Welcome to the mess.

My friend Jessica just returned from Honduras.  Today I got a message from her on facebook, lamenting the questions she’s been asked by people—well-meaning Americans who love her dearly and want to communicate their interest and affection but have no idea how.  It made me laugh to read her examples, that sort of painful half-laugh that you snort out because if you don’t you might just cry.  I suppose it’s funny.  I mean, it is funny, really.  The sarcastic side of me wants to respond to comments like the one poor Jessica had to endure (“Enchiladas, tacos, burritos… all Mexican food is the same”) with a really snappy response, like, “Are you an idiot?  One, they’re all pretty distinct foods; two, Mexico and Honduras are NOT THE SAME PLACE!!!”  But that’s not very nice.  I know that.  So I don’t say things like that, at least not out loud and in public.  When people ask dumb questions about Romania, I bite my tongue and come up with something kind and affirmative to say to the well-meaning, middle-aged, white man who has never left the country, and if I’m feeling bold enough I’ll correct him gently, but I certainly don’t open up and even try to explain the ways my life was changed.  I dare not try to paint pictures with my words of the spiritual moments from my time abroad.  I stick to anecdotes that are funny and interesting, that paint Romanian culture in its best possible light, and that never dig too deep.  I might comment on its political culture and history and how I feel about communism, and if you’re well-informed, we might have a good conversation.  But few people are.  Actually, few people really care.  Which is maybe okay, because it’s not like I even have adequate words to describe what happened, anyway.

My least favorite question is the one I get most often: “How was… uh… (thinking frantically for the name of the country I was in, and coming up short)… Europe?”  (Sometimes, if I’m feeling especially generous, I’ll interject “Romania” before it gets too painful.  But not always.)  I’m from the Midwest and therefore almost eternally polite, so I usually smile and say, “Wonderful.  I loved it.”  And I mean that, I really do.  But that’s so inadequate.  I don’t know what else I can say, really, to explain to you what Romania means to me, and because of the lack of words, I find myself now, almost two weeks back, all-too-often simply resorting to those same anecdotes and brief explanations.  Wonderful.  Romania was wonderful.

But in reality, to explain to you how it was, you’d need to live 20 years in my life to understand who I am.  And then you’d need to spend almost four months in Lupeni, walking up and down the road to Straja every day, lifting that heavy wooden gate from its peg and stepping over the cow pies to enter my host family’s farm.  You’d need to read the Psalms and cry out to God in your loneliness and run up the mountain in the morning fog and listen to “Born” by Over the Rhine while you drive through the cloud-shrouded mountains of Transylvania.  You’d need to talk to the old woman outside the Pentecostal church and eat shaorma from the piaţa and smile at the security guard with the gray sweater in Penny.  You’d need to meet my beloved friends there, to be welcomed into their homes with such generous hospitality, to wrack your brain for ways to show love back.  You need to go.  You need to go walk the streets of Eastern European cities and villages, learn the region’s history, understand its pain, mourn its brokenness, celebrate its triumph, love its people, work for its healing.  I’m not there yet.  I want to be.  I want to be so badly.

Which is why I also can’t really answer that other recurrent question: “Is it good to be home?”  I suppose so.  It’s nice to be in Iowa for the holidays, for sure.  It’s nice to be surrounded by familiar traditions—it wouldn’t feel like Christmas otherwise, and I think it’s probably good to have that comfortable familiarity right now.  But honestly?  I’m not really at home, so I can’t say it’s good to be here.  I love being with my family, and there are some things that are really nice about being back in the States, but it no longer feels like home.  Not fully.  Calvin doesn’t either.  It’s a good thing that God has already told us that our home is nowhere on earth, or I’d be really lost and confused.  I am a bit anyway.  But I can deal with it, as long as I keep looking for the kingdom of heaven.  I hope.

I’ve made a lot of interesting observations about American culture since coming back.  (Well, they’re interesting to me anyway… haha).  Don De Graaf, the study abroad guru at Calvin, told me I should write them down.  I probably will, one of these days, but for now I’m just going to leave this post unedited, in all of its somewhat-grumpy confusion.  Welcome to the world of Kelly’s muddled mind.  I’m okay with the mess, though.  At least it’s honest.

And I choose to love, and I choose to seek God, even in the midst of it.  That’s all I can see to do… so I will.

Se încheie bine.

"You get a strange feeling when you're about to leave a place...like you'll not only miss the people you love, but you'll miss the person you are now at this time and this place, because you'll never be this way ever again."

[Azar Nafisi, Reading Lolita in Tehran]

It’s hard to believe this is the end.

Funny, because a few months ago, there were days I thought tonight would never come.  But now here it is—the night before we leave Romania.  I’m sitting on the floor of the hotel room I’m sharing with Kadie, listening to Romanian Christmas music and trying to gather my thoughts (and my stuff, but I don’t want to talk about packing. Grr, I hate packing). 

When I think about the semester, my memories are scattered and too numerous to count.  There are so many moments I don’t ever want to forget, scenes and places and people whose faces are imprinted in my mind, who already seem a life apart, in some ways, and who in other ways seem so alive and near that I can’t imagine not seeing them again. 

Well, not seeing them again for a while.  Maybe I’ll return to Romania.

Oh dear God, I hope so.

Right now, I don’t want to write about leaving.  I’m going to write about this weekend in Bucharest (it’s Bucureşti in Romanian) instead.  It’s been a memorable one, that’s for sure…

We left Friday at about noon from Lupeni.  I went on one last run up Straja Road early Friday morning, which was good for my mental and spiritual health but bad for the state of my packing… it was pouring rain all morning, and I was absolutely drenched by the time I got back.  (This also, by the way, resulted in the disapproving glares of many Romanian grandmothers, who shook their heads in frustration at my ignorance, walking outside in the rain without proper clothing… I might miss the over-protectiveness of the elderly population once I return to the States!)  Anyway, I quickly had to try to dry my running clothes with fans and radiators so I could pack them, while in the meantime Julie hastily finished packing and Marit and I cleaned Apartment Lucy.  (Which also was quite a fiasco, since when Marit tried to pull the trash bag out of the can, the bag broke and spilled all over the kitchen floor… ewwwwwwwww!  Coffee grounds plus squash soup plus a moldy pomegranate plus an old pair of shoes plus clementine peels plus various other delights… mmm… we burst out laughing and cleaned it up.  If we hadn’t laughed we might have cursed.  It was gross.)

Eventually the Bates family arrived and we somehow dragged our enormous suitcases down Lucy’s dank stairwell and loaded up the vans.  Tibi, Alice, and Lindsey came to see us off.  (And the couple who own ‘Te Quiero,’ the little snack shack at the base of Lucy…)  Goodbyes suck.  But I’m not focusing on goodbyes yet, remember?  So moving on.  I rode with Brandi and her two kids, Briana and Gabe.  It was really delightful, actually—I remember the same ride, the opposite direction, at the beginning of the semester, sitting in the car with Brandi and Briana and Gabe and Kadie, when Gabe was teething and crying the whole time… that one was pretty tiring.  This one was great.  Brandi and I talked for most of the trip to Bucureşti, and it was so lovely.  Thank You, God, for gentle spirits and friendship!

Bucureşti is the capital of Romania, but it doesn’t really feel much like a capital city to me.  Granted, in three days here we certainly haven’t seen it all, but I haven’t yet seen a really modern district of the city or anything.  I kinda like it.  The weather has been awful—rain on Friday while we drove, downpour all day Saturday, and cold and gloomy today… maybe Romania’s just mourning that we’re leaving.  (Haha.)  But it’s been fun to explore Bucureşti a bit—Kadie’s friend Graciela has been showing us around, which has been such a joy.  And the time here has been a good way to say goodbye to Romania piece-by-piece—first by leaving the place and some of the people who we’ve come love; then gradually by leaving all the people we love here; then finally the country itself.  Perhaps this gradual goodbye makes it easier.

Aaah, I’m talking about goodbyes again!

OK.  Saturday.  We went to the People’s Palace, which is this ridiculously large administrative building Ceauşescu constructed in the center of Bucureşti (the second largest in the world, in fact).  It’s… enormous.  There are 12 stories above ground, and are supposed to be 8 underground as well, but only four are completed.  The building boasts a million cubic meters of Transylvanian marble, and it’s put to good use—the construction is absolutely gorgeous (albeit rather strange—700 different Romanian architects collaborated on the project, so the design is often criticized for having no real architectural style).  But since I know nothing about architecture, I simply enjoyed the building in all its splendor.  Because it really is spectacular.

The problem with the splendor, of course, is what’s behind it.  To build the People’s Palace, Ceauşescu razed 1/5 of the historic city center to the ground.  Bucureşti, once the “Paris of Eastern Europe,” had really fallen into disrepair after WWII, and Ceauşescu wanted to rebuild some of its former glory—but in his image.  (He had visited North Korea in 1972 and came back enamored with the idea of a personality cult like Kim Il-Sung’s… it was bad news.)  So, about 40,000 people were forced out of their homes, and huge parts of the city’s history and culture were destroyed.  Construction started in 1983 on this massive project in the city center, which also included a huge boulevard meant to outshine the Champs-Elysees of Paris (by being a meter wider and six meters longer).  The building wasn’t completed yet by the time of Ceauşescu’s execution in 1989, despite work crews laboring around the clock, seven days a week.  Part of the reason for the delay might be Ceauşescu’s penchant for changing his mind—apparently he’d stop by the construction site and decide that he wanted the stairs a different height, etc., so all sorts of arbitrary changes were made over and over and over again.  Obnoxious.  The more troubling legacy of the building, however, is that at the same time as Ceauşescu was building the most extravagant project he could dream of, most of his people were starving.  So much for the building’s original name—“House of the People” is the English translation.  Yeah right.

Because it was still pouring rain when we left the People’s Palace, we changed plans a bit.  We stopped at Revolution Square—the place where Ceauşescu gave his last speech in December of 1989—and then headed across the street to an amazing art museum, where we spent hours looking at art from all over Romania (I love the work of Nicolae Grigorescu, by the way… love, love, love).  We got soaked again on the way to dinner, but were allowed into the restaurant anyway, even though we looked like drowned rats… and then on the way back to the hotel, were drenched yet again.  It was definitely a memorable day.

This morning dawned dry, though still dark and gloomy.  We went to an international church, which was wonderful, and after the service grabbed a quick lunch and headed over to the rock gym where Graciela’s brother works.  (Her brother is the Balkans champion in bouldering, by the way… so I was rather nervous to meet him.)  It was sweet.  I’d never bouldered before, and I loved it.  I’m not great at it, and I’m definitely not strong enough to be really good… but I loved it.  Oh, good times.  After a few hours at the gym, we headed back to the hotel to primp quickly before our goodbye dinner with Kadie, Graciela, and the Bates family at this gorgeous downtown restaurant (Caru’ cu Bere… check it out… crazy, huh?). 

After dinner, we wandered around a park downtown for a while, enjoying the Christmas lights strung all over the city.  Bucureşti is really beautiful at Christmas time—there’s no snow here right now, but the lights are spectacular.  It was so festive—the park was filled with couples and friends strolling around, buying food and drink and crafts and Christmas gifts from lighted booths lining the path, the lights twinkling on a giant Christmas tree in the center… lovely.  We stopped and began singing a Christmas carol together, just softly, because we were so filled with Christmas spirit (or something)… and suddenly, we were stopped by a reporter and a cameraman, who approached us and asked us to sing for them.  We were shocked.  So once we stopped laughing, we agreed, and sang a couple carols for the TV crew (and the rapidly-growing little crowd accumulating behind them), and then were briefly interviewed (we were sure to mention the Fundaţia, just in case we got air time… haha).  It was hilarious.  I never would have expected our last night in Romania to end up potentially getting us on the news…  (We didn’t make the cut, by the way… we watched it at midnight.  No Romanian fame for us.)

Funny.  Altogether, a great weekend.  And now?  It’s after 2:30 AM, and I should have been in bed hours ago, but I can never sleep the night before traveling, so instead, you get a long and rambling blog post.  Sorry to all who read this.  It’s late.  I’m a little drained.

But excited.  Because although the words at the beginning of this post are true, so is the promise God has made to His people over and over again: that He is with us, so we need not be afraid.  I’ve been listening incessantly to an Advent song that encapsulates all my emotions pretty perfectly right now: “Follow the Shepherd Home” by Mindy Smith.  Look it up.  For now, I cling to this promise: that the God who has been faithful to His people for thousands of years, and who has brought me faithfully to and from countries around the world this year, and who brought me through this semester, and who has promised to be faithful to his people forever… I cling desperately to the promise that God will also be faithful in this return to the States, and that I need not be afraid.  And so?  Hai să mergem.  Onward.  To new adventures.  Through new open doors, to new blank pages.  Because God is still writing this story.

When my paper heart’s in a frantic wind

And I feel I’m all alone

My whisper is heard when I call out to Him

And I follow the shepherd home

All the burdens weighing on my back

Aren’t so heavy after all

Faith is knowing, you need to only ask

You can follow the shepherd home

You can follow the shepherd home

When struggles come like they tend to do

I hope still I will not run

I will draw my strength from the well above

And I’ll follow the shepherd home

All the burdens weighing on my back

Aren’t so heavy after all

Faith is knowing, you need to only ask

You can follow the shepherd home

You can follow the shepherd home

When my bones are tired and I’m near the end

I will know I’m not alone

My whisper is heard when I call out to Him

And I’ll follow the shepherd home

All the burdens weighing on my back

Aren’t so heavy after all

Faith is knowing, you need to only ask

You can follow the shepherd home

You can follow the shepherd home

You can follow the shepherd home

You can follow the shepherd home.

[Mindy Smith]

Ahem, charity.

The other day at IMPACT we went downstairs to sort through these boxes of charitable donations brought to Lupeni by a German group of philanthropists.  The point was to create boxes of gifts to give to the neediest families in Lupeni--so I was looking, for example, for clothes and toys suitable for a mom and two little boys, ages two and five.  Easy, right?

Wrong.

I understand the good intentions of the German group.  I do appreciate their generosity, and the selfless service of driving all the way to Romania from Germany towing trailers full of clothes.  But honestly?  Most of it was, well, junk.

And I just couldn't help but wonder... what sort of love is this?  Now the IMPACT building is full of boxes of clothes, most of them out-of-style cast-offs of the 90's, which kind and well-meaning Germans have sent to Romania in an attempt to be nice.  Little do they know that Lupeni is full of second-hand shops where even the poorest of the poor can buy plenty of clothes.  Little do they know that what the people of Lupeni really need is a way to control the population of stray dogs that periodically attack people and roam the streets in packs, or a way to get the corrupt mayor out of office and replace him with somebody who will be held accountable by the public, or better training in medical ethics in the hospital so mothers won't be forced to bribe their doctors and nurses to get a C-section when it's vitally necessary.  I could go on.  I appreciate their attempt at love.  I don't mean to knock the German group.  I'm sure plenty of my own well-meaning actions have been just as naive.  I just wonder... what do we do when charity is so misguided?

Coming unhinged.

Jack sent me this quote.  It's perfect.  This has been the fact of my semester--this coming unhinged to the place where, right now, I am completely and totally head-over-heels for Romania and the people here.  I don't really want to leave that.  But I guess that's the bittersweet beauty of loving people in more than one place, eh?

Anyway.  Enjoy.  (Thanks, Jack.)

"A sweet shame comes over them, not a bitter remorse but more like the shame one feels when falling in love. The visitors feel themselves losing their grip; or better, they feel the world losing its grip on them. What world? The world made up of important people like them and unimportant people like their hosts. As the poet Yeats says, "Things fall apart;" the visitors' world is coming unhinged. They feel resistance, naturally, to a current that threatens to sweep them out of control. They feel a little confused--again--like the disorientation of falling in love. In fact, that is what is happening, a kind of falling in love. The earth trembles. My horizon is opening up. I'm on unfamiliar ground, entering a richer, more real world."

[Dean Brackley]

All hot and bothered.

I finished my paper for Sustainable and Human Development this morning.  It's gotten me all worked up.  I'd include it here, but it's long, so I'll spare you the agony of reading through it... though if you'd like to see it, just email me and let me know; I'd love to share it (not because I think I'm all that eloquent or anything, but because the research in it is troubling).  However, if you're curious, just take a look at these two sites: one's a good overview of the US budget and humanitarian aid spending; the other shows the proposed federal budget for 2011 and relative spending in various areas.  (By the way, did you know that economists predict the war in Iraq costing $1.3 trillion dollars by the time it's over?  Do you know how much less it would take to feed everyone in the world?)  Grr.

Snowed in.

We’re snowed in on top of Straja!!!!!!!!

I would put in even more exclamation marks to capture how happy this makes me, but that might get obnoxious to read, so I’ll resist.  But rest assured that I am more than just a little excited about this turn of events.  Before I tell you the exciting snow stories, though (and put up some pictures), a brief recap of recent events.

I haven’t written much lately.  We’re entering our final full week in Romania (aaaahh!) and I’ve been trying to spend as much time living as possible (which means as little time as possible on my computer).  Classes are wrapping up, with four papers due this week instead of final exams, and on Friday we leave Lupeni for a few days in Bucureşti before we fly back to the States.  It’s weird to be this close to the end.  I try to imagine what it’ll be like to be sitting in my parents’ kitchen in nine days, and I simply can’t—the worlds are too far apart right now.  Please pray for my transition.  I’m not sure how I’m going to handle the reverse culture shock.

But anyway.  This Thursday we celebrated Thanksgiving out at the Bates’ house, which was lovely—so much delicious food (I even got to eat stuffing, hooray!  …I’m kinda a stuffing freak), a beautiful little hike to a gorgeous view of Lupeni… really, a comfortable and homey afternoon.  Thursday evening we drove up to Straja (the ski mountain above Lupeni where Viaţa is held in the summertime) to stay at the Fundaţia cabana for a couple days.  We intended to leave on Saturday evening, but it’s been snowing almost nonstop since we’ve arrived, so the road down the mountain was too treacherous to drive last night.  So we’re still here!  And it’s glorious.

I’ll try to demonstrate with a few pictures how beautiful it is up here, but there’s no way to capture it.  Last night as Julie and I came back from our hike (more about that in a second), we stopped and stood in silence, just feeling it—the icy wind on our frozen cheeks, the scent of chimney smoke and evergreens, the sound of Romanian radio from ski cabanas whispering faintly in the wind, the firmness of the snow-covered ground beneath our feet, the dark of the sky punctuated by familiar constellations, the Jiu Valley scattered with town lights like fallen stars or spilled golden glitter, the silhouettes of mountains stretching into the distance in a 360-degree panorama… I can still feel myself atop that mountain.  It’s beautiful here.  I don’t want to leave this.

 The stations of the cross end at the top of Straja

Ski lifts run up and down the peak

The church atop Straja

Straja, looking down toward Lupeni

Yesterday in the afternoon we decided to go outside and play for a while (to burn off some of our energy… most of us had been writing papers all day).  We bundled up and started climbing the mountain towards the big cross which sits above the Straja church.  Julie and I found a tree to climb on the way, but eventually we all made it to the cross… and promptly started a snowball fight/wrestling match.  I bowed out for a while to take pictures, and they’re hilarious.  (I really love these people! …even if they wrestle me to the ground and shove snow in my face.)  Eventually we calmed down and kept walking, finding this path winding into the forest.  It was beautiful—huge, tall evergreens, their boughs heavy with snow, laced overhead as we walked underneath… gorgeous.  Eventually the path ended at another ski slope, this one significantly steeper than the earlier ones we’d seen—so of course, Julie and I look at each other and decide to climb it.  The others bowed out, saying they didn’t think we’d make it to the peak by dark, but we headed up anyway. 

The view partway up

It might have been one of the more foolish things I’ve ever done, but it was completely worth it.  They were right; we couldn’t make it to the top by dark (it’s hard to make good time when the snow comes up to mid-thigh and the angle’s often steeper than 45 degrees).  But it was fun.  Julie… uh… well, she doesn’t have very good balance, so we stopped a lot for her to return herself to right-side-up, but that was fine—it was a good opportunity to check out the view, which just got better and better the higher we climbed.

The lights of the Jiu Valley, far below.

Eventually, though, it got dark.  We were at the tree line and decided we should probably listen to the voice of reason and head back down to the cabana, to prevent the others from worrying if nothing else.  But we didn’t think we’d be able to make it back the way we came safely, so instead we decided to cross a ridge of snow and head down the other face of the mountain (which was a more direct shot to Straja anyway).  It was a good idea.  Mostly.  The wind hit us as soon as we were over the ridge (which was, by the way, simply a cliff of snow about eight feet high).  It had swept some of the snow away so that portions of the mountain were now shallower (maybe 6 inches of snow, which was great); however, the wind had also created a thick crust on the snow in other parts, hard enough to make it difficult to break through but not hard enough to support our weight—so it was exhausting, pounding our legs into three-foot-deep snow, jolting through the crust and sinking deep with each step.  Occasionally we would army crawl (or, in Julie’s case, roll) instead, because then our weight was more evenly distributed and we wouldn’t break through the crust… but then the crust would get thinner and we’d find ourselves nose-diving into the powder, so we’d scramble to our feet and begin stomping again.  It was awesome.

OK, it was cold.  And once it was dark my imagination did wonder if there were still wolves and bears and dogs in these woods like there are on the other mountains surrounding Lupeni.  But hey, it added to the experience… I felt like we were exploring Everest or something.  Seriously, I might want to start climbing snowy mountains more often.  It makes you feel so alive!

Me and Julie... mountain explorers!

We eventually returned, snowy and frozen, to the cabana and spent the evening talking, playing games, watching a movie, and finishing up a couple papers.  It’s started snowing again, so I’m not sure what the plan is for today… but I’m sure we’ll get down to Lupeni somehow.  They’ve got the telescaun (chairlift) running, so maybe that’ll be our strategy…

Dragoste.

I have a lot of things to write about, especially about a magnificent weekend in Iaşi, but I don’t have time tonight.  I need to catch up on sleep.  However, I just finished my homework for Eastern Orthodoxy—our reading was on the “positive praxis” of all the theology our textbook (The Spirituality of the Christian East by Tomaš Špidlík) has thus far entailed.  And some of the quotes struck with me poignantly—I wrote them in my journal—so I wanted to share them here, too.  Enjoy.  Chew.

“The perfection of the Christian life resides in charity [love].”  (Thomas Aquinas)

“We were created to love, because we are ‘children of love’.”  (the Epistle of Barnabas)

“Apart from the love of God, neither knowledge, nor the understanding of mysteries, nor faith nor prophecy avails anything—without love all are hollow and vain.”  (Irenaeus)

“God’s love cannot be ‘a desire for His own perfection,’ the Platonic eros.  Divine agape is a super-abundance.  The Father in heaven does not seek a more that would fill Him; on the contrary, He wants to open His own treasures.”

“Love of God is not something that is taught; it is within us as a basic desire, a predisposition, a seed…. All progress in love thereby creates life…. Love is the ‘queen of virtues.’  We are not impelled to it automatically, but it is of our free choice, which is the foundation of every virtue.”  (Basil)

“To love God for God’s sake also means to choose the entire work of God, to love all of creation and the marvelous order that reigns in it, that is, to observe the commandments, especially the second, which consists in loving one’s neighbor.  It is impossible, Maximus the Confessor says, really to love God without loving our neighbor, or really to love our neighbor without loving God.  And it is this inseparable union of the two loves which makes it possible for us to love with an agape that expects no reward, with a love that goes out to the another: ‘For I was hungry and you gave me food…. Lord, when did we see you hungry and feed you?  I tell you solemnly, in so far as you did this to the least of these brothers of mine, you did it to me’ (Matthew 25:35-40).  Therefore, ‘The task of love is to behave towards every person bearing God’s image, almost as it does towards the Prototype'.”

Tuberculosis in Romania.

I thought tuberculosis had disappeared.

Honestly, seriously, I thought it was one of those diseases that was from the era of Ellis Island—one of those illnesses that would get your coat marked with chalk as you waited in line to enter America after a couple months at sea, one of those sicknesses that made you unfit for entry into the country for fear of a public health crisis.  I thought it was a disease only of the past, of the era of the plague and smallpox and yellow fever.  I thought it was eradicated.

It’s not.

Last week, a Ph.D. student from New York, Jonathan Stillo, came to our sustainable development class and delivered a lecture that’s still making my head spin.  He’s been studying tuberculosis (TB) in Romania for his doctoral dissertation as a medical anthropologist, and thus has been in and out of the country for the last decade, spending time at sanatoria across the country, talking to patients and doctors, learning more about the epidemic which is wracking lungs across Romania—an epidemic that no one will talk about.

There are about a dozen sanatoria in Romania, most of them remote, isolated from society atop mountains “beyond the sight of God.”  Jonathan described the road to one particular treatment center as treacherous, filled with potholes, impassable in the winter, winding in a series of wicked switchbacks up the side of mountains inhabited by bears but not by people.  Most of the people who work there live there—it’s impractical, if not impossible, to commute.  Few patients get visitors.  There’s only one maxi-taxi a day, and it’s expensive.  Plus, who’s going to spend a full day traveling up a mountain to visit a place full of patients with a disease that no one wants to admit they have?

Tuberculosis is a social disease.  There are economic and social conditions that predispose you to getting it—namely, poverty.  Malnourishment, overcrowding, high stress: all conditions of poverty.  All of them also will reduce your body’s ability to fight off TB.  So tuberculosis is a disease of the poor—but it’s not only a disease of the poor.  It’s highly contagious (so contagious that if you’re found to have TB in the United States, you will be locked in a hospital for months until you can’t pass it on), so rich people can get it too.  Back in the States, that’s less common—but in Romania, many of the patients at the sanatoria are taxi drivers, nurses, teachers, lawyers.  Not people in poverty.

We’d read Mountains Beyond Mountains in preparation for the class, a great book by Tracy Kidder about a medical doctor and anthropologist named Paul Farmer who’s doing great work with tuberculosis in Haiti (and all over the world, but for the sake of simplicity, we’ll leave it there).  Farmer’s inspirational.  The book will make you angry, and make you sad, and probably make you feel guilty—and that’s as it should, because he gets it.  He cautions against the “immodest claims of causality” that anthropologists like to make—those exotic cultural habits that make foreigners seem ignorant, seem like the cause of their own problems.  He does more than caution, actually—he fiercely berates that practice, calling it ignorance in its own right.  Instead, he reminds us, there are political, economic, and social realities that are the real problem behind global health epidemics and poverty.  These are the real issues.  And it’s our duty to amend them.  It is our responsibility to create a “preferential option for the poor.”

And he’s right.  Looking at Romania (especially while living here) my heart jumps to my throat and I wish, for a while, that I was pre-med.  I want to help, you know?  I want to go to the sanatorium, to the hospitals, be a doctor who’s not corrupt, nurse people back to good health.  But that’s not my place.  That’s not my calling.  I’m an international relations major.  I have a good, solid understanding of the role of politics and economics and sociology, and the ways those things affect poverty and health and, ultimately, human life.  (Or at least, I hope that’s the understanding I’m developing!)  And that matters too.  It matters a lot, actually.  Let me try to explain.

Health outcomes in Romania are the lowest of any country in Eastern Europe.  They have the lowest life expectancy, higher rates of tuberculosis, etc.  But, Romania also spends only about three percent of its GDP on healthcare, which is clearly not enough.  In this case, you get what you pay for… which is minimal.  Although under communism, countless hospitals and clinics were built across the country, they’ve fallen apart, many of them dilapidated and under-staffed.  Doctors don’t get paid enough here.  It’s only going to get worse, with the financial strain of IMF policy causing a 25% cut in pay throughout the public sector—so the corruption that’s already prevalent in the medical system is only going to increase, as doctors still need to feed their families.  People here don’t go to the doctor if they can help it—they go six times less often than people in the Czech Republic, another former socialist country that’s fared a lot better financially in the years of recovery from communism.  And if they do go, it’s usually not until late—until the symptoms have become unbearable, and they’re suddenly coughing up blood. 

No one wants to hear that they’re sick.  But especially, no one wants to hear they have TB—and especially not in Romania.  There’s a huge social stigma against it here.  Many people will describe it as a “lung disease” rather than name it.  They’ll blame the coughing on years of smoking, and they’ll try to hide their symptoms, rather than seek treatment—even though TB treatment in Romania is free.  Better to hide it than to face being ostracized by the community, anyway—because that does sometimes happen.

But when people finally are diagnosed and given treatment, a new set of issues emerges.  First of all, there’s the issue of the treatment itself.  Sometimes there will be a shortage of drugs in Romania, often for unknown reasons.  Simple miscommunication or corruption, perhaps, but regardless, it disrupts patients’ treatment cycles and makes the already-awful side effects even harder to deal with.  Tuberculosis treatment (especially under the World Health Organization’s DOTS program) is extremely regimented, with big handfuls of pills every day for months on end.  If it’s missed, the bacteria—which is highly evolved, since tuberculosis is the oldest disease known to man—quickly evolves into a drug-resistant strain.  Most MDR (multi-drug resistant) strains are almost impossible to cure, involving long-term treatments with expensive drugs that produce terrible and frightening side effects.  But MDR-TB is becoming more and more common, especially as the first round of treatment options fails on patients due to such simple causes as an interruption in the drug supply.

But there are other issues involved in treatment as well.  Sanatoria, a seemingly-outdated method of care for infectious diseases like TB, fill a social welfare role in Romania that increases the difficulty of really helping and healing patients.  There really aren’t homeless shelters or nursing homes here, and many of the patients who, in the States, would be serviced by such places, are left without options in Romania.  Some patients will skip drugs on purpose to set themselves back in their treatment, because they know that if they leave the sanatorium, they have nowhere to go.  It’s not fiscally responsible at all to keep treating these patients in sanatoria—they’re high-cost centers, far less economically efficient than a nursing home would be.  But because none of those social services exist, doctors keep patients longer.  In the words of one such doctor, it would be ‘against her Hippocratic oath to ‘do no harm’ to let the patient leave’ without having a strong support network in place—and that’s often entirely lacking.

The issues go on and on.  It’s a troubling issue, full of nuance, but also—in the eyes of people like Paul Farmer and Jonathan Stillo—strikingly black and white.  People are sick?  Treat them.  It costs too much money?  Treat them anyway. 

But the root causes remain unsolved.  Thankfully, Jonathan agrees with Farmer: to merely study the epidemic and do nothing about it would be futile—in fact, it would be wrong.  Observation alone is impotent.  Documentation isn’t the point.  From objectivity we’ve got to move to activism, to taking the step of asking how to better the situation.  I don’t want to end this post on a cheesy note, but I do want you—whoever you are, reading this—to think about it.  If nothing else, read Mountains Beyond Mountains.  Begin thinking about how to control Adam Smith’s invisible hand.  Begin thinking about liberation theology.  Begin thinking about the issues of development, of the troubling connection between a 41% poverty rate in Romania in 2001 and a skyrocketing TB rate here in 2003.  Begin thinking about the fact that over 60% of the patients in the sanatoria never receive a visitor.  Begin thinking.  And let it move you to action.