December 16, 2015

Hello from the Other Side (of back surgery)

Been wanting to post an update ever since I survived back surgery 16 days ago (morning of Nov. 30th). I've started writing about it and had to stop a couple times in the past couple weeks, and today is the first bit of time that I am finally able to share the initial story.

I say initial because the day of my surgery was pretty much in the middle of the 6 month span that this process is likely to affect my life. On the front end, since mid-August, I've had >3 months of worsening symptoms from my sciatic nerve root compressed my herniated L4-L5 disk (plain English: burning, numbness, pain, and weakness in my right leg and foot, and up to 12 pain pills a day of 3-4 different types of pain medication to allow me to continue working). And now, ahead of me, 3 months of recovery (fine print: 3 weeks of temporary disability from work, 6-7 weeks of physical therapy to restrengthen my right leg and foot, back and abs, a month or two of no driving, two months of no strenuous exercise, an indefinite amount of time with no bending over, and 3 months for my sciatic nerve to gradually heal and the nerve pain to go away completely).

On one hand it's nice to know that there's a 3 month post-surgery recovery window in which I can relax and not feel like I have to be immediately better. On the other hand, since I am not particularly patient nor disciplined by nature, I have to work at controlling my mental reactions to the speed of my healing process.  But anything that doesn't kill us makes us stronger, right?

I had to breathe deep when I saw some initial reactions from friends to my posts about surviving surgery, to the effect of, 'of course you'd survive, but how's the pain now?' On one hand, very few people experience immediate and total relief of sciatica symptoms, and EVERYONE who undergoes surgery has a recovery period where the word pain-free is a joke. On the other hand, I really was terrified of surgery. I was partially afraid I'd end up worse, worried about general anesthesia, local anesthesia, you name it. And the truth is it's not always pleasant to be hospitalized in a foreign country, even a top-notch one, because when you're in your deepest throes of needing to feel safe and secure, a foreign language, even one that you're fluent in, can push you to the edge of anxiety when no matter how you express yourself, folks just aren't getting it, or in the least, they're just not able to communicate their reasoning to you.

On the day before and the day of my surgery, that was precisely what happened: language/culture blunder #1 began with an anti-anxiety and leg pain medication that was given to me the night before, but not the morning of. Every day for 3 months, I've been on pain medications for my sciatic nerve pain in my leg, but somehow it got left out on the morning of, and so during my wait to go into the OR I was suffering and this compounded my nervousness about surgery. So when he finally arrived in the OR, Language/Culture Blunder #2 ensued, and instead of giving me the two meds and putting me on local anesthesia like we'd agreed, in the end, the anesthesiologist ended up putting me on general anesthesia. And later told my surgeon that I'd asked for it, who of course believed him. At least that was the response when he boasted that the surgery had only taken 35 minutes, and I complained that how could that be when I'd been unconscious for 3 hours.

Putting those blunders aside, I set about firming up my mental state to go through the first few tough days of recovery. Truth be told, I was amazed that my back muscles did not hurt. The incision site stung a bit when I moved funny, and I had some serious weakness in my lumbar/sacral area for the first week, but beyond that, I was able to walk, sit, and stand completely unassisted within a couple hours of waking up. To me, that proved the claim of endoscopic surgery that's it's much less invasive and permits faster recovery and mobility than traditional open back surgery, where muscles are sliced by a scalpel rather than perforated by an endoscope. Sure, it was hard to walk the first two days, and I did not really want to, but with the urging of the nursing staff and my doctor, I hauled myself out with my IV stand and did my laps in the 1st floor lobby. Walking a few minutes every hour since the day of my surgery has contributed greatly to my recovery process.

Unfortunately, there were two more hiccups in my first few days. The first could also be considered a cultural blunder of sorts. I thought I'd prepared my small mountain of pre-surgery paperwork as thoroughly as possible. The insurance company had requested a quote in writing from the surgeon and his team (which was mostly adhered to, with the exception of a couple members whom insurance didn't end up covering) as part of the pre-surgery approval process, but hadn't requested a quote in writing from the hospital. I had a choice of two or three hospitals that the doctor operated at; I was told one wasn't covered by the insurance, and another didn't answer my calls. So I went with the third hospital that answered my phone call and gave me a quote— although it's known as one of the most high-end and pricey hospitals in the area, the amount quoted over the phone sounded totally reasonable. In retrospect, I really should have gone in person to get a written quote.

I started receiving phone calls from billing to my hospital room only a few hours after my surgery on Monday afternoon, telling me that Dr. so and so had left his invoice, and what would my form of payment be? I told them to call my insurance. They informed me insurance wouldn't be covering. I was annoyed but didn't think it was too big of a deal because I could probably take some more cash out. I told them we'd deal with it tomorrow. But on Tuesday, after my doctor had discharged me and Margo went to billing to cash out, came the biggest surprise. The total for the hospital's portion of services ended up being about 18 times (Yes, 1800%) more than I'd been quoted over the phone. This huge discrepancy was one that we weren't prepared to pay, even 14% of it, which was my copay. To our dismay, they were also unwilling to bill us, in other words, I had to pay in full immediately prior to leaving.

I didn't have enough cash to cover it, nor was my credit card limit high enough to charge it. So less than 30 hours after my surgery, I spent about 6 hours sweating profusely and making calls in an attempt to raise those funds. Those 6 hours were enough for another entire blog post. Then I pleaded with billing to accept the 70% we were finally able to raise by Tuesday evening and bill me the rest, but the heads of department refused. So my discharge was cancelled, and the hospital held me hostage for another night until we could deliver the rest the next day.

As a result of the stress, my temperature rose and I immediately came down with the cold that my daughter had had a few days earlier. Aside from stressing out me, my husband, our friend who was taking care of our daughter, our daughter, my family, Margo's family, and other friends, being kept prisoner by a hospital was incredibly embarrassing. Margo had to go home and collect our daughter and I spent that third night alone in the hospital. Before he did, he got me a coffee and a chocolate glazed donut, which helped me feel a tad more human for a moment. After he left, at nightfall, I worriedly tried to send away the nurses who came to my door offering to check my vitals, fearing I'd be charged more. Their eyes widened when I explained the reason why I was still there even after I'd been discharged. They, and the dietician in charge of my meals, assured me that it was "all included," and to not worry. I accepted. Then I remembered my surgery bandages hadn't been changed since Monday morning, and got freaked out that my fever was from a surgical infection. The nurse on call assured me my temperature was low enough to not cause concern. She mercifully helped me change the bandage free of charge. The meals kept coming. My fever got under control. In the midst of such a degrading experience, I felt fortunate that some hospital staff still had my best interests in mind, and I will always remember their kind faces and words.

I finally went home on Wednesday around 11 am. Whereas I had turned my nose up at the Krispy Kreme stand when I was admitted, I gobbled down another chocolate glazed and bought another couple boxes to give to the people who had helped with our daughter in our absence. It took a few days for my fever and cold to disappear, thankfully, because their symptoms was making recovery harder. I kept walking a little every hour, forcing myself out of bed even though all I wanted to do was stay there and watch Netflix.

The first week flew by. Aside from getting in and out of bed, sitting down for meals, walking, and showering, I was pretty much totally dependent on Margo for everything around the house and for assistance getting dressed and changing my bandage. My back didn't hurt but I kept getting shooting pains down my right leg every time I'd get up from sitting or laying down. They were so strong I'd have to grab something to hold on and use my deep breathing. But they'd subside in a few seconds and then I'd be fine. I was only on paracetamol that week, which is saying a lot when you compare it to how many meds I'd been on prior. After speaking with friends who'd had back surgery before or knew others who had, they were shocked that I was up and about so quickly and that my incision was so small. That made me feel a little better. But at first, I was still spending more time resting (laying down) than up and about (sitting or walking).

On Day 5 or 6, I was finally able to lay on my back without pain in my wound area.

On Day 7, one week after surgery, things started getting better fast. The weakness in my lower back was gone, and I was walking normal pace. I was upright for 5 hours without laying down.

On Day 8, Monday the 7th, I quit using a bandage—the gauze and tape were driving me nuts—and my wound seemed to be healing well. I went for a ride in the car for the first time since a physical therapy consult, and was told I was doing very well. I started Lyrica for the nerve pain, which I was told shouldn't last for more than a few weeks.

On Day 9, I was finally able to completely dress myself (including socks, which are still challenging). I was upright for the majority of the day, and only had to lay down a few times.

Day 10, I stopped taking paracetamol. So I was completely off the morning pain meds. It was a watershed day for me, and the first time in over 3 months that I hadn't taken pain medication upon waking. I had my first beer in 3 months too, man was it good! :-)

On Day 12, I went "out" for the first time (aside from physical therapy)—to our office holiday party—I was mostly fine but by the end I was feeling pretty tired, and achy in my lower back.

On Day 13, I went "out" again, this time to the mall, to get some lightweight walking shoes. I was out for a good chunk, and felt pretty darn tired afterwards. The morning after, I was achy in my hips.

Day 14 was my last day of antibiotics (Cipro), and a day of rest took the edge off my aching hips. I finally was able to lay on my stomach for a few moments, something I haven't done for a few months (it's almost always made my nerve/leg spasm bad). The lesson learned was to be active but to increase my activity gradually, not in large amounts.

Day 15, my physical therapist added a few new exercises, and my hip was sore the day after, and my nerve pain shifted from up high to down low in my calf. I have a hard time with backslides, but I tried to stay optimistic. I was given another week of disability, and am thinking I will probably be good enough to go back to work next week. I saw my neurosurgeon for my 2 week checkup, and whereas he is happy with the results, he prescribed me more exercises for my right foot and shin, which are still pretty weak (I have a hard time walking tiptoe and on my heels on the right side—am basically unable to do so).

Day 16 (today), I got up from bed without any shooting pain down my leg. To me that's huge progress. They say that if you are improving consistently during your first 3 months, that you will only continue to get better.

Now, as my neurosurgeon is trying to impress on me, it's more important to focus on my overall health rather than worrying about the consequences of my surgery (i.e. that a spacer was inserted, that I might have any mobility limitations). He's urged me to take steps to care for my other remaining, unherniated disks, by losing weight and, once I'm further along in my recovery, by exercising. He assures me that I won't have any limitations in my activities once I'm recovered, and I am trying hard to trust him. Based on my progress so far, I am inclined to keep the faith. Margo says I am walking much more upright and without a limp, and for my part, not having to take 10 or 12 pain pills a day is a big enough difference for me.

In retrospect, even though I would have preferred not to go through this, I am compelled to count my blessings in terms of having had access to insurance that covered the majority, a clearcut and supportive Mexican workers' comp system that allowed me sufficient time off work for recovery (and  free follow-up care parallel to my private doctors), family and friends who've lent big helping hands in these last two weeks, and most of all, my husband who has been taking care of every last detail and listening to my every last peep during my recovery process. My recovery has been a straightforward trajectory without any complications so far. I am truly grateful.

Any major surgery is an experience that brings your mortality and aging into clear focus, and of course for someone who loves life and being incredibly active, it's a hard thing to face and deal with. But considering that I am only one of billions who deal with this on a daily basis, I'm going to keep focusing on the positive, the small victories, and the sweet things in life that help us rise above the pain. Although I still have the road to recovery in front of me, it feels good to be emerging on the other side.

November 9, 2015

Shades of Pain

About a month has passed since my last blog post, and whereas before I was taking only 2 types of medicine daily for my (sciatica) leg pain, I am now taking 3, sometimes 5. New levels of pain = new thresholds for pain.

The pain meds allow me to continue on with the majority of daily activities, I still go to work, can still bathe and dress myself, but that's about it. I haven't been able to pick up any of the slack at home, can't cook for myself, can't drive, no exercising or stretching, and sleeping through the night without having to top up my meds has become a rare occasion.

I also had an EMG taken of my legs, which revealed that I have nerve damage in the right leg. This led my rehabilitation doctor I'd been seeing for 6 weeks to finally give up and tell me that he thinks that surgery is the only route to solve this problem now.

By the time he told me that, it wasn't a shock. I wasn't as closed off to the idea of surgery as I was in early September. It'd been almost 2 months of treatment with no effect (in fact, only worsening). I had become worried I might occasion permanent damage to my leg, even if I could wipe out all the pain in my leg (which even with the 3-5 meds is still rare).

Both surgeons I saw subsequently (for yet another set of opinions) agreed, that surgery is my only remaining option. And also, fortunately, I am a candidate for endoscopic surgery, which is relatively less invasive than open back surgery, with less recuperation time as well.

The hope is that surgery, by removing the herniated portion of the disk, will relieve the pressure on the sciatic nerve and allow it an opportunity to heal. Both surgeons predict that I will be able to recuperate 95-100% of lost function (which luckily is not that great- some strength in my right leg and some range of motion in my shin and toes).

I definitely still have trepidations about this, as I realize it has its risks and I would have preferred to avoid the surgery route. On the other hand, I am eager to give my body a chance to continue on its way with healing from this, and regain a lot of the quality of life and independence that I've lost in the last 3 months. I'm trying to look at it as just an example of something that can easily happen to any active individual and that any person or athlete, etc. would want to obtain the care that best allows them to recover in the least possible amount of time.

Getting off the meds will be another important effect of the surgery, I hope. Even if it weren't for the EMG results showing nerve damage, I am concerned about the long term effects of so much medication for months.

Another good thing is I happen to be insured doubly- both private insurance through work as well as the state-sponsored insurance which ostensibly will provide the "temporary disability" status to allow me leave from work for the weeks I'm in recovery. Thus, in terms of timing, it really does help that I have a way to get this done without incurring significant costs that, if uninsured, might have been cost prohibitive.

A side benefit of this issue is that I decided to take my health by the reins in terms of my weight, and have lost 5 kg/11 lbs in the last 5 weeks. I am not sure if this has helped with improving my symptoms, if it has, I haven't noticed, but it will be helpful in the recovery period and long-term in my quest to reduce the likelihood of this occurring again in the future.

There are a number of administrative hurdles I have yet to clear in the coming weeks, and I hope that my instincts in navigating this unchartered medical territory will serve me well. If all goes well, next time I write I will be in recovery from what was a wildly successful intervention to get me back in the saddle again. I am pining for days where my threshold for pain can come down from "sky high" and go back to "normal." Wish me luck. 

October 12, 2015

The Chronic Pain Club

There was a YouTube channel that Bee used to like to watch when she was a little younger and was starting to learn nursery rhymes: The Mother Goose Club. It has a catchy jingle that sticks in your head which I suppose is what you want when you're promoting language acquisition. For adults, luckily, it fades from the memory before annoyance hits. But the song keeps popping into my head every time I think of the latest clubs that I am now a card-carrying member of.

I wish I could say the same about the rhythm that's colored my life as of late: sciatica. The name of the condition is cool sounding, latin in origin and pronunciation. Back in the day, when I used to have low back pain that was largely stress-related (but in poring over old results, probably did have a physical component that's rearing its ugly head today), I used to come across the term sciatica in my Google searches and, although some symptoms are hard to completely rule out, sciatica-like leg pain was always off the list. The problem occupied a "type of back pain other people have" sort of category, one that mystified and slightly intrigued me, but as long as I didn't have to deal with it, fabulous.

Fast-forward to this summer, when a lot of different things were happening. I was traveling a lot with my family and for work. I went to the Yucatan Peninsula for the first time with my parents and brother, and to a nearby National Park with Bee and her Dad and some close friends. I went on 3 long distance trips by myself (without colleagues- y family accompanied me on the last two). The nearly 3 months of heavy traveling was sandwiched in between training high seasons at work- long days with relatively higher stress levels (Good stress! But stress nonetheless...). It was a heady summer. I was feeling great.

But most of August, which is when the last two work trips occurred, I kept feeling this burning sort of pain in my right leg that wouldn't go away. It was weird because it was a pain I'd never felt before. But I didn't pay much attention to it- first, because I was busy traveling, and second because I often have pains that come and go. Just that, this one wasn't going away, and it took me a while to realize that. Actually, I never did fully come to the realization that something serious was happening on my own. My body had to sort of whack me over the head and smack me around seriously in order for me to pay attention. I am sorry I didn't listen sooner.

The weekend after an important training week at work was a three-day one, and I was jazzed because I'd finally made an appointment for acupuncture in San Miguel, and to go to the hot springs as well. (See, I do practice self-care... ;-) The stretches and physical therapy exercises for my hip that I'd been trying all week weren't doing much to help my leg, and in fact, my middle lower back had started to ache as well, which was somewhat concerning. I was unaware of the physical train wreck I'd been holding off for a month.

The Sunday before Labor Day, I woke up in terrible pain in my lower back. I basically could not sit straight or stand unassisted. I was only able to go to the bathroom with my arms around my husband's neck. I sort of freaked out too, because this was not my first time my back has gone out, and I know how it can sideline you. But once my tears of embarrassment, and of frustration, had abated, the tears of genuine pain were ushered in. This level of pain is on par with childbirth. After trying several different kinds of medication, none working, and a humiliating 30 minutes on the floor at one point in a botched attempt to crawl to the bathroom (Lest you think otherwise, Margo did try to prevent me from trying), I knew I had to do something else- I was picturing myself getting carried out of my house on a stretcher, and really did not want that to happen. I made a few phone calls, finally spoke with a doctor who recommended a specific medication, which ended up working, and I was able to sleep through the night.

This apparently, in the case of what occurred to me, was somewhat of a miracle, because the next morning I got up out of bed and was able to walk without assistance. Various trips to the doctor and MRI results later, the verdict was in: I had a very large L4-L5 disc hernation and sciatica. And just like that, I was unceremoniously inducted into the Sciatica Club.

I won't get into the gory details of my less-than-pleasant exchange with a rather knife-happy orthopedic surgeon who wanted to operate on me immediately (hey--maybe he'll end up being right in the end, but where I'm from we don't take the recommendation of surgery by scaring, insulting, threatening, and making ultimatums to patients very well, and so no, you are off my doc list although you did recommend quite a nice medicine, thank you very much). Or another questionable doctor who I went to see the day after, desperate for a second opinion, who was the closest thing to a quack that I have ever experienced personally.

Since then, I´ve also been inducted into the world of IMSS specialty medical services, where state employed doctors maintain their private practices and skim off the patients who have private insurance and want better care than the government is prepared to provide. I was out from work for a week on sick leave, another week on temporary disability, and a few days of personal leave. I have attended 8 physical therapy sessions, have had better days and worse days, but I have not had a day yet where my symptoms disappeared.

In retrospect, the sciatica was happening most of August, I just didn't recognize the symptoms. We can't really pinpoint when I herniated my disk, but it's likely that it happened on one of my trips in June, where I fell twice, and also lifted something rather heavy by myself. The natural history of herniated discs and the evolution of sciatica is something I've read more about in the last two months than I probably did reading for my Masters thesis project (Ok, maybe I'm exaggerating). But suffice it to say it's an incredibly complex process that is not yet fully understood.

Part of what's not understood is a large discrepancy between pathology and symptomology. That's to say, some people who have very small hernias have more pain than large ones. And what's more, some people can have large hernias with no symptoms at all, and some people with no hernias have terrible symptoms. Finally, some people spontaneously heal with little downtime and intervention, whereas others go on to have symptoms for years. Doctors and medical researchers do not have a full grasp as to why this is although many theories are being studied in clinical settings.

Going back to the first doctor's threat of this being an immediate surgery situation... Having had a history of stress-related pain and other disorders (IBS, situational depression), it has been hard for me to move to a mindset where I can accept a situation that's not mind over matter, and that surgery might be necessary. I am overweight, I am not always careful with my diet, and so I feel that there is still a lot that I can do to "lessen the load," so to say, on my hernia, and allow it to heal. I am also concerned about potential negative effects of surgery, or even worse, the possibility of a botched or useless surgery (in case you don't believe me, search "failed back surgery syndrome"). Having the appendix out for emergency surgery is one thing, but messing with the spinal cord is another. I am not alone in my concerns...most online literature that I've read, either on spine institutes, research papers, or medical websites, cite that only 1 out of 10 herniated disk patients require surgery.

This must seem like poppycock to most orthopedic surgeons in Mexico, especially that first doctor, but I have find, quite serendipitously, a couple doctors who share my opinion- albeit with reservations. In a number of different online sources, I've read that surprisingly enough, the largest disc herniations tend to be the ones that are resorbed (healed) to the greatest extent. The reasons for this, again, are not fully understood, but do give me a great deal of hope.

However, the caveat is that for those patients whose symptoms do not improve in 6 weeks to 6 months, the longer you postpone surgery, the higher the chances are that surgery will not resolve your condition. This has to do with the potential for nerve damage- in sciatica, the prevailing theory is that the herniated disk presses on and compresses the sciatic nerve, which runs from the tailbone down to the knee (where it splits into 3 branches that run down to the ankle and foot). Most of what I've read explains that the higher risk situations are where the patient has significant muscle weakness or loss of sensation in their extremity- the classic emergency situation is the cauda equina syndrome, where one loses control of bladder and bowels. The worst I've had so far is leg, gluteal, or calf pain at a moderate level that just doesn't go away, or a tingling sensation in the top of my foot, back of my calf, or side of my thigh, so I am not too worried about permanent damage (although it's definitely made my list of troubling possibilities about this episode) although the annoyance factor is a totally different story.

I've never been good at accepting when I'm sick, much less hurting, but I managed to get through several years of occasional bouts of back pain in my twenties. But these bouts never last more than a few days to a week, and so these two months of nearly non-stop pain have been a new realm for me. Even though the one terrible Sunday in early September was the only day I had severe, disabling pain, in the last two months, a day hasn't gone by that I haven't had pain or numbness in my leg. And that's even though I have been on medication as well- and I probably haven't had another severe event for the same reason. I haven't been able to get comfortable or go back to regular activities, and that's taken a toll on both me and my family physically and mentally. Not being able to lift heavy stuff or perform load-bearing activities (read: my daughter, laundry baskets, doing dishes, or luggage), creates a challenging dynamic. Not being able to sit in one position for more than a half-hour, and needing to lie down regularly to take pressure off the disc has led to awkward situations and difficult conversations at work. Being dependent on others, when I have always been highly independent, is just plain hard.

The idea of taking disability or being disabled is getting wider acceptance in our society especially as self-care and patient advocacy increases, but at the end of the day, the stigma remains, and the stark truth that you're just not as productive as you normally are brings it own set of complications to the recovery scenario. How are you possibly supposed to focus your energy on healing when all you can think about is; how much have I paid in medical bills this month, will I get reimbursed, will I make it through the work weeks once temporary disability is up, how can I make it up to my husband, my daughter, when I can I start to exercise, will physical therapy work...will I ever get better?

The whole situation is enough to depress anyone, even if you're taking a peck of supplements, watching your nutrition, and getting enough sleep. After exhausting my readings on disc anatomy, sciatica mechanics, physical therapy, surgery options, hernia resorption, sciatica forums, ad infinitum I have drifted into the "chronic pain management" websites, because, like it or not, I have a de facto membership in the Chronic Pain Club.

There are often silver linings in situations like these, and my case, is no exception. I need to lose weight, urgently, and although I continue with thyroid issues, this will motivate me more strongly to control calories in the hopes of shedding some pounds and taking some load off my back. To help with this, I have also looked into the anti-inflammation diet by Dr. Weil, which is largely vegetarian, which is a goal I'd been wanting to move toward anyway. Money issues and pain will be a factor, but I am going to try and join a gym to start swimming regularly. If I can, it will be meeting a goal for regular exercise that I've also been wanting to accomplish for some time.

Finally, although it's always important to be mindful and compassionate with others, there is nothing like a time of illness or pain for you to become more aware of what others in your same boat, or worse, are dealing with. The forums I've lurked on in the past month are filled with individuals going through so much pain and suffering that it's almost shocking to think that I don't run into more people with these type of issues on a regular basis- or perhaps it's our tendency as a society to minimize these types of issues for the same stigmatic reasons I mentioned above.

In any case, if there's anything I have realized as a result of this, is that I am definitely not alone in this, it's quite a common condition, and what a shame, because for how painful and disruptive it is to life, I really wouldn't wish it on anyone. Human evolution to walk upright was an amazing and wonderful thing, but the long term impact on our discs and spine of being vertical was one thing evolution really got wrong. Believe it or not, it's believed that disc degeneration begins in adolescence. I can only pray with time science and medicine--and popular culture--can implement ways to prevent and treat these type of problems, starting in early childhood, because no one deserves membership to this club when it could be avoided.

September 10, 2015

Musings on the Social/Historical Context for 'Sustainable Development' in Mexico's Natural Areas

This post was originally written in May of 2015, but was not edited and made digital until today. :-)

On May 15th, Mexico Teacher's Day, in the capital city of Mexico, the "Distrito Federal," I took part in a training workshop for Environment volunteers with Peace Corps Mexico. Our Environment program's main agency partner is the SEMARNAT agency (Secretary of Environment and Natural Resources), which is an umbrella to several Environment agencies, such as CONANP (Protected Natural Areas Commission). Our workshop was hosted by CONANP, specifically to orient our volunteers in the types of programs offered by this incredibly important institution.

CONANP can be compared to the U.S. National Parks Service, but has distinct difference with its U.S. analog in that its jurisdiction (for lack of a better word)—let's say relationship with community members within natural protected areas—is distinctly different from the U.S. NPS.  Most Protected Areas—except for a select small few—are not separate from residential lands—they're regularly inhabited by thousands of people who maintain their normal activities inside the protect areas and reserves. Thus, this greatly changes the nature of the national and local Natural Areas Management strategies, as well as the day-to-day interaction with people residing within Natural Protected Area boundaries. There is relatively little enforcement of conservation laws, and the residents of Natural Areas are often marginalized economically and even culturall. This, as well as the history of the peoples of these lands, combined with the fact that CONANP is a sorely underfunded agency in general, poses unique challenges for staff working in the area of sustainable economic development within protected areas. 

We heard from many veterans in the conservation field in Mexico who met with us that day, and in particular, we heard a talk given by staff who directs a department for economic opportunities in sustainable development. His words inspired a lot of reflection and thought on my part, and the below musings are what subsequently tumbled out through my pen as a result:


I remember a long time ago (nine years, to be exact), before I first came to Mexico, when I had a grand vision of the types of things I'd be able to do here. Ideas of things I'd be able to accomplish as a win for conservation and education. And then I arrived to reality. 

I observe a lot of initial vision and ideas held by other conservationists when they first come to Mexico (My job is working with Peace Corps volunteers). Many of these ideas find fertile ground and take fruit- one of the many potential virtues of a two-year service. 

But what happens to the grand seeds of idealism when the soil upon which they are planted is incapable of supporting life? The quality of the ground we're working with is essential in that it necessarily limits the extent of growth of ideas, plans, dreams—but as any grower knows, we can only imagine a field's potential until it is revealed unarguably before our eyes through trial and error. At least in my personal experience, no person or litmus test could really make me aware of that until I lived it myself.

Mexico's biological and cultural wealth are deep, and vast. But the history of subordination, submission, and outright conquest is nearly as formidable, and reaches—no, has pushed—multitudes to the brink into the literally remote heights of what are now considered the most "precious" lands in terms of ecological conservation [mountainous areas]. These said lands, which should hypothetically receive and give rise to the most flavorful fruits of idealism, in reality harbor the most marginalized among us—those whose ancestors had no where else to go to survive, the first peoples of Mexico, the last to confront the conquistadores. 

Forced out of the fertile lowlands into the hills, to the wilderness, likely clashing themselves with existing settlements, their legacy generations later exists precariously in an everlasting hybrid on the edge of modernization. Reminiscent of mountaintop island ecosystems whose backs are up against the wall of the sky, with little land left to stand on, they can't go much farther up, can't make do with less, are often pushed to physiological extremes—manifested by malnutrition, illiteracy, domestic violence, teen pregnancy—among other ills we're loathe to mention for fear of political incorrectness or being perceived as prejudiced. But the ills we ignore are even less certain to heal. 

Enter the ideal of education, wearing the hat of environmental conservation. A goal that can be argued worthy a million times over, as I have done so since the tender age of 15. But how do you explain to a victim of the aforementioned fate, the dispossessed, to relinquish [any of the following, for "environmental benefit"]: Land. Economic aspirations. Material goods. How can we, from an inherently comparative position of privilege, as U.S. Americans, rightly proceed (or even justify?) our position of righteousness and/or the expectation that said audience member would or could even care about anything else besides the pressing need to feed themselves, their children, cover their backs, and simply live without fear of possible judgment, or worse, retribution, from individuals who barely know them and who still have so much to learn about them?

Answers and justifications are many and diverse. People must know how much their livelihoods depend on the land they spring from. The seventh generation vision [still holds true]. But, just as we would not expect a fine wine to have aged instantaneously—that it takes time for enthusiastic sugars to meld into complex undertones—conservationists working with the most marginalized communities must carry in every breath the patience and understanding necessary for the process of, essentially, addressing the effects of 500+ years of the disempowering subjugation of a once autonomous people [and the denigration of any original 'conservation' ethic].

Every drop of insight, empathy, solidarity, and patience that foot soldiers of conservation working in low income communities can have with the neighbors with whom they're working shoulder to shoulder with to sow, cultivate, and harvest the seeds of hope and dreams for a healthier life for every denizen of this lovely planet we call home, is worth its weight in gold.

Valle Verde, Municipio de Jalpan, Reserva de la Biosfera de Sierra Gorda

February 8, 2015

No time to the right time

I miss writing. The words rolling off the tip of my fingers onto the keyboard. The blissful feeling of capturing a whole thought and expanding it, for it to blossom into something meaningful, even if only to me.

But creative expression needs time, not something I have large excesses of these days. Taking a full-time job, indeed, one that requires me to travel as well, means that writing has swiftly arrived at the bottom of my priority list, below rather more important things like spending time with my daughter, eating, and sleeping. Being out of the house 10 hours a day, five days a week has meant that even things like chores and exercise are mighty challenging to pull off.

This is where I make my perfunctory statement of awe and respect to working parents worldwide who manage to have not just one but even more children, hold down full-time jobs, and manage to still do things like throw birthday parties and get up at five in the morning to run or meditate or what have you.

Mind you, I am not complaining. Not even venting. I love my job, and the role I play is something I have been wanting to be able to commit to for quite some time. Circumstances and my daughter's age have led me to finally be able to do so. It's just that it's been a reeeaaally long time since I was in the full-time flow.

When I left the U.S. in 2006 with Margo, my professional trajectory came to a standstill and it has taken me all these years south of the border to re-cultivate it to a level that can not only do justice to my education and experience and support my family. Nothing is forever, everything and anything can change in the blink of an eye, but I am proud of how far we have come as a family—how far I have come personally—and I am so happy that this time in my life is finally here.

The trick is making it, the feeling, the moments, stick. So as to not blow by in the blink of an eye, as often happens in my memory-span of a fly. That is what writing has always done so well for me. From the time I was twelve up until now, taking time to pause, write, and externalize has allowed me to realize, reflect, evolve even.

The outside, professional world, and my movements in concert are working wonders on my self-growth and that of my family's. But those subtler, sweeter sides of life—things like writing, gardening, crafts, spending time with dear, dear friends or just sitting and thinking—are getting shaded out in the meantime.

But the gardener in me knows that seeds, though lying dormant, are faithful to the stirrings of life, and will spring forth at a moment's notice. They just need a little light shone into dark corners and new leaves will emerge when the time is right. It might not be this spring, but a growing season is something we can always count on.