Anxiety.

I thought about various other titles - ones that were not quite as straightforward, ones that seemed to sugarcoat the topic a bit.  But there it is.  Anxiety.  This post is about anxiety, and I do want to give into the guilt about writing that.

It always seemed a bit much to share on the Internet.  The last thing I wanted was more people who meant well, giving me advice via the comment section.  There is something about typing out a thought that makes us think we can say anything, without considering the consequences.  We don't have to see or hear how people on the receiving end react, and as a result, our words can come across in a million ways other than how we intended.

But if we can share our ultrasound pictures, news of a cancer diagnosis, the things that make us laugh, cry, smile, and get angry for all to see, then perhaps this story has a place too.  I am tired of the lie that you must have your life completely together, and that anything less is shameful.  I wish people reacted to mental illness in the same way they react to other illnesses, with prayers, with support, with GoFundMe accounts, with T-shirts.  That would be the true sign that the stigma has been lifted.  We still have a ways to go.

Some of you may be thinking, what is she even talking about??  I want to share a little bit about my own struggles, in the hopes that maybe someone out there needs to hear this.  That maybe someone else can read this and say to themselves, I thought I was the only one.  My friend, you are not alone.  I know that does not fix the problem, and yes, the road is painful and ridden with obstacles.  But there is hope.

When I was in college, I began to have panic attacks.  At first, I did not really know what was going on, and just attributed it to stress.  I attempted to get more sleep, exercise more, and decrease stress levels as best as I could, but my efforts were in vain.  The panic attacks intensified in frequency and quality, to the point where it became difficult to function in the most basic sense.  With the encouragement of a friend, I sought out both medical and psychological help.  Without going into the many details, the three years that followed were incredibly difficult.

I began counseling.  I had a counselor tell me that I was "hurting her heart" and she started crying during the session.  I got a new counselor.  Then it was summer so I had to get another one.  I ended up seeing 5 different individuals, each time having to start at square one, telling my story again, trying to build trust and rapport.  

Therapy alone was not helping the symptoms.  I was having panic attacks almost daily.  Performing basic tasks, like going to class or eating a meal, was becoming difficult, and the people around me were frightened and concerned.  I made the difficult decision to start medication, though I knew it would take weeks to even know if it was effective, and worse, knowing it may get worse before it gets better.  It took about 2 years to find the right drug combination that helped more than it hurt.

As the weeks turned into months, my anxiety gave way to depression.  Constantly feeling like the world was crumbling apart, night after night of panic attacks - the hyperventilating, the chest pain, the nausea, the crippling fears, the thoughts in my head telling me I was not worth it and People would be better off without me.  Eventually, I started cutting - as a physical release of the deep emotional pain.  I was becoming the person I read about in my psychology book.  I was becoming the person I just could never before understand.  I was hitting rock bottom.

In the midst of all this, I was in nursing school.  In a lot of ways, life continued on - just a double life that became almost normal.  It was an awful normal, but somehow, day after day, I trudged along.  I owe a lot of that to my friends.  Patient, loving, grace-filled friends who did not know what to do for me other than love me and be there.  It is hard to express my gratitude to those people who were there, sacrificing their own emotional energy, sleep, study time, to ensure my safety.  To ensure that I had just enough hope to propel me to the next morning.

This is the reality of mental illness.  I never thought it would be me.  Never.  And then it came into my life, and turned my world upside down.  Everything changed.

I really cannot exactly pinpoint how things got better.  It was multi-faceted, what I believe to be a combination of finishing nursing school, starting Imani, getting on medications that helped, and finding a therapist who was really good at what she did.  And the answer to the prayers of many people over a long period of time.  Over time, I no longer needed therapy or medication to function, though I know they are still available should I need them again.  I used to have so much shame about that - being on psych meds, going to therapy.  But it is the reality.  And if I ever hope to see a world without stigma, then I must do my part in being honest and open too.

Things are a lot better three years later, and I am grateful that anxiety is not a part of my daily life.  Yet it is still something I struggle with.  It did not magically disappear, and I still have to face the monster.  Sharing my story has helped.  I still have issues with guilt and shame, but each time I share about it, I take away some of their power.

For whoever needs to hear this, it is okay to not be okay.  It is okay to struggle, even if it has been the same struggle for a long time.  It does not define who you are, but it does shape who you are becoming.  God can redeem it to be a beautiful part of your story.

Waves & Wonderings

I have lost count the number of times I have tried to write this blog.  Normally, I have so much to say, to the point where I mentally write out passages to later transfer to a page.  But I find myself frustrated that I have very little to say.  It is not that things haven’t been happening, or that I am not having a great time here in Kenya.  Yet, this trip is different.  The sights, the sounds, the people – so much is becoming familiar.  In fact, when I share with people that I have been to Kenya five times now, a common response is “now you are a Kenyan.”  Of course, that is pretty far from the truth, but maybe it does shed some light on a transition that is happening.  I think maybe I am transitioning into something new.  I no longer feel like a tourist, and just “seeing” a bunch of things no longer is enough.  I long for deepened relationships.  I long to be part of the solution, and not just another person witnessing the slums.  I want so badly to truly know and understand this community, yet I don’t feel that I am supposed to move here.  It feels a lot like limbo, the in-between.

At the risk of sounding prestigious, it was difficult for me to come to the coast for vacation.  I am not anti-vacation, and going to the coast in California has always been a relaxing and rejuvenating time.  But the sudden change of scenery – from walking through one of the world’s largest slums on Monday, to arriving at a beautiful, oceanfront resort on Tuesday was confusing.  I keep replaying questions in my head – Is this okay?  What would my Kenyans friends think?  Is spending money on massages and snorkeling selfish, when it could be invested in fighting poverty?  If I am enjoying myself, does that mean I don’t care?  I keep thinking – why is it so hard to go back and forth and seemingly effortless when I am at home?  Maybe it is because when I physically come to Kenya, I see my purpose as living out the mission of Imani.  Restore hope through health.  It is difficult to see how sitting here on the beach is fulfilling that mission.

Then I gaze out into the ocean.  Tears welling up in my eyes.  My only response is to say “God I feel you.”  The ocean does that for me.  The crashing waves into the shore.  Over and over again.  Day and night.  Sun and storm.  When I am awake to stare at it in awe, and when I am asleep.  I have struggled with guilt my whole life.  Guilt and shame.  And somehow even in this beautiful, calm, heaven-like place, the emotions that have plagued me over and over strike again. 

The ocean is frightening and inspiring.  Powerful, yet calm.  Intimidating, yet inviting.  Similar to my Heavenly Father, the one who gives and takes away, the author and creator, the beginning and the end.  I think when I am here, in Kenya, I expect to feel a certain way.  To respond to encounters in a certain way.  There is this expectation that the experience is going to be life-changing, the way it has been in the past and some.  That’s a lot of pressure for a trip.  I keep asking, God, what is it that I am supposed to take away from this?  Well, that is the mature version – the questioning normally sounds more like why is this sad thing not making me cry?  Why don’t I have a collection of dramatic and amazing tales to share?  And then I hear myself.  And I question why am I insisting on making this all about me?

I am reading this book about the life of Jesus, and the author is quick to point out the historical and Biblical evidence of his humanity.  He says it much better than this, but in essence – Jesus walked, talked, slept, ate, learned, cried, laughed, got sick, etc.  I guess I have not spent a lot of time thinking about Jesus doing very ordinary things.  I tend to think of Jesus’ life as being one of performing miracles – healing the sick, giving sight to the blind, turning water into wine, multiplying the fish and the bread.  And yet, more than likely, the majority of Jesus’ life was nothing special (at least by our standards).  It was rather ordinary, mundane even.  But it mattered.  There were seasons to his existence, in the same way there are seasons in my own life.

So as the sun sets, and the waves roar on, I thank God for these quiet moments, these ordinary but precious days, and the chance to be still.  To sleep.  To eat.  To laugh.  To gaze.  To stand in wonder and awe.  To watch the tide go out and come back again.  All before my life drastically changes.  These are the days the Lord has made, full of moments – some miraculous, some mundane, but all full of meaning.

Lord, help me to be still and know you are God.

Pushing the Mountains

It's challenging to adequately sum up my experiences thus far in Kenya.  Sure, I can post photos, and tell short anecdotes, but there is just something about being here.  Being with the people.  Laughing together.  Learning from each other.  Sharing a meal.  Hearing stories.  And dreaming big.

Today, Laura and I walked all around Kibera.  You may have heard of Kibera.  It is one of the largest slums - definitely in Africa, and potentially in the entire world.  It is hard to get an exact number of the population, but those living and working there say it is close to 1.5 million people living in around 2.5 square kilometers.  When I was seeking out potential new partner clinics for Imani last year, I did not necessarily have any preference in terms of what slum they operated in.  I was more focused on finding a partner that was passionate about the community they served, provided health services, and was Kenyan born and raised.  I found that in Andrew, and in our partner, Makina Clinic.

Walking around with Andrew is kind of like walking alongside a celebrity.  He knows everyone.  He phone is always ringing.  He speaks to people in their mother tongue, as he knows 7 languages.  I told Laura it was like walking around the slum with Jesus - Andrew's heart for people is so big, and even though he had many opportunities to get out of Kibera, where he was born, he continues to stay and invest.  He is a dreamer, and hearing his passion and vision is contagious.

Today, he said "We (Kenyans) are stubborn.  We push the mountains."

He followed that up with "Alyssa....she is stubborn too."

Pushing the mountains.  What a great picture of what it feels like sometimes - trying to address such monumental issues, sometimes feeling that your efforts carry little to no weight.  There are times I do get discouraged - like when I heard about a cholera outbreak that occurred just a few weeks before I was to come to Kenya.  I felt helpless and defeated.  Sure, you can treat cholera.  With extensive fluid resuscitation, cholera does not have to be a death sentence.  Yet the epidemiology of cholera - where it came from - those issues are much more complicated to address.  Lack of clean water.  High population density.  Little to no sanitation system.  Families of 10 living in a small room.  How can one even begin to address these facts?  How can a small non-profit run by volunteers make a difference?

But I thank God for days like today.  Days were I am refueled, re-energized, and ready to fight.  To dream.  To push the mountain.  I refuse to believe that the situation is hopeless.  Just because I cannot help everyone does not mean I should walk away from the opportunity to help someone.  People matter.  One child rescued from being abandoned in the sewer matters.  One young woman who grew up in the slums, witnessed the horrors of Garissa, and is pursuing nursing matters.  One young man who used to rob people at gunpoint who now helps children with their homework matters.  One widow who now takes ARVs and encourages others to do the same matters.  And supporting those who are here, on the ground, doing this work, is a privilege and an honor.

So I will press on, as I continue to day-by-day discern the calling that God has placed on my life.  I won't give up.  I will push mountains.

Paradox

I find Kenya to be something of a paradox.  It is a place of immense beauty – the greenery, the flowers, the friendly & hospitable people, the spirit of perseverance, the widespread hope.  And yet, it can be a place of despair – the extensive poverty, the wide gap between the have’s and the have not’s, the devastation of disease, the lack of infrastructure, the widows and the orphans.  Just as in America, it is not either or.  It is both.  Good and bad.  Joy and sorrow.  Beautiful and ugly. 

It is my fifth time here.  I still am a foreigner and a tourist by most accounts, and I will always be a mzungu (white person/Westerner).  Yet there are moments when I am acutely aware of how my coming back matters.  My Kiswahili is very minimal, yet even speaking a few words instantly breaks down barriers.  I am better able to recognize and articulate cultural norms, and tend to see more similarities with the Kenyans I meet than differences.  Sometimes I stare at the world on a map and think of how there are so many places in the world that I want to visit.  And then I think how will that ever happen when I am always saving my time and resources for another trip to Kenya.  This is a selfish view, of course – one that is focused more on a bucket list than on God’s calling or building relationships.  Luckily, every time I return to Kenya, God changes my heart, and gives me renewed eyes.  I regain the ability to see His hand at work, and my small role in it. 

 

I realize taking on the mantra “small things, great love” or “dream big” runs the risk of becoming cliché.  Yet I find both of those phrases to be more than just a nice saying or something to put on a T-shirt.  In the grand scheme of things, the work Imani is doing in Kenya is small.  We are not eradicating diseases, alleviating poverty, or providing clean water.  Yet in our few days here, we have witnessed how small things can change the course of one’s life.  One of the boys who was given the task of killing Andrew, the founder/director of Makina clinic, was offered the chance to have a life outside of drugs and violence.  He ended up being our “bouncer,” showed us around Nairobi city centre, and works at the clinic as security.  We met a lady who is one of the home-care clients at Makina.  She is a widow, cares for 8 children, and is HIV+, but has been doing well on ARVs (anti-retrovirals, treatment for HIV) and makes a small income selling groundnuts.  One of the children we met at the Children’s Home was found in a sewer, but is now clothed, fed, and taken care of.  The trajectory of these individuals’ lives, and many others like them, are not small things.  By supporting places like Makina, Imani plays a role in these stories.

I am blessed to be here.  There are challenges, yes, but ones that I will gladly take on to be able to express to our partners and friends that we value the work they do and desire to have a relationship.  Sure, it is not easy to travel all the way over here, to arrange housing and transportation, to become accustomed to the time change, the food, the culture – but it really is the only way to live out the “partnership” part of our mission.  We often say we desire to “come alongside” the Kenyans, and it means something to physically be here.  To stand next to them.  To walk the roads they walk.  To eat the foods they eat.  To laugh together.  To share.  To pray.  To love.

To all of you following this, and to all of those supporting Imani, I say Asanta sana, Kiswahili for “thank you very much.”

Goodbye Craycroft

Well, it is over.  Somehow the past three years completely flew by, and I just cannot really believe it.  My co-workers completely spoiled me - a delicious, Mexican-themed potluck, a gorgeous and tasty chocolate cake Maria made, a thoughtful card and gift, and lots of laughs, hugs, and fake crying/whining :)  I love these people.  We have seen each other at our best and our worst.  We have met and cared for some amazing kids.  We have worked together in life-threatening emergencies. We have learned and grown into better healthcare providers.  We have attended funerals.  We have laughed, and we have cried.  Thank you for loving and caring for me until the end.  You are a hard bunch to leave.

Working on Craycroft (the name of the my unit, which houses a mix of oncology, hematology, nephrology, and endocrinology patients) was a gift.  It was a paradox most of the time.  Challenging and enjoyable.  Exhausting and rewarding.  Heart-breaking and life-changing.  There were nights when I left and cried the whole way home.  There were shifts where I left with my heart filled to the brim, unable to imagine doing anything else as a job.  But mostly it was somewhere in between.  One thing that never fluctuated was the support, encouragement, and teamwork of my co-workers.  I could not have asked for a better group of people to work with.  I know there will be nursing jobs out there for me, jobs that I may even love, but I will never be able to replace the people I have worked with.  The following is a collection of lessons learned, memories made, and a little humor (okay sarcasm) in between.  Disclaimer: If you do not work on Craycroft, you may not fully appreciate this.  

Things I Will Not Miss

• A new fever in the middle of the night with a double lumen Broviac
• Floating!!!
• Working on nights when Starbucks isn't open and resorting to cafeteria coffee
• When patients (or their parents) use the call light like a game show buzzer
• Bedside monitors when they are completely unnecessary
• Resident orders.
• Calling certain doctors at night....I won't name any names.....
• Getting a call from lab that you screwed something up
• PEWS
• The smell of Cefepime pee or C diff poop
• When Meditech goes down
• Upstream occlusion with bubbly fluids.  

Things I Learned

• Sometimes there are no words you can say to the parents, but you willingness to stand there in that silence means a lot
• Kids are incredibly resilient and do beat odds.
• There is no good reason why kids die from cancer.
• Patience.  Lots and lots of patience.
• Teamwork and not keeping score.  You never know when you are going to need someone to help you out.
• I am capable of far more than I ever thought I was.
• Stressful situations magnify everything.   I have seen them bring some people together, and tear others apart.  
• When in doubt, ask for a second opinion.  Or third.  There are no stupid questions (okay there are a FEW stupid questions :)
• Having co-workers you trust and respect makes a huge difference.
• Emergency situations suck, but they remind you that you really do play a role in saving lives.
• Life is precious - don't take it for granted.

You Know You Work in Craycroft When....

• you go to other units and cannot stand the beeping monitors and that everyone is on isolation.
• the charge nurses are the best - willing to help out, available, and have your back.
• it is normal for all the kids to be bald.
• giving blood, platelets, and chemotherapy are daily occurrences.
• only a handful of people are comfortable starting a peripheral IV because everyone has central lines.
• you just have to laugh about families requesting "a room with a better view" 
• the plan of care is dictated by the patient's hemoglobin, platelets, and ANC
• you have attended patients' funerals.
• everyone works together - answering call lights, admitting patients, responding to emergent situations, etc.
• you have the best co-workers ever.

It's been a good go.  Goodbye Craycroft.

Why I Make Jam

I have made jam probably a total of 6 times.  Although no one formally taught me, growing up, I remember receiving homemade jam from my grandma and my Aunt Sandra.  When I went berry-picking one summer I lived in Seattle, I had more raspberries than I knew what to do with.  The idea of making jam surfaced, but after some initial research, I realized I was not prepared to actually can jam, and settled for freezer jam instead.  But I vowed that it was a skill I would one day acquire.  Not long after, I saw a Groupon deal for a home canning class, and before I knew it, I was sitting in a class with mostly women 2-3 times my age, learning the basics of canning.  I loved it.  I took notes, careful to remember all the tips the instructor offered, as she effortlessly prepared jam in the front of the room.  After class, I immediately went to the store and bought the basics – a large pot, some mason jars, a funnel that perfectly fits on top of the jar, and a “jar grabber” to pull the jars out of the boiling water. 

So one night during my senior year of college, I was desperate to do anything that wasn’t studying or writing care plans.  Most would probably go out for the evening, making plans with friends.  I decided I was going to make jam.  And in our tiny apartment kitchen, I did.  It was not a seamless, effortless process.  I was unorganized and inefficient.  But I made jam.  By myself.  And the moment I heard that first jar properly seal with a little “pop” – the time consuming, tedious process in the hot, tiny kitchen was all worth it.

Fast forward to this past month.  I knew I would be moving.  I knew I would be leaving work.  And I knew I had quite a bit of frozen fruit, just ready to be made into a delicious batch of jam, waiting in my freezer.  I decided I would make jam as a gift to my night shift co-workers, a way to say goodbye and I love you and here’s something to remember me by.  I knew it would be another one of my projects, and require time and energy I really did not have a lot of, but that did not deter me.  I would make jam.

Outside of work, I am known as being the nurse.  At work, we are all nurses, so we have to distinguish each other by other characteristics.  In addition to being the girl who goes to Africa, I am known for baking things, not using my AC, drinking a lot of coffee, and making jam.  Writing that makes me smile.  Growing up, I always felt I did not have any noteworthy talents or abilities – at least nothing that could be showcased in a talent show.  I did not sing, dance, or act – and my athletic abilities were mediocre at best.  I wish I could tell 12-year-old Alyssa not to worry, that our passions and gifts and things that fill us with joy are not limited to performances or sporting events.  The world needs dancers and actors and athletes and leaders and intellectuals – but they also need care-givers, travelers, risk-takers, and jam-makers.

Making jam takes commitment.  It requires a fair amount of planning and preparation.  Each time I make it, I become a little more efficient, and slightly more confident.  The process is a sensitive one – each step building on the success of the previous one.  There is a lot of waiting – for things to boil, for things to cool off, for the timer to go off, but it is absolutely worth the wait.  Being a part of the entire process, from start to finish is incredibly rewarding.  Looking at the finished product sitting on the counter is the best high.  I made that.  I created something that will be enjoyed both now, but also for months to come. 

I partook in an activity that people have been doing for years and years.  Canning used to be a necessity, a way to ensure food during the winters, to bottle up the best of the harvest to be enjoyed throughout the year.  Sure, we can now just run to the grocery store and choose from dozens of products on the shelf.  For just a few dollars, you can save yourself a ton of time and energy and often even money.  But in my opinion, you miss out on a beautiful, creative experience.  The chance to make something, the end product nothing less than a work of art in my mind. 

And so, I made 35 jars of jam this past week – strawberry, strawberry nectarine, and strawberry apricot.  I kept one jar for myself; the rest will be distributed to my fellow night-shifters.  A small token of my appreciation for their support, guidance, reassurance, and companionship the past few years.  I cannot think of a more jam-worthy bunch. 

So why do I make jam?  To create.  To invest time and resources into a process that ends with a delicious treat to enjoy and to share with the people I love.  Homemade jam does not say I picked up this generic gift last minute out of obligation.  It screams I put my heart and soul and sweat and the better half of my morning into this precious jar – guard it!  Savor it!  Enjoy it!  I made this for you because I specifically thought about you and how you would enjoy this.  You matter!  You are worth it!  

Letter to Imani

April 27, 2015

Dear Imani Family,

I want to share some upcoming changes that will be taking place in my life, and how those will affect Imani Care International.  After months of deliberation, considering pro’s & con’s, prayer, and seeking the wisdom of others, I have made the decision to relocate to Seattle, WA.  (I previously lived in Seattle from 2008-2012 while I attended university.)  There are a number of reasons behind this decision, but ultimately, it came down to choosing the place I felt would allow me to best pursue my passions, re-prioritize, and live amongst a community in a similar life stage.  I have given notice at work, and my last day at Valley Children’s will be June 1.  I will then travel to Nairobi, Kenya, and as I will not be employed at the time, I am taking advantage of the opportunity to spend 6 weeks there.  As we partner with three clinics, having a few extra weeks than originally planned in-country will allow me to spend ample time with each clinic.  I will return to Fresno at the end of July, and physically move to Seattle sometime at the beginning of August.

What does this mean for Imani?  There are still many unknowns, but I can assure you that Imani is not going anywhere.  It will continue to operate as a tax-exempt, charitable organization in the state of California.  Eventually, I would like to pursue adding Washington as a state of operation, but Imani’s home base will remain California.  The board of directors will continue to physically meet through the end of 2015.  In 2016, board meetings will likely be a combination of conference calls, Skype, and meeting in person.  We will still have our annual event, Harvest of Hope, as planned this fall.  It will be on Saturday, November 14 at the Clovis Veteran’s Memorial Building.  Our mailing address will continue to be our P.O. Box in Clovis.

It is my hope that this move will eventually allow me to spend more of my time and energy on Imani.  It has become increasingly difficult for me to work full-time night shifts at the hospital while running a non-profit.  I will continue to work for profit outside of Imani, but hopefully, I will have the opportunity to work fewer hours in a less demanding position.  I would love to see Imani continue to flourish and grow, and expand our community in the Seattle area.  I look forward to being in a city that is a hub for global health, and provides many networking opportunities.

I so appreciate your encouragement and prayers during this season of change.  As with most major decisions, it is bittersweet.  It will be difficult to leave my job, and to leave the security of the life I currently live in California.  I am more than willing to answer any questions or curiosities you may have.

Thank you for your continued support of Imani.  What started as a crazy dream has grown to be a thriving organization that is impacting the lives of those living in the slums of Nairobi.  I look forward to sharing with you after I return from Kenya this summer.

Blessings & Gratitude,

Alyssa Singh

Executive Director, Imani Care International