Running in Lima: Loving baby Jesus

      
            LIMA, Peru – Here, when I run, I cross myself.

It’s not the danger of getting more blood clots in my legs (although that will worry me for quite some time). It’s not the fear of getting hit by a car. It’s not the pollution. Rather, it’s the number of Jesus statues and Nativity scenes everywhere.

Fifteen days after Christmas, Christmas is going strong in Lima.

The Christmas lights are still strung all over this vast city, up and down palm trees, on light poles, on hotel fronts, on city signs, and, of course, around all the manger scenes – the thousands of manger scenes, most of them with flashing colored lights forming an unnatural border.

The truth is, there is no greater love here than the love for baby Jesus, and I saw that firsthand over the weekend at the National Children’s Hospital, where outside the children’s tuberculosis ward over the weekend the staff held their traditional (and sad) ceremony to take down the manger.

They called out for everyone on the ward to witness the scene. Children with TB who could walk came out. The staff and their children filed around. Doctors, nurses, and family members all gathered around. 

Two things happened. One was that everyone was invited to take out one of the 300 figures in the manger scene (from tiny lambs to large cows to the very heavy statues of Mary and Joseph) and then to put a coin in a collection box.

The second was that the baby Jesus could not just be simply packed away.

No, baby Jesus would linger outside the cardboard box that held all the other figures. He was passed from nurse to nurse, child to child, doctor to doctor. The nurses, though, didn’t want to let him go. They cradled him in their arms like he was the baby Jesus, kissing him on the forehead, whispering words of prayer, squeezing him to their bosoms, some shedding tears, and ever so reluctantly and carefully passing the baby to another’s arms, and the whole loving baby Jesus started over again. I stood in awe.

            I know this is a running blog. And I’ll write about the running in Lima in the next post. For now, the reverence for the meaning of the season, the birth of Jesus, is more than enough for me. I don’t think I’ll look at a manger scene the same ever again.

Rangeley, Maine: ‘All my pores are open’

For the last several Christmas breaks, we’ve traveled to Peaks Island, Maine, off Portland, for a pre-Christmas stop with my parents and then driven with them to the northern Maine town of Rangeley. Rangeley is home not only to Saddleback ski area, but it also has many other small-town charms, including a great ice skating pond in the middle of town and a great sledding hill in the middle of a golf course.

I haven’t been running much since I had an episode of deep-vein thrombosis after a long flight to Manila in mid-November, but, now cleared by doctors to exercise on all sports that don’t include the risk of head injury (there goes downhill skiing), I’ve been slowly building back.

This morning, I checked the local Rangeley map and found a route along the Harold Ross Road, named after the legendary New Yorker editor who had the good sense to hire E.B. White. I admit to running slowly before reaching Harold Ross Road; to get there I had to run a good three-quarters of a mile along the Saddleback access road, and it was steep, befitting the beginnings of a good mountain road.

But once I reached the turnoff, I relaxed and fell into a steady rhythm. It had snowed an inch or two overnight and that made for the best type of winter running. I had soft landings. My footfalls were almost silent, save for a slightly squeaky land and push-off. The north wind pushed me south.

I registered only a few things along the way: some street signs – my favorite was Stub and Luraine’s Lane -- and also animal tracks. The deeper I ran down Harold Ross, the greater the number of tracks. I was running on a deserted road as well as an animal highway.

The most common track was moose. I stopped and put my running shoe next to a hoof print, and the hoof was significantly longer than my shoe, probably a size 12 man’s. I paced off the distance between prints, and one stretched five feet. I started out again and ran along the ridge, up and down, over streams, and pass pine wood, looking for but not finding moose.

Fifty-five minutes after my start, I returned back to our rented house on Rangeley Lake, called Windy Cross, perhaps because of the wind and also all the crosses in the house. I found my father, Mike. I had tried to persuade him the night before to go into the hot tub next to the house, and he had demurred, saying “let’s wait until morning.”

He was carrying bags to his car, getting ready to return home with my mother, Mary.

“Want to go in the hot tub, Dad?”

“Sure!” he said.

Five minutes later, we opened the hot tub and stripped down to our shorts. Barefoot, we made the short walk across snow and ice before submerging in the warm water. It was wonderful. (Check out the video.) Afterward, I asked my father how he felt and he said, “All my pores are open.”

How does that feel?

“I am feeling generous and benign,” he said.

We laughed, and he and I understood exactly what he meant. All is good.

Estonia: Running in the deep dark

During winter, I often run on weekdays in the dark. For the past few days in Estonia, in the far Baltic north, I’ve been running not in the dark but the deep dark. Night here in mid-December stretches for close to 17 hours; the sun sinks by 3:30 p.m.

Maybe it’s all in my head, but when I set off at 6:45, as I have in the last few days, it feels like late in the night, not early in the morning. The sun won’t rise until after 9 a.m. So when I set off, there’s no dawn peeking around the corner.

I’m in the university town of Tartu, and it feels very European. Fanciful truffles are in the windows of shops. Women wear thigh-length wool coats and knee-high black boots, brightly colored scarves knotted around their necks. Men, hair stringy, rush by in suits, scarves, cigarettes between their fingers.  They all watch their steps along the narrow cobblestone streets of Old Town or along the bridges that are for pedestrians not cars. Christmas lights are everywhere, strung up on lamp posts and bridge posts and high in the air above Town Square.

The Christmas lights don’t only raise holiday spirits, but they also raise spirits, period, it seems. They provide light. This morning, I ran underneath a string of holiday lights along the Mother River and up and over an impressive pedestrian bridge, passed by a few bikers wearing winter coats and scarves that flew behind them, flapping in the breeze. Then I headed along the river again on a long stretch of blackness.

When it’s dark, I often feel a lightness of being. I’m concentrating on not falling and I watch the ground for holes or humps. I’m not thinking. That is freeing mentally and sometimes, when my pace is just right, I can run for a mile or two and not realize it. Night makes you feel invisible. Night also makes others invisible, of course, which can be a problem. But when you see an occasional person, and when it's exceptionally cold (as it is in Tartu), and when wind is cutting across your stride, it is possible to relax into a rhythm and lose yourself.

On the run this morning, I retreated into this zombie-state and only snapped out of it when I looked up the sky and saw light. It was limited to a large circle in a bank of low-lying clouds. I couldn’t figure it out at first. But then it dawned on me that the lights from the street, Christmas decorations, and a nearby mall had reflected upon the clouds. It reminded me of one of those spaceship movies in which the scene is all black until shafts of light reach to the ground. Only in Tartu, the direction of the light is up, not down.

I don’t know why, but the scene almost made me laugh. It was entirely a man-made phenomenon, and it seemed a rare one. I thought to myself it’s not often on a run when you think of nothing in the dark and then you look up and think of spaceships.

First run

I missed running. I didn’t know how much until now. I’m just back from a run, my first in 24 days. On my last run, I had to stop after three minutes. I could barely breathe. Days later, I learned that I had blood clots in my legs and my chest. I stayed in a hospital for three days and left with a pile of blood thinner medication and the words of a doctor not to exercise for a while.

So that stopped me. It stopped me not only from physically exerting myself but it also stopped me from thinking about running. I put it all out of my mind. I focused on my legs, my heart, my breathing, making sure I did a kind of internal body check-up several times a day. Everything was stripped back to the basics of being able to live.

My run today, then, is a step back to reclaiming something lost, or maybe even it is reclaiming my life. I didn’t have a euphoric moment. I ran for 25 minutes. I ran slower than normal, half the distance of my short daily run, consciously checking on my breathing. Was I breathing too hard? Was my chest contracting? Was that slight pain in my leg a sore muscle?

But when I finished, I felt a trickle of sweat twist and turn from under my running jacket and flow down my right thumb. I opened the door of our house and called for our dog, Juluka, and she knew what that meant; she shook her nine-year-old legs and bounded out the door. I ran around the block with her, tossing a tennis ball ahead of us so that on first bounce she could leap and snare it, and she did, again and again.

We stopped in an open area under pine trees. I stretched. I felt the aches of calves, of my lower back, of my shoulders. My hair was damp at the edges. Then I walked back into our house, took off my running jacket (which was wet on the sleeves), fed the dog, boiled water for black tea, and thought for a moment about how the pieces of a carefully constructed life are coming back. I really missed running.

I live, she dies: Access to quality health care

(A version of this blog appeared in Global Post)          

I am thankful this season for good health care, and yet I am sad that many don’t have it. Here’s why.

            Three weeks ago, I flew to Manila, stayed a week, and then flew back to Washington, D.C. My calves felt extraordinarily tight during the whole trip, and when I went running one day in Manila I had to stop every three or four minutes. I have run marathons, but I couldn’t breathe after three blocks. (And that's where I left things in my last blog post. See below.)

            Back in Washington, I walked up three flights of stairs and again had to stop to catch my breath. I knew something was wrong so I opened my computer and typed in Google: “calf pain + shortness of breath + long flights.” Google told me what I feared: deep vein thrombosis, or dangerous blood clots that could migrate to my lungs and possibly kill me.

I drove myself to an emergency room, where 15 minutes later a technician using ultrasound found two clots in my leg; a doctor told me the clots were also almost surely in my chest. A nurse injected me with blood thinner, and after a few days in the hospital, I am now out of danger. I left for home and now recuperating.

            I am fortunate. I know this from years of experience of reporting about people who have poor or no access to quality health care, from rural areas of West Virginia to Afghanistan to Zambia. But today I feel this deeply, in large part because of an email that I just received from Rudi Thetard, the country director for Management Sciences for Health (MSH), a Cambridge-based non-profit that works globally to improve health care.

This summer, I met Rudi in Malawi and he had introduced me to Lucy Sakala (see Dominic Chavez's photo above), an HIV counselor at Salima District Hospital in Malawi, about a two hour drive from Lilongwe, the capital of the southeastern African country.

            Lucy was battling cancer and I wrote about her difficulties in getting treatment. Here’s what she told me in July about how she tells people that they are infected with HIV:

            “I tell people who just learn their diagnosis that they should live positively,” Sakala said. “I tell them that there are several conditions more serious than HIV, including some cancers. And I tell them I have cancer, and it’s difficult, but that I live positively. Then I say it’s so important for them to take their medications properly so they won’t have opportunistic infections, and that they shouldn’t fear much. They should listen to their health provider.”

            Those patients, Sakala said, sometimes “feel sorry for me, and their problem becomes a little lighter. But I tell them not to feel sorry. I tell them to live as positively as I am.”

            The story documented how Lucy couldn’t afford the cost for chemotherapy. MSH staff around the world donated $2,000 for her treatment.

            In the end, it was not enough. Rudi’s email was Lucy’s death notice. She died a week ago from her cancer, which had spread from her uterus to her brain, esophagus, and lungs.

            Here’s what he wrote:

            “Lucy has for the last year battled her own cancer whilst continuing to counsel persons who have tested positive for HIV.  Her death has been felt strongly by MSH staff in Malawi as we had all hoped that she would recover.

            “Her story echoes the story of many other cancer sufferers in Malawi.  Following the diagnosis of cancer she was able to start with a program of chemotherapy which had to be supplemented by radiotherapy.  It is at that point that that the doctor advised a course of radiotherapy which was only available in Zambia.  MSH staff (in Malawi and globally) contributed generously to the expenses she incurred in travelling to Zambia and she was able to complete a course of radiotherapy.  She returned to Malawi a few weeks ago and had to face a reality of a shortage of essential chemotherapy – these drugs have been out of stock since September in Malawi.  She died this morning and was only 28 years old, leaving a daughter and husband.”

            I told this story to Dr. Kevin De Cock, a pioneering global health researcher who is now director of the Center for Global Health at the Centers for Disease Control and Prevention in Atlanta.

            “This story of the 28-year-old woman is regrettably a common one,” he said. “But at the same time we need to step back with non-communicable diseases and say where we are: The world is just starting to recognize the global problem. Not a large amount of resources are being made available to for specific non-communicable diseases, such as cancer, hypertension, and diabetes. … Still, a great deal can be done through appropriate public health policies. This does not solve the problem of the sad story of this woman, but there is an awful lot we can do now.”

That is almost surely true. The reality today is that someone like me who was born in a middle-class family in a rich country has the means to access health care that can add years – maybe decades – to my life. Lucy Sakala, by virtue of being born in a poor country with poor health care, didn’t have that. Basic chemotherapy treatment was not available to her. And because of these facts, I live and she dies in November of 2011. It’s not right.

Manila: Xmas, shops, and ‘I want to marry that girl’

            HONG KONG – I’m now at the Hong Kong airport, on a layover, thinking about Manila and running and thinking about Manila and not running.

I had a run that I would rather forget. At dusk one night, I ran inside a gated Makati neighborhood – an exclusive part of the city -- and then rather foolishly went out the next morning at 6 a.m. A few minutes into the morning run, I wasn’t running. I was out of breath. So I walked. I started up again, and I stopped again, covering four blocks. My run-walk continued for a half-hour.

I’m not sure if it was the Manila humidity, the air, jet lag, or general fatigue from my life of too much travel, but it didn’t matter. I had one choice. No more running for a few days. And when I don’t run, a couple of things happen. One is that I have time.

So I explored Manila in a different way, just not in my running shorts.

It was hard to avoid experiencing how the city was gearing up for Christmas, even in the second week of November. My five-star hotel, the Makati Shangri-La, produced a “lighting of the (fake) trees” ceremony in its giant entryway.  The hotel brought out a choir of women all dressed in red floor-length gowns who sang from the top of a curving staircase. They hired a woman who wore a flowing golden gown and who belted out Christmas tunes as she walked down the stairway. She burst into a Motown song at one point, and the Filipinos in Red shook like they were from African-American sisters from Detroit.

The hotel also erected a two-story-high artificial Christmas tree, which stood in the middle of a forest of artificial one-story trees. And running around them were a bunch of elves, or girl-thin women dress in red skimpy outfits with caps on their heads.

A crowd witnessed the spectacle, of course. Who wouldn’t want to see this? Everyone had some sort of camera, either real ones or those on phones or other devices. (People were forever taking pictures in this hotel, even in the elevators, of themselves.)

Later, when I talked about this scene to a Filipino friend who had come to take me shopping (I had to find time for that), she said, “We’ve been celebrating Christmas since September! This is a late party!”

Shopping followed. Bernie, the mother of a friend in DC, took me to a shopping mall an hour’s drive away. Inside was a kind of an upscale flea market featuring knock-off brand clothes and bags, pearls, coral jewelry, hand-made bags, and Santa-and-elf figures. Plus a lot of Jesus statues.

(Did I mention the Philippines was “100 percent Catholic”? It’s not, of course, and in fact the Muslim population is large in certain areas, but people like to joke (sort of) about it.)

Bernie is a shopping pro. All foreigners need Bernie to take them by the arm. We had a short strategy session beforehand (I was looking for over-the-top pink/oranges/reds polos for my suddenly fashion-conscious 17-year-old boy; jewelry; anything locally made) and she marched into the place. I struggled to stay two steps behind.

We wandered into a maze of little booths selling thousands of strands of pearls and coral beads. We waded deep into the booths selling polos on major discounts. We found woven handbags, including some with coconut shells, and silk ties going for $5. “Give him your lowest price,” Bernie kept telling them.

When they lowered their price, Bernie would say, “No, I said, your lowest price.”

So we bargained and bought presents at their “lowest price,” and I filled a couple of bags, and felt like Christmas was here, even if it wasn’t.

But the best non-running moment was a third excursion – to a massage parlor. I went with my two companions on this trip. (The purpose of this trip, by the way, was to report on how the Philippines has attacked the ancient disease of tuberculosis.) Toward the end of the week, the three of us, all guys, found an upscale massage place and treated ourselves to an hour of massage.

It was heavenly.

When it was over, as I changed back into my clothes next to Riccardo Venturi, an Italian photojournalist who is working with me, I asked him how it was.

“Oh,” Riccardo said, “I want to marry that girl.”

“That good?”

“If I don’t marry that girl, the girl I marry will have to know how to massage like that girl.”

 We laughed. He said it was his first massage.

“First professional massage,” he said, correcting himself. “Shall we come again?”

“Sure.”

“Tomorrow night?”

We later went out for a beer, a San Miguel, which everyone in Manila calls a “ladies’ beer,” probably because it’s so light. I enjoyed the ladies’ beer, the massage, the lowest-price shopping, and the elves and the two-story-high fake Christmas tree. This was not a running trip, perhaps for the best.

A first-time run in Manila and rule No. 18

The flight here was horrendous. Thirty hours door-to-door. One 16-hour flight in the middle, during which both of my legs cramped up. It meant I was really looking forward to my run this morning in Manila.

I’m staying at the Makati Shangri-La, a five-star hotel surrounded by malls on all sides. There’s a triangular-shaped park a few blocks away – I can see it from my 14^th floor room. It doesn’t look so big, but it may be my best bet. A doorman pointed me in the right direction and also talked about going into a neighborhood “past the park.”

                

That’s the trouble, and the opportunity, when it comes to running in a place for the first time. I have been to Manila once before, in 2008, but I stayed in a section of town along the bay, about five or six miles away. It might as well be another country for this city of 12 million.

At first light, about 6 a.m., I found the park easily and started running around it. It took me seven minutes for the first lap. That meant it was too small. I want to run 40 to 50 minutes a day here, and I can’t imagine running around this park six or seven times a day. It’s leafy, it doesn’t have any traffic, but who wants to run in circles?

                

So after two trips around, I branched out.  I crossed a busy road for a smaller one and ran straight for a  half mile until I came to a line of cars waiting to get into a gated community. I ran past the guards without saying a word, appearing like I was staying at the place. That’s one of my rules of running, No. 18: Never ask permission to go into a gated establishment unless a) It’s an African game park; b) it’s a military installation; or c) You are in a country run by a dictator.

This was none of the above, and I had found a small version of running heaven in the middle of  a crowded humid city. I ran along the perimeter, passing large homes, men sweeping the streets with long-handled, heavy-straw brooms, and an occasional walker. One walker, an Aussie, was kind enough to tell me how to stay on the perimeter all the way along by talking a tiny alleyway that led to a bridge that led to a small pass-through, and then, he said, I would be able to run 2.5 kilometers (about a 1.6 miles) around. 

The run took me 45 minutes. I arrived drenched in sweat at my five-star hotel, found some free tea by the front desk, and hustled to my room. For a first-time run in a city, it was top-rate. I wouldn’t be running in seven circles every morning. I had found my gated community – not quite like my inner self, but not bad.