Category Archives: Cities

Tasha

Tasha says she never, ever – never! – raised her kids – Darius, who’s dead, and Isiah, who got shot in the face three weeks ago – to be criminals. I had asked her if either had run into trouble with the law. No, she said, shaking her head, no, no, no. I noticed her teeth, long snaggly things shaped like the rounded, prehistoric teeth of a long-extinct feline, interspersed in her mouth so sporadically, clumps of white protruding here and there like boulders. Her jaws are tight, she’s clenching them on and off and on again and grinning at me with half-shut eyes like she’s about to explode. Craig says she might have hooked up with some poor white trashy speed freak who’s started to hang around lately, feeding her the latest cocktails of bliss from the white side of the world. No, says Tasha, Isiah and Darius were good kids, good kids. Darius got slain down on 14th and Peralta a year ago next week, on October 7th at 10 A.M in the morning – 10 AM! – and it took the police 40 minutes to arrive at all and the whole time Darius just lay there dying, dying, dying, dead by the time they got there and the fire station was just a block away. But the fireman can’t come unless the police get there first, she says.

Old Tasha is familiar with how the city works, how to break its balls, bust it, milk it, fuck it up and suck it down, drain it of all its power. She shakes her head and the tears start spilling out and down her soft brown cheeks. So there it is. And now in the way she’s talking to me, calm and articulating wherever she can and maybe saying the things that she thinks I want to hear – that she’s a good person, that she loves her kids, wants what’s best for them, and she’s shaking her head and saying all this and then suddenly she’s laughing. Darius was shot down at 10 AM in the morning and he wasn’t even the target, he was just sitting or standing, she can’t be sure which, with the wrong set of boys at the wrong time and in the wrong place, and here comes a car full of the wrong kind of people and – ratta-crack-ratta-ratta-crack – down he goes in blood – and he wadn’t even the target — and it took the police 40 minutes just to get there, and the fire station is only a block away – a block! She’s laughing now.

“So much for aim,” she says, the kind of thing a kid says to impress a teacher, I think. She shakes her head. In her right hand she holds a cigarette away on the other side of the rotting banister and she shuffles her feet along the boards that make up the stairs, also rotting and tells me to watch where I sit because the boards are old, and her pink velour sweatshirt is open part way and every now and again when she gestures a giant scar in the middle of her chest rears up, an ugly, closed eyelid seared into her sternum and I want more than anything to ask her where she got it but I don’t. Next time, I think. Tasha says that for years she lived in the basement of the house, or the bottom floor, it isn’t entirely clear what’s what, until the old lady who used to live upstairs died and then she had to move out for a while. But Tasha doesn’t really want to talk about all that. She wants to talk about Ms. V. Ms. V who lives down the street, right there, in that big white Victorian house with the two windows in front and the black SUV parked in the driveway because Ms.V has always been her rock, her mother to go, her lean-to here in this neighborhood which is going to shit, with all the drug dealers running around and the kids who can’t walk home from school no more and the people who can’t sit out on their front porches no more – shit, I get nervous just sittin here like this – and the random men truckin around with their shopping carts full of cans and bottles which they’re gonna take to the recycling center down the street. Ms. V has lived here for years, longer than anyone and she’s the one Tasha goes to when she’s got problems, problems with her kids or her ex-husband Carlos, who’s just one of the fathers to her three sons gone, Darius shot down in the street a year ago, Tyrone sent to prison for armed robbery earlier this year and now Isiah shot in the face and gone into hiding and not even Tasha really knows where he is and even if she did she’s not going to say to me, who’s just come up on her front porch like this and started asking questions. Ms. V knows Tasha’s pain she does, she knows it because she’s probably lived through it herself, and because Ms. V, well, her name is Lavine but that’s all Tasha knows, is about the closest thing she’s got to, to, to a mother, you know? She’s all Tasha’s got. Well, except for Isiah, who’s gone now and she don’t want to bother him none until he comes up for air, and then he’ll be ready to talk and Tasha will be there for him. That’s how it’s gonna be, that’s how it always has been, and ain’t nothing gonna change that now.

Alo Presidente

Hugo Chavez is celebrating the Bay of Pigs victory.

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I went to Venezuela in 2005. I didn’t meet Chavez. But I met some other people. Part 1 follows from a piece that originally appeared in Letras Libres, in Spanish:

Iris Fundora, a taut, stout woman with a thick braid of kinky black hair and the faintest hint of a mustache leaned comfortably back in her chair at a makeshift clinic in Caracas, where she works as a doctor. It was a humid day and in the waiting room a few women fanned their babies with their fingers, or with brightly colored educational pamphlets that lay scattered about the floor. From behind a door-less bathroom, a stench of urine and soiled diapers wafted out.

This clinic used to be a police station, a two-room outpost crowning both the road whose end it caps and the hillock it commands. In 2003, the government seized the two rooms and donated them to a program called Barrio Adentro that provides health care to millions of poor Venezuelans. The building is white and simple, and the front is adorned with a delicate likeness of the Virgin Mary made of twigs. Outside, a few men were squatting on their haunches in the shade and smoking cigarettes. From there, they could look out down the long road that winds up through the heart of the barrio, Los Frailes — past rows of apartments piled one on top of another, past stalls selling thimble-sized cups of espresso and giant bottles of Coca-Cola, past the localized smog of a camioneta waiting to hurl out a gaggle of old women — and down to the valley floor where the high rises of Caracas stand like the legs of clouds in the morning sky. In each of the two rooms a Cuban doctor was busy seeing patients. Iris Fundora was one of them, and when I met her, she had been working there for about a year.

Many of the people Fundora sees are children who have fallen ill due to the degraded environmental conditions of Los Frailes. Diarrhea is widespread among children, as are skin diseases. Large amounts of trash have collected in the neighborhood streets, often piling up right in front of the clinic itself. Recently, Fundora has seen a lot of hypertension among her older patients; she said she didn’t know what to attribute that to. At first, Fundora, who is 33 years old, didn’t want to speak to me, and when I asked her why she came to Venezuela, she told me I had no right to pry, that it was the same as if she had asked me about my family, my kids and my personal life. So I asked her about Cuba. She began to smile, and told me about the part of the island called the Alligator’s Head and the town of Granma where she is from. She said it was renowned because Fidel Castro, whom she simply called Fidel, first landed there, on the Playa Colorado, when he returned from Mexico in 1956. Some of the people who come to see Fundora don’t approve of the Venezuelan government having imported over 20,000 Cuban doctors – many of them veterans of wars in Angola and elsewhere — sports trainers and dentists in the last two years. Fundora said that sometimes she has had to deal with “rejection.”

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At the mention of this, a woman named Enayide Lozano, who runs the Comité Medico that oversees the Cubans in Venezuela, inserted herself into the conversation. Lozano is 49 and has lived in this neighborhood her whole life. She is an avid supporter of both the Cuban doctors and the president who brought them to Venezuela. “We were fed up with doctors who didn’t want to touch their patients,” she shouted. “They were horrible. Our own Venezuelan doctors were afraid of touching the poor, as if we were going to give them a disease or something, like we were going to sting them. It got to the point that we had to bring in these foreign doctors.” As Lozano spoke, Fundora sat back in her chair and smiled, almost benevolently. “Look at her,” Lozano said, pointing to Fundora, “She is saying good things about Cuba. We should be saying good things about Venezuela as well. I have to say good things about my country.” When Lozano left, I asked Fundora what she thought about the Venezuelan doctors she had worked with. She said that for the most part they were good, and they wanted to help. But there was one problem. She then told a story about how Venezuelan doctors were all too quick to demand tests of their patients before giving them something to feel better. The tests require money, or insurance, or both — tests she said were impossible for most poor people to afford. “These doctors, they have to erase from their minds the idea that they’re not part of the society.” Before leaving, I asked if this – the erasing of these doctor’s minds — was part of the revolution, styled the Bolivarian revolution by its creator, Venezuela’s president, Hugo Chavez. Fundora smirked, nodded, and chose her words carefully. “This is going to take time,” she said, “It is part of the work of change that has to be done here.”

Caracas, 2005

Mental

Check out this interesting BBC story on Egypt’s mental health care program. It’s from 2009. It may be premature, but I really wonder whether what Egypt is going through now is in any way similar to what Iraqis went through after the fall of Saddam Hussein, when they began to deal with the collective trauma of 25 years of oppression, dictatorship and a very sudden freedom.

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Here’s what I found in Iraq in 2004:

A few strains of Mozart float through an iron-barred window of Baghdad’s Al Rashad Hospital. In an empty eating hall, a woman watches an American soap opera on a television that has been locked inside a steel cage. Behind two locked doors, a flock of hunched women greet me with garbled chirps and shy, toothy grins. All in all, it’s a relatively peaceful scene for an insane asylum.

Looters and thieves had swarmed into the hospital even before U.S forces had entered Baghdad, stripping away expensive machinery and cheap bedding, and setting fire to many of the rooms. Over five hundred criminally insane patients escaped from a high-walled inner fortress and made off into the countryside. On the ground of the Zanab ward, a gaunt woman lay sprawled on the ground, sedated or comatose, no one could say for sure, while hundreds of black flies crawled across her face and body. Dazed hospital staffers in white lab coats wandered blithely past her, careful to avoid the shards of broken glass and debris that littered the grounds.

As far as mental health professionals are concerned, the country is a virtual black hole of information. What had once been a burgeoning mental health care system was essentially stopped dead in its tracks after Saddam took power. The regime deliberately suppressed or modified statistics on mental health in many cases. Reliable data on sensitive or potentially damaging issues like alcohol and drug abuse have never fully surfaced. Hundreds of highly qualified Iraqi psychiatrists and psychologists fled the country. Those who did remain were ordered to trim their studies to the needs of security services, or trash them altogether. “Psychiatry in Iraq was better in 1979 than it is today,” said Dr. Sabah Fakhuredin, a British-trained Iraqi psychiatrist, and national advisor to the Ministry of Health on mental health care, “The situation is grim. The problem is huge.” There is not a single qualified psychotherapist working in Iraq today, and there are only two hospitals, both of them in Bahgdad, for a population of 25 million.

Demand for therapy is intense. At the Ibn Rushd Hospital, a beleaguered staff receives between 250 and 300 outpatients a day complaining of depression and anxiety, but also of severe trauma and psychosis. In a spare room on the hospital’s second floor, Wahaida Jameel, 35, struggles with the memories of the war last spring when she and her 10-year old daughter faced the bombing alone. But it was when the bombing ended that the sadness began. Every day as the sun set, she would begin to cry uncontrollably. Shortly after, she started to fear simple things like food, air and water. As Baghdad became increasingly dangerous after the war, she developed a fear of open places, then traffic. When she stopped sleeping, she finally sought help. Now she’s on medication. But the societal fractures created by the war and its aftermath have opened the floodgates of long suppressed emotions. Sitting with a resident psychiatrist last week, Jameel fingered the lace fringes of her hijab and lamented her situation. “I never used to get depressed,” she said to the resident, welling up, “Now I’m afraid of food, I’m afraid of water and breathing, I’m afraid of dying.”

Electric shock therapy is still standard procedure at Ibn Rushd for depression. One day, I watched nurses give a woman named Mona 10 mg of Valium (far below the generally accepted standards for anesthesia) and hold her down while she convulsed from the shocks.

Group therapy hasn’t yet been widely implemented, but doctors agree it would likely be very successful in the Arab world where people enjoy social gatherings and tend to be more family and group-oriented. “The extended family is extremely important here,” says Dr. Abdul Karem Salman Al-Obeidi, who has focused on children in Iraq, “They act as psychotherapists themselves. This is different from the West.”

Obeidi estimates that some 2 million children are suffering from depression now. Doctors have already reported that their waiting rooms have become their own talk therapy centers, with patients avidly discussing what they’ve heard from other people during their own sessions. After hours, in the darkened psychiatric wing of Medical City, nurses hang back to talk to their patients. “Once they start talking they don’t stop,” said Dr. Al-Jadiry.

In any other place, a war on the scale of the one last spring in Iraq would have led to large-scale diagnoses of post-traumatic stress disorder, as it did in New York and Washington after September 11th. But the last 30 years of Iraq have been so consistently traumatic that doctors here find diagnoses difficult, even irrelevant. What may begin as a conversation about the traumas of the past often segues quickly into one about the war, the treatment at the hands of U.S soldiers or simply feelings of hopelessness and despair about the future. Jameel Wahaida, who is not insane, just terribly sad, is a case in point. “We are the victims of Saddam,” she begins, trying to describe how she feels; she finishes with a fitful description of how she has come to fear the soldiers who a year ago she welcomed: “They will kill us without any reason.” The confusion of years of trauma is only now beginning to surface. “You can’t pinpoint one major event in Iraq following which there was morbidity that you had to deal with,” says Dr. Fakhuredin, “It has become a chronic mental health problem. To deal with such an issue as PTSD as it applied [in New York] after September 11th does not apply in Iraq.” The type of regressive behavior that usually characterizes individual pathologies is taking place on a massive, societal scale in Iraq. “It is like a regression to an earlier stage of development,” says Dr. Zainy of Ibn Rushd, “There is a collective need to be nurtured by a father figure.

In some cases, long exposure to stress has made Iraqis more resilient to hardship, even as anecdotal evidence suggests an increase in PTSD cases over the last year. “It changed Iraq, and it changed Iraqis,” says Dr. Hashim Zainy, Ibn Rushd’s director.” Patients who have come to Zainy’s private clinic have complained of chronic low mood, inability to plan for the future and indecisiveness – all key indicators of clinical depression, even as their material situations and salaries have improved. “People used to be spoon-fed,” he says, “Now they’re not able to test their lives, they don’t know what to do about their future.” At the same time, doctors haven’t been able to pursue long-term psychotherapies with patients. “It’s very difficult to use psychotherapy for 250 patients a day,” says Zainy, “Most people want to get their drugs and just go away.”

– Baghdad, 2004

emergencia

Mexico City is a violent place, and more and more in the last few years.

I used to go out with the ambulances when I lived there…

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The rear of the ambulance was a jumble of hypodermic needles, respirators and gauze. Above an oxygen tank, Nicholas Cage stared down from a promotional poster for a movie in which he had starred as a disturbed Red Cross medic who sees visions of dead people and angels in New York. “Santissima Nicolas,” the medics whispered.

The driver, whom everybody called Captain, wore 1940’s era aviator sunglasses, left the chin strap of his helmet dangling loose and chain smoked Marlboro Reds. He peeled out of the parking lot blaring three horns at once. I asked him if he had ever been in an accident and he said it was unavoidable; at that moment he changed lanes so that we were heading, deliberately it seemed, the wrong way down Avenida Insurgentes. The Captain’s cigarette had gathered ash and it blew into the rear as he spun the wheel with one hand. Edgar, one of the chief medics, sat in the passenger seat leaning out the window and shouted at people through a bullhorn to get out of the way. A gurney clattered on the wall, the ambulance filled up with a pulsating red light, bottles of oxygen rocked in their plastic hammocks.

It was late afternoon by then, sometime in the autumn, the long summer rains were beginning to end. We entered the courtyard of a halfway house for juvenile delinquents. On a low wall made of stone sat a boy, no more than 15, bleeding from gashes in his shaved head; his eyes had been beaten black. A pair of female orderlies fluttered about until Edgar, donning rubber gloves and murmuring instructions into his radio, put his hands on the boy’s head and began to feel around. A gang had attacked him, said the women, probably over a drug deal gone badly. The boy had two deep gashes on each side of his head, and more scattered across his back and neck. Edgar and the Captain pulled him to his feet and put him on a vinyl bench inside the ambulance. He sat there dazed, staring at me as Edgar wiped the cuts clean and dropped the bloodied bandages into a plastic sack hanging from the rear door. If he knew where he was he didn’t let on, only now and again mumbling or nodding his head to Edgar’s repeated questioning. When we dropped him off at the hospital, Edgar stuck a hose in the back of the ambulance and pink water drained out slowly under fluorescent white lamps.

Later that night, in a rundown neighborhood where the streetlights didn’t work an old woman sat in a wooden chair in her kitchen with her head thrown back, laughing. Her eyes were rolled into white and her nose was broken. Her two sisters dabbed at her face with rags soaked in blood. They stepped aside while Edgar dug into his black bag.

“I fell on the floor,” the old woman said, and the two sisters laughed.

“She fell on the floor,” one repeated, laughing again. All of them were drunk. Edgar laughed as well. The woman turned her head and smiled at me through broken teeth and bleeding gums.
Edgar laid a gurney down and started to move her onto it. Her husband came out, and the sisters went quiet. He wore a white frock that ended just above his knees. The shirt was covered in blood, and he, too, was drunk. They had all been drinking since three o’clock that afternoon and half a dozen empty bottles of Tecate and Johnny Walker were scattered about the kitchen. He had gotten angry and smashed one of the glass bottles on her head, breaking her nose. Now he grinned stupidly.

“She fell down,” he said.

On the night of the Virgen de Guadalupe, the streets were choked with pilgrims. Small children carried likenesses of the Virgin and colored candles that they shielded with the palms of their hands, and their mothers carried baskets of tortillas and blocks of goat cheese and bright woolen blankets. They peered into the tinted windows of the ambulance and moved in one long illuminated procession towards the darkening mountains that rimmed the valley. Mostly it was quiet that night. There were a few calls, drunks and vagrants; a woman passed out in a market and a crowd gathered around to stare; a man fell down dead on a street corner. It made sense, seeking refuge in other sorrows. It was surprisingly easy to fall in love surrounded by the ostracized, the wounded and the dead.

Mexico City, 2003