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» Hatrack River Forum » Active Forums » Books, Films, Food and Culture » Humans without borders

   
Author Topic: Humans without borders
MrSquicky
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I generally frown on people just posting an article and not commenting on it. Here's the thing though: I don't really have any comments to add. Using it to support a position or something just seems low to me and whatever comments I have pale in comparison to the article itself. So, here's something that a friend of mine wrote about his experience in Sierra Leone. I think it's something that people should read.
quote:
CLINIC
Occasionally you might try to sneak out between patients to survey the waiting room. Clinic day is never pleasant for the surgical intern, and you always hope that maybe no one else will show up. Maybe there’s a blizzard and everyone decides it’s just too dangerous to go outside. Usually not, though, and you peek through the Staff Only door around the corner from the physicians’ restroom and the free coffee and count the afternoon’s lineup. Every hour or so you may reassess the arrangement of comfortable patients in their cushioned chairs. Eighteen more. Twelve. Seven, then home. Clinic isn’t unbearable, but it only resembles what you think of when you think of medicine and try to remember why you wanted to become a physician in the first place. There is no real detective work, no mystery. Almost everyone comes referred with CT scans and full workups and diagnoses already assigned by their primary physician. There’s barely any examination to do and you almost always know exactly what the story is from the chart on the door: Patient referred by primary physician for (fill in diagnosis) requiring surgery.

From here the surgery intern does what he knows best: paperwork. There are insurances to check, clearances and consents and confirmations. Maybe someone will need a few more tests to avoid a lawsuit or console the anesthesiologist. There are instructions to go over and over and sign and review again. After 45 minutes the attending may or may not appear, announce the time in his schedule when the case can be slotted in, and then quickly retreat to his office where he can complain about how little he will be paid for the procedure you just spent an hour arranging. So goes clinic day in the large metropolitan US city.

Transfer the same surgical intern from the climate controlled architecture of the modern US city to a sweltering cinderblock box. Transfer to this village and its adjacent camp of refugees recovering from what the United Nations called the most brutal civil war of the ’90s. You are now in Sierra Leone, not far from the Liberian border (where another brutal civil war just officially ended), and you are once again on clinic day. Only you aren’t a surgical intern anymore, you are The Doctor and you are not here to do paperwork. There is no paper. When you arrive in the morning there are 50 starving women hovering over emaciated infants, waiting for you. They live next door in the camp, away from the relative wealth of the devastated subsistence agricultural economy in the village. They are the ones lucky enough to have walked here from the Mano River, crossing without being killed by the Liberian army or the Sierra Leonean army or the rebels or the local militia or the gangs of armed children that sprout like weeds in any country that survives a “brutal civil war.”

The cinderblock box has two rooms and you set up your pharmacy in the first. The pharmacy is donated by wellmeaning persons who gather supplies from other wellmeaning persons in the United States and other Western countries. It contains many lifesaving items like antibiotics and antimalarials and rehydration salts. It also contains many useless items like colostomy supplies and Chapstick. You set up your office in the second room—a small wooden desk, a steel basin of well water, a keg of soap, a small bag of disposable scalpels, lidocaine, a flashlight, and some gauze pads. You are not sure what you are supposed to do with any of it. The sea of rags and bones swells on the broken benches outside your room.

There is no chart. There is no referral from a primary physician. There is no primary physician. There is no diagnosis neatly packaged and ready to be checked off on the office visit face sheet. Patients file into the 6x6 room and present themselves at the tiny schoolchild’s desk behind which sits The Doctor, fresh and white and reeking of health. Sometimes the translator can help decipher what the Sierra Leonean villagers are saying, cobbling together enough Mende or Krio to get out a rough history. There are no translators for the Liberians. Individual histories are impossible to ascertain but the collective story you can guess. You have seen the empty rice sacks and corrugated tin that frames their houses. You have seen the grids of sewage that form their property lines. You have tasted the cassava pap and fetid water that keeps them (barely) alive. You have bathed yourself in designer chemicals and prophylactic antimalarials to fend off the swarms of insects that are the only creatures to have found a paradise here among the sweat and heat and excrement of so many disrupted lives. The path that most took to get to the camp can be estimated as well from the same stories we know from other brutal civil wars. Accused of being rebels by the military and accused of being military by the rebels, these particular Liberians faced a very simple choice: leave for an uncertain future in an unknown place along an unsafe route or stay and die for sure at the hands of whichever group decided first that today was the day to murder everyone in the village.

A mother walks in cradling her half-dead child in layer after layer of filthy blankets. The child wears a diaper made from a frayed dishrag and a torn plastic bag. The mother’s dark yellow eyes, stained by malaria and unrelenting dust, tell yet another story of suffering and desperation. You do not need a translator to see the fear in a young mother’s eyes, you don’t need words to make you understand that she is saying “I am hungry and sick and my child is hungry and sick and we have nothing and nowhere to go and please help us because even as miserable as this existence seems we still don’t want to die today.”

The child is on fire. The skin, marred by superinfected weeping scabies, looks shrink-wrapped around a toy-store skeleton. The muddy eyes barely move and the child doesn’t make a sound as you poke it and roll it over and squeeze the chest to appreciate the raging pneumonia. She weighs 12 pounds. Maybe 15. There is no scale and there is no one who can say her age. She does not look like she will get much older. She seems destined to become one of the 240 out of a thousand here who do not reach 1 year of age. You can treat the malaria, the worms, and the pneumonia. You can cure the scabies. You can bring down the fever. We have all these medicines and the mother will get them all today. With pantomime and broad gestures we will try to explain what to take and when. Pills for malaria crushed and taken with pap. Syrup for the fever and pneumonia. Creams to spread on the scabies. The mother will get everything we can give— from chloroquine to Chapstick. And she’ll be shuffled out and the next ghost will walk in with her half-dead baby and her malaria and her cataracts and her malnutrition.

The acutely ill patients are in some way easiest to see. Typhus and malaria can be treated. Parasites can be cured with one dose of medicine that costs less than a quarter. Diseases are easy. Life in a refugee camp is not. The children without pneumonias, the mothers without malaria, and the fathers with nothing more pathological than a lack of food are the most troubling. There is no cure for them, nothing you can pack in a bag and dole out from your makeshift pharmacy. To be a doctor here for even a day brings you face to face with the ordinary brutality of a life filled with hunger and violence and hopelessness. You are faced, too, with the insignificance of everything you have learned and forced to rethink the illusion of power you may have once felt at being able to cut someone open, fiddle around a bit, and put him back together. One day in one clinic a few kids were lucky enough to get sufficiently disinfected and sent back to their tin shacks to slug it out a little longer. A few mothers were relieved of having to watch their children die. For now.

Occasionally you might try to sneak out between patients to see what kind of dent you are making in the line of 50 that started in the morning. Clinic here is sometimes overwhelming and you hope that maybe a freak rainstorm will keep everyone away for the rest of the day. You peek out of the suffocating cinderblock room at the herd of bones, stiff and limping, littering the broken benches and spilling onto the cement floor. A hundred. A hundred fifty. They keep streaming in, dreaming that you have some magic that will make it all better, counting on their faith in The Doctor just as you have been losing yours. Off to the side, under a dying tree, in the sunbaked dust of the view from your window, you see the Liberian woman, holding on desperately to her infant with the same stained eyes, eating a tube of Chapstick.



[ September 27, 2004, 12:24 AM: Message edited by: MrSquicky ]

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Icarus
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Thank you for sharing this. I too am unable to frame much of a response, as I suspect much of Hatrack.
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Farmgirl
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I'm assuming your title is a reference to the wonderful program "Doctors without Borders"??

What your friend wrote paints a very very vivid image. I admire anyone who tries to help in a poverty-ridden nation.

I actually hope to do something similar someday -- go to another country and work for a little while -- hoping to make a difference in the life or even one or two...

Farmgirl

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Teshi
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You're right; there isn't anything to say.
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Brinestone
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Wow. Everyone should read this. I'd start a chain email, much as I hate them, except that if I did, nobody would believe it was true.
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MrSquicky
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errr...bump
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Tammy
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[Frown]
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MrSquicky
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bump
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MrSquicky
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And yet again, bump.
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twinky
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...
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Kwea
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A bump for you.
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MrSquicky
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Another friend of mine has volunteered at a infectious disease clinic in Ethiopa and he's been sending out emails from time to time. I figured, especially what with Live 8 and all, I'd share what he's shared of his experiences.
quote:
This ain't no Toto Song:

So I have been in Ethiopia for 2 nights. It has been poretty intense. I saw 20 patients in 3 hours at the HIV hospice this morning, all of whom in various stages of dying or hopeless illness. The nuns try, and they do have some meds, but we have little or no diagnostic tests. It takes several weekes to transfer a patient to the public hosptal; where they would wait for another week anyway for the tests they need. The epople heer are very kind, but I can hoinestly say that this is the poorest place I have ever been. The per capita income is $700 (this may be generous) and the dcountry would starve without cahritable contributions and NGO's to feed them. You know things are bad when there is an entire expat community who mostly work for charitable organizations rarther than real businesses.

The food is decent (mostly befcause of all the expats). For those of you who have been in Dalak at West Philadelphia, the food there is actually
relatively authentic. However, injera (the Ethiopian bread) can get old after a few days because it is so salty. I'm not sick of it yet, btu give me a week. The coffee is magnificent, and everything is cheap. getting around in Addis Abeba has been a challenge because there are NO street signs, and if the streets have names none of the locals know what they are.

quote:
I think my hotel is a brothel:

So I'm sitting on the porch of my hotel drinking a beer, minding my own business when I see this man and woman drive up in a cab. The man gets out, goes to the reception desk. He walk out a few minute slater and he and the woman go upstairs. He and then woman then come out an hour later and leave. Weird I think. This happenes a few more times over the next three days. I then ask the reception if it is possible to get a room by the hour and they answer taht it will cost app. 65 birr ($8) an hour.

This week I have seen the same guy on 2 different nights with different women. I should have known something was up when I found a box of condoms amongst the towels and soaps that were left in my room by the woman who cleans it. Apparently they expect everyone to use it, so they leave it their with the soap.

Apparently this sort of thing is common in Ethiopia, almost all of the budget hotels in addis do this to supplement their income. This place is crawling in prostitutes, I woudl say every ethiopian women in the club I went to Friday night was a prostitute. Nice.

Went hiking yesterday, should have remembered that it takes about 5-10 days to get truly acclimated to high altitude, nearly passed out on a hill. Played soccor today with the kids of Dr. Hodes, tralked them into letting me play goalie so they wouldn't have to do CPR when I had my cardiac arrest.

Also wen tback to the clinic, saw 15 patients in 2.5 hours, 2 of whom were babies. One was 6 months old and had not eaten in a week and had watery diarrhea. Looked like crap, was not really moving and was staring at me with sunken eyes. Had a sunken fontanelle too. My pediatrics attendings in med school would have been proud. I admitted her and gave her oral rehydrating salts. The other baby had an ear infection (I hope). Also saw recurring fever a few times and acute HIV. I admitted the acute HIV patient for a viral load, we'll see if thsi actually happens. Hopefulyl he will be negative and will turn out to have mono, and be scared enough to stop sleeping with the ubiquitous prostitutes in Addis Abab. Seeing children is pretty stressful, esp. since I haven't actually seen one in 3 years. They are not just little adults unfortunately.

Anyway, I'm going to get Indian food. Supposedly it is good, but you never know. I've been fooled before. The pizza has been pretty good though, but I haven't the guts to try the Chinese or Korean food yet.

quote:
Driving Miss Daisy across Africa...:

So I met these two British guys with enormous motorcycles last week. Apparently they are doing a cross continent motorcycle trip and are on their way to Johannseburg, South Africa. They started in London, took a ferry from Spain to morocco, tan drove west. They took a flight over Chad and Sudan (apparently they were not crazy enough to drive through tose two countries) to Addis Ababa, where I met them. I aksed them when they hoped to get to South Africa, I guess the plan is Christmas, though one of them admitted that is might take a few more months than that. I than met 2 more brist who were doing the same thing, though they only started in Cairo and were drive directly South. I then met an Australian doing the same trip but in reverse, he started from South Africa and was heading north to Egypt. I asked him about driving through the Sudan and he said it wasn’t a big deal (“Just follow the Nile all the way, it’s easy.”). Right. I’ve decided that I’m avoiding traveling for FUN in countries where genocide is occurring in messy, socially unacceptable ways. That leaves Sudan out I guess.

Working at the mission has gotten easier. I’ve decided I don’t see kids anymore, which has made my life much less stressful. Funny thing today, these first year med students from McGill University showed up. Talk about deer in the headlights. One of them asked me if they should be concerned about “catching” anything. I replied “do you really want to know? Because I’ve got a list. It might just be better if I don’t tell you and you just wash your hands a lot.” He didn’t seem to happy with my answer, but he should have known better.

Anyway, things are going well here. I met some nice students from George Washington medical school who showed me the ropes and put up with me for two weeks, but they have now left and I am alone. I am working on this project now, hopefully I will have everything done in two weeks at which time I can also travel. It also might not be the worst time in the world to be out of Addis since the election results will be certified July 8, hopefully people won’t go crazy. I don’t think they will, but you never know.


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ElJay
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Wow.
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romanylass
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Squick, thanks for posting these. There is not much to say except they are really moving.
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Tatiana
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That's not far away, it's right in our neighborhood. It sure makes me feel a whole lot less contentious to see what wars actually mean to people, to children, in the areas affected, you know?

We need to figure out how to arrange things so that wars don't happen anymore, and everyone has food and a reasonable chance at a peaceful life. It's something we can do, our species. We just need to work hard, with discipline and self-control, and all the knowledge we can bring to bear, and do it.

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MrSquicky
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Bump..because Irami said he didn't know any doctors who got into it for deep reasons.
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quidscribis
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I can't believe I didn't comment on these the first time I read them. Thanks for posting them, Squick.
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ketchupqueen
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My mom went on a medical mission to the Dominican Republic with her church. She brought along her pediatric nurse practitioner friend. They and the doctor (with a specialty nowhere near family practice, internal medicine, or pediatrics, the three that would have been most useful) were the only medical professionals on the trip; most of the "medical mission" for the rest of the group consisted of cleaning up the village as much as possible, rebuilding buildings, and those who were fluent in Spanish trying to teach the young mothers basic hygiene and health procedures (the Dominican Spanish wasn't the same as the school Spanish or Mexican Spanish that these mostly very young people possessed, and the curriculum that had been prepared assumed that amenities were available that weren't, such as drinkable water, toothpaste and brushes, shoes, and designated latrine areas.) Because there was no one else qualified except the doctor and her NP friend, who both had to see patients non-stop, my mom ran the pharmacy. For eleven hours a day or more, behind a table in the coat room of the one-room schoolhouse they were using for a clinic (the largest building in the village), she distributed the meager medicines they had, corrected the doctor's dosages so as not to poison the pediatric patients, and handed out vitamin supplements, toothbrushes and toothpaste, and antacids to the patients who were less in need of immediate medical attention. They saw about 150 patients a day; some had walked more than ten miles to come. In between, she ate in their homes, slept in an old military barracks, and once in a while went into the rich part of town, where she says the contrast made her sick in her heart. She came back and started giving things away; ever since she went, she feels guilty for all she has (despite all she gives and all she does without to do so.)

She's also gone to Tibet and Cuba with Operation Smile (she's an RN/OTR/PHN who runs the craniofacial clinics for Kaiser Southern California; she didn't pay for most of her trips, Kaiser paid part of it and doctors she worked with donated almost all the rest), but the DR trip was the one that affected her most profoundly; perhaps because the abject poverty was the worst she's ever seen and was in juxtaposition with such wealth, or perhaps because it coincided with the birth of her first grandchild, or both.

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Eduardo St. Elmo
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Thanks for the reality-check. Makes me want to help in any way that I can. My respect goes out to all the people who are trying to lessen the suffering in this world
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MrSquicky
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A recent post about doctors made me think about this thread. So *bump*
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Belle
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Yeah, thanks for bumping. That first post - she is an amazing writer. Not just an amazing person, but she has a writing gift.

My husband has been to Honduras twice for a medical mission - he's a paramedic, so he was the guy they saw after the doctor prescribed the drugs from their makeshift pharmacy. He dressed wounds, and gave instructions in his halting Spanish.

He had a hard time dealing with kids, who were suffering from massive infections from what in America would be tiny wound, treated at home with Neosporin, or perhaps one or two stitches in an ER. In rural Honduras, that wound can kill.

The head of the clinic he worked with was a native Honduran, who came to America to go to college, and graduated with a medical degree and specialized in infectious disease. He had multiple job offers, and could have taken a research-oriented post and provided for his family comfortably in America. Instead, he went home, to live in a cinder block house that was connected to the clinic and take no pay - he was completely supported by donations from churches in the states. He was also the pastor of the local church, and worked to provide spiritually for the people of the region as well as physically.

Now, in case you're wondering if he was a missionary first and doctor second - this is the man that told my husband that the church should do more mercy work meeting people's physical needs, because "No one will listen to your recitation of the gospel when their baby is dying in their arms."

He's no longer in Honduras, but only because he turned that operation over to another doctor and has moved on to practice in Africa.

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kmbboots
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The only appropriate response that occurs to me...

http://www.doctorswithoutborders.org/donate/

Thanks for the reminder.

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Raymond Arnold
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I cried when I read this. There was nothing here that I didn't already know. I've read/seen plenty of other stories just as powerful, but... wow. I've spent the last few weeks stressing out over intense schoolwork, financial aid, and current lack of friends. This is the most I've ever struggled in my life, and then this story just totally knocks me down. This is suffering.

The most soul-crushing thing here is the knowledge that it will always be like this. No matter how good a person I try to be, no matter how many people who are better than I am give up their lives and become The Doctor, the line of people will always be there.

I donated $10, which is what I can afford right now, hoping it would make me feel better. Maybe it did, a little, but no matter much money I could give, I can't fix it.

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kmbboots
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If more of us were moved to do even a little, it would change the world. You did something and that counts.

And $10 goes a lot further there than we might think. What is the saying? "Whoever saves one life, saves the world entire."

Don't be discouraged.

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Raymond Arnold
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I try. The article says you can cure a parasite for less than a quarter, so maybe I just saved 40 lives. Which is kinda cool. In a few days I'll have gotten over it and go back to judging myself based off of what's actually reasonable, not what I could do if I were Martin Luther King.

But until I do... man. The problems the world faces are so incredibly deep... The Doctor is treating a symptom. And when the symptoms are so horrifying that it takes someone that heroic to deal with it, how can we ever treat the disease itself?

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Strider
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The first step for any person, family, community, society to better their situation is to be healthy. This is just one piece in the puzzle, but without it nothing else is possible. If you're not healthy no amount of education or social and political stability will mean anything.
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Raymond Arnold
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But if you don't have social or political stability, being healthy can be pretty hard. (In this particular case, the whole problem, or at least the most obvious one, was that there was a civil war).
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Raymond Arnold
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(I'm not disagreeing with you, just pointing out how circular, and therefore difficult, the problem is)
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Wendybird
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Thank you for bumping this. I missed it the first few times and it was a very moving read. Someday when I have more than just barely enough to fill my gas tank I want to give to these organizations.
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Raymond Arnold
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Heh. I only have a bike right now, and I plan to keep it that as long as possible. I stopped paying attention to how much it costs, until a week ago when I was talking to people and they started complaining about it, and I was like "It's THAT much!? Holy @#$@!!"

I think the best use of donatable (which isn't a word, but I'll pretend that it is) money would be the group that gives families a live goat or cow. That provides a meaningful, permanent contribution that's better in the long run, since it provides them with continuous milk and and (assuming they get two) can provide additional offspring to sell/eat. (Writing that's a little weird for me. I'm a vegetarian but in this case I think it makes sense).

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ketchupqueen
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We did Heifer Int'l for the Hatrack donation one year. [Smile] I ask for gifts to them for presents.
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Raymond Arnold
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This essay played a pretty important role in my development as a person. Previously, I read it shortly after the Dark Knight came out, and the two pieces collectively produced a rather weird emotional crisis.

Four years later, and another Batman movie's come out, which coincides with another emotional moment. Seems like as good time as any to bump.

I will probably post about Dark Knights and Doctors and why they're particularly interesting sometime later.

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