As we’ve spent some time getting to know each other outside of our medical school classes this year, we’ve learned that she runs marathons, that she spent a year riding a motorcycle around Burkina Faso as she learned about maternal health there, that she speaks English, French, and Moore. Arabic is next on her list. But it’s not just the list of things she’s done that makes Sara inspirational – it is the things that motivate her, her view of the world, and the way we are certain she will some day change it.
Today, we are asking her more about her story, what makes her tick, and where she is going. Sara tells us she is an open book, and so we begin…
Sara, like many nine year olds, was torn between a future career as a ballerina or as a Supreme Court justice.
“And it didn’t really wear off until I realized I had to go to law school…” Sara describes herself as not exactly conflict averse, but says she prefers the opportunity to step into someone else’s shoes, such as in medicine. Her first experience with anatomy was in tenth grade dissecting a cat. She remembers being obsessed with identifying all the structures; connecting the things she found in the cat to the structures she could feel in her own body. She was so enthusiastic that she found the impossible-to-find feline adrenal gland. Her teacher, who certainly appreciated her enthusiasm, gave her the nickname Adrenal Rendell.
Sara likely developed some of this ambition thanks to her mother, who works tirelessly as Medical Director for HDI, which is a healthcare claims audit service
And her dedication to the pursuit of knowledge is something she inherited from her grandmothers, both of whom she describes as iconoclasts. Her father’s mother, a professor, spoke eight languages. She would tell Sara, “someone can take everything else away from you, but they can’t take your mind.” The only Holocaust survivor in her family, Sara’s grandmother immigrated to the United States as a young woman and gave birth to her father in a Salvation Army hospital in the Bronx.
“I think it meant a lot to me when I would bring up an idea to her and if she liked it or if she didn’t.” Sara tells us that her grandmother taught her to always, “…Answer questions with a question, don’t settle for easy answers, there’s always something else…if your answer is that easy, your question isn’t very good.”
…Answer questions with a question, don’t settle for easy answers, there’s always something else…if your answer is that easy, your question isn’t very good.
Sara is now wrapping up her first year in medical school, and has spent innumerable hours over the past ten months learning all the facts about the healthy and diseased human body that might one day help a patient. She’s found the adrenal gland in a human cadaver, and learned all of its layers and what they secrete. She’s found the thymus and the thyroid, the medulla and the vagus nerve. She knows what cells live there, how they developed and what they do. When we asked Sara whether her need and drive to ask bigger, deeper questions has been difficult for her in medical school, her eyes got huge and she said, “YES!”
She has had a strong draw to medicine since the ninth grade but it is difficult to keep asking questions in an environment that forces you to learn so much so quickly. She describes a phone call to her father in the first few months of classes: “I suck at medical school,” she told him. “I suck as a person, I literally suck in every area. In classes, all I can do is fixate on this random detail and I look up primary sources and I start reading articles and I lose track of the lecture and then I want to know more and they’re like ‘Don’t! No! Just memorize!’… I want to know how; I don’t want to just be told. It just doesn’t work for me.”
“I was just lost in reading—what is refugee care like in other places. I had these interviews with women and I just wanted to do more and to know more. I was just reading and reading and reading, not medical school stuff… I was like dammit Sara you are so privileged to be here, you have all these brilliant experts teaching you [medicine]…and here you are being ungrateful, not able to buckle down and do the thing that you committed to…look at you trying to run away…I was really critical.” She laughs as we come to the end of this description, realizing that she might have been just a little hard on herself. Her father, an endocrinologist, offered her a piece of advice after hearing these concerns. “You said you’re not intelligent…I don’t know that memorizing all the information they pour at you is intelligence. There is always too much of anything. Tell me about the work you’re doing in the Refugee Clinic…now that, that’s intelligence.”
The work at the Refugee Clinic and the need to immerse herself more fully into the work and give herself protected time to ask bigger questions has inspired Sara to apply for a PhD program in anthropology in addition to her MD degree. “I think in science, I love science, I geek out over science, but the ability to introduce nuance in the context of human interactions is something that I need.” She hopes to follow four refugee women across four years and try to understand, as much as possible, their experiences as they arrive in America and work to build new lives. As part of her work, she is gearing up to learn Arabic, something she sees as imperative to meeting the refugee women on their turf. “Language is important to me,” Sara says, “but also what is contained within the language… what unravels in nuance across worlds.”
Almost two years ago, in Burkina Faso, Sara sat at a wooden desk near a window that allowed gusts of 100 degree wind struggling to learn Mòoré.. Sweating and frustrated with herself, she looked over at Mariam who was her language instructor at the time and said, “I can’t do this. I’m never going to be able to speak Mòoré well enough to interview women without interpreters.” Mariam reminded Sara that she had only had two language lessons, and that no one learned Mòoré after two lessons. Marriam is a Mossi woman who has worked for the World Bank and the Peace Corps and quickly became one of the people most important to Sara’s life in Burkina. Mariam helped Sara become fluent in the language, and also read through questionnaires that Sara wrote in Mòoré. Mariam would often say, “If you ask it this way, they may say this—I think you want to ask it this way…” Her help was invaluable to Sara’ success in navigating Mossi language and culture.
For ten months, Sara lived in Ouagadougou, Burkina Faso and rode a motorcycle to Gampela, Balkuy, and Yamtenga to interview women (in Mòoré! She did it!) about pregnancy, childbirth, and sexual norms and experiences. Almost every day as she buzzed around on her motorcycle to the various towns where she was interviewing women, she saw a collision – motorcycle versus truck --- smoke, blood, bodies. As common as motorcycle deaths are in Burkina Faso, it is even more dangerous to be a pregnant woman. Sara told us that, “More people die from pregnancy than die from motor vehicle-related accidents. Everyday I was like another one, another one…”
Despite the fact that it is has been eight years since the Burkinabe government rolled out a plan to make maternal medical care essentially free for women, there are still over 2,000 deaths each year due to complications from pregnancy and childbirth (http://www.amnestyusa.org/our-work/campaigns/demand-dignity/maternal-health-is-a-human-right/maternal-mortality-in-burkina-faso). Sara’s goal in living in Burkina Faso for ten months was to conduct an ethnographic study of maternal health to try to understand why the reduced financial barriers to maternal care have not translated into substantial improvements in health outcomes. Each day, sitting on the hot buzz of her motorcycle to get to her interviews, she saw deaths by the roadside; to her mind, each death represented a pregnant woman.
“So, it’s 120 degrees in the hospital, you haven’t slept in 22 hours, and you’re watching these women scream and deliver their babies. You would be frustrated, you would be tired. A lot of midwives would hit women—it was abuse.” This was before Sara began the interview process, but she was curious why this was the norm within the hospitals she frequented. Healthcare providers she asked told her that she didn’t understand because she came from the US, where women are pampered and given pain medication during the labor and delivery process. One midwife told her, “This is the reality of the African woman. She is habituated to pain. We don’t have pain-free conditions like you in occidental countries.” Later, interviews with women told a different story. Women described being afraid to go to the hospital because they were unsure what type of midwife they would receive or if they would anger their midwife. One woman showed Sara the bruises up and down her arms after giving birth. Another woman, who was a 26-year old Burkinabe mother of two, told her: “The most awful part is the pain. They have the shot [lidocaine] and they see you suffer, but if you angered them and misbehaved while the child was coming, you won’t find it.” However, Sara saw that the midwives were suffering as well. She tells gives us some background information about the midwives: “These are young women, with two years of medical training after high school, who are forced into situations where many babies and young women are dying. It is a traumatic and stressful environment for the healthcare provider and the patients.”
Sara then begins to tell us of Josephine – of companionship and loss. Josephine was Sara’s neighbor. She became pregnant soon after Sara arrived. As their friendship developed, they began to rely on each other for help. “She and I quickly became very close, and I would interview her but it wasn’t even like interviewing. It was like friends having conversations.” They often cooked together and even cared for each other when one of them was sick, whether it be Josephine with morning sickness or Sara when she contracted malaria. Sara also described when she and Josephine would lie on the cool tile floor to escape the extreme heat. “We would lie on the floor and look up at the ceiling. And sometimes we wouldn’t say anything at all. It didn’t matter; it was just her presence. She became a sister [to me].” Josephine’s son Fai would call Sara ‘tante’ (aunt). Sara even extended her stay in Burkina in part to be present for Josephine’s delivery.
“In March…she [Josephine] hadn’t been looking good, she hadn’t been eating…she looked kind of yellowish…and then one morning she was vomiting yellow and her nails turned yellow. It was just this shock moment.” Sara realized Josephine was very ill and immediately took her to the hospital. Over the course of a week, she became sicker and nodules were found in her liver and lungs. Sara describes Josephine’s passing so vividly, “It happened so suddenly, and it was like three in the morning…I just went and held her hand. It was like she’s there; she’s gone. [Sara thought] wait this isn’t suppose to happen, we are waiting for new life…we did everything, we took you to the appointments, we did everything we were suppose to. It was just awful.” Sara describes Josephine as an incredibly intuitive person even though she had never traveled outside Burkina. “She didn’t go to school past seventh grade, but she was one of the wisest women I ever knew. She was so intuitive…she was almost too good to be true.”
In addition to learning the language, Sara had to learn to navigate the gender norms in a society where men held most of the power. She learned when to avert her eyes when speaking with a man, how to click her tongue when listening to their answers to show respect. Still, she did things that defied the cultural expectations of women; she lived alone and , rode a motorcycle, and was often the only women in a room of men, leading the discussion and asking the questions. When people would ask her, speaking in Moore, “Who owns you?”, which was a way of asking a woman whether she was married or single, she would answer, “I’m the one who owns me!” She laughs, describing how people thought she was completely crazy for giving this response.
The men in her community noticed her. She received multiple proposals, offers to save her from living alone and give her male children. She could be a valued second wife. With her male friends back home, Sara was often seen as “just one of the guys”, something she took as a compliment. She knew they saw her strength and the fact that she doesn’t ask for permission to be who she is. In Burkina, however, she was acutely aware of her gender for the entire 10 months. Once, a Burkinabé embassy worker paid her a complement and compared her to a high-ranking American woman working at the embassy. Then he said, “It was a mistake. You both should have been born men.” Although he meant it as a complement, Sara eloquently described how that made her feel when he, or any one, complements a woman by calling her a man:
“You are telling me that the thing that I am, my nature as a woman, is so incongruent with my success, with my work ethic, with the degree to which I can engage you in conversation, with my self-confidence, with all these things I associate positively with myself, that I shouldn’t be that. That my nature is incongruent with everything that is good about me. Bull shit!”
You are telling me that the thing that I am, my nature as a woman, is so incongruent with my success, with my work ethic, with the degree to which I can engage you in conversation, with my self-confidence, with all these things I associate positively with myself, that I shouldn’t be that. That my nature is incongruent with everything that is good about me. Bull shit!”
“Sara, at this point, I don’t speak the language you speak everyday where you live, I don’t know what it’s like, I’ve never been there. I trust your ability to make decisions that will keep you safe. And at this point, I think that you are better able to do that than I am.”
Despite making all the right choices, though, Sara didn’t always feel safehad been in situations that threatened her safety. When we asked Sara if she would ever go back to Burkina, she said, “Yes. But not yet. I need time before I would feel safe again. Right now I would need a big dog and big, huge husband.” The three of us had a good laugh over that one, because we all know Sara as a fiercely independent person. Considering this independence, we were curious what she sees her life looking like in the next 10 years. Her passion for medicine and social justice could be enough to fill her days. But does she want a partner or children?
Sara tells us something that her grandmother instilled in her, “Things don’t matter, people do.” She repeats this twice. She tells us how she wants to focus her time and energy helping people who would otherwise be neglected, such as the women in Burkina Faso living in a patriarchal society or the women living as refugees in Philadelphia, trying to find their footing in a new country and culture.
Career-wise she explains how she needs to be challenged, to always be learning new things, to conduct research, and to have that research fit into the broader social context. Personally, before this year, Sara never felt the draw of having a long-term life partner. She is independent and didn’t feel like she needed someone to complete her. However, she tells us, “This year has been really hard, and I’m actually craving the opportunity to commit to someone else, to have a life partner. To be invested in that person’s goals and dreams and desires.” As far as children go, she is not certain that being a mother is something in her future, but she’s open to the idea. She tells us, “I have a lot of role models, women who had kids and some of them didn’t and so I’ve seen happy fulfilled lives with kids and happy, fulfilled lives without them.”
As we finish up chatting with Sara, we want to know what is next for her. She tells us a few things she has checked off her bucket list, such as running a marathon, learning a language that was like none other she spoke, living outside the US for an extended period of time, and even peeing in a urinal. We all laugh at that one—it was during a high school track meet and the bathroom was empty, she swears. Her next goals are to learn Arabic, be able to speak Spanish, and complete a triathlon. She lets us in on another secret: that she hopes to write a book someday. “I want to…maybe this is over-ambitious or overzealous…but I really want to write a book.” We assure you, Sara, it’s not over-ambitious. Can we pre-order now?
So here we are, at the café, sipping the last slurps of our iced tea and coffee, talking about what makes a full life. Soon, we will go back to class and learn all the cell types of the gastrointestinal tract and the pathogenesis of colorectal cancer. But Sara will keep thinking about the women she met in Burkina, about the refugee women she is getting to know now. And one thing’s for sure --- Sara, Adrenal Rendell, who belongs only to herself, is going to shake things up.
We would like to thank Stephanie Scott for photos of Sara in clinic and at the market.