different sort of panic. And I must be careful not to focus so heavily on stimulation-seeking that I forget to give myself that minimal amount of comfort and familiarity which I also need to function. (Incidentally, this is why I am writing to you from Africafe, Arusha’s best attempt at a Western-style coffee lounge and diner, where I have spent nearly every Sunday for the past few weeks. That the home fries, pancakes, and even the scrambled eggs taste a little “off” is not nearly so important as the knowledge that I am eating a diner-style breakfast in a plush chair with the sound of clanking plates and a whooshing espresso machine in the background).

After my first few weeks though, I figure the high-risk period for overstimulation has passed. And as I grow more comfortable at CHISWEA, such that I can now tell the boys apart and remember their names, better tolerate the language barrier, trust that they respect and like me, etc., it becomes apparent to me how difficult it is to fill a five-hour day. I teach the kids how to play UNO cards; that’s good for an hour per day. I work on improving my embarrassing soccer skills, whether it’s playing a game or just dribbling the ball with them a while; there’s another hour. We point to things and trade the English and Swahili terms for them; a half-hour. We identify cities and countries on the world map; fifteen minutes. Now what? Lots of sitting around, is what.

And lo, there He looms, grinning and galloping sideways on all fours, back and forth, on those gnarled feet and heavy knuckles, eagerly waiting to infect my brain.

On any given day I’m bound to drift several times in to (and hopefully out of) at least the earliest stages of boredom-induced brain death. Under the right circumstances, however, these early stages can be an asset. Because my brain still preserves most of its functions, and senses danger, it is capable of taking swift inventory of all available resources, internal and external, in the hopes of developing an original solution to reverse the death spiral. Viewed in this way, creativity is something of a survival mechanism, one that produces interesting and occasionally useful byproducts. CHISWEA has already benefited much from the threat of boredom. Maartje, a fellow volunteer from Holland, raised funds to have a layer of concrete poured over the dirt lots inside the compound. Sarah, from Australia, organized a talent show.

Me? I bought forty liters of paint to liven up the drab alley between the boys’ dorm and the common room. I found someone to fix the stove and chimney so that the kitchen hut does not fill with smoke. And with any luck, I will begin my own fund raising campaign to get the boys some proper Tae Kwon Do equipment (STAY TUNED). In many cases these mini-projects require paying a little out-of-pocket, but I don’t consider it charity and I doubt my fellow volunteers do either. Once the idea occurs, acting upon it is usually a no-brainer. It gives us something worthwhile to do for people we like whose gratitude runs deep, and the costs often range from surprisingly to shockingly low. So it’s simple economics really; a small investment with a high rate of return. I cannot, for instance, begin to describe how much satisfaction I derive from watching, every day, smoke come out of that chimney instead of out the door. If only all donations were so personal, the results so tangible and dramatic, charitable giving would be triple what it is now, but alas the abounding opportunities for such charity are separated from us by thousands of miles and vast oceans.

Don’t get me wrong. I will find a way to casually mention my list of angelic acts abroad to every attractive woman I ever meet. But it’s not false modesty to claim that the giving I’ve witnessed and practiced here is hardly charity, at least not in the sacrificial sense of the word. I encourage you to plan such a trip and see for yourself!

Not every problem is so easy to solve, however. I have been frustrated to discover, for instance, how difficult it is to sponsor a child for school despite the reasonable costs. Payments are required annually, if not monthly, and unless you are physically present to handle the transactions you cannot trust your money will end up where it’s supposed to go.

Still, if you keep your eyes open and make Boredom work for you, little projects present themselves. Among these, I have found medical projects to have the greatest cost-to-benefit ratio. None of the children at CHISWEA have severely crippling or immediately life-threatening illnesses, but there are several who possess treatable maladies that, if corrected, might significantly improve their quality of life. The answer to why they go untreated is always cost, and usually the dollar amount imposing this barrier is—again—shocking. Not long ago I accompanied a fellow volunteer and his eight year-old student to Moshi, about 80 km away, to visit one of only two pediatric opthomalogists in the country capable of performing a surgery that could correct the child’s “lazy eyes” (his condition is similar to Bahati’s except that the unseeing eye turns inward, not outward). The surgery involves anesthetizing him, then detaching and reattaching the muscles around his eyes. The price tag on this delicate procedure? Twenty-seven dollars.

So, really, how expensive could a pair of replacement teeth possibly be?

*     *     *

If I may return to Boredom and brain death one more time, I have two basic theories to explain my frantic relationship with mental stimulation. The narcissistic theory is that my brain is extraordinarily unique and highly advanced, and that this is both a blessing and a curse. My exceptional output requires greater input, and if these higher input demands are not met the whole system breaks down. For my brain, it’s all or nothing. The gifted are often mad, no?

The second theory is that I am a symptom of developed, and perhaps over-developed, society. I think most would agree that the body can and will get used to almost anything, bad or good. Hence, what serves to bring stimulation or pleasure initially may, over time, lose its effect the way many drugs do. It’s as if every stimulus in the world is a mild narcotic. First it was hanging dangly things over my crib, then action figures, then video games, television, textbooks, the Internet, gourmet cuisine, horsepower, hi-defintion, screen size, surround sound, faster Internet, travels abroad, culture tours, post-graduate education, much faster Internet. Can a brain developing under those conditions possibly experience stimulation in the same way that that a brain which develops within the bounds of a “simple life," limited to the same mud huts, talking to the same ten people, working the same profession and selling the same array of items, eating the same meal day in and day out, walking about within the same half-mile radius?

No one can deny that the average Tanzanian possesses little or nothing above what they need to survive, and yet my general observation has been that they are every bit as content as Americans are. I don’t want to sound naïve— I probably lack exposure to the most destitute and desperate in Arusha and I’m sure there is trauma, both collective and individual, buried so deep that a visitor of three months could never possibly begin to ascertain them. But joy is joy, I can sense it in others, and I’ll be damned if Tanzanians are more wanting of it than we are. If that’s true then it raises some pretty big questions, like what the hell am I doing here in Africa in the first place? What is it that I think I have, and that I want to offer to those who don’t? Even in America there’s plenty of skepticism around how much happiness one can ultimately derive from luxuries and material possessions (not that this stops us from trying). But what about privileges we consider more fundamental, like education? I can’t say with any certainty that I and my college-educated friends are any happier than the mostly uneducated street merchants I pass every day. Is it best to pack as much experience, exposure, enlightenment into your life as possible, to never be satisfied, to always be striving? Or is it better to live simply, to experience boredom as completely routine, to find that you occasionally have to struggle—struggle not to cope with disappointments and hardship and identity crises, but struggle to survive?

Carpe diem? Or hakuna matata? Who am I to say?

At any rate, this distinction may provide some framework for understanding why the Tanzanians who are practically falling out of their chairs at St. Elizabeth can extract such excitement out of a pleasure as simple as watching children play a board game. I am at once envious and sympathetic.

We’ve been playing for nearly three hours when we are finally called in by the doctor. I’m pleased that the office appears clean and organized, perhaps not to the standard I’m used to but nowhere near my imagined, worst-case house of horror. Bahati lies in the long chair and the doctor begins to poke around in his mouth with gloved fingers. I stand off to the side observing, trying to determine whether or not this guy knows what the hell he’s doing. He has a few exchanges in Swahili with Bahati, pokes around some more. Eventually he sighs, sits upright in his chair, and to my utter astonishment he says, “Today we will take an impression of his teeth. Tomorrow or maybe Saturday he can come back to have the teeth fitted.”

“That fast?” I blurt out

Yes. This will be a removable denture, he says, which is better suited than a fixed denture for a mouth that is still growing like Bahati’s. The doctor proceeds to dial someone on his cell phone, and after a short conversation he hangs up, and tells us to wait an hour for another doctor who is coming to take the impression.

He begins speaking in Swahili again to Bahati, who is now standing against the wall with his hands in his pockets, looking toward the floor. The doctor is talking for a long time, and soon his assistant, a heavy middle-aged woman with thick glasses, begins talking to Bahati as well. Her tone is stern; in fact she seems rather angry, which confuses me since the kid hasn’t said more than ten words in the last five minutes.

Eventually the doctor looks at me and smiles. “We are counseling him.”

“Counseling?” I ask

He explains that Bahati’s appearance is a little sub-standard, that his clothes aren’t pressed and a little dirty and that his hair is uncombed (what hair?). The woman is still going at it with Bahati, scolding him. I think back to earlier in the morning, when I asked Bahati if he was ready to go; he beamed and said “Wait,” then disappeared for over five minutes to change into the clothes he wears now.

I wish intensely at this moment that I knew more Swahili than I do, so I that I could counsel both these assheads that they ought to focus on their job instead of offering unsolicited advice.

I (politely) assure them that Bahati took his time this morning and that he’s a real, real good kid. We exit the office and wait for the next doctor to arrive, playing another round of Snakes n’ Ladders followed by some UNO cards (where I suspect Bahati and I are both secretly attempting to let the other win). An hour passes and we are back in the office again, where the new doctor is pressing a tray full of stiff blue goo against the roof of Bahati’s mouth. Doc Number Two strikes me as a nice man but his hands seem unsteady, and don’t inspire the confidence I’m used to in a doctor’s office. I grow acutely aware that he is not pulling his instruments out of sealed plastic, and rinses the goo-mixing bowl with hand soap and water instead of using a new bowl and disposing of it after one use. For all I know, Western practices like these are largely for show. Regardless, I start to hear the sounds of all the bacteria in the room, buzzing, chatting, doing cannonballs into Bahati’s mouth as if he were a pool party. I suppose these are parental instincts kicking in. I haven’t had much experience with these (I assume that’s obvious) and make a mental note to discuss it with my therapist when I return to Boston.

Our walk back to CHISWEA is quiet. Bahati makes a point of thanking me a few times, in his fast and small gnome voice: “Thank-you-ve-ry-much.”

We return the next afternoon, and before we can even get through one game of Snakes n’ Ladders the Doc Number Two arrives and beckons us in to the office.  After a few unsuccessful jabs with this thumb and some behind-the-scenes adjustments, the doctor is able to slip the denture securely over Bahati’s front teeth. My latest worry has been that the denture, which cost a mere 30 dollars, was either going to be extremely uncomfortable, look totally ridiculous, or both.

But Bahati does not appear uncomfortable, and from where I stand he appears to have a full set of natural teeth.  The overweight assistant from the previous day, who is still on my list but I’m about to forgive, approaches Bahati smiling and carrying a small mirror, which she hands to him. He takes a hard look and exclaims something in Swahili, bouncing a little in his chair. I think he is smiling but I can’t tell for sure.

In a voice approaching a whisper I ask the doctor, “Is he happy?”

“Yes,” the doctor smiles back.

Bahati grins wide and looks hard in the mirror again, seriously, as if needing to confirm that his first glance was not a fluke. He breaks into a smile again, chatters something and then this boy, this teenager, begins tap-tap-tapping his feet together as if he were five and had just been sprinkled with pixie dust, ready to float off his chair and out the window. I didn’t cry, but I came awfully close.

Talk about your simple pleasures.



2 comments:

Ashley said...

What a wonderful story! I hope Bahati keeps enjoying his new teeth! :)

Hanna said...

Lovely-- and well paced. A nice mix of storytelling and introspection..