Livesay Haiti

Grease the Wheels and Keep Hoping

It is said that hopelessness is the enemy of justice. 

Also, it is often said, mainly by women we work with at the Maternity Center, "Haiti has no justice". As you read that you might think, well - that's hyperbole - certainly there is SOME justice.  
There cannot be zero justice, right?!?
We first came to Haiti in early 2002. I came one week per month for seven months while I waited for Isaac and Hope to legally be free to come to the USA. After all of these years of meeting and working with average Haitians and hearing their experiences and stories, I am here to tell you that it is no exaggeration.
Justice is a commodity - as in you can buy it if you have the means to do so
Because the average Haitian citizen does not always have the means to eat three square meals a day and purchase a sufficient amount of potable water and keep their kids in school. For them there is definitely no expendable income to grease the seized-up wheels of justice.
Earlier this year we helped a young woman file a police report for sexual assault. She described what had taken place in detail over and over many times to interview rooms full of men. The manager of that department of the police was very enamored with my friend, KJ.  He was less interested in helping the young woman filing the report than he was in finding a way to get KJ to flirt with him.  He claimed we could pick up a copy of the report if we returned a few days later. We returned no less than four times, but were  given another (always new and creative) excuse why we could not have a copy of the report we had filed. 
It is said that hopelessness is the enemy of justice.
Last week in postpartum class we talked about abuse in Haiti, specifically sexual abuse and children. I shared a few personal stories and posed a question to the women seated in the room. "If we never talk about it or acknowledge it is happening at an alarming rate, how will it ever change? Can we change what we don't address?"  The next 45 minutes were spent with different new mothers sharing horrific stories of abuse. It was hard to hear what had happened in their neighborhoods. Not one had ever been able to report it to authorities. Not one had seen the abuser face consequences. 
It is said that hopelessness is the enemy of justice.  
On Monday, November 5th a little girl named Love was born with probable (not yet diagnosed) VACTERL association at the Heartline Maternity Center. Due to a connection with a long-time volunteer at a local hospital we were able to go directly to a hospital that would see the baby. Typically, Haitian mothers will visit several if not dozens of clinics and hospitals before there is one that takes on the responsibility of diagnosis and care. 
Our experience of being seen the day we walked into that hospital is atypical. Justice in that way came due to connections, which we are INCREDIBLY grateful for and also no more deserving of than any other person. The hospital sent baby Love for several tests, most of which took 8 days to complete. On Monday the 19th we hope to return to the hospital with all of the results of the tests and lab work they ordered to learn what happens next. Returning to the hospital will depend upon the ability to arrive there.  There are rumors of blockades and protests in the coming days which can easily lock up the entire city and render us helpless to arrive at the hospital. 
Mercifully, baby Love has been peeing, pooping, and eating without trouble or these 8 days would have been entirely different.  Love's mother keeps long socks on her to keep her neighbors from seeing her malformed legs and feet.
It is said that hopelessness is the enemy of justice.
Last night a baby boy named Wisler was born at 6:01pm. His one minute APGAR was 1 and his 5 minute APGAR was 2 and his 10 minute APGAR was 3.  At minute eleven he and his mom were in an ambulance heading toward the closest hospital.  At the closest hospital two female medical professionals began asking good questions, at that point Wisler was 30 minutes old. A male doctor walked up and barked, "Can't you see how many malformations and abnormalities this baby has? You need to go to _____ right now!" (He named another hospital.)
Wisler born 11/16 at 6:01pm

I assured him I did see but that we had always been told they were an excellent pediatric hospital. He dismissed us with a flippant wave and told us to get going. Trying to lighten the mood I asked, "What if the next hospital doesn't like my face, we won't get this baby accepted."  As we turned to walk out of the triage room he said, "There are foreigners there, they will like your face." 
We arrived at the second hospital before baby Wisler was an hour old.  The first medical employee to greet us was annoyed we did not have a NICU at our Maternity Center or a referral letter and she did not especially enjoy the fact that the first hospital had sent us on to her. I explained that breathing for the baby and driving to the hospital seemed like a better use of time and resources than sitting down to write a referral letter.  
Wisler was admitted, for which we are grateful.  The reason he was admitted was because we assured the hospital staff that we can pay for his care.  The average Haitian could not afford the small amount (only $57 USD) we spent last night to get things started. The average Haitian would not have arrived at the hospital in an hour. Public transport takes about two and a half times as long as private. 
It is said that hopelessness is the enemy of justice.
Last night, we returned to the Maternity Center at 9pm with Wisler's mom. In just three hours her entire world turned upside down - technically, she is one of the "lucky" ones, she had the connections needed to help grease the wheels.

** ** **
It occurs to me regularly that those of you that read these social media updates and pray specifically for situations we share and financially support the work of Heartline Ministries are the reason we keep hoping.  Your sacrificial love and concern is hopeful and it trickles down. 
You might imagine we don't read messages or see your donations in the busyness of day to day work in Haiti.  
I want you to know today that we do see you. 
We feel the power of your prayers. 
We are lifted from discouragement by your generous words of love sent via several social media outlets. 
We know we can support the costs of the rare sick baby that needs hospitalization because of your generous giving.
You are the grease to the wheels, you are stubborn in hopefulness  - and we thank you this Thanksgiving. 




To learn more about the work of Heartline Ministries, please visit:www.HeartlineMinistries.org 


Lastly, meet two beautiful little ladies born in the last 24 hours ...
Nadia and MarieLiah - born 11/16 at 5:24pm
MarieAnoute and yet to be named baby girl - born 11/17 at 12:05 am


Waiting on Love to Arrive

New life has always been a symbol of hope. Birth is a new start. On the wall of our prenatal consultation room a sign reads, "Where there is life, there is hope."  
Midwives have the high and holy honor of being with women as they usher in new life and new hope. 
Last night at 10pm Lovely arrived in active labor. She seemed shocked by the pain. I lost track of the count, but she said, 'Miss Tara, this hurts' approximately 73 times in the five hours she labored before her little girl arrived.  
The only thing to respond, 70 times over, is, "Yes, it hurts. It really does."
Motherhood hurts. 
Whether you have an easy life and all the material blessings or a very difficult life with a focus of just surviving day-to-day, giving birth is only the first painful thing in a sequence of events that has literally just begun. 
It is often said, watching your child grow-up and struggle and develop and become their own person is a bit like living with a piece of your heart outside of the protective wall of your own chest. 
Lovely talked a lot during second stage. In between pushes she told us she wasn't sure she could do it.  Once after a particularly long contraction with focused pushing she said, "Am I done?"  
We said, "The baby is still not out, you're not done but you are getting so close."  Lovely told us that KJ had said that it was a little girl during the ultrasound and that she chose the name Chrislove for her daughter but that she would simply call her, Love.
Lovely pushed Love out at 3:13 and ten sconds on Monday the fifth of November. 


Her labor had started at home on Saturday night and  included the extra hour of "falling back", which hardly seems fair.  
In total she worked 34 hours straight. Her labor took her from evening Saturday, through Sunday and into the early hours of Monday before it was finished with a screaming baby girl called Love.
Lovely watched her heart leave her chest last night. 
As we dried off little baby Love I noticed her left foot was formed abnormally. I quickly covered her with a warm blanket to wait and get a better look later.  Love was placed on her Mother's chest and began to nurse.
When it came time to take Love for her newborn exam and allow Lovely to take a bath and clean up, I lifted Love off her Mom's warm chest and saw that both of her feet had not developed normally. Upon further examination we realized her rectum is abnormal as well.
In those moments the very first irrational thought is, "How can we keep this from upsetting her Mother."  As if that is a thing. Midwife Guerline and I whispered about how to tell her.  My brain was busy trying to tell me maybe I could wait and tell her until after she had a few hours to sleep. 
Moms examine their children, and we knew Lovely would come out of the bathroom to really see her daughter for the first time.We showed Lovely her daughter's gorgeous face and perfect hands, we ooohed and aaahhhed over her. We opened up the blanket and talked about her feet and legs.  Lovely shut down fairly quickly.  The words of reassurance and hope fell on deaf ears, she needed time to integrate what she had just seen.
After we had Lovely and Love moved out of the birth room and settled in her postpartum bed, Lovely's Mother in Law came to me. She motioned that we go outside. Then she asked me how we could hide the baby's legs from visitors. I didn't understand. I began to tell the Mother in Law that the main focus for now was to encourage Lovely to bond with her baby and to begin breastfeeding, with our without her eager willingness we need Lovely to hope for Love. I said, we don't have to hide her legs, she's beautiful.
Midwife Guerline saw that I was not understanding what was being communicated. Guerline explained that Lovely's Mother in Law was concerned people that came to visit the baby would say inconsiderate things and believe the baby had a demon or a curse upon her, but if we hid her legs, they would not see it and therefore would not hurt Lovely's chance of bonding. 
We asked Lovely to let us hope for her until she can hope again. 
Will you please pray that supernatural connection is formed today and that by some miracle we can head directly to the correct people that can help address Love's medical needs in a timely manner. 
I read this last night while we waited on Love to arrive .... 
The deepest darkness is the place where God comes to us.
In the womb, in the night, in the dreaming; when we are lost, when our world has come undone, when we cannot see the next step on the path; in all the darkness that attends our life, whether hopeful darkness or horrendous, God meets us. God’s first priority is not to do away with the dark but to be present to us in it. -Jan RichardsonI pray God comes to Love and Lovely and is present to them now.

I Find It Hard Enough To Just Be Faithful

Everything in the grey smaller font print below is what I wrote in 2011 about measuring success. I am reposting it for a specific reason.

This year I have begun to struggle more than ever with the stress of this work we do. Instead of easily remaining mainly hopeful and joyful I have had to fight hard to try to be that way.

I just got back from 16 days away from Haiti. It was a perfect trip and Troy and I truly rested and forgot about work. During our time away I never ever felt a physical desire to drink alcohol.  We had an occasional glass of wine and beers many nights but it was not the slightest bit driven by stress or compulsion.

Today around 4pm I started thinking about having a drink. My desire was not simply because I wanted some down time with Troy. 

For the last year due to stress and some specific situations we are facing I have been medicating my pain, anger, and stress with vodka and wine.  I rarely ever drink one drink only and I went from drinking a couple times a week to almost every single day in 2018. 

I decided about a week ago that I have to do better. I decided not to drink anything for at least two months and re-train my habits of using two Vodka sodas or Moscow Mules to make myself feel less angry and anxious.  I decided to begin November 1, 2018.

Tonight I am staying in my bedroom because the temptation to pour my nightly stress-reliever is too great. 



* ** * ** *In this work we often find ourselves wanting and needing to provide progress reports to the kind and generous souls praying for or financially supporting it.

While we understand and desire that accountability and honesty with anyone investing in us or in Haiti, it can sometimes feel quite discouraging and uncomfortable trying to quantify progress or label success.

We (Troy and I) spend many nights sitting together asking ourselves what is being accomplished. Is it good? Do we believe in it? Do we feel good about it? We never want to get in a rut or get so comfortable with ourselves or our routines that we don't examine both our motivation and our trajectory.  We need to be asking ourselves difficult questions.

We have no desire to take donations from our church, family, and friends to live here if we cannot say at the end of the day that we are walking this path with God, being faithful to Him and doing things we feel honor Him and exhibit His love. Some days are really confusing because the things that happen in the course of a day aren't necessarily quantifiable. Some days we fall into bed asking each other "Is it right? Does this matter? Should we stay? Is God in this?" 

American culture likes numbers, efficiency, and strict time-tables.  You've got to be able to prove yourself with stats and spreadsheets. In the sports world a new coach has just a few years to produce a championship team or he's out of a job. Even the American church wants to count how many butts are in the seats and how many people signed on a dotted line marked "follow Jesus" or how many will commit to come to the quarterly membership class.  In theory those are good things to value. Who doesn't want tangible outcomes? I'm not up for debating the rightness or wrongness of any of that today, I'm only saying that those sorts of western pushes for big numbers drive ministries working in other cultures abroad to produce reports that don't necessarily represent total truth.

Whenever I read reports out of Haiti spewing numbers, I read between the lines and wonder if the numbers are less about actual provable outcomes and more to please a culture that demands numbers. Accountability is good. We want it. More than that, we need it.  The question becomes, how do the expectations of one culture fit into the reality of working in another? 

If we actually believed like Jesus did that touching one hurting person truly matters, that going the extra mile for one lost sheep is worth it, we wouldn't need to spend so much time counting and proving and counting and proving. 

I'm thankful to be able to honestly share the struggles and not fold to that pressure of reporting big fancy numbers. The frustration lies mainly in the self-imposed pressures to chart it and prove it matters. 

Troy can spend entire day(s) with one timid and afraid 20 year old recently diagnosed and already ill with HIV helping to advocate for her medical care.  He can be at ease as one day turns into three while waiting to get her the tests she needs and fighting a broken, inadequate, and unfair medical system - knowing that he is not expected to quantify the outcome of those hours  ....  time with one person isn't usually looked at as success nor is it at all impressive when plotted on a spreadsheet  - but it matters and it's Kingdom work.  

Last night I read this in Gregory Boyle's memoir titled "Tattoos on the Heart" - it jumped off the pages and deeply resonated with me:


  
"People want me to tell them success stories. I understand this. They are the stories you want to tell, after all. So why does my scalp tighten whenever I am asked this?
Twenty years of this work has taught me that God has greater comfort with inverting categories than I do. What is success and what is failure? What is good and what is bad? Setback or progress? Great stock these days, especially in nonprofits (and who can blame them), is placed in evidence-based outcomes. People, funders in particular, want to know if what you do "works".
Are you in the end, successful? Naturally, I find myself heartened by Mother Teresa's take: 'We are not called to be successful, but faithful.' This distinction is helpful for me as I barricade myself against the daily dread of setback. You need protection from the ebb and flow of three steps forward, five steps backward. You trip over disappointment and recalcitrance every day, and it all becomes a muddle. God intends it to be, I think. For once you choose to hang out with folks who carry more burden than they can bear, all bets seem to be off. Salivating for success keeps you from being faithful, keeps you from truly seeing whoever is sitting in front of you. Embracing a strategy and an approach you can believe in is sometimes the best you can do on any given day. If you surrender your need for results and outcomes, success becomes God's business. I find it hard enough to just be faithful."



Success, I find it hard enough to just be faithful.


* ** * ** *


I feel the same way I did when I wrote this in 2011.  Success cannot be easily measured and some setbacks are actually necessary to correct a ship that is heading off course.  

The only thing that is different is that now I feel more afraid of my anger and grief than I did then.  

I also feel pretty afraid of choosing unhealthy things to help me with stress.  

I hope if you are a praying person or someone with similar struggles that you could toss up a prayer for me to be healthy and take care of this concern now, before I have an even bigger problem.

I would like to be faithful, but I know numbing myself is not the answer to the pressure of it all. 

When you find something good -- SHARE IT

This month is very exciting for us.  We are getting closer and closer to having a completed "How To" manual for the Heartline Maternity Center.

Our model is being shared and we are calling it, "The Starting Place".

The manual contains eleven years of learning and the details of the current Prenatal Program, Postpartum Program, Birth Control Program. and Youth/Teen Program. It has taken many years to get here. We are hosting our first  (pilot) class this week with four participants from other organizations also working in Haiti.

**  See this post for more information about The Starting Place.  **


What is it?
It is a technical manual. It describes everything we do, from the beginning to the end. It includes protocols and tons of administrative details. It includes ways to start small as a prenatal education or birth control program and and grow into a full service holistic birth center offering maternal health care from early pregnancy until months after delivery. It shares a few case studies. It is practical. It is step by step. It includes all aspects: education, relationship, medical, spiritual, physical, cultural, etc., etc.  It is incredibly practical. It is a little bit overwhelming.

What is it not?
It is not hundreds of stories or case studies or interesting detailed descriptions of the more than 850 women that have delivered at the Heartline Maternity Center. It is not all and only medical and practice protocols. It is not all statistics and information you can find about Maternal Health by doing a google search.






Each time a new woman starts the Prenatal program, we do a social and obstetric history interview.  
Often women we work with in Haiti have a hard time recalling and easily verbalizing much of their history. It can take a while to gather the information. It is usually important to ask the questions in a unique ways to get the desired (and hopefully accurate) information.

We are realistic enough to guess that at least half the time we still did not get it all completely accurate because it was neither recalled or shared with that sort of precision.
It is best to ask questions in an assumptive tone.  For example, sometimes women assume if we are asking them, "Have you ever had an abortion?" that I will judge them if they say yes.
Instead we ask, "How many times have you ended a pregnancy?"  We can also pose that same question in four or five other ways, changing wording to be assumptive.

If the answer is zero they are fine sharing that but if the answer is 10, it helps that I assumed it was part of her history because it removes their hesitation or concern of being dismissed due to an answer that they fear we won't find pleasing.  
Daily life is so difficult, it makes survival and the immediate present the priority, which in turn means that recalling history is not an easy task. The blanket term "poor historian" fits pretty well.  Having and knowing your own medical history is actually a privilege. Many in the developing world have no idea what happens at medical visits and more often than not nobody takes the time to describe things to them.


* * * 
We interviewed a 37 year old woman. 
We asked, "You've been pregnant many times in your life, yes?"  She said, "No, only seven." 
That's our bad.  That's a cultural difference.  7 is a lot to me.  Not necessarily true here.
We started at the beginning and walked through each pregnancy and delivery.  Her first four children were all born at home in the house she and her husband have always lived. Those four children, two boys and two girls born in 2005, 2007,2009, and 2012 are all alive and well.

In 2010 their home was badly damaged and some injuries happened due to the earthquake but nobody in their home died. In 2013 she had a baby boy born in a hospital that was never well. She described several anomalies and said he died at 21 days of age. She thinks she was under some sort of curse (persecution) during that pregnancy.

In 2017 she described a situation of a breech delivery and her baby's head being entrapped. She said they had to pull and pull to get the baby girl out. The baby was dead upon delivery. She is now in her 11th week of her 7th pregnancy and will be getting prenatal care for the first time ever in her life. 

When I finished the interview I said, "Wow. That is a lot of trauma you have experienced in your life. That is really difficult."  Tears welled up in her eyes.  So often in a culture of non stop challenge and frequent trauma, there is not time for anyone to fully acknowledge the pain of what they have experienced.   Part of the model at Heartline that we are hoping to share with others, is the importance of empathy.  
* * *


From the Starting Place Manual - an excerpt from the Philosophy of care section ... 


EmpathySpend any amount of time at a hospital in the developing world and there is one key component to women’s health consistently missing: empathy.
Being a woman in the developing world requires a tremendous amount of grit, resourcefulness, and resilience. But a woman is almost never as vulnerable as when she is pregnant, giving birth, and post-natal.
Trust matters, relationships matter, and empathy is more valuable than we can express. Empathy is communicating a message of great value, a message that says,  “You are not alone.” It is rare. As Tara says, “Several of the hospitals in the city where I live, as well as the hospitals and clinics where we’ve worked around the world, who serve the materially poor are lacking the most valuable resource: compassion. Nothing sustainable and life-affirming happens without warm, loving relationships and a lot of compassion.”
It might seem odd to start off the technical manual of Heartline’s Model of Care with a seemingly unprofessional words like “kindness,” “empathy,” “compassion,” or “love” but it has been our experience that this is what truly transforms women. It can bring calm to chaos, hope to despair, connection to isolation, faith to fear. And all of those things matter every day in life but particularly so in birth.
Working in the middle of devastating poverty, one quickly learns that not every story has a happy ending. There are areas of frustration, despair, and brokenness all around us. We cannot fix everything. But we have decided to embrace love and compassion as our philosophy, as much for our patients as for our own souls. This is even more important to us in the face of despair, hurt, wounds, and trauma.
As one small outpost of health and wholeness in the worldwide maternal health crisis, we choose empathy and love and we center love and we practice love. We are committed to excellence, to integrity, to thorough training, to steady competence. But even our excellence of care, our integrity, our training, our competence must be grounded in a philosophy of love. Maternal health has for too long been sidelined and de-emphasized in the world: we believe women deserve not only competent and thorough care but they also deserve dignity, respect, and to feel loved in their most vulnerable moments.

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Why is she talking about this again?


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She is talking about this because it eventually becomes a thing for half the population. By all means, please, don’t read this if it does not apply to you. 
If you will ever, in the history of always and forever, know a female that is age 40 to age 55, it applies to you.  

Those that know zero females that are currently that age and they also think everyone they know will die at age 40, you are free to leave now. Sorry about your loss.
My doctor recently told me perimenopause is a term that pharmaceutical companies made up.  He said there is before menopause and you know, NORMALish life, and then there is menopause - like you are done forever with bleeding and having a cycle. 

Uh.  Okay???  So the years in between are not called anything?

Whatever, I am talking about this thing that apparently is only created by Big Pharma.  It is a thing to me because I am in that middle time where I am unsure of what the heck each day will be because I am more like a yo-yo than any human thing. 
I feel it is my duty to prepare all of my 20 and 30 something friends for what is to come.  I know that you are tempted to read this and think, Ah, she’s just being over the top and silly. No.  No,  Not what I am being.  I am being real with you. Dead.Serious.Real.
Okay, so first, you’re going to gain some weight in the middle section of your body.  You’re going to think, “Am I imagining this?”  You’re going to realize you are not.  It’s not a big deal, because you have shit to do and some extra adipose tissue is not going to stop you from being totally amazing.  It might cause you to leave your top button undone on your jeans.  That’s all.  No big thing. Carry on.
Second, you are going to go from having your periods at an interval you can predict, to having them whenever.  Maybe you’ll have them every 15 days, then take 60 days off, then that will be boring and it will toss you a new and exciting surprise that is not at all a pattern.  

You don’t get to move away from (Big Pharma created) perimenopause until you miss 12 whole months in a row of having your period.  
Everyone says that once you are done with this middle time, it gets easier. Everyone better not be lying.  If I live through the next five years and eventually reach true menopause, I expect life to be glorious non stop.
Third, you are going to do so many embarrassing things and people are going to mock the heck out of you. Those people are your family and maybe you don't even need them. Who's to say?   

If you do not have thick skin, get to work on changing that. Go drag your hands and feet over hot coals. You are going to need the thickest skin to endure your idiocy and the mocking material it will provide your loved ones.
EXAMPLES that Have been said to have happened - 
1.  You might get up one morning early and put your contacts in your eyes.  You might then leave the house and go do a little bit of work or some errand or something of that sort.  You might come back home and jump in the shower.  You might rub your eye wrong and one contact in your eye will twist up funny.  You will maybe call your husband to come take that contact to the case on your dresser.  After you shower and get dressed you might walk over and put the contact back in your eye.  About two minutes later you might go over to the dresser and start to look for your contact, because you think you cannot see and you need it.  You might say to your husband, who might have the name Troy, "Hey, did you put my contact in here when I asked you?"  That husband might say, "Yep. I did."  Then, I have been told, you might tell him he did not.  You might act like a jerk and say, "Well, it is not here."  Then you might really dig yourself in deep and just claim he must have dropped it.  THANKS A LOT you might say.  THAT WAS MY LAST RIGHT EYE contact I had.  Then maybe your friend, who sort of knows you well might say, "I think you put it in your eye again already."  Then, maybe you'll see that the contact is in your damn eye already. Then you will go bake yourself some humble pie while you eat crow.
2.  You might need to use a calculator to do some math on an accounting report and you might repeatedly open up your phone and start using the dialing pad of your phone to add numbers and then after you put in twenty six dollars and you go to find the add button you'll be so confused because the place where you dial your phone does not have that function. You'll switch to your calculator but that will not be something you only do once. You might need someone to tell you to just stop using your phone as a calculator because it is too frustrating for you.
3.  You will write yourself notes.  You will think you are brilliant to be writing it down to help you later.  That's hilarious. You are not brilliant. You are bad at writing reminders that help you remember. Your notes section of your phone will be filled with meaningless incomplete and unhelpful blurbs such as: 
  • Contact Knoxville person, knows Anne and Melissa
  • Umba dra umba tab
  • Cold sore - Valtrex - risk HSV ensephalitis
  • The wart something dot com
  • Crying out for justice
  • Civil engineer design waste water pump station
  • May 19
  • Taco burrito what you got in that speedo?
  • Things I can't handle for 400, Alex
4.  Perhaps you will get a gift certificate for your 46th birthday for a store you love. You will buy your favorite smelling lotion at 8pm on a Friday night.  Maybe after that you will use the lotion on Saturday morning around 10am and then maybe you'll never ever know where it went and you will never see it again.  You are a person that loses $10 of brand new lotion.  If your kid did that, you'd be uber ticky about it.  So don't tell your kid you lost brand new expensive lotion.  Make a call to the hotel you stayed at and listen as the front desk person acts like you are an idiot to want to know if you lost lotion in their hotel room.  LOTION?? Uh. Okay, I'll check lost and found. He doesn't understand so just give him grace after you swear under your breath.


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