Reflections on the Past and International Women’s Day

“Does the walker choose the path, or the path the walker?”   ~ Garth Nix

Technically, I should have written this about 3 ½ months ago, my one-year anniversary from starting a new job in the U.S. after completing a 5 year mission term at Buea 7^th day Adventist Health Centre in Cameroon.

One year would have been December 15, 2015.  That date was a day overflowing with memories. Good memories from Cameroon but paralysing fears regarding the future. 

I used to have goals to work toward. There was always something in the future that infused meaning into the present labour.  There was a confidence that the present trouble was a stepping-stone for reaching higher and better accomplishments.

And now?

Now I wonder if the past five years in Cameroon were the pinnacle? Will my identity culminate with living overseas for five years? Was service in Cameroon my destiny? Is there anything left for the future?

The Pacific North western culture is different. The art of medicine is different here as well. I haven’t seen a single case of malaria. There’s been only a small handful of cases of traveller’s diarrhoea, none of which were Typhoid.  A typical clinic visit might be exemplified by Ms Ariel:

Ms Ariel is a hybrid that represents a commonly encountered scenario that occurs on a daily basis in my office. In the interest of privacy, I have created an amalgamation that preserves the essence of my work in American healthcare but doesn’t identify any personal details of one individual.

I knock on the patient’s door.

“Come in,” she answers absently from the chair she’s seated in scrolling through her Face book alerts on her iPhone.

As I seat myself on the stool in the room and log into her electronic medical record on the computer, she eventually tucks her phone away in her purse and turns to face me.

“Cool hair,” I comment on her recently dyed tri-coloured hair, transitioning from royal blue to aqua turquoise. It is eye-catching and somehow seems to fit with her multiple body piercings that compliment her tie-dye skirt and tall leather boots.

“Thanks,” she smiles.

“Did you dye it yourself?”

“No, my friend wanted to practice,” she shakes her head. “She’s going to cosmetology school.”

Now that I have her attention, I glance down at the paper in my hands on which my medical assistant has written the main concern today, “palpitations”. The paper also reminds me to ask Ms Ariel to schedule her pap smear and get her flu shot while also filling out the questionnaires to screen for alcohol abuse and depression.

“Yea, in the past few weeks I keep feeling like my heart is going to jump out of my chest,” Ms Ariel begins. “I feel like I can’t breath sometimes.  I can feel my heart flip flopping like a fish inside my chest, especially when I’m in bed trying to sleep.” She stops.

“Anything else you notice with these feelings of your heart beating too fast?” I prod. “Other symptoms that seem to be associated or bring them on? Did anything change in your life recently before these palpations began?”

“I get headaches sometimes,” she replies. Her iPhone rings and she reaches over to retrieve it and turn off the ringer.

I wait. “Is there more stress in your life recently? Have you ever had these palpitations in the past?

“I recently started a second job at the service centre,” she remembers. “My boyfriend and I broke up after that. I haven’t been sleeping well either. And, that’s another thing I wanted to mention, doctor,” she looks at me. “I need something to help me sleep at night. I can’t fall asleep until after midnight and then I wake up after a couple hours. My friend gave me one of her sleeping pills and it helped. I want to see if you can give me a prescription today.”

I nod in recognition of her change in topic. “And has your lack of sleep made your palpitations worse?” I try to steer her back to her original reason for consulting.

“Yes, I think so,” she answers after a pause. “I had palpitations before when I was a teenager, I think,” she continues. “The doctor gave me some kind of medication and eventually they went away. I stopped taking the medicine. I don’t remember what it was now.”

“Have you ever fainted during these spells? How long do they typically last? Do they just go away on their own eventually?” I attempt to garner more information to assess the severity of her palpitations.

“No, I have never passed out,” she answers, “except for that one time when I was really sick with some GI virus and I was vomiting and having diarrhoea. I was headed to the bathroom when all of a sudden the next thing I knew I was on the bathroom floor. I couldn’t remember how I got there. My mom says I fainted. I don’t know how long I was out. Probably only a few minutes. I guess I was sicker than I thought. I was also feeling dizzy at that time too…”

I take a deep breath and interrupt her meanderings to direct her back to our original problem. “So what do you think is going on with your palpitations? Do you think they might be related to the recent stressors in your life?”

“Probably,” she answers after a thoughtful pause. “They don’t really bother me except that one time when I was at work and my boss had just brought me back to tell me I needed to meet certain deadlines. She was upset and it made me upset and then I started having a panic attack and I couldn’t breath and the room was going all dark and my heart was beating too fast. I actually had to take the rest of the day off, doctor.” She looked at me for a moment then continued. “Usually these episodes I feel now go away in a few minutes. Really I haven’t tried anything for them because they’re not that much of a bother. I know I can be a bit of a hypochondriac about my health but I just don’t want things to get worse, you see.”

I nod while she continues her monologue.

“Honestly, I think the palpitations will go away on their own. I don’t think they’re really dangerous, do you doctor?” Without waiting for a reply she continues, “Anyway, I don’t want to take any medication. I don’t like having to be dependant on a pill every day. Maybe you could just write me a prescription for that sleeping medication that my friend let me try? That way I could use it as needed when I can’t sleep. I tried melatonin already and then my naturopath suggested some teas and meditation techniques but really, they’re not the same as taking that pill when I really just need to knock myself out.”

Attempting to reorient myself to her new concern, I answer. “So, you think your palpitations are related to more stress and not sleeping. And, if you can sleep, you feel your palpitations will go away?”

Ms Ariel nods and taps a reply on her phone. “My friend just texted me the medication name, “She says it’s called lor-az-e-pam. I’m sorry if I didn’t pronounce it correctly.”

“You did fine,” I reassure her. “I understood the name.”

“And what kind of things do you think will help you manage your stress better so you can avoid the heart palpitations, the panic attacks, and the sleeping pills?” I query as we negotiate the safety concerns of a benzodiazepine.

Ms Ariel shrugs. “I don’t know.

“Would you be interested in talking with a counsellor to learn some strategies for handling stress better?”

“I don’t think I have time, doctor.”

“I’ll give you some things you can practise at home with deep breathing and progressive muscle relaxation,” I add with a resigned nod regarding her thoughts on stress management. “You might also find yoga helpful. It’s good for the brain and your muscles, particularly your core back muscles. It could help the lower back pain you’ve had before.”

“Oh, that’s another thing I wanted to ask you,” Ms Ariel suddenly remembers as I type my orders into the medical record and complete her printed visit summary. “Can I have another referral to my chiropractor? I’ve been having pain in my neck recently.”

Already past our appointed time, I sign back into her electronic records and we go through the requirements of a chiropractic referral.

As I type in the orders and fill in the allotted questions, Ms Ariel watches. Suddenly she blurts out, “You know, I think I might have ADHD. I can never remember anything and I can’t seem to concentrate at work. My boss is always reminding me to focus. I’m always forgetting something. I should probably be evaluated for it. I was thinking that I might be allergic to gluten too. Maybe I should get tested for that?”

I complete the entry for the chiropractic referral. “Let’s try to get you sleeping regularly and in a better place with stress levels, first. We can talk about your concerns with concentration and focus at your next visit, ok?”

As I finish typing her note in my office at the end of the day, I sigh. Ms Ariel represents a multitude of relatively young, stressed-out, women that I see every day. So many life stressors that affect their health in ways they can’t imagine, or are willing to admit. And there never seems to be enough coping skills and supportive relationships to help mitigate the affects of such stress.

From a physician’s perspective, it’s often less-than-satisfying to identify the problem and yet be unable to vanquish the problem. I cannot eliminate Ms Ariel’s stressful job. I cannot be that nurturing shoulder to cry on as she goes through the break-up with her boyfriend. I cannot find her a replacement boyfriend. I cannot force her to exercise, go to yoga class, practise deep breathing and relaxation techniques, eliminate caffeine and incessant texting, and choose healthier food options. A sleeping pill, even the less addicting option that we agreed upon today, is only a temporary patch for the real problem that keeps her awake at night. Her spinal pain will continue to plague her. I doubt she has clinical ADHD. She’s an intelligent, functioning women. She’s also distracted and under enormous stress without the time or relationship skills to cope.

I should have written this 3 ½ months ago. I was distracted and unprepared to cope though. I have a tough time concentrating and focusing. I have difficulty finishing tasks and find it impossible to sit down and actually type a complete thought. Perhaps I have adult ADHD? Haha. Perhaps I just need to turn off my technology and take a real holiday.

Happy International Women’s Day!!! (March 8)

Don't Welcome Me Back Home

Photo: Natasha Kanji 2011

A/N: Thoughts after attending the Institute of World Mission Welcome Home Family Re-entry Seminar 2015. I'd rather have a mission than welcome home accolades. 

Don’t Welcome Me Back Home

“My desire is to depart ... But to remain in the flesh is more necessary .... Convinced of this, I know that I will remain and continue with you all, for your progress and joy in the faith, so that in me you may have ample cause to glory in Christ Jesus, because of my coming to you again…”

Philippians 1:24-26

I don’t want your welcome back greetings.

Please don’t think me ungrateful. Obviously, I won’t tell you to stop since I know you mean well. Your motives are pure.

But the greeting is erroneous. I am not  back home. Not by my definition of ‘home’ anyway.  Home doesn’t represent a permanent place on earth for me. Yes, there are pockets of space where I am best adapted, places I feel safe and abide within a relatively congenial community. These locations are familiar to me. They are a domicile where I sleep and eat my meals and where I am most relaxed and at ease. But they are not home. Instead, my heart yearns for a deeper home.

As C.S. Lewis so eloquently penned in the following quote:

“If we find ourselves with a desire that nothing in this world can satisfy, the most probable explanation is that we were made for another world.”      ― C.S. Lewis

Living for any significant period in another country, another culture changes you. Whether you were an accountant, a nurse, or a pastor, you cannot leave without permanent scars. The simple act of surviving in a foreign environment spoils naïve ideas about a cohesive, simplistic worldview.  The world is a messy place to live where chaos thrives. Submerged under the colours of a strange and different culture, you emerge with multicoloured lenses. Unlike real glasses though, you can’t remove them. There is no returning to your virgin views.

Even as your heart aches for home, a permanent resting place, travelling around the world proves there is no place completely safe, completely perfect. Heaven is not yet; it is still a hope; your heart’s anticipated future. You may have citizenship in your passport country but real homage belongs to the Lord of heaven and earth. We are citizens of another world as Paul outlines in Philippians chapter 1, verse 20: “…But our citizenship is in heaven, and from it we await a Saviour, the Lord Jesus Christ…”

And so… I remind you, there’s no need to welcome me back home. No adulations, please. Don’t put me on a pestle and treat me like a hero. Don’t try to reacclimatise me to a life of mundane mediocrity with wrappings of cultural adaptation. Instead, remind me that there is a reason for reverse culture shock.  Acknowledge that there’s a basis for why I don’t feel at home. Tell me there is value in my brokenness. Comfort me with words that give meaning to the bleeding of my wounds.

Don’t tell me everything will be ok.

Don’t tell me to ‘give it time’.

Instead, remind me I’m part of a bigger picture. These tears that flow without warning from deep recesses of my soul are reminders that the process of homecoming isn’t finished. The grand universal cosmic conflict is still ongoing and I have a part to play in it.  The epic isn’t complete. The novel hasn’t come to the last page.

When I am overwhelmed by yet another teary-eyed patient in my office with problems beyond medical solutions, remind me that I’m still God’s hands to comfort the suffering.  

When the sun has set and I’m putting in prescription renewals and answering messages while completing a hectic days worth of charting, all the while tired and hungry because I’ve missed lunch and now supper, tell me that the sacrifice is worth it.

When I fear I cannot face another unsatisfied patient seeking easy fixes for unsolvable circumstances, remind me I’m an ambassador of love and not of miracles. And when he gets angry and storms out of the room because I suggest changes in diet and weight loss to ease his aching arthritic knees or bring his diabetes under control, remind me again that I can still love without expectation or reciprocity.

I don’t need a hero’s welcome home. I don’t want a hero’s welcome.

I want a hero’s mission.

Remind me I’m part of a higher calling. I’m still part of a mission. I still have a job to do on this earth to represent Christ’s love to those I come in contact with each day.

Remind me that my mission service is not over. I am not coming home. I survived five years in Cameroon as a naïve and inexperienced physician. Through threats, thefts, fire, and tragedies, I survived and came through changed for the better. When I am tempted to forget, remind me of those valuable lessons I learned through people management, administrative duties, intercultural communication, adaptation, and flexibility. I am stronger than before. I survived adversities and adulations in Cameroon. Surely I can endure the challenges of today.

When I sigh and complain that home is tedious and dull, don’t tell me to appreciate my blessed abode. . Instead, remind me that I’m not home. I remain God’s ambassador to the world, whether here or in Africa. He hasn’t called it quits on my mission yet. There is a purpose in the pain that imbues meaning in the suffering. I can accept the frustrations, disappointments, disillusionments, and fatigue when I remember that this isn’t the end. The mission continues.

“ All this is from God, who reconciled us to himself through Christ and gave us the ministry of reconciliation: that God was reconciling the world to himself in Christ, not counting people’s sins against them. And he has committed to us the message of reconciliation.  We are therefore Christ’s ambassadors, as though God were making his appeal through us.”

2 Corinthians 5: 18-20

Six Months and a Carpenter's Stethoscope

Disclaimer: Pardon the hiatus. I find I am out of practise with writing down stories of life and work. 

June 16, 2015

Yesterday marked the six-month anniversary of starting a new job in a very big, primary care clinic. More than sixty doctors, nurses, and physician assistants care for thousands of outpatient in the rapidly expanding urban medical complex where I work.

Did I mention it’s big? It’s a vast labyrinth of medical services. I often find myself feeling like the mouse-doc scuttling around in a medical maze and discovering a delightful piece of cheese tucked away in a hidden corner of the system.  I am constantly greeting new faces and finding new pieces of “cheese” within the clinic.

Although my work environment is a dramatic change since relocating to the Northwest there are many additional cultural differences to decipher: Church. Local community. Politics. Socials. It’s another foreign country, in a way. Portland is a ‘hipster’ city where food that is cooked without meat is no longer termed “empty”. Instead eating establishments proudly proclaim “gluten-free”, “vegan”, and “organic”.  Being a vegetarian is not on the extreme end of the spectrum. It’s more on the moderate end of a very broad spectrum of dietary preferences.  

The vast dietary spectrum of preferences if relatively an easy cultural adjustment – instead of green leaves floating in palm oil there is organic kale salad with alfalfa seeds and thistle milk or something along those lines. The bigger struggle for me has been to find a sense of belonging and assurance that I’m still ministering to others and leading a worthwhile life. I find it challenging to feel like I’m a part of a bigger picture. I have an inner, subconscious sense of losing an exclusive membership in a noble club. I find pieces of my heart sometimes shifting around uncomfortably like a loosened shingle, pulsating against the battering of life’s storms. One end is still fastened firmly to the practical, logical area of my brain and affirms that I’m still doctoring. I’m still performing a necessary service to those suffering and sick and in need. But a portion of my emotional, irrational subconscious wobbles with uncertainty and doubt when adversity and discouragement pour down in a deluge of negativity. I waffle at the fringes, constantly questioning myself:

Am I still serving God in a secular clinic?

Are my skills as a physician needed in a country with so many doctors?

Am I utilising my time appropriately seeing so few patients in comparison to Cameroon standards?

Without the external affirmations one receives as a missionary, can I believe in my calling here?

Do I believe in my heart that I’m currently where God wants me?

Do I believe He’s called me to such a large, institutionalised office to serve as His ambassador of love?

Lately I have found my creative writing energy sapped. I don’t find it easy to outline interesting and noteworthy aspects of my work. I am not involved in the same severity of life and death struggles that clawed at my work while in Cameroon.  I am surrounded by ailing people but of a different type. Sick but a different kind of sickness.

I discovered when I first met Mr AT that he had been having ankle pain for years. It had been worse lately with all the activity necessary in his new job as a construction worker. He’s already been appropriately treated with the anti-inflammatory medications (Aleve, Advil). He had an ankle brace. Work notes that dictate modified work activity had been written. Physical therapy had been offered although he couldn’t find the time to attend such therapy sessions due his demanding daytime job schedule.  

“What are you hoping to get out of your visit today?” I searched his face for a truthful explanation. I dreaded his answer though as I was pretty sure I knew what it was going to be.

“Well, doctor, I guess I was hoping maybe you could just fix things, make all the pain go away.” Mr AT laughed nervously and gave an apologetic shrug.

I return his laugh with an echoing helpless shrug. “I wish I had my magic wand and could fix all your problems. It sounds like you already know what you need to do to fix your ankle though. You’ve just told me that your ankle is fine on the weekend after you rest it.”

He nods.

I continue. “Either you need a new job, one that doesn’t involve all the heavy labour that you’re doing; or, you need a younger body, a new ankle. I’m not sure how to give you either of those though.”

Mr AT gave a rueful smile. He understood I couldn’t satisfy his wish to make all his problems disappear. I could listen. I could empathise. I could affirm him in what he already knew. But, I couldn’t cure him of chronic ankle pain. In the end, we agreed upon the imperfect solution of partially masking the pain with pain killers while he promised to try eating healthier and losing weight – two modifiers that were controllable unlike his job duties and taxing work schedule. It was a temporary patch and not completely satisfactory for either of us. I would have loved to have taken away his diseased ankle and vanquished his pain forever. However, such was not going to happen. It wasn’t even possible under the circumstances to enact physical therapy and a different job. Those were the long-term solutions he really needed for ankle healing. Such situations leave me feeling helpless and frustration. I wonder if this is really what God is asking from me: to temporarily placate people’s pain brought on by poor lifestyles and bad luck?

Work days in Cameroon could be long and emotionally challenging. A frenetic pace from 8 o’clock in the morning with staff worship until the last patient of the day was served. Some days were certainly busier than others. It was hard to quantify the hours spent in the hospital and clinic. Now my days are more regimented. No early morning doorbell signalling a hospital emergency or midnight obstetric summons. Four days a week I walk to work, closing the door behind me at 6:30 in the morning and generally wrapping up the last of my charting and phone messages by 6:30 at night. Long days but defined “off time” away from sick patients and clinic duties. No call except the occasional urgent care shifts. So why is it that I feel less productive overall? Why do I feel like I accomplish less outside work than when I lived and breathed hospital air in the same mission compound? I am still sorting out that answer. Twelve hour days, four times a week, should give me plenty of free time, right?

Perhaps part of the reason for my lassitude outside clinic is due to the emotional tragedies that siphon off energies previously used in other pursuits.

Madam T came in for anxiety and depression. It’s a very common problem in Portland. People are “weird” here but also rather prone to worry-laden depression.  As I sat down to listen to Madam T, the floodgates opened and she spilled out a story of woe rivalling Lemony Snicket’s [series of unfortunate events].  Reflective empathetic statements of compassion are appropriate in such times and yet incapable of dispelling the sad consequences. Life is unfair. I wished for a loving community safety net that I could toss her into for that moral support she needed. Does they exist in Portland? Are there communities that have the resources to help such sad souls in need of a friend? Traditional medicine is not designed to manage the intricacies of psychiatric depression and anxiety. It’s frustrating.

“I know I need to call the mental help line, I just don’t have the energy,” Madam T laments.

I nod. “I wish circumstances were different for you. If I could change them for you, I would.” I pass her the box of tissues so she can wipe her tears and blow her nose.

By the time we part with appointments scheduled to touch base again on the telephone, I find myself relieved to escape. The atmosphere is full of suffocating despair.  I feel for her but I don’t want to absorb all the misery and bitterness she carries. I rather doubt that I’ve done anything clinically to improve her health. I’m not sure if we’ve connected at a therapeutic emotional level either. She’s still shedding tears when I exit. Is this what God has planned for me? Are these the type of encounters He wants me to keep muddling through year after year?  My emotional fatigue level leaves a huge margin of doubt on the reasonable longevity of such a plan.

And so as six days have turned into six weeks and now six months since beginning my new job in Portland, I find that the saying is true: ‘the days are long but the years are short’. It’s hard to imagine that it’s been six months. It feels like forever and yet it feels like I’ve only just begun. I have so much still to learn.

I’m still a novice with most things at work.

I am still part of the “newbie” group of primary care providers.

I still haven’t found my place in the community.

I am still a stranger at church.

I am still finding those friends that you can just “pop on by for a drop of tea and encouraging hug”.

I am still searching for a small group to nourish my spiritual fellowship needs.

I am still learning how medical services like chiropractors, massage therapists, and acupuncture work.

I am still adjusting to all the naturopaths and alternative healers available.

I still have “I miss Cameroon” days

I still refrain from mentioning my time in Cameroon for fear of being forever labelled  “the doctor from Africa”

I still worry about losing my identity as a physician with a mission heart.

I still fight against the temptation of self-pity when I work long hours without the same affirmations that come from working internationally

I still have grey days of depression and self-doubt about the future

I still am figuring out what my calling in Portland is these days.

There are a lot of unknowns. In the midst of the unknowns I have hope. God has been a guide for me in the past; I have faith he will continue to mentor me here in Portland.

Jesus spent 30 years in Nazareth, first growing up as a boy and then working as a carpenter. He spent three years in active, public ministry. Thirty years sawing wood, carving wood, pounding wood, smoothing wood, and sweeping wood dust off the floor of his tiny shop. He could have been doing spectacular, crowd-pleasing miracles like curing world hunger, walking across oceans, raising whole cemeteries, and eradicating leprosy and blindness. He could have reached more people, ministered to more sick, done more impressive feats of glory, fed millions instead of thousands, if he’d left Nazareth at 20 years instead of 30 years of age. Was it really that important to craft another kitchen table, another oxen yoke, or carve that one-hundredth window frame? Jesus spent the majority of His ministry plodding along, a faithful carpenter with the lathe and the hammer in the mundane duties of life. Perhaps I’ve re-entered the proverbial carpenter shop? Crafting another wooden stool might be compared to reassuring another sniffling American that it’s a viral respiratory infection. Hanging out in the carpenter shop chatting to a few clients over the latest design in wooden ox yokes might be like sitting next to a tearful, depressed Portland hipster and offering encouragement and a box of tissues. Our small, insignificant mundane acts can still be sacred acts to God. Perhaps?

“That we ought not to be weary of doing little things for the love of God, who regards not the greatness of the work, but the love with which it is performed.”

― Brother Lawrence, The Practice of the Presence of God

Broken

It's not always easy to love others with the same love that Christ gives to me.

Broken  People

I’ve been back in the States and practising medicine in a traditional primary care outpatient clinic now for three months. One of the most common questions that I am asked, “What’s it like being a doctor in America again?”

Good question.

Complicated answer.

I’m not sure my language skills can quite express the every-changing kaleidoscope of reactions that whirl through my brain each day. There’s a lot I like about working in the U.S. again; there are other aspects I quite dislike.

One of the biggest challenges has been to find the assurance that my work as a primary care physician in an affluent society is worthwhile.

“I’m still searching for meaning in my job,” I reply to my colleague who asks me how it’s going over a lunch meeting.

He nods and listens as I continue.

“When I read about my colleagues that are still in Africa; read their blog stories; or exchange internet messages about the frustrations and difficulties of practising in resource-poor setting like Cameroon, Chad, or Malawi, waves of nostalgia and inadequacy wash over me.  I’m no longer the leader of the team. I’m no longer seeing 30 or 40 outpatients in a day PLUS managing a hospital and labour and delivery service. I feel so tiny when I think about the small number of people I see in clinic now and the minor ailments I attend to during the day.”

“For example, I saw a patient with insomnia and restless legs at night that had elevated blood pressure today. Compare that to a typical patient in Cameroon with severe anaemia and malaria that’s underweight with HIV and tuberculosis.”

“Give me some patients who are really sick,” I’ve said more than once in the past couple months.

At night I pray, “Lord, please help me not compare. Help me with my pride that tries to boost my inner ego by comparing herself to others and then gets discouraged when she perceives others are better and doing more important tasks.”

All around the world physicians are fighting against illness. Spiritual sickness. Emotional turmoil. Physical ailments. Mental distress. There is no comparison. Missionary doctors in Africa are under certain stressors like limited diagnostics, untrained staff, and organisational politics. Missionary doctors in America are under another set of stressors with paperwork, legal issues, and insurance limitations.

Ministering to the suffering is a challenge everywhere. I pray for my colleagues in Africa that God will give them patience in dealing with inadequate electrical power and corrupt political officials while at the same time I pray for my colleagues in America as they deal with twisted insurance prerequisites and drug addicts.

One young woman came to me last week. We’ll call her Veronica, although of course that’s not her real name.  She had a festering wound on her buttock that she’d just been seen for two days prior.

“Have you been taking the antibiotic that was prescribed?” I inquired as I looked over at Veronica, shifting uncomfortably on the exam table, dressed in a gown with a sheet over her lap.

She grimaced and I noticed little sweat beads across her forehead. Her blood pressure was a bit high too. “Yes, Doctor, but I’m not any better.” She shook her head for emphasis. “The pain is unbearable. I can’t sleep at night.” Tears welled up in her eyes as she spoke of the suffering. “I just can’t take it anymore.”

I bent over to examine the infected area on her body.

“Ouch!” she jerked away involuntarily as I touched the sore, red, spot on her skin. “Sorry,” she apologised and braced herself as I took another try at examining the infection. She winced but managed to hold still the second time.

The skin was red and inflamed and acutely painful. Without proper treatment of the infection, it could spread to the rest of her body, potentially landing her in the hospital on IV treatment if things weren’t taken care of today. I wondered why the original medications hadn’t seemed to help her. On reviewing her case, it appeared that appropriate measures had been taken. She should have been getting better by today.

“Given the fact that you’re still not improving even though you’re been taking what normally is the right medicine for this infection, I’m going to change the antibiotic,” I informed Veronica.

She nodded, grim-faced.

“I’m going to order an ultrasound exam to make sure the infection hasn’t formed a pocket of pus deep inside that might need draining too.”

Again, she nodded her understanding.

“And because I want to make sure this infection gets under control as quickly as possible, today I’m going to order for the antibiotic to be given as an injection.” I paused waiting for her response.

“Ok, doctor,” she nodded in agreement.

Satisfied that I was making the correct medical decision based on her symptoms, her exam, and the failure of her infection to respond to the initial first-line antibiotics prescribed a few days earlier, I went about typing in the orders into the computer.

“But, doctor, what about the pain?” she broke the monotone of my typing.

“Are you using ibuprofen and Tylenol?”

“Yes, but its not enough. I can’t sleep,” she winced again as she shifted her weight.

“OK, well,” I glanced at the last prescriptions given a couple days ago by the urgent care doctor, “I’ll refill the Vicodin (narcotic) pain killer that you were given before. Take it with the ibuprofen though,” I instructed.

“OK,” she relaxed.

“Now go do the ultrasound right now and get that first injection of the antibiotic,” I cautioned as she prepared to leave.

She shook my hand and thanked me.

I handed her the prescription for the Vicodin and the instructions for the ultrasound and injection.

That was the last I saw of her.

I waited for the ultrasound report. It never came. I looked her up in the computer system. She’d never gone for the test. I noticed that the Vicodin prescription had been picked up. The antibiotic prescriptions had not been filled.

I hate being snookered.

My first reaction was anger. It made me angry that Veronica would lie  and manipulate me and the medical system just to get a few narcotic pain pills. Later, I felt rather sorry for her. She wanted those pain pills so badly that she was willing to put her own physical health at jeopardy by neglecting proper antibiotic treatment for a real infection. 

Veronica was actually sicker than I’d originally assessed. It wasn’t an obvious illness amenable to a few tablets of antimalarials or antibiotics though, sadly. It was a deeper illness of the mind. Addiction.

Unfortunately, addicted and twisted minds wrapped up in a milieu of complicating psycho-social factors are not easily ‘fixed’. It takes more than a primary care doctor and a 10-minute clinic appointment to help heal the underlying suffering. Perhaps that’s why there is so little personal job satisfaction in these situations. It’s easier to prescribe a cream for the scabies rash or a worm tablet for the tummy ache or a course of Coartem (antimalarial) for the malaria.

Broken people are all around. In Africa. In America.

Perhaps some different flavours of illness hit my radar here in America versus Africa. I am trying not to compare though. Illness comes in all colours, shapes and sizes. I am continually astounded by the magnitude of broken souls that I meet.

It doesn’t matter whether it’s Africa or America, Asia or  Australia. People come with deep, penetrating wounds – raw and festering – expunging shame, guilt, depression, anxiety, unfaithfulness, and violence.

The song “people need the Lord” seems rather appropriate. God is teaching me to avoid the comparison game that only brings discouragement to my heart. Instead He is telling me to simply go forward and treat each person, whether it’s one or one-hundred, with the same love and grace that He extends to me.

Isaiah 61: 1-4 

The Spirit of the Sovereign Lord is on me,

because the Lord has anointed me

to proclaim good news to the poor.

He has sent me to bind up the broken-hearted,

to proclaim freedom for the captives

and release from darkness for the prisoners, a

to proclaim the year of the Lord’s favour

and the day of vengeance of our God,

to comfort all who mourn,

and provide for those who grieve in Zion—

to bestow on them a crown of beauty

instead of ashes,

the oil of joy

instead of mourning,

and a garment of praise

instead of a spirit of despair.

They will be called oaks of righteousness,

a planting of the Lord

for the display of his splendour.

Homeless

Jesus replied, “Foxes have dens and birds have nests, but the Son of Man has no place to lay his head.” Matthew 8:20

I’m tired.

I want to go home.

What home?

Oh, yeah, right, I’m homeless.

Jesus' comment to the potential recruit in Matthew has new meaning for me:

Over the past couple months, Bill and I have been dependent on other people’s charity. Now don’t get me wrong. I am deeply appreciative of the generous hospitality shown to us. It’s not easy inviting two people that you might not have seen for a few years, or at least a year, into one’s house and having them invade your privacy, disrupt your routine, and block your vehicle in the driveway. I am very much indebted to the wonderful welcome so many of our friends and family have shown us. In fact, I am so thankful that I am also struggling with guilt. Why am I so unsettled and tired of living from house to house when so much kindness has been floated my direction? I feel ungrateful.

I should be more thankful. Less unsettled. Less grumpy.

Guilt and loneliness has a way of sneaking up and rearing its sinister little tongue in my ear at the most inopportune moments. For example, driving down the speedway from Zion National Park to San Bernardino California after a fabulous camping trip. And when I say fabulous, I mean it was perfect. Great weather. Great company. Delicious food. Inspiring views of nature’s beauty. It was a flawless get-a-way. I couldn’t have asked for a more perfect adventure.

It’s over now. We’re driving away toward the smog of the L.A. West. We’ve packed up the little red Honda Fit once again. Although our clothes smell like campfire smoke and items might have “shifted” a bit making the piles in the back more ‘poofy’, everything is settled enough that one can view out the rear-view mirror. Our temporary tent shelter is cleaned and packed and now a distant memory. We are driving onward to another yet another temporary shelter.

Our yellow duffle bags contain most of our clothes. Our two backpacks contain the other essentials, like a laptop computer, documents, and electrical wires for charging the mobile phone and iPad. The camera and day planner are in my shoulder bag. Bill and I can carry all our necessities in two hands.  We don’t need much: deodorant, toothbrush, clean underwear, pyjamas, and a nail clipper. Our life on the road is pared down to the bare essentials. And yet, with all our comforts more than amply supplied, why do I feel so “homeless”? Like a vagrant or a gypsy?

How many more WiFi network passwords can our MacBook remember? McDonalds, Starbucks, Panara, and even Zion National Park have public Internet access now. I’ve used them all. The downside of daily changes in my IP address was that my Google account locked me out. It noticed "erratic usage patterns" in my account!

How many different ways of brewing coffee can we learn? Instant…Drip… Pods… Press… Fancy machines and not so fancy machines…

How many varieties of soaps and shampoos will our skin adapt to?

How quickly can our bodies adapt to the ever-changing time zones and schedules?

How many different brands of washing machines and dryers are available in the U.S. these days? The fully automated ones practically require a PhD to be able to utilize. I never new laundering a pair of wool socks was such a complicated science!

Our new Honda Fit has driven over 16,000 miles in under 4 months and passed through 26 different U.S. States. Our Visa company is almost on speed dial so we can let them know we’re in yet another country.

I have one address on my driver’s license. Another address for my Visa Card. When someone asks for a mailing address, which one should I give? My Amazon account contains over 20 potential addresses for shipping.

Oh, and a phone number, you ask? Well….I have  a new mobile number this year. A Trac phone. One of those pay-as-you-go phones. Great for avoiding the FBI if I were a secret agent spy; not so great when others want to contact me or I want to look up a friend in my phone’s contact list.

Want to confuse someone? Try scheduling a doctor visit or a dental check-up with the receptionist. The conversation can be a bit awkward:

“I can put you in for an appointment with the doctor on Wednesday, December X,” the receptionist pauses, waiting for my affirmation.

“Um… I won’t be in Virginia then. We’re only in that State for the last week of November. Might you have another appointment slot open, please? We only come back to the U.S. for a short period of time for our annual holiday, you see. Sorry for the confusion.” I apologize. Sometimes one can make appointments more in advance but then one risks misunderstandings through the crackling, unsteady Skype connection.

The receptionist (rolling eyes on the other end of the line most likely) finally answers after a significant pause, absorbing the information, “Well…let’s see…” I wonder if she thinks I’m making up the situation to entice her to try for a more urgent slot. I have no idea.

~o~

One day it will be nice to have a home address again. A home to ship our belongings to that are scattered all over the world. Some cartons are waiting on the dock in Douala tagged to cross the Atlantic soon -- we hope. Other boxes are shelved in our longsuffering parent’s basement. Our dog is lodged temporarily with my parents while we drive across the country like migrant workers in search of a permanent position. Our cat is distributed to a friend of a friend until we have a final destination. Other mementos are stored in at my husband’s relatives. And the rest of our things -- those little essentials that we can’t bear to part with -- like our guest book, a favourite pillow, and my husband -- are nestled ‘fittingly’ into our Honda Fit.

One day Bill and I will have our own bed again. One day we’ll be able to set our toothbrushes down on the bathroom counter and not worry about forgetting them when we pack up again. One day it will us giving out the password for our own WiFi network. But, for now, we’re homeless and on the road. Two days here. Three days there. House to house. Friend to friend.

I am thankful. I am grateful. I am blessed by the interactions and the opportunities. I wouldn’t trade this unique experience of transitioning from Cameroon back to the U.S. for anything. I won’t forget it.

And yet… I  think I will be glad to finally unpack…one day. At least for a while.

~o~

Lord, I cannot fail to see the spiritual lesson in all of this. What a reminder that yes, we are pilgrims and sojourners on this earth. We cannot get too settled. Earth is not the final home; heaven is our destination. Heaven is our home. Until then, we keep travelling.

And I do ache for that heavenly home. These past few weeks have demonstrated that more than ever to me. Home is heaven.

 The hymn in church last week seemed fitting. It is probably a familiar hymn for many of you. The words have been filled with additional meaning for me recently. Here they are: (the YouTube version is quite nice, btw).

This world is not my home, I'm just passing through.

My treasures are laid up somewhere beyond the blue.

The angels beckon me from Heaven's open door

And I can't feel at home in this world anymore.

O Lord you know I have no friend like you

If Heaven's not my home, then Lord what will I do?

The angels beckon me from Heaven's open door

And I can't feel at home in this world anymore.

They're all expecting me and that's one thing I know.

My Saviour pardoned me and now I onward go.

I know He'll take me through, though I am weak and poor.

And I can't feel at home in this world anymore.

O Lord you know I have no friend like you

If Heaven's not my home, then Lord what will I do?

The angels beckon me from Heaven's open door

And I can't feel at home in this world anymore.

I have a loving Savior up in glory-land,

I don't expect to stop until I with Him stand,

He's waiting now for me in heaven's open door

And I can't feel at home in this world anymore.

O Lord you know I have no friend like you

If Heaven's not my home, then Lord what will I do?

The angels beckon me from Heaven's open door

And I can't feel at home in this world anymore.

ust up in Glory Land we'll live eternally.

The Saints on every hand are shouting victory.

Their song of sweetest praise drifts back from Heaven's shore

And I can't feel at home in this world anymore.

O Lord you know I have no friend like you

If Heaven's not my home, then Lord what will I do?

The angels beckon me from Heaven's open door

And I can't feel at home in this world anymore.

There and Back Again -- with a Hitchhiker! (part 2 of 2)

Jordan and Milo's Health Books from Cameroon

Part Two: And Back Again

So now you have the “There”… time for the “Back Again — with a Hitchhiker”.

“You want to take the cat back?” my husband inquired with undisguised hope that I’d answer to the negative.

Ignoring his unspoken plea, I answered, “Yes, I would like to Milo (our cat) back. We don’t know if there will be a replacement living in this house when we leave; someone might not come to replace me for months, it wouldn’t be very nice for Milo (our cat) to abandon her when it’s not that difficult to bring her with us. We brought the other volunteer’s cat back last summer and it wasn’t too bad, remember?”

Bill rubbed his temples and massaged his neck muscles at the memory. “Yes, I remember.” Grudgingly he admitted, “she was pretty easy to transport. However, I don’t mind if someone else wants to keep her here in Cameroon.” His voice lifted for a moment at the end, still hopeful the cat might find a friend to take her in Cameroon.

“Well, I think we should move forward with trying to bring her back in case no one else wants her,” I answered.

“I’ll call the vet and set up an appointment for her rabies vaccination then,” Bill caved to my wishes with a patient sigh. The rabies vaccine for international travel must be up to date within one year but also administered more than 30 days prior to the departure date. Both Jordan and Milo were appropriately vaccinated and boosted with rabies vaccine.

~o~

Rabies Vaccination Signed and Stamped in their Health Book

“How’d it go in Douala at the Brussel’s office?” I asked Bill after his trip to the international airport.

“Fine, fine. I have the tickets for the pets and us.” Bill slouched down into his chair and tried to forget the harrowing driving conditions that a trip to Douala entails these days. He showed me the pile of boarding pass sized airline tickets. The pet tickets specified one carry-on pet (that would be Milo, the cat) and one extra luggage of a pet as great or greater than 15 kilograms (that would be Jordan, the dog). The pet tickets were tied to our own passenger tickets, specifically, Bill actually. I found it a little ironic that in spite of my husband’s reluctance, he still ended up tying his airline ticket with the dog and the cat.

~o~

“I read the email from your husband,” the local veterinarian hopped off his motorbike and sat down next to me. Bill was still away in the U.S. while I remained to finish my last few months of mission service in Cameroon. “Bill seems to be quite anxious about the pets.”

I nodded. “Yes, he wants to make sure that the animals get their health certificates without any problems. He wanted me to ask about any blood tests that the dog might need too. He mentioned something about a test for screw worms…” my voice trailed off. I really didn’t know what to make of this last requirement Bill and I had read about on the custom’s website.

The veterinarian nodded. “The health certificates have to be obtained one or two days before the departure date. It’s still too early. We can have everything together though and be ready to take the documents for signature and stamps on Thursday.”

“And what about any blood tests?” I prompted again.

“To be honest, your dog hasn’t had any non-healing wounds, right?”

“Never,” I affirmed.

“Well, then, we don’t need to worry about screw worms. She doesn’t have any signs or symptoms suggestive for the worms.”

“So we don’t need any blood tests?” I wanted to be clear on this last point. I didn’t want to find myself in the situation of getting down to the day of departure and suddenly being informed that my dog couldn’t travel because she hadn’t had the required blood test for worms or whatever.

The veterinarian shook his head. “We’ll get the certificates for the dog and cat on Thursday. The signature and stamp will be from the government veterinarian so the paperwork will be what the airline officials in Douala are used to.”

“Oh?”

“Sometimes people have their private veterinarians sign the certificates but then you might get questioned at the airport. It’s better if I get the government signatories that they’re more used to in Douala,” the vet tried to reassure me.

“OK then,” I smiled, “but since our departure date is Thursday, how about we try to get the certificates on Wednesday?” I suggested. “I mean, what if the official is not on-seat on Thursday? Maybe it’s better to try the day before since the date can be two days before departure?”

The vet smiled. “Oh, ok. I get you. That’s ok then. I understand you. No problem.” He hesitated like he wanted to say some more but held back at the last minute.

“You have the health booklets with the pet’s rabies vaccination certificate inside, right?” I checked to make sure he hadn’t forgotten.

“Yes,” he answered, producing the booklets to show me.

“I have the photos for their books now too.” I produced a four by six inch photograph proudly. With the help of one of our volunteers, I had taken a photo of the dog and the cat and had them printed in such a manner as to come out the appropriate size for pasting in the health booklets — 2 inches by 3 inches. They were even in color!

Milo's Passport Photo
(2 inches x 3 inches to fit her health book)

Jordan's Passport Photo

Our veterinarian was duly impressed and proceeded to paste them into their respective booklets with great care. I’ve never seen anyone take so long to glue two photos down. At last he departed with the promise to get back with me next Wednesday. “I have to travel next week,” he informed me, “but, I’ll have someone get the documents next Wednesday.” He drove off in a puff of exhaust.

The next Wednesday our motorcycling, traveling veterinarian was still far away in Kumba. Thankfully, he kept his promise and sent his brother who collected the signed and stamped official health documents and delivered them to our doorstep. The check list was complete:

1. One dog; one cat - check

2. small health booklet with photo pasted inside and stamped, official rabies vaccination record — check and check

3. printed tickets from agent at Brussel’s airlines for cat and dog, including receipt of payment - check

4. dog crate - check (same as the one we used bringing her) - check

5. cat carrier - check (brought by Bill and borrowed from our friend who used it to transport her own cat the year before) - check

6. health certificates - check and check

7. Small bag of dry cat food and dog food - check (not that the animals actually ate on their trip)

8. attachable bowl for water/food for dog; small bowls for water and/or food for cat (again superfluous but psychologically comforting for owners)

9. extra towels and pad for cat carrier and dog crate (should have brought more disposable towels for cat carrier…)

The All-Important Vet Certificate of Good Health
(Must be dated within 2 days of departure date)

Thursday dawned. So many goodbyes were said. We fed the animals early. We gave them last chances to relieve themselves. The cat was a bit miffed that I locked her in the kitchen for the afternoon. The dog was happy to go for an extra walk. She could sense that we were traveling and she wanted to be as close as possible. She sat determinedly under Bill’s legs with an ‘I’m-not-letting-you-out-of-my-sight attitude. She at least was able to maintain her nearness to “her Bill” during the taxi ride to the airport since the vehicle was jammed pack with 4 suitcases, 2 backpacks, 1 large and disassembled dog carrier, 1 husband, 1 driver, 1 friend, 1 cat in her cat carrier, and me  — does the list remind you of a song?! …’two missionaries — and a kitty in a cat cage.’

We arrived at the airport and our driver parked the vehicle in the parking lot area, allowing us to assemble the dog crate, bolting top and bottom together. Bill walked around with Jordan, giving her last chances to relieve her bladder. We joked nervously and munched on chin-chin snacks, feeding Jordan who happily snapped up the treats tossed her direction. The goal was to check in without feeling rushed but still not check-in so early that Jordan would be left on the tarmac for too long before boarding and plane departure.

“Let’s go in at 9 pm?” I suggested. “That way we’ll still have three hours before scheduled departure but if we’re hassled, we’ll still have some leeway to figure things out.” Bill agreed with me. Jordan wagged her tail. I rubbed my jeans and sniffed a damp corner of my shirt. “Uh! I think the cat peed already. The carrier is not pee-proof.”

“Sorry, dear,” Bill replied absently as he comforted his dog.

Our friend helped me change the absorbent pad in the cat carrier and replace it with a clean towel. I should have brought more old rags that would have served as disposable pads. I tossed the soiled pad in a sealed plastic and splashed on some instant hand sanitizer. “Perfume would have been nice,” I mused to myself. At least no one else seemed too bothered by my urine tinged travel clothes. *sigh*

We bid our good byes to our driver and friend and several luggage attendants came eagerly forward with their carts and hauled bags and dog carrier into the airport. With a few francs tip, it’s amazing how many willing hands and able backs are available to assist!

(Bill picks up the story here)  Health officials stopped us just before the Brussel’s check-in counter and inspected our pets’ documents (health certificates and vaccination records).  We paid 5,000 XAF (about $10 USD) per pet and received another two official-looking documents stating the animals had been inspected and were healthy. Tucking them safely into my bundle of travel documents, we continued to the check-in counter.

Health Certificates from Airport Inspector - One of the "chat" and one for the "chien"

The check-in agent weighed our luggage, inspected our documents, placed luggage tags on the four bags and dog crate DLA / IAD, indicating that we should not expect to see the dog or any of the luggage until Washington DC.  I took Jordan out of her crate and the check-in agent sent our bags and the crate down the belt.  Trixy was free to pass through the process of departure. I went with Jordan and a DLA (Douala Airport) security agent down to the baggage handling area where they inspected the crate and had me place Jordan back inside (note: I handed off my passport to another security agent in this process and retrieved it on my way back to the normal departure process line).  I said my good-byes to Jordan and wished her well, praying silently for her safety and special blessings for all who would handle her in process. Once back in the normal departure area, I handed in my white immigration card and processed through immigration to the departure gate.

Milo remained with us (Trixy’s possession mainly) as we traveled.  She was pretty quiet, like her daughter, Friday. I had traveled with Friday, Milo’s daughter cat, only the year prior, bringing her back to America for a friend and former volunteer in Cameroon.  Sad meows echoed pitifully from the interior of her carrier only during walking off the airplane in Brussels and again coming off the flight in Washington D.C. It appeared that the gravitational changes and alterations in environment gave the cat a false hope of escape from her cat prison at these times.

Brussels has two routes they fly to/from Douala, depending on the day of travel.  It might be BRU>>DLA>>NSI>>BRU or it might be BRU>>NSI>>DLA>>BRU.  We specifically booked the second for the shortest flying time to BRU.  We followed the advice of the airlines to book the full flight with them (they send checked dogs as excess baggage, United Airlines considers them as cargo. Apparently there can be problems when switching between the two. We didn’t care to find out).

In Brussels we mentioned we had a dog in the hold and enquired as to what should we do as we were transferring to a Washington DC bound flight.  The agent at the counter said the dog would transfer and we need do nothing special.  To verify we found the transfer desk and enquired about the process.  Same answer.  We settled into some very comfortable sofas in the airport waiting area for the next eight hours praying that our dog was also somehow comfortable wherever her crate was situated.  Since Trixy had the cat, we did not exit the airport and tour Brussels. Europe tends to have stricter import rules regarding animals than the U.S. We decided not to bother with attempting customs for just a few hours in the city.

We boarded our last airplane for the trip from Brussels to Washington DC. It was the last and longest leg of the journey. Milo settled down to a quiet sullen silence, curling up on another fresh towel, having refused food and water in spite of Trixy’s offers. We could only pray that we’d see Jordan when we reached America.

“So, we have to declare some things on the custom’s declaration form, right?” Trixy looked over for confirmation, pen poised.

“Yes, we have to go through the line at the custom’s counter for people with items to declare. Put down both the dog and the cat.”

In the end, it made little difference that we had pets to “declare”. The first official, the Immigration officer, welcomed us back without comment on the pets.  But a few questions on the “food” we were bringing.  Satisfied there was no risk or issues for America he passed us on to Baggage claim with a “Welcome home”.

“Over here,” I called to my surprised wife. “The luggage was tagged ‘priority’ so it’s already here.” I pointed to an exclusive pile of luggage at the head of the luggage turnstile.

“Where should we look for our dog?” Bill tried to flag down one of the attendants hovering over the luggage claim area. Suddenly, I spotted Trixy waving from across the room.

“Over here,” she waved and pointed. A smiling airport employee rolled a familiar dog crate out into the luggage claim area. “She made it. Jordan made it.” My wife smiled.

“Jordan!” the furry canine inside wagged her tail furiously and whined in impatience — ready to break out of her 30-hour confinement.

On the way home from airport with furry friends

General notes:

While no one past Douala checked our documents, you are advised to keep with you at all times: health certificates, vaccine documents, tickets (i.e. everything related to your pet’s health and travel).

There are some good resources if you are traveling with pets and coming to the United States.  I am sure Europe has their own as well.  The CDC has these links:

A very good overview:  http://www.cdc.gov/features/travelwithpets/

Lots of details:  http://www.cdc.gov/animalimportation/travelingpets.html

We have two preferred airlines from Douala to Washington DC:  Brussels Airlines and Turkish.  Air France is also very good (we flew them to Cameroon).  But they tend to be more expensive.  We should also note that five years ago we were required to collect Jordan at the baggage claim in Paris and check her and my luggage back in before the next flight.  I don’t know if that is still how they work today.

We have heard stories that Turkish Airlines doesn’t always have a pressurized cargo area for pets.  I don’t know if this is true or not.  Our main reason for not choosing them was their longer flight pattern.  I flew Brussels Airlines with Milo’s youngest one year before we returned.  The Brussels personnel were helpful and never showed any sign of unpleasantness at me for having a cat on board.  In this first case I flew Brussels from DLA to BRU and then switched to United Airlines from BRU to IAD.  I would advise against this as you may have to pay twice, once for each airline. While not difficult, switching airlines, even partner airlines, adds a level of complexity. Both airlines counseled that it is best to fly one airline when possible.

We complicated our travel somewhat by booking our tickets and then changing our dates.  This caused some confusion within the airline.  I rebooked in the USA and should have just kept the rebooking with the agent in Douala.  That would have been the best thing.  In any case the agent in Douala made sure everything was set correctly and our rebooking secure including the pets.  The pet tickets are valid for one year from the date of purchase.  We paid for them in May and when we rebooked the confusion was what to do with the tickets, one person said we would have to pay a second time and we would be refunded the first amount, one person said there would be no refund, but the agent in Douala and the tickets themselves indicated no specific travel date and so were flexible to their human’s tickets, provided the pressurized cabin was not already fully booked.

Limits of our information:

Seriously, this is a review of our experience.  We normally travel DLA / IAD, we know the airports and the airlines we have used. Your experience may be very different.  We don’t know what it is like to have onward travel beyond the port of entry.

Here are the summary bullet points:

Choose your airline carefully (if you have options)

Fly the same one from your foreign home to the USA, if possible

Your foreign-based vet should be knowledgeable in securing Health Certificates a couple of days before your intended travel

Pets should be up to date on Rabies vaccine and proof in your pet’s health book/passport

Appropriate pet carriers should be secured well in advance

Food/Water for travel

Summary of Costs:  These will vary to your own circumstances, but be prepared.

Vaccines

Health Certificates

Airline tickets

Exit fees

I would also suggest you keep a photo record of your pet’s documents.  Be able to produce them on your smart phone, tablet, or laptop if anything should happen to the physical documents.

Airline tickets

Health Certificate(s)

Health book