Pizza Problems

I lost my second spoon in the blender. You’d swear I am both an idiot and a crap cook and I’ll argue I’m not either. But the compulsion just strikes me, my herbs floating on a current of air just above the blades. They somehow evade being pulled under with the nuts, garlic, and oil so I am left with whisked olive oil and the sound of a whirring blender. And initially I do the right thing. Initially I stop the whole affair, pat down the herbs with a spoon, stir them around a bit, before turning the whole thing on again. But it is a reenactment from the moment before. Still waving basil (and in this case arugula) leaves defying their pesto fate.

Don't judge; it was still delicious, splinters and all.

And so I stuck my wooden spoon into the mixture, gently…gently. Only those blades don’t understand the meaning of the word and so to a bite out of my spoon. My weathered and seasoned wooden spoon. 

Last time it was veggie burgers (pre-food processor) and my bright red silicone spatula. At least it is a variation on an inept theme and not a duplication. 

Shrug.

Tonight was a culinary comedy of errors. Wrecked spoon aside, I struggled to pull together a dish I’ve recently started cooking at least once a week: pesto pizza with some variation of vegetarian toppings.

An abundance of arugula from my CSA box inspired me to try out a variation on my pesto recipe. All out of cashews I used almonds instead (I prefer the creamier texture the cashews provide), but the arugula added nice flavor and aroma and made me feel as if it was somehow healthier as well. 

The simple yeast dough proved problematic. I usually do it first, allow some time for it to rise a little even though the recipe doesn’t call for it. But I was on the phone and I kept forgetting about the water so it would cool beyond the appropriate temp to activate the yeast. And when I finally remembered the yeast never quite bubbled properly. And when I added the flour I realized I hadn’t used enough water to begin with.

Sigh.

Rolling it out on the table I used too little flour and the whole thing stuck to itself when I tried to transfer it to the pan which forced me to begin again to get it right. 

Of course, right is a bit of an overstatement because as I suspected, the crust never properly rose and it took forever to brown. And so by the time I pulled it out of the oven, the sides just beginning to tan, the kale had dried up and browned in places, the potatoes were following its example, and the eggplant was drowning in my overly liquefied fresh mozzarella cheese.

Whatever its issues (the mushrooms I forgot to purchase, among them) it was still a delicious meal. I still have another bundle of arugula, some daikon, collard greens, baby potatoes, broccoli, and squash to consume…I’ll see what the coming days inspire.

Ebola at a glance

There were more people than I expected. Although with Dr. Paul Farmer involved there were bound to be a lot of people. The first time I saw him speak was in graduate school, my first semester of graduate school, the seats were filled early, the aisles shortly after, and the final surge was relegated to the overflow- their ears straining to hear what he had to say. That was before I knew he was the golden boy of international public health. An MD PHD. Medical doctor slash anthropologist who also started an international nonprofit (in Haiti) while getting those degrees. 

Yeah. That guy. 

Most famous for his work in Haiti, his presence is all over the developing world. Working to make antiretrovirals available in their generic form so that low-income countries can afford to provide them for their citizens. That isn’t the half of it. 

I wasn’t sure how he factored into the Ebola discussion he was slated for, but as soon as I saw the advertisement I bought a ticket. His finger is on the public health pulse the world over…he’d have something of note to say.

Settled in my seat an hour before his start time, an attempt to avoid the lines and craze I anticipated, I stared at the chairs on stage and wondered who would be joining him. 

We started the evening with humor. One of the five men on stage, seated at a jaunty angle, introduced himself as the host, “not the parasitic kind,” he assured us. And the Nourse theater giggled in public health geekery. Drs. Paul Farmer, Dan Kelly, Raj Panjabi, and Ambassador Eric Goosby, a collection of men with impressive letters behind their names and decades of experience in Africa and beyond under their belts, began a very elegant, if abstract conversation about the Ebola outbreak epidemic pandemic.

Of course there were the basics. How it spreads, where it started, a brief mention of treatment. There was a glossing over of what the situation looks like on the ground. At least two of the doctors were freshly from Liberia and Sierra Leone and they fluttered briefly over what care, treatment, and patients look like. What it feels like to be there. 

The bulk of the discussion was big picture thinking. What are the implications for America? What is necessary to get Ebola under control? How do we evade the current worst case scenario of 1.4 million infected by January? 

There was assurances that we are safe here. Not because Ebola has preferences or because it isn’t mobile –our first case in Dallas proves how untrue that is- but because we have a public health and medical infrastructure – hell, a social and political infrastructure, that offers protection (or at least a very convincing idea of protection).

Controlling it is something else. Controlling it is complicated and full of questions and “if, then” uncertainties. 

How extensive is the under-reporting?

How reliable is airport screening?

How feasible is it that people will employ basic universal precautions while working with the sick?

If we deploy 3000 troops now then…what?

If we have beds but no clinicians then…what?

If all the promises of resources and staff from other countries doesn’t come until next week, or next month, or next year then…what?

And we can’t really know. We can speculate and hypothesize. We can create contingency plans for all of the foreseeable possibilities but we are ultimately at the mercy of time and reality. 

There are, of course, other things to consider. The public health professional in me is screaming out how crucial it is that we use this as an opportunity not to respond to Ebola – as everyone is imploring – but that we respond to the yawning gap in public health services and infrastructure that are inherent in developing nations. 

When the first case of Ebola appeared in Nigeria I was fearful. Lagos, population 21 million, with slums flanking the sprawling city, could have been a teeming petri dish of infections raging out of control. 

It wasn’t.

And while comparing it to Liberia is Apples to moon rocks, it is the most logical place to push an agenda of infrastructure building. 

Nigeria had one initial case (that led to 20 total cases) but its handling of that one case was admirable. Some of the success was luck (no one on the flight got infected), but it would be shortsighted to attribute luck to its success ta holding Ebola at bay. Nigeria has infrastructure. It has doctors and nurses and community health workers. It had a polio Emergency Command Center the Bill and Melinda Gates foundation provided in 2012 and transformed it into an Ebola Operations Center. Nigeria had recently cross-trained 100 doctors on basic epidemiology and they deployed 40 of that cohort to oversee the 18,500 contact follow-ups of 900 people. 

Yes, Nigeria was lucky. But Nigeria was also quick thinking and prepared.

Last night Paul Farmer repeated on several occasions West Africa’s dearth of Ses: stuff, staff, space, and systems. 

Gloves drying in the sun in Bong County Liberia

Stuff- the material resources necessary to provide service. Basic right? So easy to take for granted that a clinic or hospital will have gloves or medication, but when I was working in Liberia (years before Ebola) the clinics I had were so desperate for gloves they washed them and left them to dry on the grass or on bushes. Sun and latex is not a great mix and either is reusing single use latex anything. 

Staff- trained individuals who understand what care needs to be given and the proper way to protect themselves from infection. Health care workers are dying too. Exposed through imprecise precautions or the possible mistake (inadvertent needle prick or contact with contaminated materials). Not to mention the sheer number needed. In resource poor areas like Guinea and Liberia, trained professionals can be hard to come by and poorly paid. Tack on the short intervals that care can be offered while donning an impermeable PPE (personal protection equipment) in the sweltering almost-equatorial sun and things are even more complicated.

Space – is in high demand. How many beds are there? Where are they? Can people get to them? Are they properly equipped? Space can seem like the easiest of problems to solve but as West Point town in Liberia discovered, it is not. 

Finally, the most complex issue of all. Systems. This circles back to at least one of the reasons Nigeria was able to get out in front of the spread of Ebola on its soil. 

Of course all of this conversation dangles its feet in the pool of health disparities. Who has access to what? Why did American doctors get access to the blood serum of recovered patients (an old technique for fighting diseases with no known cure) and experimental medicines while African doctors and patients were left to die? 

A West African friend of mine had a much more America forgiving point of view.

“There is popular saying that 'charity begins at home'. Why is the west being blamed for not taking the lives being lost in West Africa seriously...when over the many years and many wars and many bad governments and many deaths past...Africans have not demonstrated that we value our own lives? And I get that we live in a 'resource constrained' part of the world and it is morally reprehensible for richer countries not to act...but for how long will we our lives continue to be at the mercy of aid?

Charity begins at home can be interpreted to mean 'others will value us and quickly jump to our aid to the extent that we value ourselves and add more value than burden to other countries of the world.

I am just tired of belonging to the part of world that is so helpless problematic and looked down upon.”

 But I disagree – not to the notion of Nigeria or, on a macro level, Africa, developing agency and self-sufficiency, but that it somehow makes it ok for America, Americans, to only appreciate the need that threatens us personally. Where is our humanity if we only care about a sprawling scourge on the world because someone we can relate to is impacted…because we might be?

One of the last questions of the night came from a woman who works with MSF (Doctors Without Borders). Freshly back from working in West Africa, she was passionate about how big the need and how understated our civil discourse on it had been. We were talking in abstractions and meanwhile MSF was at its limit. She wanted to know where the discussion about the reality on the ground was…where was the worry that we are still uncertain about leadership, next steps, and timelines.

I would have liked to see her on the panel. I would have liked to see a less abstract perspective on what it looks like and feels like. A closer examination of the naked need to temper the theoretical macro thinking that I realize is also essential. If you haven’t seen what hospitals in resource poor areas look like on a good day, how can you truly understand what they look like in crisis…what is needed in crisis?

When I worked in rural South Africa I would write and talk to my parents about my schools, how poor they were, how much they needed. My dad was a new teacher and working in a poor school in Texas and he would emphatically share that he knew exactly what I meant. I assured him that he did not and with all of the certainty in the world he would end the conversation with the affirmative. He knew.

When my family came to visit me I took them out to one of my schools. My dad walked in through the gaping hole in the side of the building that the kids also used instead of the door. He saw the 20 or so rickety desks that seated three kids at a time, and looked at the rotting chalkboard (that was only useful when we actually had chalk). He didn’t assure me that he understood anymore.

We need to visit the classroom. Not to rally pity or fear but so that we have a realistic understanding of the fight we are in for and where we are starting.

Fear Swings Both Ways

Fear is visceral. 

We respond to fear. We have to. It may be freezing in place, or fleeing without thought, or fighting for what we hold dear. 

Fear doesn’t promote clear rational thinking. The part of the brain activated when we are face-deep in fear is the primal part of who we are, the part that dates back to living in caves and fighting off wild animals. Us before fire. 

Fear has led us to arming ourselves with ever more lethal weapons…mace, knives, and guns. Fear inspired us to teach our children about “stranger danger” (despite the reality that most children are abducted by people they know). And Homeland Security was built on fear. 

Post 911, the vision of smoke and falling buildings still fresh in the collective American mind, and our government told us that we needed to be protected. Danger wasn't past tense it was ever present. And so we lamented  our withering freedoms but took solace in the safety that its withering would provide. This isn't new; this reality has had many a birthday. But it is relevant now as the FBIis denouncing the new encryption capabilities that both Google and Apple have placed on their phones. The changes they have made make it difficult for law enforcement to gain access to materials even if they have a valid warrant. 

When I read about this, the phrase, “even if they have a valid warrant” stood out to me. Screamed at me. Blinked in neon colors. It is that line that clarifies everything. That line explains how acutely we respond to fear.  That line reveals the expectation that law enforcement might be accessing our information without a valid warrant. The subtle implication nestled in the FBI’s whine is essentially, “even if we follow the rules we still might not get to play.” And for the moment the response is, “no, you cannot play.”

To me, the most obvious reason that Google and Apple have scrambled to get encryption in the first place is the recent bullying from NSA and the like.* Forced to offer up client information even after fighting the demand in court; outrage followed when we, the public, found out how much of our information was being demanded.

And so we fell down a hole our own fear made. And this encrypted reaction is the ladder we’re making to escape. A ladder of fear – only this time a different kind.

Unchecked power is a frightening and insatiable beast.  Feed it a few rights, access to some things, and soon it will devour everything – offered or not. And so more than a decade after 911…post NSA snooping phone calls…post skimming our emails for whatever phrase proves our guilt...we see a backlash. Emails sealed, phones held tight, secrets locked away.

I delight in this fear. Delight in the audacity of the FBI to be indignant about their own cavalier behavior towards rules and limitations, even when it is those very things that have brought us here.

And here is not the best place. 

Here is where child pornographers might be able to breathe a little easier because their emails are a little more secure. Here is where actual terrorists may have an extra moment, drug dealers may have hiding places that remain hidden. 

But here is where fear put us. First the fear of everything without. Fear of all the things that go bang in the daylight and leave us bewildered at the destruction. And now fear of the people that swore to protect us and abused that trust, relished in our fear that gave them latitude to ignore rules that were created to keep us all safe to begin with.

Fear is visceral. Fear spreads. We respond to fear, just not always in predictable ways.  

*I’m sure there are other reasons that have nothing to do with this but the rush…the rush I maintain is linked at least in part to law enforcement’s intrusion.

White Threads

This morning I managed to roll myself out of bed too late to meet my friend at the YMCA but just in time to actually join it. The Mayor of the Y (as I dubbed him), a loquacious older man who graciously allowed me to sit with him as I filled out my paperwork, began to pepper me with questions.

“Where are you from?”

“Do you have a husband and kids?”

“Where’d you go to school in Louisiana?”

A friendly guy, older than my dad, or not preserved quite as well, I enjoyed the banter well enough. The community atmosphere of the Y is part of the reason I joined. I like that people speak to each other. I like that there are tables at the front that serve as a designated social spot. 

Finished with my application I looked up at the Mayor and smiled. He leaned in just a little and said, “I love those decorative white threads in your hair.” His hand almost grazed my forehead as he reached to touch the “threads” and I leaned back to avoid the grazing. “I smiled and responded, “Those are gray hairs, just like yours.” With that I shuffled my papers and waved to him as I presented myself at front desk for the remainder of my intake process. 

Motivation dresses itself up in interesting costumes. Gorging myself in Peru on alpaca, quinoa soup, and what I presumed to be frozen vegetables; I came home craving vegetables. Not just craving vegetables, I came home forsaking meat and dairy…for a week. Then I signed up for a CSA (Community Supported Agriculture) with plans to continue a veggie heavy, from-scratch cooking reality. 

Imagine my wonder when it was cheese and butter that I missed more than bacon. 

Food wasn’t the only thing Peru left me craving. Craving is the wrong word; I crave long days in a comfortable bed. Peru bluntly reminded me that I need to move more. Hence, the Y. Walking around at 3,300 meters (more than 10,000 feet) in Cusco, and then climbing mountains at almost 8,000 feet at Machu Picchu, and I was reminded just how out of shape I am (actually, my 67-year-old father perched on a rock waiting patiently on his favorite youngest daughter to catch up, reminded me how out of shape I am).

And so here I am, returned from vacation with my sights set on a healthier day to day. My first CSA box arrives October 1 – we’ll see what all this looks like by then.