malaria dreams

thinking and anthropologizing through the global health fight against malaria in senegal. previously: malarialdreams.wordpress.com

[malariadreams-blog]

Some thoughts on Ukraine and the West's demands

I'm not sure how far I'm going to get in this line of thinking before I run out of steam, but the situation in Ukraine has got me thinking about the current upsweep of anti-gay legislation in African countries and the role of "developing countries" or "supposedly independent countries" or "countries that become a playground for the world's major powers" in those large scale global politics between the "West" (US and EU) and its Others (primarily Russia and China). 

So, Ukraine has found itself in a really uncomfortable spot. Some (proportion unknown) vocal and active part of its population is actively seeking to get on track to eventually become part of the EU and to begin getting the benefits of affiliation and of promising the EU that affiliation is its ultimate goal (trading relationships, etc. - I should figure out what benefits Ukraine gets in the lead up to becoming part of the EU, whether or not the EU will promise certain things in the meantime or try to fast track the Ukraine if the EU and the US can manage to set the deck how they want it and get a West-leaning Ukraine in the next weeks/months/years - I'm feeling really uncomfortable about how much the EU and the US think that this is absolutely their business, but they and Russian have made Ukraine a tentative site for a showdown, so I guess this is happening). 

Some other (proportion still unknown, reporting of numbers is highly political and "propaganda" gets thrown around a lot) active and vocal part of its population is actively seeking to have Russian ties/become part of Russia/be a part of the future-existing Eurasian Union instead ("EU" is gonna get real confusing come January 15th, 2015 - is this intentional? Putin, the trickster). Logically, there is also some (potentially very large) part of its population in the middle that is torn up about the whole issue (or understands that they've been put in a horrible position of having to choose between Russia and the West), but which will likely be chipped away at over the next weeks/months/years as it gets cordoned off into one of these two distinct Ukrainian groups because it is precisely this political game that the West and Russia are demanding Ukraine plays. 

Can Ukraine stay an undivided country in this moment of cleavage between the desires for two distinct futures? At heart, this is a question of political discourse (and, I would argue, obviously empty political discourse). The West-leaning part of the country wants a political future that strengthens its ties to the West, with all that political imaginary's focus on "democracy" and "economic freedoms" and "religious and sexual freedoms," etc. A moment in which this political discourse was blatantly empty was when the EU representatives were indifferent to the radicals' refusal to sign the agreement constructed by German, Polish, and French officials to bring an agreement between Yanukovych's side and the opposition. EU representatives were present for what Dmitri Trenin has called an "unconstitutional regime change." These are the moments when "democracy" and "dictatorship" become one in the same, and it is a moment like this that you would hope the media would jump on to prove that all that political discourse is empty and that this is really only about a standoff between the West and Russia and that the logical solution is to ask everyone to cut this shit out because a whole bunch of Ukrainian lives are hanging in the balance, but of course we can't demand that our politicians be honest about their actions and who knows, maybe even if everyone was honest Ukraine and Russia (and eventually, probably, US and EU troops) would still be heading towards war. 

One distinguished part of this political future cleavage has to do with the political or non-political nature of homosexuality. During the Winter Olympics, the anti-propaganda laws around homosexuality in Russia were constant discussion. How athletes would or would not protest, officials' thoughts on how to address the issue (or not), Johnny Weir's fabulous fashion choices as interpreted as a low hum of protest, etc. Because Russia is a world power, there was certainly never a question that countries would boycott the Sochi Games, but the emphasis on this discourse clash shows just how much LGBT rights have become a main issue between different political discourses. 

In recent years, there has been a major upswing in anti-homosexuality legislation in African countries, and it seems to be accelerating at an extreme rate in the past few months. Now, this is where I get into highly polemic ground, but I would argue that this increasingly present legislation is actually a direct impact of grassroots AIDS political campaigns, beginning in the 1990s, that focus on de-stigmatizing the disease and de-stigmatizing homosexuality. I would also argue that this grassroots presence has increased in the last decade or so, as the tide has slowly turned in the West towards legalizing same-sex marriage and the general sea change towards accepting the reframing of the violence against and discrimination of members of the LGBT community within a civil rights paradigm. 

My argument for this comes from the fact that homosexuality is certainly not a new thing in African communities (CAUTION: MAKING ARGUMENTS ABOUT "AFRICAN COMMUNITIES"). I will narrow this down to the few countries with which I have experience: Senegal, the Gambia, and Côte d'Ivoire, and I will take from conversations I have had with other researchers. 

In Senegal, homosexual acts are illegal. They have been illegal since the country was made independent in 1960. When it constructed its constitution, it borrowed heavily from France's, which at the time also part of its penal code devoted to the illegality of homosexual acts. [Wait, this is what a French researcher told me, but I just looked this up, and I found that it is former British colonies that inherited sodomy laws and not French? But Côte d'Ivoire also has a form of this Penal Code, it's just a reference to "public" acts rather than "private" acts - so I'm confused.] The Penal Code in question, Article 319:

"Without prejudice to the more serious penalties provided for in the preceding paragraphs or by articles 320 and 321 of this Code, whoever will have committed an improper or unnatural act with a person of the same sex will be punished by imprisonment of between one and five years and by a fine of 100,000 to 1,500,000 francs. If the act was committed with a person below the age of 21, the maximum penalty will always be applied."

Côte d'Ivoire incorporated this part of the constitution as a reference to strictly "public" acts of homosexuality, thus homosexual acts, as long as they are private, are not illegal there. 

In the Gambia, things are more extreme and more alarming, in an almost absurdist way. As a former British colony, the Gambia inherited stricter sodomy laws, but in 2005 amended its criminal code to specify the explicit acts that are classified as "unnatural offenses" and to state that they are felonies liable to prison sentences as high as 14 years. In February of this year, Gambian President Yahya Jammeh had this to say about homosexuality:

"As far as I am concerned, LGBT can only stand for Leprosy, Gonorrhea, Bacteria and Tuberculosis; all of which are detrimental to human existence."

Jammeh has certainly never been known as one for subtlety (or, if we are honest, facts - he has said that both AIDS and malaria have been eradicated from his country in recent years), but his extreme case highlights the fact that because homosexuality has become an increasingly political issue on the global stage, political leaders are forced to make definitive statements about it. In many communities within these countries, homosexuality has been present but explicitly never talked about. Taboo. And because it has been hidden, it has largely been a non-issue. [Yes: you guys may now start making arguments about how I am all for keeping homosexuality "in the closet" - but if making it known that being a homosexual is going to get you killed in your direct environment, then I'm afraid I don't know why I would ask someone to come out of it. I'm afraid that my main point here is that universal rights are in reality trampled by local, violent actions all the time, and that this sucks but that doesn't mean that we can forget that it's a reality.] In recent years, homosexuality has become an issue and violence has come in the path of its politicization. Even in Côte d'Ivoire, where homosexual acts are not illegal, violence has been on the upswing against local political "homosexual" associations that are explicitly affiliated with the fight against AIDS (I'm referencing the NGO Alternance, in particular).  

During his visit to Senegal at the end of June, 2013, the day after the US Supreme Court deemed the Defense Against Marriage Act unconstitutional, US President Obama called for African countries to legalize same-sex marriage. By many peoples' account, this was a political gaff on his part, both because it soured public opinion (somewhat) against him in Africa [there I go again, making statements about "Africa" - OK, in Senegal, for sure], but also because he brought homosexuality out into the open - forcing Senegalese President Macky Sall to make a statement about homosexuality where he hadn't needed to before and increasing the enforcement of Article 319 of the Penal Code (according to one researcher I spoke with). 

This is explicitly where the West's desire to involve itself in the human rights of populations outside of its own jurisdiction becomes a dangerous game. Introducing the discourse around the protection of individuals' rights to sexual and religious freedom is all well and good, but this discourse itself has caused a cleavage potentially like the one we are seeing in Ukraine. Certain EU members have threatened to withdraw development aid from countries that have or are passing anti-homosexuality legislation. It is a threat, and, at this moment, it is unclear just how empty (or full?) the threat is. But from outside of the global power game, it looks explicitly like a demand to conform, or else (PS: health, education, and general social services in most African countries are still mostly funded by international aid). Thus, we have the West interfering with national future-making in a similar way that it is currently involved with in Ukraine. There is no global powerful "Other" involved in this game like in Ukraine - although, we could guess that China would never make conditions on its international aid in the way these European powers are threatening. It may be precisely that (and a game of priority making) that would keep these threats empty, but the more local and violent impacts of the clash of discourses, of course, remains.

The discourse of human rights are defined by the fact that these rights are universal, but the universal (except in the most extreme and globally public cases) exists through the local and national - and the more emphasis there is on the political nature of homosexuality, the more the local and national will rile up against it, particularly when they are made to make a choice between two distinct futures. And particularly when the making of LGBT rights as civil rights is seen (understandably) as an imposition of Western beliefs on local populations.

[malariadreams-blog]

Evidence.

The question of "Where is the evidence for that?" is such a ridiculous one with respect to the promotion of the use of Artemisia annua tea to treat malaria (and it's a question that a British doctor working in Uganda asked of a Ugandan researcher doing research on the tea). The question and its asker structure what this evidence can look like and there are so many things restricting the availability of that evidence. 

Right now, as everything, this feels related to the Zimmerman trial. WHERE IS THE EVIDENCE? This is the question, and the system is rigged. Of course the evidence doesn't exist because so many things: there is very little money available to run clinical trials on A. annua tea, because of the pressure from the WHO to remain silent about the tea, because there is too much money in the pharmaceutical industry to produce antimalarials, BECAUSE THE SYSTEM IS RIGGED. The assumption going into the situation is that A. annua tea is not effective and that artemisinin combinational therapies (ACTs) are, DESPITE THE FACT that A. annua tea has been used for millennia (in China) while ACTs have been used for the past ten years (in Africa). Because endless studies have been done on the effectiveness of ACTs in certain situations, every time a new drug comes out, every time there is a new artemisinin derivative available, because the funding is there to check up on it. To produce the evidence. Because there is the desire to build up the reserve of evidence ("LOOK AT ALL OF THIS EVIDENCE I HAVE. YOU WILL NEVER PROVE ME WRONG"). So that when that question is asked ("Where is your evidence (which has to look like my evidence)? How will you prove to me that I am wrong on the terms that I have decided?"), there is no answer. Even when clinical trials are run on the tea, the evidence is not the "right kind of evidence" ("It is not a randomized controlled trial but an observational study" - actual quote from British doctor). It's inadmissible. 

But that "assumed effective" status is not freely administered, just like the "assumed non-guilty" status in the American system. In America, race relations so blatantly and fully saturate the judicial system that so many heartbreaking cases come up of the white man being labeled "assumed non-guilty" and the black man (or woman) being labeled "assumed guilty." Those are the conditions we start with. And then that question - WHERE IS THE EVIDENCE? That question means radically different things in those two cases. It's an absurd oversimplification (but only slightly), but evidence protects hegemony and hinders the oppressed. Right now, I'm ready to simplify it all into a justification exercise (those in power are gonna do what they want to do anyway and just attempt to retroactively explain it). 

A. annua tea as use for an antimalarial in Africa means that a solution to what is widely described as an "African problem" could be produced within Africa. It means, conceivably, that African states would not be indebted to multilateral and bilateral funding entities that "donate" antimalarial ACTs every year. It means that families who have to deal with malaria multiple times a year would be able to afford treating their family members whether or not they have access to monetary means. Research done on A. annua tea in African institutions would be an example of African researchers having a voice in what kind of research is done in their countries, what kind of evidence they can produce about what is best for their own communities.

[malariadreams-blog]

Malaria Nexus presents the 2013 results of this study as potentially having "major impacts on the way patents with malaria are treated from now on." Unfortunately, I'm less hopeful. The very jaded perspective is: there's no money in Artemisia annua. I have heard the arguments on the part of the architects of the Artemsinin Project against using the plant in favor of (here, French-manufactured) ACTs - there is too much uncertainty about dosage when prescribing tea made with the plant, or that it would take too long to grow and the harvest wouldn't be reliable, or that the plant is too vulnerable to environmental factors. That there are too many factors to keep into consideration when trying to make a viable treatment out of the plant itself, even though there are hundreds of years of experience of using an infusion of the plant in China to treat fevers. 

From my perspective, this is a discussion about "standardization" and "rational use," which is so intricately tied to the center of the global health fight against malaria. Of course, at this moment, ACTs are theoretically free in Senegal, as long as you go to a public clinic to procure them (and not a private clinic, a private pharmacy, or the informal sector). The National Malaria Control Program, with the help of international aid, provides them for free, along with nets, to Senegal's 14 regional depots. From those regional hubs, the medicines and equipment get filtered down to the postes de santé and cases de santé in 75 health districts. Needless to say, there is a distribution problem, and often ACTs do not reach the most rural areas of the country. A campaign to get people to use the plant, which could have its roots (pun intended?) in the work being done at the BIOMOL lab at the Hôpital le Dantec, could at the very least be a great complement to a centralized pharmaceutical supply chain. 

But this is one of many points at which artemisinin becomes a political object, as there are many pressures, financial and otherwise, to keep focused on a "rational use" of a viable pharmaceutical rather than promote a more locally controlled means of treating the disease (and which I will return to later). 

[malariadreams-blog]

Journée scientifique at the Good Rade for the National Malaria Control Program. Favorite moment of the day: a running joke about a conniving mosquito and his conspiring buddies.

[malariadreams-blog]

On December 17th, the WHO released their 2012 World Malaria Report, with an accompanying "fact sheet for journalists" that serves as a nice bullet point sum-up of many of the important points from the very large report. One of these key points is about how 2012 showed quite a bit of progress on the availability of ACTs in malaria endemic countries (from 182 million courses procured in 2010 to 278 million in 2012). The fact sheet then goes on to say: "This increase was largely driven by the scale-up of subsidized ACTs in the private sector through the AMFm initiative, managed by the Global Fund to Fight AIDS, Tuberculosis and Malaria."

However, the Global Fund decided to discontinue the AMFm initiative in November, saying that they would fold in the goals of the AMFm into existing funding grants. The AMFm has certainly been at the center of many critiques of the current global health fight against malaria, but the shift from a more encompassing program to make access to ACTs more affordable to a "more country-driven" approach is an interesting move. As Victoria Fan and Heather Lanthorn discuss at length in a Center for Global Development blog post, moving away from a concerted effort may in fact prove problematic for the more global goals that the AMFm set out to achieve. 

The way that initiatives are funded does indeed impact the kinds of results that are culled from global health efforts. The AMFm has been a prickly topic for some time, but its discontinuation does point to some very difficult questions that arise with attempts to improve access to and monitoring of "appropriate pharmaceuticals" on a necessarily global scale (because of the nature of the global health fight against malaria and the way that fears about drug resistance circulate). That the AMFm's existence has been pointed to as the reason for increased access to quality ACTs of course makes its discontinuation particularly problematic. 

[malariadreams-blog]

Artemisinin tea. Mboup's lab is studying the effectiveness of the tea in comparison to the molecule of artemisinin itself. There are also efforts currently in Mboro to adapt the plant to Senegalese soil and conditions. Apparently there is already a Gambian version. FASCINATING. (at Hopital Aristide Le Dantec)

[malariadreams-blog]

Everyday Sexual Harassment

Dear man who followed me for two blocks in downtown Dakar today at a quick clip, yelling at me to give you something, anything: just because I eventually did give you a cigarette (which was to be read, I thought clear, as: "I will give you this so you stop hounding me"), after we had established the fact that I had no change - this does not mean that you are then allowed to touch my ass.

Dear man getting on the bus as I was getting off on Rue Bourguiba: let's be clear - the bus was fucking stuffed and, first and foremost, it would have benefitted everyone involved if you would have let me and the other passengers get off the bus before you tried to get on at the designated exit. Just because I was then forced to squeeze by you when you refused to move does not give you a right to cup my butt.

Dear man I was unlucky enough to be crammed next to in the back of a station wagon for five hours from southeast Senegal to Koalack (including the two hours we waited by the side of the road as our taxi was being repaired): just because I am a white woman traveling alone does NOT mean that I am going to get off at the next town with you to go to a hotel, no matter how progressively crude your insinuations get. And of course it's a big deal that you keep pushing the issue despite the fact that you're married and that I've told you countless times that I'm not interested.

What is it that is going on in your minds? Does it have to do with the fact that the color of my skin signals an idea to you about "Europeanness" or "Americanness" that is seeped in sexual looseness? Do you think that if you can manage to get me into a hotel room this will somehow be your path to that mythical "Other World," that I am a green card on legs and sex is all it takes to get that application process in motion? Or is this what it means to be a woman in Senegal in general: constantly being barraged with unwanted advances and groping hands and no matter how many times you say no or yell at them those advances won't stop?

I've tried yelling at these men, which I suppose is an attempt to shame them or to show them how inappropriate they are being. The response to this is usually a casual shrug or, worse, no response at all. My desire to flee the situation as quickly as possible encourages their performance of innocence. I may glare at them or make an angry noise, but these actions do not force accountability.

And these undeniably physical violations are invasions of my sense of assuredness within my female body. The other sorts of uncomfortable male attention I receive, like lingering looks or persistent attempts to get me to give up my phone number, have their own means of making me feel out of control or frustrated, but they at least let me have my peace with my body.

[malariadreams-blog]

I will be working at Senegal's National Malaria Control Program for the next six months, and I just got set up with my own desk that is currently surrounded by boxes full of this comic book. It was published by IntraHealth International, and it is written in French. Its target population seems to be mothers living in rural villages, although everyone acknowledges the fact that many mothers in rural Senegal either do not speak French or cannot read it.

Portraying the stories of three young children, it emphasizes the difference between serious and uncomplicated malaria and drives home the point that mothers should bring their children to the poste de santé as soon as certain symptoms are visible (particularly a "hot body" and lack of appetite). 

[malariadreams-blog]

These biological illustrations were hanging in one of the rooms of Dr. Mboup's lab at the Hôpital Le Dantec, which is one of my fieldsites. I found myself surprised by the beauty of the illustration. And I was, once again, amazed by how abstracting the object away from the experience of illness (in this case, P. falciparum - but with malaria as a public health target, there are many things to abstract and isolate, not the least of which is the mosquito) produces a thing that can gather meanings outside of its original context. Here, abstraction allows the life cycle of a dangerous parasite to become a thing of beauty. 

It also makes me want to re-read Raffles' Insectopedia. 

A: Stages of P. falciparum in thin blood smears.  Fig. 1: Normal red cell; Figs. 2-18: Trophozoites (among these, Figs. 2-10 correspond to ring-stage trophozoites); Figs. 19-26: Schizonts (Fig. 26 is a ruptured schizont); Figs. 27, 28: Mature macrogametocytes (female); Figs. 29, 30: Mature microgametocytes (male).

Illustrations from: Coatney GR, Collins WE, Warren M, Contacos PG. The Primate Malarias. Bethesda: U.S. Department of Health, Education and Welfare; 1971.

[malariadreams-blog]

I spend an awful lot of time in cabs in Dakar, and it's been far too long since I've taken the bus. This video is a little taste of what it's like to drive out of my quarter of the city, which is called Ouakam-Cité Assemblé, south toward downtown Dakar. It's dubbed "Cité Assemblé" because it has a bunch of GIGANTIC houses where the members of former president Abdou Diouf's national assembly live now. Ouakam is also an extremely large quarter with many little different pockets of life. But I wanted to take a video on my favorite way toward downtown, through the windy street you see here.

Also, the elevator music version of soft rock in the background of the video is not a usual occurrence - more often than not, there is a man screaming in Wolof on the radio whenever I get into a cab around here. I had been hoping to film this journey when said radio show was on, but I kind of like the soft rock in the end - it can give you an idea of how often completely unpredictable sights, sounds, tastes get juxtaposed on a day-to-day basis in Dakar. 

At the beginning you can hear me say: "I feel real awkward about it." It's probably obvious, but I'm not really comfortable taking pictures (let alone videos) because I don't want to impose on anyone or feel like I'm invading their privacy. For this reason, I have very few pictures of what things look like around here in my daily life. 

Also, I would like to apologize for the poor quality of the video, but y'know, I gotta use what technology I've got.

[malariadreams-blog]

RTS, S - an experimental malaria vaccine developed by GlaxoSmithKline, PATH, and the Bill and Melinda Gates Foundation - has proven to be not as effective as expected. Last year, clinical trials run on older African infants (12 weeks to 17 months) showed the vaccine to be roughly 50% effective. Results from the latest clinical trials, on children younger than 12 weeks, show that the vaccine is not as effective for younger infants. Since 1987, GlaxoSmithKline has put $300 million into developing the vaccine and the Gates Foundation, by way of PATH, has put in another $200 million. It appears that decisions must be made.

[malariadreams-blog]

Well, I've been living in Dakar more than a month now.

"Fieldwork" has so far consisted in making this place home. And so, mostly without my understanding how it happened or attending to the process, Dakar has become home. This is a picture of my roof, where I have done my laundry a couple times, where I watch the sun hide behind the lighthouse hill on some evenings, where I have cut Juan Carlos' and Tim's hair (another major step in making this place home). 

I feel myself inching along, feeling the boundaries of what is ok, what is not. Can I wash my sheets myself in Christelle and Gracia's (my lovely roommates) single, tiny bucket? (A: Yes, incredibly.) Can I wear short shorts out of the house, even just to the boutique around the corner to get phone credit? (A: Not yet - I still feel a little too exposed.) Can I get a taximan to bring the fare down to a reasonable 1,000 CFA (USD 2) to get from here to the research center I work at? (A: Nope, explicitly because I'm not Senegalese, which is both infuriating and completely logical.) Can I force myself to take the bus most days rather than the relatively luxurious taxi-route? (A: I'm definitely not hitting "most days.") 

The "work" of "fieldwork" has, thus, been largely the work of acclimating, peppered with some serious preparations I have to do to jump through some bureaucratic hoops with the Senegalese Ministry of Health. There are emails waiting to be sent, and I can feel myself comfortable enough in myself, my French, and my (slowwwwly developing) Wolof to get going on this. 

[malariadreams-blog]

Castilians in Senegal

Set against the absurd angst that colored my entire trip to the southwest corner of the West African country during the summer of 2011, the pure joy of the Castilian tourist family Eric and I encountered shook me. While I allowed myself to be fettered by constant worries about the infinite consequences of my actions (a self-aggrandizing task, to be sure), these lovely people took in the world around them, not uncritically, but with a perspective that did not paralyze them from action.

The mother turned to me, at one point, and asked me: What do you think of giving the begging children candy?

It was obviously something she and her partner had discussed at length, and they had very different opinions on the matter. But their worries were ones I had yet to consider.

I hear, she said, that it is better if you play with them, if you give them love and attention.

By that point, we had been giving the children attention, taking them on our adventure to see hippos. I had been doing it without question, without thinking about it, really – one of those few moments when I was just acting rather than running a constant pros and cons list in my head. We held their hands, lifted them over creeks, helped them climb over logs, I spoke French at them and they spoke Pulaar back at me, sprinkled with ouis and nons, neither of us really understanding the other but enjoying our weird language dance nonetheless. And come the end of our hippo journey, we were climbing back into the tourist van – different in my eyes since my bus crash – and the kids were asking for presents. And this is when the mother turned to me to ask what I, as an anthropologist, thought about giving the children candy. What was my expert, ethical opinion?

I had no opinion on the ethics of giving candy versus attention, love. I had plenty of opinions on giving candy versus money, but that at mostly to do with the talibés in the city – who would have to give over their earnings to their supposed Qur’an teachers rather than enjoy something themselves, directly. It seemed to me, perhaps naively, that rural children would have more control over their spoils. Nonetheless, I responded that I often gave candy as presents and didn’t find anything morally reprehensible in doing so. At which point it became clear that she was also worried about what the candy would do to their teeth, which she voiced as she watched her partner gleefully hand out a bagful of candy to ready hands.

So many layers of need. Which things do you worry about? In my mind, the enjoyment the kids would get out of the candy would be worth the possible cavities. But how many groups and families do they guide and tag along with on these tourist quests for hippos? How many of them gave candy or money or nothing at all? What are the right ways of giving? And how could you not give? Yes, the attention was nice, I’m sure. But I’m certainly not assuming these children are starved for attention. Nor do I put so much value in my company to think that holding a little girl in my lap as we sit in a bar in the jungle could do anything for that child but allow us to be humans, together, for one brief moment. And I heartily believe that is a larger gift to me than it is to her.

[malariadreams-blog]

Here. In Dakar.

I'm happy, calm. Not lost, not overwhelmed. I'm seeing the possibilities not the impossibilities. I'm loving this place (of course, I've only encountered one dragueur so far, soooo). [STOP IT WITH THE PESSIMISM!]

This tumblr will serve to replace my defunct Malarial Dreams wordpress blog. I find I like this interface infinitely more, and, y'know, I'm already on tumblr way too much, anyway, so why not just add to it? This tumblr will focus primarily on questions of fieldwork and will allow me a first think through of what I'm seeing, doing, hearing, saying, etc.