August 25

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Reliable vs. Variable-which do you prefer?

Since arriving on the continent of Africa I have come to recognize that two words “reliable and variable”, and their respective meanings, have much greater significance in individuals’ lives than what I would of previously thought.  During moments of self-reflection I have realized that my life has been “very rich” with reliability; variability is not acceptable unless by choice.  Let me give you some examples, in the United States, if your cell phone network drops calls or there is limited service (Can you hear me now?), you can switch networks and might even be enticed, or rewarded, by another network to switch to their “more reliable” plan.  For the most part, our cars get us reliably from here to there, the grocery store consistently stocks your favorite brand of ice cream, and you can trust that your local pharmacy has multiple brands of cold and headache remedies to offer you when you don’t feel well.  When you turn on a light switch, it is fairly certain that the light will come on.  If the electricity is out from a recent thunder or ice storm, you RELY on the knowledge that the outage will be short-lived and that the energy company has personnel working overtime, probably in horrible weather conditions, to fix the problem.  When you flush the toilet or turn on the faucet you depend on having water and I would even go so far to say it is guaranteed 99.9% of the time. Reliability is expected and variability is not tolerated in many of the services I have previously taken for granted.

So many of you may be thinking, I am super flexible, change is good-what’s the big deal? No car for the day-yeah a hassle, but call an Uber, no power one night last February-so you enjoyed a candlelight dinner or had an excuse to go out.  You survived the water outage when a pipe froze –annoying but no big deal, the plumber showed up later the next day so you showered at the gym in the morning.   My point being, when things are unreliable, we have options.

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(Below-typical water station-where you buy water)

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For me, living here in sub-Saharan Africa, it is striking the lack of reliability in what are the most basic of life’s necessities; electricity, food sources, and clean running water. In rural Rwanda variability is the norm and it goes way beyond modern conveniences and extends deep into the fabric of society.  For me, as a nurse, beyond the daily living conditions, it is most evident in the healthcare system.  It would be correct to say that you can RELY on the variability. It is difficult for me to write examples of how the variability in the health services impacts patients’ lives.  Situations I cannot conceptualize because, as I mentioned above, my life is “rich”, filled with reliability.  For just a moment think of your reaction to these realities –“your baby may die, she needs a ventilator, we have none here” (only a couple hospitals in the country have ventilators).  “Your breast cancer surgery has been postponed indefinitely there are no surgical drains in stock.”  “Your teenage son, who has advanced bone cancer, may not get his morphine this week since it is out of stock right now; we are working on it but not sure when it will be in stock.”  Medical resources are stretched to the limit and the acuity is high.

The government is working to improve health standards in partnership with many individuals, academic institutions, and NGOs and has done an impressive job moving forward on millennial goals, but it is difficult to sustain quality standards when the reliability of even the most basic services, like running water and electricity remain unreliable.  So, for the foreseeable future, the only thing you can depend on is that there will be variability and life in a “variable country” is very tough, especially for the most vulnerable in society.  Each day brings different and difficult challenges and yet these resilient, generous people, smile warmly focusing not on what they lack but instead being grateful for what they have today.

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