Slow down.

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I had coffee with an Ethiopian student from the School of Nursing the other day and I asked him what he missed about his home culture. His response was simply, “time.” I understood fully. He went on to explain that when he was living in Ethiopia he could stop and have coffee and chat with a friend for an hour in the middle of the day. I experienced the same while I was there. Even though I had a ton of work to accomplish, I still had time… time to think, time to talk, time to sit. In my first week back from Ethiopia, I sensed myself wanting to jump back into the rat race of life here, and I have been trying to resist every since. This quarter I have had rural health rotations, which has made life a bit busy with the weekly 9 hours of driving. On the up side I have cozied up to some great podcasts. Right now I’m sitting in a cabin in Winthrop, WA by myself. I don’t spend much time by myself. Sometimes I’m alone at home, but there is always a checklist of things to do while I’m there. Rarely, if ever do I just stop. I could have driven home tonight, but I decided to live into the value of slowing down, so I’m spending the evening alone in the woods. When I first arrived it felt a little awkward. I’m used to Ben putting the music on and then together figuring out what the evening will look like. Tonight it’s just me. I eventually settled into the space quite nicely. The crackling fire is doing a fine job of keeping me company. I know my life won’t always afford me the space to embrace being alone, but I’d like to try and take the moment’s when they come.

Monastery Rehab

I’ve been meaning to write about this for a few weeks now, but leaving Ethiopia and arriving in Tacoma has monopolized my time. My thoughts returned to monastery rehab last night as I watched a film entitled, Calvary with Ben. The film chronicles a week in the life of an Irish priest. It’s a week of particular importance for the priest, as an unknown congregant has declared that he will kill the priest in a week’s time (don’t worry, you find that out in the opening scene of the movie). The movie weaves its way through the stories of the flawed congregants, as well as the imperfect priest.

Calvary brought my thoughts back to a trip that Kate and I made to Bahir Dar before we left Ethiopia. We had a unique tour guide who lead us around Lake Tana and walked us through a couple of island monasteries. At the second monastery, we were greeted by the warm smile of a young monk. At the conclusion of our visit we were invited to share a meal with the monk. Our food and “beer” were blessed by the head priest and we ate our fill of injera and shiro. Our guide informed us that he knew these monks well because he had sent addicts from town to this monastery in order to dry up. I found this news unbelievably encouraging.

As the film last night reminded me, our world is full of hurt, struggle, and pain. This is where the church must exist, in the midst of the mess. The church is a place for pain, hurt, struggle, questions, confusion, ugliness, and exhaustion. “Come to me, all you who are weary and burdened, and I will give you rest.” Christ does not speak of solutions or answers, but rather simply promises rest. Respite and repose are what is offered rather than ease and explanations. I think there are moments of clarity to be found within the space of rest, but that is not the promise. Simply rest.

I imagine the battered and defeated addict, carrying all of her hurt and pain onto this island monastery and finding “rest for her soul.” No judgement and no easy solutions. Ah. Sweet Jesus, that’s what it’s about. Thank you for the places and spaces in this life where we find rest. I pray for those who are plagued by grief, strife, and struggle, may they find your rest. May your church around the world be a place that provides divine rest for all those who voyage through life.

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Lunch with a monk.

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Our tour guide.

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Lake Tana

Poverty and Ideas

I had dinner with a newly arrived, German anesthesiologist the other night. It often amazes me how much I have to talk about with someone I just met, when the context is an overseas one. He is working to enhance the education of anesthesiologists here in Ethiopia. I asked him, casually how things have been going. After thinking for some time, his response was two-fold. He first said that sometimes he feels like he can’t quite figure out why he’s here. The people he is supervising seem quite well qualified and he is quite unfamiliar with the drugs and equipment they are using. “What do I have to offer?”

The second part of his answer went something like, “what is wrong with Ethiopia?” He is currently reading a book called Cutting for Stone, which takes place in 1940’s Ethiopia, a fantastic read if you haven’t found your way into it already. We were agreeing that the vivid images in the book seem not so different from what we are seeing today, more than 70 years later. So, why can’t countries like Ethiopia get it figured out?

I started doing some digging and not surprisingly the main issues repeatedly mentioned as responsible for Ethiopia’s current situation were pervasive poverty largely due to corrupt governments and “crony capitalism,” coupled with a long history of conflict. Well, what are we supposed to do about that?

Today I read an article about the city of Camden, NJ, which mentioned that 40% of Camden’s residents live under the poverty level. Ironically, that is the same percentage of Ethiopians living in “poverty.” Now, obviously “poverty” in the U.S. is vastly different from “poverty” in Ethiopia. I doubt very many Camden residents are living on $1.25/day. The point is, “poverty” is everywhere. None of us have it figured out.

Of course I have no answers to the problem of poverty, just ideas. But I guess the world runs on ideas, doesn’t it? Even those who claim to have the answers, really only have ideas. But answers always starts with an idea.

I think my German friend’s two-fold answer to my casual question was perfect. He both recognized that he doesn’t have all the answers, while at the same time allowing himself to wonder just what the answer might be. That is the birthplace of ideas.

 

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A single mother working at a local NGO to support her family.

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A group picture from the first SCOPE steering committee meeting here in Gondar. Some ideas were born there.

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Kate, the other SCOPE fellow and some of the members of the steering committee brainstorming.

Notice the Beautiful Things

A recent increase in rainfall altered one of my routine morning runs a bit. I arrived at the river, which I usually cross easily by stepping on the largest stones jutting out of the water, only to find that the water had risen and my usual path was obscured by rushing water. I watched as men and women of all ages walked across the river through the water. I really didn’t want to get my running shoes wet. Soggy running shoes are fine at the end of the run, but I wasn’t even half way through yet. Suddenly, I spotted my savior. I man of 50 years or so had been standing on the edge of the river peering hesitantly at the other side. He was carrying what looked like a couple of very heavy bags, one in each hand. Just when I expected him to turn around and admit defeat, he started across the river. He hopped from stone to stone and was completely dry when he made it across. All I had to do was follow his footsteps.

I laughed a little to myself as I started across the river in the shadow of the man with the bags. My shoes stayed dry. I never listen to music or podcasts when I run, so I was alone with my thoughts as I continued on. The man from the river lingered in my mind and reminded me of how often we discount those from whom we have the most to learn. We approach a situation and immediately start sizing it up, assuming that we are equipped to determine the best way to proceed. I spent close to 5 minutes standing on the edge of the river attempting various paths across before I looked up and realized that I could learn from the unassuming old man next to me; a man who has likely lived with this river every day of his life, rainy season after rainy season.

Working for the summer in a country scarred by wars and pervasive poverty, I have often felt overwhelmed. The man with the bags reminded me of a lesson I have gleaned from a number of my grad school classes. People are resilient. Learn from their resiliency. When I see a person or persons facing a seemingly insurmountable obstacle I immediately start thinking about how they should maneuver through or around it. Instead I must sit and watch. I do myself, and them a disservice if I fail to notice what is already working.

As I walk through a clinic here in Ethiopia, I am tempted to focus on the lack of running water, the unreliable electricity, the seeming disarray, and the fact that most of the patients probably should have presented for care days ago. Then I watch a pregnant woman receive care. I watch her HIV test turn negative and her blood pressure read within normal limits. I watch the midwife warn her about the danger signs of pregnancy and childbirth and instruct her to return to the clinic as soon as possible if she develops any of them. I watch a nurse hold a sick child and prescribe antibiotics in order to hasten his return to a healthy state. She may be saving his life. I think to myself, “there is a lot that is working here.” I want to make it look “pretty,” but in reality there are a lot of beautiful things happening right in front of me. I can hear my professor’s voice saying, “notice those beautiful things.” Okay, I’ll try. The next time I come to an impassable river, I’ll look to those around me and notice how they are getting across before I decide I need to build a bridge.

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A beautiful woman at the Dabat clinic.

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A beautiful face at the Dabat clinic.

Thyme

Ethiopia FB-860I just returned from the Simien Mountains where my soul found the expected respite that has always greeted me when I wander into the mountains. Breathtaking views, playful monkeys, elegant hawks, vibrant flowers, fresh breezes, cleansing rains, and the smell of wild thyme, which speckled the hillsides, were our companions. I found myself wishing I could bottle the smell of the thyme. My virologist friend, who traveled with me, assured me that people are working on making that very thing possible, but the technology just isn’t there yet. Plenty of pictures and videos were taken, but those things never quite capture the entirety of an experience. The physical moment of being present in a place can never be fully detained. Mountains have always played an important role in my life. From family vacations to summer jobs I have sought their company. On the rare occasions when I meditate, I often find myself trying to find my way into the mountains where I am afforded clarity of thought and peace of mind. It’s a place I know well because I have been there often.

During my down time I am reading a book called The Plague by Albert Camus. It is about a small port town in Algeria that is stricken with the plague. At one point in the book, the town’s doctor who is charged with fighting the incurable disease, is listening to the radio and hears the emotional cries of cities and towns, near and far, ringing out their support for those confined within the walls of the town. In response, the doctor’s thoughts point out the great chasm that separates those who are suffering within the city’s walls from those who sit comfortably outside of the sufferers’ world. He speaks of the, “incapacity of every man truly to share in suffering that he cannot see.”

We live in a world filled with suffering. Suffering people can be found in every corner of every place. During my quiet time in the mountains I found myself reflecting on the value of experiences where I have been afforded the opportunity to sit with those who are suffering. In the same way that a picture will never bring me the full experience of sitting on that mountain top, a news story or a book will never tell the whole story of suffering. We are incapable of comprehending suffering from a distance. I have to touch it and smell it in order to recognize its complexity and have my thoughts and actions changed by my encounter with it. Time and space may explain the distance between ourselves and the suffering of the world, but we also have a choice. We can choose to see it, to be affected by it, to be changed by its reality.

My thoughts as I left the mountain were dominated by thankfulness. I am thankful for the opportunity to see not only the suffering but also the incredible resiliency of the people here in Ethiopia. My hope is that my eyes will remain open to both the suffering and resiliency of all those with whom I come into contact, whether half way around the world, or right in downtown Tacoma.

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Taking in the view and enjoying the monkeys.

 

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Girls in Addis playing futbol.

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The end of a church service in Lalibela.

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Smile!

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Beautiful church in Lalibela.

It is worth it.

Her age is 20 years. The skin on her face is dark with a golden hue, and is as smooth as well churned butter. She is shy, but I can see a fierceness burning beneath her averted gaze and sweet smile. I feel awkward asking her questions but there is so much I want to know. What are her days and nights like? What tasks consume her time? What thoughts consume her mind? What are her worries and cares? What are her passions and loves?

The mother is at the Azezo Health Center for an antenatal care visit. The child growing inside of her took form 28 weeks ago and this is her first visit. You can see the love she has for the child in the way she strokes her belly with her hand. You can see her love for the child when you imagine her trudging an hour through the mud to cover the ground between her rural dwelling in the hills and the health center where she seeks care for herself and her baby. You know it is not easy for her to come. She has another little one at home to care for. Her daily responsibilities are vast and consuming. She came because she knows it is good.

The midwife asks her questions about her health history. “When was your last menstrual period? Do you have any chronic illnesses? Have you ever had malaria? Do you use an impregnated bed net? Can we test you for HIV?” She answers with single words. “Yes, no…” When she lies down on the exam table the midwife manipulates her swollen belly as she attempts to determine the lie of the child, and estimate the gestational age. The small room is crowded and two eager midwifery students gaze on and drool over every word their wise teacher offers them. I know what it’s like to want to know everything, to want to learn it all right now. But don’t forget about the person lying in front of you, I find myself thinking. Be present with her. Be curious about her.

After she is done in the exam room I walk in silence with the mother through the waiting room filled with cries and coos as mothers holding and feeding their brand new infants wait in the immunization line. We walk outside and across the muddy grounds, which try to steel my slip on shoe from my feet once or twice. We arrive at the window of an adjacent building. The lack of a common language prevents us from sharing words, but we communicate with touches and smiles. She offers her blood and urine to the laboratory technician for examination then sits outside on a covered bench to wait for the results. It’s warm and sunny and she invites me to sit next to her. Kefyalew, our trusty translator arrives on the scene and we begin a brief conversation. She delivered her first baby at her mother’s home as is customary in her village. I say a quick prayer of thanks that the delivery was free of complications and that mother and child are alive today. She says she wants to deliver her second baby at the health center and I offer my encouragement in support of her decision.

Her lab results come and we walk back to the exam room to present the completed lab slip to the midwife who has a few more questions and teaching points and then she is free to walk back home through the mud. We say good-bye and I head back to the University Hospital in a bajaj.

This mother carried her pregnant belly an hour through the mud and postponed the duties that will surely await her when she returns home, for a 30-minute visit at the health center. Is it worth it? Does she really need to make the journey again in 6 weeks for a similar visit? She is healthy and her baby appears to be healthy. There was nothing abnormal in her labs. She would probably be fine delivering at home by herself again. But what if they did find something? What if her blood pressure was high, or the baby was breech, or her HIV test was positive… She must come back. I pray she comes back. I pray she tells her friends and neighbors to come. I pray this prayer on behalf of all those whose lives have been altered due to the lack of this care. I pray that the work I am involved in here sees the realization of its intended effect, and brings more women and children to health centers for this precious care. Is it worth it? It is certainly worth it.

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A fierce mother seeking care for herself and her unborn child.

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A group of priests and religious women who have been trained in the importance of ANC, HIV testing, PMTCT and related topics. They refer pregnant women to the local health centers for care. Their passion for their work is inspirational.

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A healthy mother and her baby.

 

Change

little girlOne of the tasks assigned to me during my time in Ethiopia is to look at various health centers and explore which ones are best suited for the expansion of SCOPE’s Soul Fathers as Health Educators project. I have visited all five sites being considered and found the task not nearly as straightforward as expected. Each location has its own set of strengths and challenges and it is hard to separate myself from what I imagine could be and sit with what is.

Last week we had dinner with a lovely Swiss midwifery student, Laura who is here for a five-week clinical rotation. When asked what impressed her the most about her experience she replied, “the strength of the women.” She spoke of how brave they are during the birthing process. She then shared one tragic story, which had also left an impression on her. A mother had tried to deliver at home but the presenting part was the baby’s arm rather than the head, which stalls the passage of the baby through the birth canal. In the U.S. this represents an emergency and the mother likely would have been rushed to the operating room for a cesarean delivery. The woman in Laura’s story lived over four hours from the hospital and by the time she arrived, the baby’s life had been lost. Laura described the wailing and sobbing of this poor mother as the baby was literally torn from her. She labored the baby out after the baby’s arm had been removed. I cannot begin to imagine the trauma of this experience for that mother. As a hopeful mother I mourn along with this woman and all women whose lives are needlessly altered by similar stories and all children whose lives will never be realized as a result. I hope for physical and emotional healing for that mother and father. I hope for meaningful change that will prevent such tragedies.

Laura’s story served to personalize the statistics I have been gathering during my time here. One of the health centers I visited is seeing only about 11% of the pregnant women in their catchment area. The remaining 89% are receiving no care at all. Receiving antenatal care and giving birth with a skilled attendant can be life saving for the mother and the child. 

Doubts and questions cloud the hope I hold onto for mothers and children like the ones in Laura’s story. How does change actually happen? Where will it come from? Whose demand for change will be heard? Who will be the hearer of their demands? Change… progress… development. Sometimes the needed change seems so obvious and easy, yet it exists within a complex system of real people with real struggles and the process is anything but simple or straightforward. I’m glad to be here. It’s a privilege to have the opportunity to ask these questions and sobering to be reminded that there are no easy answers.  

The Other

Who is she? The other. The one who is different than me. There is always an other. The one I see as completely different than who I am or what I am about. We all have others in our life. We think we understand them without ever having asked if our understanding is accurate, or every considering if we might not know everything there is to know about their story. The tragedy is that the other is our own creation. Otherness was not in the plan. We created otherness. Oneness, unity, peace, love, understanding and communion, these were all in the plan, but otherness was not.

Yesterday morning I found myself missing my home church, so I decided to listen to the pastor’s sermon from a few weeks ago. The sermon centered on the story of Abraham, Sarah, Isaac, Hagar, and Ishmael. This is an admittedly messy story. God chose Sarah’s husband, Abraham as the father of Israel. Abraham’s concubine, Hagar threatens Sarah because Hagar bore Abraham’s first son and was therefore higher in social status than Sarah. Sarah eventually bore Isaac, but he was Abraham’s second borne son so there were likely questions surrounding whose son would inherit Abraham’s lot. So, Sarah separates herself from Hagar and labels her as other. While God does not stop her from doing so, God also does not join her. Hagar was a disruption in Sarah’s world. As a result of their problematic presence in Sarah’s story, Hagar and her son, Ishmael are cast out into the desert to die. God hears the cries of Ishmael and Hagar. God had chosen Israel to bear a message to the world, but he did not turn away from those whom Israel labeled as others. Similarly, those whom we have cast aside, thrown into the desert, or whose stories inconvenience us or whose suffering we forget, those whose stories we will never hear because we choose to label them as other and close our ears to their words, God does not forget them. For God, there is no other.

In light of recent events in Palestine and Israel, and in the midst of my experiences here in Ethiopia, the presence of otherness in the world has been a prevailing topic in my thoughts. As I walked to the hospital today I saw a man, naked walking down the street toward me. His testicles were swollen to the size of a small melon and he was displaying his deformity and begging for money. People walked by trying to avoid eye contact and I joined them. I gave him an awkward smile and kept on my way. What is his name? What is his story? Who will listen? Who has cast this man out? Likewise, as we walked back to the hospital after a visit to a local health center with our colleague Adino, I noticed some young women sitting in the grass. They waved hello and I waved back. Adino explained that they were fistula patients. These women were likely married off at a young age and their bodies were not ready to bare children when they became pregnant. This fact paired with the lack of a skilled birth attendant can lead to prolonged labor lasting several days, which can cause the formation of a fistula (Click the link for more detailed information about fistulas). Due to the malodorous nature of their condition, they are cast away to live in isolation, and are often subject to desperate circumstances. These are just a few of the others of our world.

Those labeled as the other are often those whose reality makes us uncomfortable, or whose needs inconvenience us, or whose opinions seem irrational. The only way to overcome this otherness is to hear the stories we don’t want to hear and to acknowledge the likeness that we all share as those who are loved and fully accepted by God.

Stories. We all have them. Some of our stories are told often, while others are never heard. What stories are we not hearing? Who is the other? So often we create otherness where there should be oneness. We create division where there should be unity. We create war where there should be peace. Lord, have mercy.

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The gate that Kate and I walk through to get to the University of Gondar Hospital. The sign celebrates the repair of 60 women’s fistulas.

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The Fistula Training Center at the University of Gondar Hospital

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Ethiopian Orthodox Christians performing their morning ritual of prayer

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A beautiful view from a morning run. My morning runs here have provided me space to think and process my experiences.

Lessons from Misbah

Nothing can make me smile like the sight of Misbah. As I round the corner from our guesthouse apartment building and walk toward the main road, I find myself always crossing my fingers, hoping that Misbah will be playing in the street so I can feed off his infectious smile. This boy of 10 years has stolen my heart. As I have realized his effect on me, I have wondered just what it is about this small boy that draws me so eagerly toward him. I came up with three life lessons I have learned from Misbah.

Lesson 1: Life is all about love. It has become a joke that Kate and I want Misbah to come with us to America. Whenever Misbah is asked if he wants to come to America with us he wrinkles up his nose and exclaims with conviction, “No, no, no!” At first this surprised me. I have grown used to people from the developing world proclaiming their dream of one day coming to America. Not this boy. When asked why he wouldn’t want to come he replies something like, “my family and my life are here.” What a beautiful sense of place and belonging this boy has. I found myself inspired by his commitment to fully embrace his life and those whose love surrounds him.

Lesson 2: Accept hospitality when it is given. Misbah, along with his family and his auntie Gamila have welcomed Kate and me with open arms into their lives. Kate and I were walking up the street to grab some food the other evening when Misbah spotted us from across the road. He came over and shook our hands and then said, “come.” We followed, and he kept peering back and repeating the phrase, “come on, come on” to make sure we were still in tow. He lead us into Gamila’s one room apartment and ordered us to sit on the floor cushions while he filled a basket with the bread he had just purchased. I have never seen a more satisfied look on anyone’s face. He had invited us in and we had accepted his hospitality. We have eaten at Gamila’s a handful of times now and she has given us milk and honey, and warm smiles and kisses on the cheek, and I find myself feeling guilty because I am so heavily on the receiving end of things. I am trying to shake this sense and learn from Misbah’s satisfied look, which reminds me that sometimes accepting hospitality is a gift in and of itself.

Lesson 3: Laughter heals. This kid can laugh. His joy is contagious and I can’t get enough of it. Kate and I have shared our surprise when we realize that the strain and energy expenditure associated with cross-cultural interactions doesn’t apply when we are at Gamila’s. Misbah’s laughter is no small part of this phenomenon. His laughter melts away the worries of the world and the cares of the day. He lives in the moment and brings me into that moment with him. As a future healthcare provider, I find this lesson invaluable. Being present with people and bringing them joy is a special gift this boy has been given and I am grateful for its timely presence in my life.

This boy has been such a gift. I am trying to avoid the sad thought of leaving this place, and Misbah behind in September. For now, I’ll try to remain an attentive student to the many lessons he has to teach me.

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Misbah sharing his smiles.

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Misbah goofing around with Kate.

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Misbah showing his dimples.

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Gamila preparing coffee for us.

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Gamila pouring us some of her honey.

 

Getting Out of My Own Skin

Our skin, or integumentary system is the largest system in our entire body. It plays so many roles both positive and negative, from keeping us safe and healthy, warm and dry, to creating separation and discrimination based on its color. The barrier it creates between us and the world is essential for survival. Without our skin our body would be inundated with bacteria, parasites and viruses that would overwhelm us. Our skin allows us to live, and in some ways defines our experience of living. When others look at us they see our skin, and we in turn see the world around us from within that skin.

This past week’s work was dominated by interviews. I sit down with the interviewee and ask the predetermined questions. I am not sure what exactly I expected, but my surprise at many of the answers I received evidence the fact that I did hold some sort of expectations at the outset of the interviews. As an interviewer listening is of utmost importance, and not just to the words that are spoken, but also to the meaning behind the words and the lived experiences that bring those words to utterance. As humans existing in our own skin we see the world from our own perspective, with our own unique biases. We see problems and solutions from within our skin. There is no way out of it. From the moment we are born, our skin is our companion here on earth. As I interviewed people this week I stumbled upon moments when I allowed my mind to wander outside of my skin and catch a glimpse of the world from within another’s. While we will never be able to do this fully, the moments life gifts us with when we can shed our skin and sit in another’s world are precious; I believe this is the birthplace of life’s slivers of wisdom.

Dr Shitaye, an Internal Medicine Doctor here in Gondar who has worked with SCOPE for many years shared some beautiful words during a casual conversation following her interview. She shared her passion for knowing her patients as people with stories to tell rather than as diseases. She cares for Magda the fierce mother and Misbah the gentle farmer rather than the diabetic and the hypertensive. Her face lit up as she talked about her passion for making sure medical students here in Gondar know how to listen to patients and gain wisdom from their stories. This requires stepping out of one’s own skin, shedding assumptions and preconceptions and listening, really listening to what another’s life has to tell us. If I have learned nothing else from my education at UW, I have learned that as a healthcare practitioner I am powerless without my patients’ stories. I believe Dr. Shitaye holds many slivers of wisdom from her 30 plus years of experience getting out of her own skin and stepping into the lives of her patients.

As I head into another week of interviews and clinic visits, my practice will be to step out of my own skin and to listen. Knowing that I will never fully master this practice, I will keep trying. After all, life is full of practices that we will never master, but that doesn’t excuse us from trying. With each attempt our practice grows and we gain those little nuggets of wisdom.

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A couple of shots from an interview with Kesis Dawit, an Ethiopian Orthodox priest who has been involved in SCOPE for a long time. His passion for the SCOPE’s mission was inspirational.

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Kate goofing around with our favorite neighborhood boy, and me with Gamila, our favorite local shop owner who has taken us under her wing.

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Gamila preparing coffee for our Iftar meal. She is a Muslim and is fasting for Ramadan. She invites us almost daily to break the fast with her in the evening.

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Waiting in line and then sitting in the stands at University of Gondar’s graduation ceremony. This year marks the University’s 60th anniversary so there was plenty of celebrating!

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A beautiful sunrise greeting me on my morning run.