Sudan pics
Top to bottom: Daily workout; check out the mohawk!; my newly-renovated tukul with veranda (until i got promoted to the house); skyline; elderly man; local fish market.
posted by damien at 2:43 AM
Wednesday, June 18, 2008
Top to bottom: Daily workout; check out the mohawk!; my newly-renovated tukul with veranda (until i got promoted to the house); skyline; elderly man; local fish market.
Sudan pics 1
Top to bottom: Net fishing next to the compound; local "Oakley's"; water-point outside the surgical ward; a beaming young boy who arrived unable to stand or walk - who likely got better in spite of rather than because of treatment, but who cares - check out that smile!; mum's relaxing with kids outside the feeding centre for mlanourished kids.
posted by damien at 2:16 AM
TB Village
I’ve just woken from my post-lunch siesta, and I feel all the worse for it. The afternoon heat and humidity is unavoidable, and now I have that groggy, drunken sleeping-in-the-heat losing-half-your-body-weight-in-sweat need-to-peel-the-sheet-off-your-body when you get up kinda feeling. And feeling as fresh as that egg you hid in your old high-school desk was by the end of term, when the lid was chewing-gummed shut and the whole classroom smelled positively volcanic (not that I ever did that)... Back to it.
Outpatients are pretty quiet this afternoon due to the huge storms and flooding yesterday, so now seems like a good time to try and catch up with the 45 TB patients living in the “village” here; I haven’t had time for a couple of weeks.
Out our expat gate, wave to the usually-sleeping guard, left past the new ward being built and then – WHAMMO! – that smell I always forget and am so grateful that I can – past the over-full patient’s latrines to the TB “office”, an oversize mud-hut where Paul, our always deliriously happy TB medic is usually entertaining friends (could it be possible that he’s high on poo-fumes?? Is it like petrol if you sniff it for too long, I wonder…).
Paul, as usual, asks me everything, but waits for nothing. We tap each other’s chests in the Nuer greeting (strangely omitted with women…), he asks (or tell’s me – I can never be sure) about 3 dozen times “You are well, yes… are you well? You are well! Because, eh… you are well…. Are you well?!”
I like it; it makes me laugh, it goes on, and after a couple of minutes no-one is any the wiser about the wellness of the other. But I’ll take what I can get in the way of pleasantries and laughter in this town. Although there’ll be no hand-holding with me on today’s round, I’m afraid! Line’s been drawn.
We pick one end of the village to start from; one of the larger mud-walled and tin-roofed buildings, with many smaller spaces within for the TB patients and their families to make a home for the 6 months their treatment will take (It always amazes me when new patients are diagnosed; So, you will need to spend 6 months here, every day. You must live here. You understand? “But I have three children”. That’s OK, they can stay as well. “OK”. Just like that. Imagine that back home? “Your appendix is pretty screwed up Mr Jones, it’s a real f#*ken mess to be honest. Tell you what: call your wife, tell her to bring the kids on over and we’ll bundle you all into a little unit out the back for, oh, say, 6 months. That suit?! Great. Lets get cracking then…”).
I have never encountered a space on this planet that has more contrasts, more contradictions, or is a bigger dichotomy than the TB village. It’s like a school-yard for intractably happy kids, backing onto the shitty-diseases wing of a large Hospital for Truly Shitty Diseases.
As we approach the first building, the usual gang of kids mobs me; I love these kids the most – they have all been here longer than me, they own this place and I know them all by face and by greeting now. Some want a hug, others want a throw into the air, others want a hi-five (and then a brief game of who-can-whack-the-white-guy’s-hand-the-hardest begins), and one little guy, proudly wearing nothing but a few colourful strings of beads around his waist and neck, just wants to hold my hand for the ward round. Hero.
Then I step into the first room. Village of the damned. A big intra-muscular dose of humility, administered with the biggest f#*ken syringe on the planet right into my arse, on the bit where you sit down. And then a little more on the other side too. Hero to zero.
The scene in the first room: an elderly man with a spine so deformed it would make Quasimodo wince lies on a bed to my left. The drugs we give will kill the TB, but nothing will reshape his spine, or restore the nerves it collapsed on to. Nothing in Sudan, anyway. He greets me warmly. I’m slowly getting to know all the faces. He says he has back pain. I bet you do, sir. I give the first of many “We cant fix it, but we can help it” speeches for the afternoon. Some gentle pain-killers, a shake of hands, and a turn to see the bed alongside his.
This guy is a complete medical disaster, and if you ever wondered how much a human can take, I suggest a visit to this fella. He lies under his mosquito net, which seems crazy as surely it can only be a further impediment to the already minimal airflow in the stifling room (an idea for an oven in the current global energy-crisis: 3 mud walls with a small opening on one side, cover with tin and place under the Sudanese sun for a while). In his twenties, he has a growth the size of his head inside his buttock, and it constantly drains fluid; inoperable according to the previous surgeon. He cant walk, he cant lie on his other side, he cant pee without assistance. He has pain he says. Well, stress not my friend, because here’s the doctor with some paracetamol. And if thing’s get really bad, we’ll give you some nurofen. (Must save the limited morphine stocks for the really severe acute stuff).
Still in the same room, we step past the 8 year old grand-daughter of the guy with the bad back who’s milling the sorghum by hand, in between looking after her siblings. So she wont be breaking the cycle and learning to read and write any time soon then.
But oh, thank God! On the last bed in the room is our little joy of the week – the most gorgeous little 14 month old boy with eyes like almonds, who only 3 weeks ago was floundering in our malnutrition centre, but is now thriving since we started TB treatment. Fan-blood-tastic. Lets continue the round then!
And it goes on for hours, and we only get through half the patients. Twisted spines, hopeless cases, lost causes that probably end up on TB treatment as a “last ditch” effort to try something, but fortunately – and mostly - patients with lung TB that respond fantastically and are happy.
The round can at times seem like an endless sea of people that seem to just want to complain to me: my foot aches, I have a cough, I need more food, my legs are still not working, it’s hot, get back hear and listen to my painful leg with your stethoscope… when I started here, it did my head in, and at certain moments I still have to catch myself to reign in my frustration. I cant solve all your problems! I What more do you want??
But I think I’m getting far better at dealing with that frustration. A sympathetic ear, an “I understand, we will try and help but we cant fix this 100%” goes a long way. People just want to be heard. They see the doctor for a few minutes every week, and the recovery can be slow for a lot of them. Though there’s the occasional bugger that pushes my patience just a little too far – and wants to fight because we wont buy a plane ticket to Khartoum for him, or fly him to Ethiopia to go back to his uncle, or re-imburse his lost earnings while he was receiving life saving treatment. (Though with 20+ years of European agencies handing out things in a place where anything is a bonus, you cant blame them for trying...).
And interspersed in this little microcosm of chronic disease, suffering and at times hopelessness, is that African icon: that ubiquitos presence, and surely the continent’s most valuable resource: seemingly endless numbers of healthy, happy, cheeky-arsed kids with way too much personality (- though unfortunately too-often, almost as much snot, and usually wiped by themselves a moment before they grab my T-shirt or shake my hand with their sludgy, albeit cute little hands).
Note to self: distribute face-wipes next week in the TB village. Or carry hand disinfectant lotion.
Outpatients are pretty quiet this afternoon due to the huge storms and flooding yesterday, so now seems like a good time to try and catch up with the 45 TB patients living in the “village” here; I haven’t had time for a couple of weeks.
Out our expat gate, wave to the usually-sleeping guard, left past the new ward being built and then – WHAMMO! – that smell I always forget and am so grateful that I can – past the over-full patient’s latrines to the TB “office”, an oversize mud-hut where Paul, our always deliriously happy TB medic is usually entertaining friends (could it be possible that he’s high on poo-fumes?? Is it like petrol if you sniff it for too long, I wonder…).
Paul, as usual, asks me everything, but waits for nothing. We tap each other’s chests in the Nuer greeting (strangely omitted with women…), he asks (or tell’s me – I can never be sure) about 3 dozen times “You are well, yes… are you well? You are well! Because, eh… you are well…. Are you well?!”
I like it; it makes me laugh, it goes on, and after a couple of minutes no-one is any the wiser about the wellness of the other. But I’ll take what I can get in the way of pleasantries and laughter in this town. Although there’ll be no hand-holding with me on today’s round, I’m afraid! Line’s been drawn.
We pick one end of the village to start from; one of the larger mud-walled and tin-roofed buildings, with many smaller spaces within for the TB patients and their families to make a home for the 6 months their treatment will take (It always amazes me when new patients are diagnosed; So, you will need to spend 6 months here, every day. You must live here. You understand? “But I have three children”. That’s OK, they can stay as well. “OK”. Just like that. Imagine that back home? “Your appendix is pretty screwed up Mr Jones, it’s a real f#*ken mess to be honest. Tell you what: call your wife, tell her to bring the kids on over and we’ll bundle you all into a little unit out the back for, oh, say, 6 months. That suit?! Great. Lets get cracking then…”).
I have never encountered a space on this planet that has more contrasts, more contradictions, or is a bigger dichotomy than the TB village. It’s like a school-yard for intractably happy kids, backing onto the shitty-diseases wing of a large Hospital for Truly Shitty Diseases.
As we approach the first building, the usual gang of kids mobs me; I love these kids the most – they have all been here longer than me, they own this place and I know them all by face and by greeting now. Some want a hug, others want a throw into the air, others want a hi-five (and then a brief game of who-can-whack-the-white-guy’s-hand-the-hardest begins), and one little guy, proudly wearing nothing but a few colourful strings of beads around his waist and neck, just wants to hold my hand for the ward round. Hero.
Then I step into the first room. Village of the damned. A big intra-muscular dose of humility, administered with the biggest f#*ken syringe on the planet right into my arse, on the bit where you sit down. And then a little more on the other side too. Hero to zero.
The scene in the first room: an elderly man with a spine so deformed it would make Quasimodo wince lies on a bed to my left. The drugs we give will kill the TB, but nothing will reshape his spine, or restore the nerves it collapsed on to. Nothing in Sudan, anyway. He greets me warmly. I’m slowly getting to know all the faces. He says he has back pain. I bet you do, sir. I give the first of many “We cant fix it, but we can help it” speeches for the afternoon. Some gentle pain-killers, a shake of hands, and a turn to see the bed alongside his.
This guy is a complete medical disaster, and if you ever wondered how much a human can take, I suggest a visit to this fella. He lies under his mosquito net, which seems crazy as surely it can only be a further impediment to the already minimal airflow in the stifling room (an idea for an oven in the current global energy-crisis: 3 mud walls with a small opening on one side, cover with tin and place under the Sudanese sun for a while). In his twenties, he has a growth the size of his head inside his buttock, and it constantly drains fluid; inoperable according to the previous surgeon. He cant walk, he cant lie on his other side, he cant pee without assistance. He has pain he says. Well, stress not my friend, because here’s the doctor with some paracetamol. And if thing’s get really bad, we’ll give you some nurofen. (Must save the limited morphine stocks for the really severe acute stuff).
Still in the same room, we step past the 8 year old grand-daughter of the guy with the bad back who’s milling the sorghum by hand, in between looking after her siblings. So she wont be breaking the cycle and learning to read and write any time soon then.
But oh, thank God! On the last bed in the room is our little joy of the week – the most gorgeous little 14 month old boy with eyes like almonds, who only 3 weeks ago was floundering in our malnutrition centre, but is now thriving since we started TB treatment. Fan-blood-tastic. Lets continue the round then!
And it goes on for hours, and we only get through half the patients. Twisted spines, hopeless cases, lost causes that probably end up on TB treatment as a “last ditch” effort to try something, but fortunately – and mostly - patients with lung TB that respond fantastically and are happy.
The round can at times seem like an endless sea of people that seem to just want to complain to me: my foot aches, I have a cough, I need more food, my legs are still not working, it’s hot, get back hear and listen to my painful leg with your stethoscope… when I started here, it did my head in, and at certain moments I still have to catch myself to reign in my frustration. I cant solve all your problems! I What more do you want??
But I think I’m getting far better at dealing with that frustration. A sympathetic ear, an “I understand, we will try and help but we cant fix this 100%” goes a long way. People just want to be heard. They see the doctor for a few minutes every week, and the recovery can be slow for a lot of them. Though there’s the occasional bugger that pushes my patience just a little too far – and wants to fight because we wont buy a plane ticket to Khartoum for him, or fly him to Ethiopia to go back to his uncle, or re-imburse his lost earnings while he was receiving life saving treatment. (Though with 20+ years of European agencies handing out things in a place where anything is a bonus, you cant blame them for trying...).
And interspersed in this little microcosm of chronic disease, suffering and at times hopelessness, is that African icon: that ubiquitos presence, and surely the continent’s most valuable resource: seemingly endless numbers of healthy, happy, cheeky-arsed kids with way too much personality (- though unfortunately too-often, almost as much snot, and usually wiped by themselves a moment before they grab my T-shirt or shake my hand with their sludgy, albeit cute little hands).
Note to self: distribute face-wipes next week in the TB village. Or carry hand disinfectant lotion.
posted by damien at 2:15 AM
Sunday, May 18, 2008
A day on call in Nasir
Saturday 17th May: An actual day on call here
My mobile phone’s alarm goes off at 6.45am, and reminds me that by the way, there’s no reception out here. Among a couple of other things.
Lying in bed contemplating the day ahead (and even possibly how to avoid it… who do you call if you want a day off around here?!), I remember yesterday’s dire “warning” by one of our staff, who approached me discretely, very concerned, outside Outpatients.
“Dr, eh, big problem here in Nasir. We need surgeon back quickly, very ‘portant, or you need help us. There’s outbreak in town – you hear about it?? Many peoples suffering. (Bite of lower lip and shake of head)…. Sufferings….!” Head still shaking.
Fantastic, thinks my selfish brain. Because the hospital’s not busy enough, and I don’t have enough to do…. What’s it now… Cholera? Measles? Meningitis?
He hands me a folded up piece of paper – carefully – and asks me if I know about “thises diseases”.
I unfold the paper many times. Good Lord, which of the biblical pestilences these people present with daily is now going to inundate us…?
There’s only one word on the paper. I kid not: “Haemorrhoids”.
But this morning’s affair is a little more serious. I have to decide by 7am whether or not to divert the MSF charter plane to transfer one of our patients for surgery.
The dilemma: The guys likely got appendicitis. No biggie. But our surgeon’s left (note to self – no more missions before I can do Caesareans and appendicectomies). So I have to make the call (and like all patients here, every time you ask about their symptoms, the story changes completely. Pain for 3 weeks, no 1 day, here, no there. And until the moment they are discharged, most patients have a very melancholic, serious demeanour, which is hard to differentiate from mind-set rather than a severe underlying medical condition…). On top of that, one of his friends is a very powerful figure in town and wants him transferred. Not a bloke you want offside, so a potential security issue. And it’s going to cost a not insignificant $1500 extra just for the plane to land here. Public health issues are raised. But he’s worse for sure, a call is made and MSF divert the plane. Sorted.
I sneak home – about 15 metres from the ward, just behind the TB village - for a quick brekky and tea. Someone’s on pancake duty this morning. Perfect.
Back to Outpatients. By 8am, there are well over a hundred people waiting outside to be seen. Most days are like this, it seems the village must be on a rotation system. Where do they all come from?
“OK, the western half, listen up – its your turn again today. Everyone to Outpatients. And don’t forget – don’t give them a consistent history. If the bald white one asks you where the pain is, point to one spot, then when he goes to examine it, point everywhere. Just everywhere. Confuse the bugger. And if he re-asks you questions, whatever you do don’t give him the same answer. The longer you’re in, the more likely to get prescribed the good stuff.”
The guys are triaging already, and the four health workers have until 1pm to get through all the patients. I leave them there – they call me often enough when they have questions.
A quick office visit to quickly check my emails, before walking across the drive to the medical ward. There are no empty beds left, but I’ll have to come back. Surgical ward is in more need at the moment – no surgeon for a week now, and there are 20 beds of patients with problems I’m not as familiar with. Families and friends are already crowding everywhere; cooking just outside the ward, 4 on a bed “Its going to break – I told you yesterday – off!”, the kid with burns providing the always present background sound of crying-baby, despite pain relief.
The surgical ward is a large corridor of a room, and the right hand side is lined by mostly young guys, mostly in traction devices for broken – usually shot – lower limbs, with one guy that looks like he has an AK-47 stapled to his arm, due to the mass of external-fixation device holding the various remnants of his humerus in place. As the previous surgeon quipped, there’s no ward round here, it’s the “war round”.
Four small cases for theatre this morning. A large thigh gunshot wound that came apart and needs to be cleaned and closed again, a partially amputated finger that needs tidying up, a broken forearm that needs to be pulled straight and a kid with a huge abscess on her neck that needs drainage. No worries. A quick review of the surgical text books (paying special attention to my favourite diagrams illustrating the “DO NOT CUT HERE!” bits of the body), and off to theatre. (I’ll be honest, the procedures I do are small fish. But then when you haven’t spent much time fishing, even catching the small ones can be tricky…).
All goes well, both I and the patient with the battered finger survive my first encounter with the “bone nibblers”. (And I might add – for the first time I understand the real appeal of surgery – theatre must be the calmest, most controlled environment on the continent. And (usually I guess) problem goes in, solution comes out. It all seems so neat!).
Back to the medical ward. Deary me I wish I could have hidden in theatre all day. Some good stories, but the ward is slowly getting bogged down with adults with chronic illnesses we are unlikely to cure. I suck at discharging people, I know, I have to start sending some home. It’s too full. So is my head. An hour of ward round, but that’s a whole other story on its own.
11am, back to outpatients. We go through the usual routine, making a mockery of my attempted teaching sessions (see following blog with some reflections on our health workers). ‘This patient has a fever’. And what else? ‘No, nothing’. Fever since when, what other problems, did you examine them….?? ‘Er, no’. And how long has her eye been bulging out like that with the infection….? ‘Err… I didn’t see the eye’. Of course not. Its not like its staring at you… I’ll come back in half an hour when you’ve examined your patients.
So follows an afternoon ping-ponging backwards and forwards between inpatients and outpatients, trying to put out spot fires before they become infernos. A quick visit to the TB village, where there’s a problem. The health worker is a truly hilarious guy who I cant understand, and he holds my hand in his as we walk gaily to the hut of the problem patient; quite common in Nuer culture and no big issue. Unfortunately the Aussie bloke in me isn’t overly comfortable with this; I opt for a manly pat on the shoulder instead.
We arrive at the problem: a young man, the leader of the ‘food ration rebellion’ where all the patients briefly walked out a few weeks ago in protest of a small change in food rations. He’s finished treatment, and he wants us to pay for a ticket back to Ethiopia for him. He’s insistent and getting testy. Mate, what part of the free drugs, health care, food, accommodation, and you going from the verge of death to the healthy specimen you are now, has caused you to become so angry, I ponder? Oh. So please, take stock of what these guys did, don’t burden yourself with a thankyou to our staff who’ve nursed you these six months, and understand that a chartered flight back to Ethiopia is not part of the standard TB treatment regimen.
Back to outpatients. Young girl with an umbilical hernia that’s stuck, she’s distraught. Quick trip to the theatre, a light anaesthetic and gently push it back in. Too easy, two very happy parents and a groggy child with a normal looking belly. If only it were all so simple.
Back to medical ward; 6 patients waiting for admission. But they’ll have to wait for the staff meeting to finish; yes that’s right; the afternoon sun invites us to swelter beneath it, go through statistics and discuss the numerous issues for the week. I’d rather be on the ward. Or experimenting on my own finger with the bone-nibbler in theatre.
4pm: Find myself standing back on the ward, staring at that all-too familiar sight of a floppy child, with her eyes as yet undecided as to whether they are gazing up to heaven, or still at this world. They always look so peaceful, there’s a resignation in those eyes as they roll back, then re-engage with you, then close. But with some quick initial treatment she picks up, and for a moment I am actually confident she will make it (naïve, overly hopeful or just inexperienced….?). We take her off the drip to weigh her quickly, she stands there, she shits, she sits down on her mother’s lap, and she dies. Just like that.
Another body in a blanket in a cardboard box.
Another wailing family.
Another fuck-up.
Or is it? I have no idea. She’d been sick for weeks and bundled in only now. Probably no chance. We seem to be doing what the books say, what my course said, what I think is right, what I learned at home (But then what if I’m just reading the wrong page of the manual...? And you don’t get kids this sick at home – other than the annual presentation that is this sick, but you can be sure you will be standing in line behind about 10 specialists attending to them). If only to have a more experienced Dr standing next to me to reassure - or reprimand - me.
Anyway. Next admission needs to be done.
____________________________________
On my way back to the compound for a quick dinner, I get accosted by the same rapidly-expanding gang of young kids from the TB village that track me down at least daily. “Throw!” they yell in Nuer. Seems I’ve backed myself into a corner here… my occasional throwing-and-catching of a young kid into the air has now morphed into a daily sport for them… only the numbers are growing, the sizes are increasing (some of these ‘kids’ almost equal my height), and my back is giving out. But I can’t resist, and the contrast with the events that passed minutes ago on the ward are not lost on me.
Nine little briefly-air-born-reminders of why in fact I am here.
A quick dinner and an even quicker half-beer. An episode of Friends on the DVD player. And to chase it all down, a call to Maternity. And yet again I find myself in theatre, yet again an unfamiliar set of tools in my hand (not the fancy ones of the rare Curettes I have done in Australia), Curetting a woman who has retained-products after a miscarriage, and heavy bleeding.
But finally…
She stops bleeding, I stop thinking, and a cold shower washes away the day’s memories. To sleep, to pray, not to be woken by another disaster again tonight.
Or for that rumoured Haemorrhoid outbreak not to strike our over-stretched hospital…
My mobile phone’s alarm goes off at 6.45am, and reminds me that by the way, there’s no reception out here. Among a couple of other things.
Lying in bed contemplating the day ahead (and even possibly how to avoid it… who do you call if you want a day off around here?!), I remember yesterday’s dire “warning” by one of our staff, who approached me discretely, very concerned, outside Outpatients.
“Dr, eh, big problem here in Nasir. We need surgeon back quickly, very ‘portant, or you need help us. There’s outbreak in town – you hear about it?? Many peoples suffering. (Bite of lower lip and shake of head)…. Sufferings….!” Head still shaking.
Fantastic, thinks my selfish brain. Because the hospital’s not busy enough, and I don’t have enough to do…. What’s it now… Cholera? Measles? Meningitis?
He hands me a folded up piece of paper – carefully – and asks me if I know about “thises diseases”.
I unfold the paper many times. Good Lord, which of the biblical pestilences these people present with daily is now going to inundate us…?
There’s only one word on the paper. I kid not: “Haemorrhoids”.
But this morning’s affair is a little more serious. I have to decide by 7am whether or not to divert the MSF charter plane to transfer one of our patients for surgery.
The dilemma: The guys likely got appendicitis. No biggie. But our surgeon’s left (note to self – no more missions before I can do Caesareans and appendicectomies). So I have to make the call (and like all patients here, every time you ask about their symptoms, the story changes completely. Pain for 3 weeks, no 1 day, here, no there. And until the moment they are discharged, most patients have a very melancholic, serious demeanour, which is hard to differentiate from mind-set rather than a severe underlying medical condition…). On top of that, one of his friends is a very powerful figure in town and wants him transferred. Not a bloke you want offside, so a potential security issue. And it’s going to cost a not insignificant $1500 extra just for the plane to land here. Public health issues are raised. But he’s worse for sure, a call is made and MSF divert the plane. Sorted.
I sneak home – about 15 metres from the ward, just behind the TB village - for a quick brekky and tea. Someone’s on pancake duty this morning. Perfect.
Back to Outpatients. By 8am, there are well over a hundred people waiting outside to be seen. Most days are like this, it seems the village must be on a rotation system. Where do they all come from?
“OK, the western half, listen up – its your turn again today. Everyone to Outpatients. And don’t forget – don’t give them a consistent history. If the bald white one asks you where the pain is, point to one spot, then when he goes to examine it, point everywhere. Just everywhere. Confuse the bugger. And if he re-asks you questions, whatever you do don’t give him the same answer. The longer you’re in, the more likely to get prescribed the good stuff.”
The guys are triaging already, and the four health workers have until 1pm to get through all the patients. I leave them there – they call me often enough when they have questions.
A quick office visit to quickly check my emails, before walking across the drive to the medical ward. There are no empty beds left, but I’ll have to come back. Surgical ward is in more need at the moment – no surgeon for a week now, and there are 20 beds of patients with problems I’m not as familiar with. Families and friends are already crowding everywhere; cooking just outside the ward, 4 on a bed “Its going to break – I told you yesterday – off!”, the kid with burns providing the always present background sound of crying-baby, despite pain relief.
The surgical ward is a large corridor of a room, and the right hand side is lined by mostly young guys, mostly in traction devices for broken – usually shot – lower limbs, with one guy that looks like he has an AK-47 stapled to his arm, due to the mass of external-fixation device holding the various remnants of his humerus in place. As the previous surgeon quipped, there’s no ward round here, it’s the “war round”.
Four small cases for theatre this morning. A large thigh gunshot wound that came apart and needs to be cleaned and closed again, a partially amputated finger that needs tidying up, a broken forearm that needs to be pulled straight and a kid with a huge abscess on her neck that needs drainage. No worries. A quick review of the surgical text books (paying special attention to my favourite diagrams illustrating the “DO NOT CUT HERE!” bits of the body), and off to theatre. (I’ll be honest, the procedures I do are small fish. But then when you haven’t spent much time fishing, even catching the small ones can be tricky…).
All goes well, both I and the patient with the battered finger survive my first encounter with the “bone nibblers”. (And I might add – for the first time I understand the real appeal of surgery – theatre must be the calmest, most controlled environment on the continent. And (usually I guess) problem goes in, solution comes out. It all seems so neat!).
Back to the medical ward. Deary me I wish I could have hidden in theatre all day. Some good stories, but the ward is slowly getting bogged down with adults with chronic illnesses we are unlikely to cure. I suck at discharging people, I know, I have to start sending some home. It’s too full. So is my head. An hour of ward round, but that’s a whole other story on its own.
11am, back to outpatients. We go through the usual routine, making a mockery of my attempted teaching sessions (see following blog with some reflections on our health workers). ‘This patient has a fever’. And what else? ‘No, nothing’. Fever since when, what other problems, did you examine them….?? ‘Er, no’. And how long has her eye been bulging out like that with the infection….? ‘Err… I didn’t see the eye’. Of course not. Its not like its staring at you… I’ll come back in half an hour when you’ve examined your patients.
So follows an afternoon ping-ponging backwards and forwards between inpatients and outpatients, trying to put out spot fires before they become infernos. A quick visit to the TB village, where there’s a problem. The health worker is a truly hilarious guy who I cant understand, and he holds my hand in his as we walk gaily to the hut of the problem patient; quite common in Nuer culture and no big issue. Unfortunately the Aussie bloke in me isn’t overly comfortable with this; I opt for a manly pat on the shoulder instead.
We arrive at the problem: a young man, the leader of the ‘food ration rebellion’ where all the patients briefly walked out a few weeks ago in protest of a small change in food rations. He’s finished treatment, and he wants us to pay for a ticket back to Ethiopia for him. He’s insistent and getting testy. Mate, what part of the free drugs, health care, food, accommodation, and you going from the verge of death to the healthy specimen you are now, has caused you to become so angry, I ponder? Oh. So please, take stock of what these guys did, don’t burden yourself with a thankyou to our staff who’ve nursed you these six months, and understand that a chartered flight back to Ethiopia is not part of the standard TB treatment regimen.
Back to outpatients. Young girl with an umbilical hernia that’s stuck, she’s distraught. Quick trip to the theatre, a light anaesthetic and gently push it back in. Too easy, two very happy parents and a groggy child with a normal looking belly. If only it were all so simple.
Back to medical ward; 6 patients waiting for admission. But they’ll have to wait for the staff meeting to finish; yes that’s right; the afternoon sun invites us to swelter beneath it, go through statistics and discuss the numerous issues for the week. I’d rather be on the ward. Or experimenting on my own finger with the bone-nibbler in theatre.
4pm: Find myself standing back on the ward, staring at that all-too familiar sight of a floppy child, with her eyes as yet undecided as to whether they are gazing up to heaven, or still at this world. They always look so peaceful, there’s a resignation in those eyes as they roll back, then re-engage with you, then close. But with some quick initial treatment she picks up, and for a moment I am actually confident she will make it (naïve, overly hopeful or just inexperienced….?). We take her off the drip to weigh her quickly, she stands there, she shits, she sits down on her mother’s lap, and she dies. Just like that.
Another body in a blanket in a cardboard box.
Another wailing family.
Another fuck-up.
Or is it? I have no idea. She’d been sick for weeks and bundled in only now. Probably no chance. We seem to be doing what the books say, what my course said, what I think is right, what I learned at home (But then what if I’m just reading the wrong page of the manual...? And you don’t get kids this sick at home – other than the annual presentation that is this sick, but you can be sure you will be standing in line behind about 10 specialists attending to them). If only to have a more experienced Dr standing next to me to reassure - or reprimand - me.
Anyway. Next admission needs to be done.
____________________________________
On my way back to the compound for a quick dinner, I get accosted by the same rapidly-expanding gang of young kids from the TB village that track me down at least daily. “Throw!” they yell in Nuer. Seems I’ve backed myself into a corner here… my occasional throwing-and-catching of a young kid into the air has now morphed into a daily sport for them… only the numbers are growing, the sizes are increasing (some of these ‘kids’ almost equal my height), and my back is giving out. But I can’t resist, and the contrast with the events that passed minutes ago on the ward are not lost on me.
Nine little briefly-air-born-reminders of why in fact I am here.
A quick dinner and an even quicker half-beer. An episode of Friends on the DVD player. And to chase it all down, a call to Maternity. And yet again I find myself in theatre, yet again an unfamiliar set of tools in my hand (not the fancy ones of the rare Curettes I have done in Australia), Curetting a woman who has retained-products after a miscarriage, and heavy bleeding.
But finally…
She stops bleeding, I stop thinking, and a cold shower washes away the day’s memories. To sleep, to pray, not to be woken by another disaster again tonight.
Or for that rumoured Haemorrhoid outbreak not to strike our over-stretched hospital…
posted by damien at 7:18 PM
Months of shit food
Having been here a few weeks, and having walked the river’s edge at sunset (on those rare evenings out of the hospital); watched the thousands of birds fly north on their morning mini-migration, only to return in the evenings as I sit below, awed by the audible swooshing of their thousands of collectives wings beating them across the east African skies; and having jogged through the town at dawn, as families stir in the rapidly waning coolness of the early morning air, I am moved to describe this town, my home for the moment, thus, in the most descriptive prose I can conjure: it’s a dusty shit-hole.
But change is afoot. I will despair not.
Its rapidly becoming a muddy shit-hole.
The rainy season arrived 2 days ago following a sarcastic remark that now appears to have revealed a freakish gift for prophecy; when we asked one of our national staff when the season started, he joked at 2.12am on the morning of the 12th. He was off by a few minutes.
On cue, the storm blew in during the wee ours of the morning, a deluge of rain so grand it was as if the gods were trying to make amends for centuries of drought in a few hours. Meanwhile, I lay with a sheet over my head in my mud hut, reassuring myself that my understanding of the behaviour of materials was obviously wrong, and that the sturdily patted-together walls would surely hold up against the horizontal rain.
And contemplating the cunning design by the hut’s architect whereby the top metre of the walls is left open in all directions – obviously to facilitate that wonderful interplay between expatriate, mosquitos, scorpions, rain and other delights of this region. Like trying to sleep with a garden blower in my face. With a bloke dumping handfuls of sand and leaves in it periodically, just to shit me.
So as from today, gumboots are the official footwear of choice for the coming months. Muddy shit-hole indeed.
This last week in the hospital has been a little kinder to me; just a little. Following the departure of our midwife (fortunately not permanent) and now also surgeon this morning - with no one yet to replace her, I found myself the general attender of all problems large and small; interpreting Obstetric problems by torchlight at night, with ye olde illustrated “Obstetrics for those who’ve never done it!” (unintended pun there) guidebook in my other gloved-hand; and – a profound-sweat inducing time this afternoon – releasing the tightened skin on a young boy’s penis to reduce the damage from swelling after he burned it standing too close to a fire, on top of this morning’s efforts at debriding dead muscle from a bloke who shot himself (accidentally I presume) through the thigh a couple of days ago.
On a massive upside, we have had no deaths in a week now, in contrast to the mayhem a couple of weeks ago. I also survived a now second attempt on my life by the Assassin (“cook”) with yet another night spent in a feverish haze with frequent short vacations to the latrine.
I’m getting to know the local staff in the hospital a lot better now, which has provided for some sobering moments (“no, I would empty about three-quarters of that syringe into the bin first – yup, that’s bordering on a lethal dose you’ve got in your hands there tiger…”), but far more humorous moments.
First, the disclaimer: It must be remembered that these guys grew up in an extremely volatile context of civil war, with a government that actively bombed them, their food distribution centres, and their pets. Contrast this with my government that built pretty squares, argued over a flag, charged the “outrageous sum” of peanuts to go to uni for 6 years, and fined me for doing 111km/h on a highway that you could comfortably land a 747 on. Consequently survival skills are the order of the day here, formal education a luxury available to few, medical education almost non-existent. Suffice to say the standard of most of our health workers is far below what would be encountered in most other countries/settings.
Second: the funny stories. I am acutely aware of trying to not be patronising, but I think as often it is my lack of ability to speak their language (hence 2 and often 3 way translations taking place) and cultural differences that lead to these situations…
One of my favourites is the random guess. Usually in the context of taking a history.
So you said this patient has pain in her abdomen for a month now?
“Yup”
Had she had it before?
Silence. Regards the patient, tilts head to side. Silence continues. I’m waiting for him to ask the patient, but something more profound is going on here… yes… he’s guessing!
“Errrr, no.”
“Could you ask the patient that…?”
“No, it looks OK. I think she hasn’t had it before.”
(This technique is also used frequently with examining patients: How long has that lump been there…? “Oh, it looks like about 7 months to me…” Indeed).
Or the random guess coupled with a whacky diagnosis:
(After being called to see a patient, as usual, with no history or examination by the paramedic): So what do you think this (healthy looking kid sitting on mum’s lap with a runny nose) has?
“Cholera!”
Whooaaaa there buddy!! Just like that?! Never mind that there is no cholera here at the moment… Couple of other issues here.... Firstly, did you ask mum what the problems were?
“No”
Well… (Ensue about 4 minutes of intense conversation between them, boiled down to essentially 2 words for me. I know more was said! The answer lies in all that, but I can never get it out….!).
“OK, she says no vomiting, no diarrhoea.”
OK good. Now did you examine the child? Doesn’t look particularly dehydrated to me.
So could it still be cholera?
“No way”.
Uh huh… do you see why I want you to go through the seemingly pointless and perhaps laborious task of asking but a few questions first….?? And maybe even – God forbid – touching a patient…?
Or a shining example of HR management, and how being the new guy means a few staff are certain to see how far they can push it…
“Excuse me Shamiane… [my name here due to difficulties in pronunciation. Don’t ask.]…. But I need time off”
When?
“Tomorrow. For a week.”
But James, you are the only one doing this ward now, your work-partner is due back from holidays next week… you’ll have to wait. You know this.
“Yes, but I wants it now (smiling). Its very important!”
What’s the reason?
“Er… I’m getting married!”
Tomorrow?? And I presume you didn’t plan this wedding just this afternoon…?
“No, [laughing, vigorously shaking my hand], but I forget to say. What about not tomorrow, but the rest of the week….?”
So you’ll shift your wedding, just like that?
“It’s no problem….”
Hmmm. James, you’re not getting married are you? You’re fishing for days off, wouldn’t you say? (hysterical giggling). Yup, I think that’s a great idea; talk to your ‘bride’, explain that you gave your employer about 12 hours notice about your “wedding”, and I’m sure she’ll forgive you and you can shift the whole imaginary celebration…!
I could go on for weeks. Actually, its going to have to be months…
In the meantime, I’m off to uncover more secrets of this organization and this hospital (This weeks big revelation was finding out what MSF actually stand for: “Months of Shit Food”).
But change is afoot. I will despair not.
Its rapidly becoming a muddy shit-hole.
The rainy season arrived 2 days ago following a sarcastic remark that now appears to have revealed a freakish gift for prophecy; when we asked one of our national staff when the season started, he joked at 2.12am on the morning of the 12th. He was off by a few minutes.
On cue, the storm blew in during the wee ours of the morning, a deluge of rain so grand it was as if the gods were trying to make amends for centuries of drought in a few hours. Meanwhile, I lay with a sheet over my head in my mud hut, reassuring myself that my understanding of the behaviour of materials was obviously wrong, and that the sturdily patted-together walls would surely hold up against the horizontal rain.
And contemplating the cunning design by the hut’s architect whereby the top metre of the walls is left open in all directions – obviously to facilitate that wonderful interplay between expatriate, mosquitos, scorpions, rain and other delights of this region. Like trying to sleep with a garden blower in my face. With a bloke dumping handfuls of sand and leaves in it periodically, just to shit me.
So as from today, gumboots are the official footwear of choice for the coming months. Muddy shit-hole indeed.
This last week in the hospital has been a little kinder to me; just a little. Following the departure of our midwife (fortunately not permanent) and now also surgeon this morning - with no one yet to replace her, I found myself the general attender of all problems large and small; interpreting Obstetric problems by torchlight at night, with ye olde illustrated “Obstetrics for those who’ve never done it!” (unintended pun there) guidebook in my other gloved-hand; and – a profound-sweat inducing time this afternoon – releasing the tightened skin on a young boy’s penis to reduce the damage from swelling after he burned it standing too close to a fire, on top of this morning’s efforts at debriding dead muscle from a bloke who shot himself (accidentally I presume) through the thigh a couple of days ago.
On a massive upside, we have had no deaths in a week now, in contrast to the mayhem a couple of weeks ago. I also survived a now second attempt on my life by the Assassin (“cook”) with yet another night spent in a feverish haze with frequent short vacations to the latrine.
I’m getting to know the local staff in the hospital a lot better now, which has provided for some sobering moments (“no, I would empty about three-quarters of that syringe into the bin first – yup, that’s bordering on a lethal dose you’ve got in your hands there tiger…”), but far more humorous moments.
First, the disclaimer: It must be remembered that these guys grew up in an extremely volatile context of civil war, with a government that actively bombed them, their food distribution centres, and their pets. Contrast this with my government that built pretty squares, argued over a flag, charged the “outrageous sum” of peanuts to go to uni for 6 years, and fined me for doing 111km/h on a highway that you could comfortably land a 747 on. Consequently survival skills are the order of the day here, formal education a luxury available to few, medical education almost non-existent. Suffice to say the standard of most of our health workers is far below what would be encountered in most other countries/settings.
Second: the funny stories. I am acutely aware of trying to not be patronising, but I think as often it is my lack of ability to speak their language (hence 2 and often 3 way translations taking place) and cultural differences that lead to these situations…
One of my favourites is the random guess. Usually in the context of taking a history.
So you said this patient has pain in her abdomen for a month now?
“Yup”
Had she had it before?
Silence. Regards the patient, tilts head to side. Silence continues. I’m waiting for him to ask the patient, but something more profound is going on here… yes… he’s guessing!
“Errrr, no.”
“Could you ask the patient that…?”
“No, it looks OK. I think she hasn’t had it before.”
(This technique is also used frequently with examining patients: How long has that lump been there…? “Oh, it looks like about 7 months to me…” Indeed).
Or the random guess coupled with a whacky diagnosis:
(After being called to see a patient, as usual, with no history or examination by the paramedic): So what do you think this (healthy looking kid sitting on mum’s lap with a runny nose) has?
“Cholera!”
Whooaaaa there buddy!! Just like that?! Never mind that there is no cholera here at the moment… Couple of other issues here.... Firstly, did you ask mum what the problems were?
“No”
Well… (Ensue about 4 minutes of intense conversation between them, boiled down to essentially 2 words for me. I know more was said! The answer lies in all that, but I can never get it out….!).
“OK, she says no vomiting, no diarrhoea.”
OK good. Now did you examine the child? Doesn’t look particularly dehydrated to me.
So could it still be cholera?
“No way”.
Uh huh… do you see why I want you to go through the seemingly pointless and perhaps laborious task of asking but a few questions first….?? And maybe even – God forbid – touching a patient…?
Or a shining example of HR management, and how being the new guy means a few staff are certain to see how far they can push it…
“Excuse me Shamiane… [my name here due to difficulties in pronunciation. Don’t ask.]…. But I need time off”
When?
“Tomorrow. For a week.”
But James, you are the only one doing this ward now, your work-partner is due back from holidays next week… you’ll have to wait. You know this.
“Yes, but I wants it now (smiling). Its very important!”
What’s the reason?
“Er… I’m getting married!”
Tomorrow?? And I presume you didn’t plan this wedding just this afternoon…?
“No, [laughing, vigorously shaking my hand], but I forget to say. What about not tomorrow, but the rest of the week….?”
So you’ll shift your wedding, just like that?
“It’s no problem….”
Hmmm. James, you’re not getting married are you? You’re fishing for days off, wouldn’t you say? (hysterical giggling). Yup, I think that’s a great idea; talk to your ‘bride’, explain that you gave your employer about 12 hours notice about your “wedding”, and I’m sure she’ll forgive you and you can shift the whole imaginary celebration…!
I could go on for weeks. Actually, its going to have to be months…
In the meantime, I’m off to uncover more secrets of this organization and this hospital (This weeks big revelation was finding out what MSF actually stand for: “Months of Shit Food”).
posted by damien at 7:15 PM
Sunday, May 04, 2008
Beaten with the olive branch
Sudan didn’t extend the olive branch when I returned; it spanked me around the head with it.
It’s been said (that means I can’t remember who said it, or perhaps am making it up) that laughter is the opposite, and often substituted reaction to crying. That may explain then why we were all hysterically giggling last night in the “safe room”, on the back of what is undoubtedly the most overwhelming 2 weeks I’ve experienced.
It was about 9pm and I’d just got out of the shower (ie pipe of cold water that opens above your head in a room I’d be ashamed to lock a cat in – and I hate cats), after another remarkably unremarkable plate of food prepared by our assassin (formally employed as our “cook”). Just when you think it couldn’t get worse – hey! – she pulls out another ripper dish.
It’d been a truly shitty Saturday; I hadn’t slept the night before, up in the hospital dealing with various medical disasters (below). Then that afternoon, as we were getting on top of things on the ward, a truck pulled up outside our compound with victims of the previous nights’ cattle raid, all shot and with significant injuries. Them old cattle raids. Back to it.
So by the time I took the shower, I was truly buggered and with a first class Emirates-reclinable-seat-with-eye-pads-and-earplugs-and-glass-of-red-wine-and-sleeping-tablet-so-you-wont-even-know-what-planet-you’re-on-when-you-wake-up ticket to bed in my hand. Actually not quite, but a lumpy bed after a night like that is just as good.
Strolling across the compound en route to my mud ‘tukul’ (hut) from the shower, I heard gunshots in the distance. Our co-ordinator yelled for us to get in the “safe room”, and being a complete stranger to the sound of gunfire with my heart in my throat, it goes without saying I got there fairly quickly, trying to duck non-existent bullets on the way like a tool. With only my towel on. And the rest of the team in the already crowded room. And me now locked in there as well… And the realisation that I may in fact be the first MSF expat to be evacuated essentially naked… And images in my mind of the live press images after our escape, coming down the stairs of the (preferably aforementioned Emirates first class) flight onto the tarmac, my colleagues in their MSF T-shirts… and me in my f@#ken towel. No dignity in that.
I have felt at times in the last 2 weeks that I may have had a glimpse of the 7th circle of hell. Apparently an exceptionally busy and unusually catastrophic period here (re-confirming my shit-magnet status), its been an exercise in sleep deprivation, questioning and sanity preservation (time will tell how well I do with the latter).
It began when I got off the plane last Saturday, fresh from closing an outreach project that week (ie telling a community that for various reasons we could no longer provide healthcare for them, and the staff of 9 years that they had been great, thanks for coming, try the fish and by the way good luck with the future). Bags in hand, I got ushered straight to the hospital here.
And there I was, bag over my shoulder, in the inpatient department only minutes on the ground, staring at a pair of wide eyes, sunken into an oversized head that appeared to be balancing – just – on a child’s skeleton with skin draped loosely over it. Welcome back to Mars. All those old feelings back - torn somewhere between anger, disgust at the situation that allowed this, and overwhelming pity. But the eyes just stare back at me so pathetically. They look so frightened, but maybe that’s just because the eyelids and everything else on this tiny body is just so malnourished and wasted and dehydrated. I never can tell if they are frightened, desperate, or (hopefully) just vacant by this stage. It’s unsettling. But the kid’s in dire straits, I’m determined not to let it die, and this mum is freaking out (which begs the question why, like so many others, she waited two weeks until the kid was in a big hole before bringing him here... chill, Damien. Education, distances, logistics, 20 years of war…. It’s different).
So we begin the slow, delicate and anxious process of rehabilitating them. Can’t just whack in an IV, her heart is too weak and she’ll likely die of heart failure. So gently, slowly, we begin the drugs and fluids by nasogastric tube and by mouth. But this kid is just so thirsty… every time I take away the syringe of fluid, she cries, and looks at me with those frightened big eyes, and she sucks the plastic of the empty syringe, no its dry, so she picks up a stick and sucks it, no its also dry, so she puts her head towards my shoe. She’d grab the cup of fluid off me if she could, but with 6kg of flesh on her 1-year old skeleton, there’s not much chance of that. It’s pathetic to watch. And she tears strips off my heart with every rapid breath of her pneumonia-ravaged lungs. Every few minutes her bowels just unload a seemingly impossible amount of fluid from her dessicated body, and I vow she wont die, I’m on tonight and I’ll keep a close eye on her (because as sure as shit the night health-worker duty will be reclined and snoring, dreaming of night-clubs and burkhas in Khartoum within half an hour of my departure).
But as time has already shown me, don’t go vowing things like that… cos that night she dies anyway. And this week so did two others just like her, and so did a young boy shot in the stomach, and a man who exsanguinated on the ground outside our compound only hours after I sat chatting with him and his young family, and a young mum with Kala-azar who we had spent so much time with and who now left a young orphan with no breast milk, and a 20kg 10 year old boy with TB… it just goes on.
I’m actually tired of thinking about it today. Perhaps this afternoon I am suffering “compassion fatigue” (as not giving a shit is so pleasantly labelled these days). And fatigue of the usual issues in the field… what if I was wrong, what if I did that differently, what if we had an X-ray and instead of guessing I could actually see something. We had a mortality meeting yesterday to try and sort it out. General consensus is its been an unlucky week with sicker than usual patients coming, and of course some things we could improve around the place. But with 5000 outpatients a month, 300 inpatients, 45 TB patients, HIV patients, malnourished kids, one doctor (yours truly), one surgeon, a nurse and a team of local health workers who struggle with basic numeracy, let alone management of simple illnesses, it’s a little tricky to keep track of everything all the time. Actually, it’s impossible.
Is it wrong to be fantasizing about a week on Zanzibar after only being here 2 weeks….?
So while I look forward to buying the new Nokia 51-Tryhard-Turdmaster with live American Idol updates on my holidays in coming months, these people will continue to struggle for God knows how long. I dare anyone not to be moved at the prospect of human beings dying for lack of simple necessities. (Compassion Fatigue sufferers aside. Its really hard to care sometimes, there’s so much nasty news these days). Although concerningly I am turning into the whingeing turd I vowed never to become, so its time to stop.
And reflect instead on the 50+ inpatients, 44 TB patients, 32 malnourished kids and 1300 outpatients who are doing fine this week. Perhaps I’ll do it over an Ethiopian beer right now…
Only the f@#ken medical report and statistics and stock orders need to be done. Damn it!
It’s been said (that means I can’t remember who said it, or perhaps am making it up) that laughter is the opposite, and often substituted reaction to crying. That may explain then why we were all hysterically giggling last night in the “safe room”, on the back of what is undoubtedly the most overwhelming 2 weeks I’ve experienced.
It was about 9pm and I’d just got out of the shower (ie pipe of cold water that opens above your head in a room I’d be ashamed to lock a cat in – and I hate cats), after another remarkably unremarkable plate of food prepared by our assassin (formally employed as our “cook”). Just when you think it couldn’t get worse – hey! – she pulls out another ripper dish.
It’d been a truly shitty Saturday; I hadn’t slept the night before, up in the hospital dealing with various medical disasters (below). Then that afternoon, as we were getting on top of things on the ward, a truck pulled up outside our compound with victims of the previous nights’ cattle raid, all shot and with significant injuries. Them old cattle raids. Back to it.
So by the time I took the shower, I was truly buggered and with a first class Emirates-reclinable-seat-with-eye-pads-and-earplugs-and-glass-of-red-wine-and-sleeping-tablet-so-you-wont-even-know-what-planet-you’re-on-when-you-wake-up ticket to bed in my hand. Actually not quite, but a lumpy bed after a night like that is just as good.
Strolling across the compound en route to my mud ‘tukul’ (hut) from the shower, I heard gunshots in the distance. Our co-ordinator yelled for us to get in the “safe room”, and being a complete stranger to the sound of gunfire with my heart in my throat, it goes without saying I got there fairly quickly, trying to duck non-existent bullets on the way like a tool. With only my towel on. And the rest of the team in the already crowded room. And me now locked in there as well… And the realisation that I may in fact be the first MSF expat to be evacuated essentially naked… And images in my mind of the live press images after our escape, coming down the stairs of the (preferably aforementioned Emirates first class) flight onto the tarmac, my colleagues in their MSF T-shirts… and me in my f@#ken towel. No dignity in that.
I have felt at times in the last 2 weeks that I may have had a glimpse of the 7th circle of hell. Apparently an exceptionally busy and unusually catastrophic period here (re-confirming my shit-magnet status), its been an exercise in sleep deprivation, questioning and sanity preservation (time will tell how well I do with the latter).
It began when I got off the plane last Saturday, fresh from closing an outreach project that week (ie telling a community that for various reasons we could no longer provide healthcare for them, and the staff of 9 years that they had been great, thanks for coming, try the fish and by the way good luck with the future). Bags in hand, I got ushered straight to the hospital here.
And there I was, bag over my shoulder, in the inpatient department only minutes on the ground, staring at a pair of wide eyes, sunken into an oversized head that appeared to be balancing – just – on a child’s skeleton with skin draped loosely over it. Welcome back to Mars. All those old feelings back - torn somewhere between anger, disgust at the situation that allowed this, and overwhelming pity. But the eyes just stare back at me so pathetically. They look so frightened, but maybe that’s just because the eyelids and everything else on this tiny body is just so malnourished and wasted and dehydrated. I never can tell if they are frightened, desperate, or (hopefully) just vacant by this stage. It’s unsettling. But the kid’s in dire straits, I’m determined not to let it die, and this mum is freaking out (which begs the question why, like so many others, she waited two weeks until the kid was in a big hole before bringing him here... chill, Damien. Education, distances, logistics, 20 years of war…. It’s different).
So we begin the slow, delicate and anxious process of rehabilitating them. Can’t just whack in an IV, her heart is too weak and she’ll likely die of heart failure. So gently, slowly, we begin the drugs and fluids by nasogastric tube and by mouth. But this kid is just so thirsty… every time I take away the syringe of fluid, she cries, and looks at me with those frightened big eyes, and she sucks the plastic of the empty syringe, no its dry, so she picks up a stick and sucks it, no its also dry, so she puts her head towards my shoe. She’d grab the cup of fluid off me if she could, but with 6kg of flesh on her 1-year old skeleton, there’s not much chance of that. It’s pathetic to watch. And she tears strips off my heart with every rapid breath of her pneumonia-ravaged lungs. Every few minutes her bowels just unload a seemingly impossible amount of fluid from her dessicated body, and I vow she wont die, I’m on tonight and I’ll keep a close eye on her (because as sure as shit the night health-worker duty will be reclined and snoring, dreaming of night-clubs and burkhas in Khartoum within half an hour of my departure).
But as time has already shown me, don’t go vowing things like that… cos that night she dies anyway. And this week so did two others just like her, and so did a young boy shot in the stomach, and a man who exsanguinated on the ground outside our compound only hours after I sat chatting with him and his young family, and a young mum with Kala-azar who we had spent so much time with and who now left a young orphan with no breast milk, and a 20kg 10 year old boy with TB… it just goes on.
I’m actually tired of thinking about it today. Perhaps this afternoon I am suffering “compassion fatigue” (as not giving a shit is so pleasantly labelled these days). And fatigue of the usual issues in the field… what if I was wrong, what if I did that differently, what if we had an X-ray and instead of guessing I could actually see something. We had a mortality meeting yesterday to try and sort it out. General consensus is its been an unlucky week with sicker than usual patients coming, and of course some things we could improve around the place. But with 5000 outpatients a month, 300 inpatients, 45 TB patients, HIV patients, malnourished kids, one doctor (yours truly), one surgeon, a nurse and a team of local health workers who struggle with basic numeracy, let alone management of simple illnesses, it’s a little tricky to keep track of everything all the time. Actually, it’s impossible.
Is it wrong to be fantasizing about a week on Zanzibar after only being here 2 weeks….?
So while I look forward to buying the new Nokia 51-Tryhard-Turdmaster with live American Idol updates on my holidays in coming months, these people will continue to struggle for God knows how long. I dare anyone not to be moved at the prospect of human beings dying for lack of simple necessities. (Compassion Fatigue sufferers aside. Its really hard to care sometimes, there’s so much nasty news these days). Although concerningly I am turning into the whingeing turd I vowed never to become, so its time to stop.
And reflect instead on the 50+ inpatients, 44 TB patients, 32 malnourished kids and 1300 outpatients who are doing fine this week. Perhaps I’ll do it over an Ethiopian beer right now…
Only the f@#ken medical report and statistics and stock orders need to be done. Damn it!
posted by damien at 3:10 PM
Sunday, April 20, 2008
Evacuated - medically and literally
I made it to Sudan. For 4 days. Now I'm out again. After all the delays, cancellations and disasters of the previous few months, you gotta laugh....
Survived the beaches and restaurants of Cape Town for a couple of weeks whilst waiting for another job with MSF. Tough gig, but pulled through. Still jobless, I headed back to Switzerland; already feeling as appreciated as a puppy who just shat on the new suede, the Swiss went a step further and welcomed me back by locking my bags overnight in the offices and giving me a hotel reception floor to sleep on. Au-revoir hommes.
Fortunately the Dutch came through; a brief trip to Amsterdam followed, and 2 days later i was sitting in the MSF compound in the north of Kenya waiting for my flight to south Sudan. With recent trends, it goes without saying that my travel permit didn’t come through, but nothing like a dusty one-horse town with locals as friendly as pit-bulls to kill a week.
So last Friday I finally boarded a plane to South Sudan. Small, rickety, overloaded and with howling winds, clutching my bottle of duty free and once-again becoming a devout Evangelical for the duration of the flight. Fan-bloody-tastic (and always that lingering question - when those kids were swinging off the back flaps when we were loading on the runway, could they have ripped off something? Is that strut supposed to be rusted and bent?!). Landing at my new project, again the flaps providing shiny new play equipment and the tyres a fun object to spank with a stick for the village kids, we received a sat-phone call - the plane is to be diverted, there are some wounded that need to be picked up elsewhere and ferried to the surgical project. An hour later we descend to another dirt airstrip, where an MSF team meet us with a handful of wounded from a big clan-fight that morning.
So about 2 hours after entering Sudan, I find myself straddling a large young man on a stretcher in the back of the plane, battling the biblical clouds of flies feeding off these guys' wounds. He’s got a wound through his chest and neck, and for sure a chest full of air and blood. Not conducive to flying well. Seemed a good time to practice that chest decompression with a needle and syringe I’ve seen so often in the books – bite your bottom lip tiger, this isn’t going to tickle (I must admit I also bit my bottom lip at the thought of being attacked by his mates who saw a white bloke plunge a needle into his chest).
The flight went well, made it to the MSF hospital in South Sudan where there was a surgeon. Weekend spent floating around theatre and the wards. Stoked to finally be back out in the field.
Until Sunday… woke up great, then whammo! Fever, headache, Delhi-belly, the works. Spent the following 36 hours lying in a steaming mud hut sweating myself into the mattress, deliriously watching the coming and goings of the lizards on the wall, with frequent short vacations to the latrine. Sheer joy. And in setting possibly another new record with MSF, I get med-evacuated by a plane the following day. A thoroughly un-respectful 4 days in the field. I defy anyone to beat that!
So here I sit now, in Kenya again, fattening myself up and waiting for my flight back out in a couple of days. Lets see if I can make a week this time…
Email access still in the field – if you write to my hotmail address, it will ping back the new ones.
Survived the beaches and restaurants of Cape Town for a couple of weeks whilst waiting for another job with MSF. Tough gig, but pulled through. Still jobless, I headed back to Switzerland; already feeling as appreciated as a puppy who just shat on the new suede, the Swiss went a step further and welcomed me back by locking my bags overnight in the offices and giving me a hotel reception floor to sleep on. Au-revoir hommes.
Fortunately the Dutch came through; a brief trip to Amsterdam followed, and 2 days later i was sitting in the MSF compound in the north of Kenya waiting for my flight to south Sudan. With recent trends, it goes without saying that my travel permit didn’t come through, but nothing like a dusty one-horse town with locals as friendly as pit-bulls to kill a week.
So last Friday I finally boarded a plane to South Sudan. Small, rickety, overloaded and with howling winds, clutching my bottle of duty free and once-again becoming a devout Evangelical for the duration of the flight. Fan-bloody-tastic (and always that lingering question - when those kids were swinging off the back flaps when we were loading on the runway, could they have ripped off something? Is that strut supposed to be rusted and bent?!). Landing at my new project, again the flaps providing shiny new play equipment and the tyres a fun object to spank with a stick for the village kids, we received a sat-phone call - the plane is to be diverted, there are some wounded that need to be picked up elsewhere and ferried to the surgical project. An hour later we descend to another dirt airstrip, where an MSF team meet us with a handful of wounded from a big clan-fight that morning.
So about 2 hours after entering Sudan, I find myself straddling a large young man on a stretcher in the back of the plane, battling the biblical clouds of flies feeding off these guys' wounds. He’s got a wound through his chest and neck, and for sure a chest full of air and blood. Not conducive to flying well. Seemed a good time to practice that chest decompression with a needle and syringe I’ve seen so often in the books – bite your bottom lip tiger, this isn’t going to tickle (I must admit I also bit my bottom lip at the thought of being attacked by his mates who saw a white bloke plunge a needle into his chest).
The flight went well, made it to the MSF hospital in South Sudan where there was a surgeon. Weekend spent floating around theatre and the wards. Stoked to finally be back out in the field.
Until Sunday… woke up great, then whammo! Fever, headache, Delhi-belly, the works. Spent the following 36 hours lying in a steaming mud hut sweating myself into the mattress, deliriously watching the coming and goings of the lizards on the wall, with frequent short vacations to the latrine. Sheer joy. And in setting possibly another new record with MSF, I get med-evacuated by a plane the following day. A thoroughly un-respectful 4 days in the field. I defy anyone to beat that!
So here I sit now, in Kenya again, fattening myself up and waiting for my flight back out in a couple of days. Lets see if I can make a week this time…
Email access still in the field – if you write to my hotmail address, it will ping back the new ones.
posted by damien at 12:00 AM
Sunday, March 09, 2008
Mozambique pics
Top to bottom: transporting goods up the river for a distribution to camps, elderly man weaving straw, crossing flooded land, fisherman with (rather undersized?!) fish, young girls outside the clinic trying to show me how to dance.
posted by damien at 10:01 AM
a nutrition survey: reflections on faffing
Morrumbala, Mozambique 3rd March
Its 5am and I am standing in the carpark of our ‘hotel’ here in central Mozambique. We are supposed to be leaving now, and once again, myself and the two logisticians are still waiting for our local staff to arrive. We made it very clear – not African time this time please peoples. It’s a 4.5 hour drive and we have to be back here by sunset, so there’s no room for faffing. Which is ironic, as that’s what our staff seem to be best at.
One nurse is still sleeping. Two of the drivers are not here yet. One reckons he has malaria, and the rapid-test I do proves positive. The nurses promised by the local health department are not here with their promised scales and height measuring tapes. And yet for some strange reason I am actually surprised – despite this being our daily routine (which is not as exasperating as waiting for dinner, which comes between 3 and 4 HOURS after we order it daily). So I find myself gesticulating wildly like an angry Italian to get some momentum, because its hard to be clear when you’re pissed in another language, and my Portuguese doesn’t yet allow for rants, so flailing arms seems to get the point across. No, now is not a time to find someone to wash your clothes for you. Forget the coffee. You need mobile phone credit..? Now….?! Tough! Get in the car.
As we begin the arduously slow drive towards the Malawi border to another displaced people’s camp, I settle into that euphoric dream-like haze that is the morning drives. I fall asleep for a few seconds before the next pothole prompts the window to spank my head and remind me to enjoy the view. The sun’s rising over the mountains in the distance, kids are already walking to school with chairs and books balanced delicately on their heads, mums are out in the corn fields and rice-paddies and men are lugging unbelievably large loads of pretty much everything on the back of their bicycles (which here serve as family wagons, cargo haulers, recreational vehicles and food transport vehicles here – I saw a bloke with a live goat tied from his handle-bars down the top bar of his bike. So I guess everytime the goat sneezed he goes left, and if the goat coughed he veers right…?). Then asleep again for a moment, before the next whiplash-inducing pothole.
We arrive in Jonassi by mid-morning, and are greeted by the usual quorum of dozens of children. They watch as we unpack, they watch everything, and they are the easiest audience you could have – my unco-ordinated attempts to swat a wasp draws laughter, as does a sneaky attempt to pick my nose. Life in a fish-bowl.
Setting up for the days’ screening begins, as we set up crowd and queue control barriers, the tent, and quickly recruit local workers to help. Today we are doing a nutritional screen, and the idea is to file as many kids between 6 months and 5 years as you can through a line where we measure their upper-arm circumference; over a certain level and they leave with a de-worming tablet and a glob of purple ink on their finger (so curious kiddies don’t sneak back around again for another ‘lolly’!). Under a certain level and we measure their weight, height and screen them for medical problems. Malnourished kids are admitted into a program of supplemental feeds and followed up.
It sounds easy. At least I thought so when it was sold to me. It looked so on paper. It’s not. The population we are working with is a very rural population, with variable levels of numeracy and literacy. To get a local worker to read a scale accurately and write down the number is not as easy as you would expect. A significant number of mums don’t have any idea when their kid was born, give or take a year or two. Getting others to interpret graphs of which kids are malnourished based on their stats is equally tricky – either way too many healthy kids are admitted, or malnourished kids are sent home. So everything has to be supervised, repeated, questioned and re-explained (with patience I hope) over and over again… and then one more over again for good measure.
And all this is going on at once. So there’s a line of hundreds of people waiting, its 40 degrees and the humidity is through the roof, and we are all already caked in dust. Adults are getting in line wanting pills for their headaches and two of our local nurses are fighting over which protocol to use. Kids are sneaking through the barriers – curious kids want to be weighed, others want to dip their fingers in the dye, others want to just sit and watch near you. Other kids are screaming bloody murder when it comes to measure their arm, and in true crowd mentality, when one kids starts screaming, they all do - perhaps a kind of sympathetic show of solidarity on their behalf. So it goes through phases – for 15 minutes kids will wander up and grin at you as they thrust their arm into the tape, then one kid will start screaming and everyone behind him will be convinced that we must be ritualistically torturing him, so they all start and are petrified when they get to the white guy. Then it settles after a few minutes and you go through a happy phase again.
The dipping-of-the-fingers-in-dye is another fascinating little insight into child psychology. Like the different approaches to waving at cars (previous blog), there are many variations – there are those that are convinced their finger will dissolve in the cup and will do anything on earth not to let that happen; it’s a little bizarre (and perhaps unnecessary!) to watch a mum and two grown men wrestle a 4 year old’s hand towards a cup, and occasionally it seems the kid just may win. Then there are those that are a a little hesitant, but curiosity overwhelms them and they just cant resist. And finally, those that just dare anyone to stop them, bathe their hand in the stuff and make a grab for the cup to take a sip. And one cheeky little dude who wet his finger in it, regarded it for a few seconds, decided it looked like something that would make for brilliant finger painting and that his mum’s white dress was just the canvas.
So it goes for several hours – a somewhat organised chaos, but we get through hundreds of kids and sort out the malnourished ones. And when we start to pack up, I am once again humbled and floored by the needs of these people. Dozens of people crowd around… please, I need treatment for this, please, my husband is really sick at home, please, my daughter that. A girl who broke her arm months ago but still has the bone poking out of her skin – unbelievable – and surely infected, but she gets lost in the confusion (I curse myself later and vow to head back tomorrow to find her and bring her to hospital). And local health workers pitch in – we haven’t been paid in months, we have no supplies, please give us what you can. And so begins the routine that I was previously familiar with – but had pleasantly forgotten in the last year in Australia – sorry, we don’t have drugs for that, sorry we have to leave soon, yes I promise we will be back soon but I cant say when, sorry, you need surgery for that in the capital which means I may as well just tell you that there’s a clinic on Mars that will look after you.
But our day is done. We have to high-tail it back to our town before it gets dark, and our other Australian logistician (also Damien, also from Melbourne, also bald – so I am “Kangaroo” here) is trying to calmly explain to the nurses who have now ordered goat for dinner from a family that he will leave them here if they don’t get into the car in the next 30 seconds, but they refuse anyway. Our other logistician got given a chicken for our help here, which is too cute to eat I decide. I am dripping wet from sweat, the kids crowd around the car again laughing and smiling and we pull off back to town as I settle into my trance-like state for the ride home, waiting hopefully for the little chubby kid to do his foot-shuffle dance as we drive past.
Addit: the following day, I go to see our driver with malaria. He’s much worse. Take your tablets today? Yup. Last night? Yup. Let’s see the packet… its full! You didn’t take any did you? No. Well, may I hazard a guess then as to why you are worse….?!
Another day in another universe goes by.
Its 5am and I am standing in the carpark of our ‘hotel’ here in central Mozambique. We are supposed to be leaving now, and once again, myself and the two logisticians are still waiting for our local staff to arrive. We made it very clear – not African time this time please peoples. It’s a 4.5 hour drive and we have to be back here by sunset, so there’s no room for faffing. Which is ironic, as that’s what our staff seem to be best at.
One nurse is still sleeping. Two of the drivers are not here yet. One reckons he has malaria, and the rapid-test I do proves positive. The nurses promised by the local health department are not here with their promised scales and height measuring tapes. And yet for some strange reason I am actually surprised – despite this being our daily routine (which is not as exasperating as waiting for dinner, which comes between 3 and 4 HOURS after we order it daily). So I find myself gesticulating wildly like an angry Italian to get some momentum, because its hard to be clear when you’re pissed in another language, and my Portuguese doesn’t yet allow for rants, so flailing arms seems to get the point across. No, now is not a time to find someone to wash your clothes for you. Forget the coffee. You need mobile phone credit..? Now….?! Tough! Get in the car.
As we begin the arduously slow drive towards the Malawi border to another displaced people’s camp, I settle into that euphoric dream-like haze that is the morning drives. I fall asleep for a few seconds before the next pothole prompts the window to spank my head and remind me to enjoy the view. The sun’s rising over the mountains in the distance, kids are already walking to school with chairs and books balanced delicately on their heads, mums are out in the corn fields and rice-paddies and men are lugging unbelievably large loads of pretty much everything on the back of their bicycles (which here serve as family wagons, cargo haulers, recreational vehicles and food transport vehicles here – I saw a bloke with a live goat tied from his handle-bars down the top bar of his bike. So I guess everytime the goat sneezed he goes left, and if the goat coughed he veers right…?). Then asleep again for a moment, before the next whiplash-inducing pothole.
We arrive in Jonassi by mid-morning, and are greeted by the usual quorum of dozens of children. They watch as we unpack, they watch everything, and they are the easiest audience you could have – my unco-ordinated attempts to swat a wasp draws laughter, as does a sneaky attempt to pick my nose. Life in a fish-bowl.
Setting up for the days’ screening begins, as we set up crowd and queue control barriers, the tent, and quickly recruit local workers to help. Today we are doing a nutritional screen, and the idea is to file as many kids between 6 months and 5 years as you can through a line where we measure their upper-arm circumference; over a certain level and they leave with a de-worming tablet and a glob of purple ink on their finger (so curious kiddies don’t sneak back around again for another ‘lolly’!). Under a certain level and we measure their weight, height and screen them for medical problems. Malnourished kids are admitted into a program of supplemental feeds and followed up.
It sounds easy. At least I thought so when it was sold to me. It looked so on paper. It’s not. The population we are working with is a very rural population, with variable levels of numeracy and literacy. To get a local worker to read a scale accurately and write down the number is not as easy as you would expect. A significant number of mums don’t have any idea when their kid was born, give or take a year or two. Getting others to interpret graphs of which kids are malnourished based on their stats is equally tricky – either way too many healthy kids are admitted, or malnourished kids are sent home. So everything has to be supervised, repeated, questioned and re-explained (with patience I hope) over and over again… and then one more over again for good measure.
And all this is going on at once. So there’s a line of hundreds of people waiting, its 40 degrees and the humidity is through the roof, and we are all already caked in dust. Adults are getting in line wanting pills for their headaches and two of our local nurses are fighting over which protocol to use. Kids are sneaking through the barriers – curious kids want to be weighed, others want to dip their fingers in the dye, others want to just sit and watch near you. Other kids are screaming bloody murder when it comes to measure their arm, and in true crowd mentality, when one kids starts screaming, they all do - perhaps a kind of sympathetic show of solidarity on their behalf. So it goes through phases – for 15 minutes kids will wander up and grin at you as they thrust their arm into the tape, then one kid will start screaming and everyone behind him will be convinced that we must be ritualistically torturing him, so they all start and are petrified when they get to the white guy. Then it settles after a few minutes and you go through a happy phase again.
The dipping-of-the-fingers-in-dye is another fascinating little insight into child psychology. Like the different approaches to waving at cars (previous blog), there are many variations – there are those that are convinced their finger will dissolve in the cup and will do anything on earth not to let that happen; it’s a little bizarre (and perhaps unnecessary!) to watch a mum and two grown men wrestle a 4 year old’s hand towards a cup, and occasionally it seems the kid just may win. Then there are those that are a a little hesitant, but curiosity overwhelms them and they just cant resist. And finally, those that just dare anyone to stop them, bathe their hand in the stuff and make a grab for the cup to take a sip. And one cheeky little dude who wet his finger in it, regarded it for a few seconds, decided it looked like something that would make for brilliant finger painting and that his mum’s white dress was just the canvas.
So it goes for several hours – a somewhat organised chaos, but we get through hundreds of kids and sort out the malnourished ones. And when we start to pack up, I am once again humbled and floored by the needs of these people. Dozens of people crowd around… please, I need treatment for this, please, my husband is really sick at home, please, my daughter that. A girl who broke her arm months ago but still has the bone poking out of her skin – unbelievable – and surely infected, but she gets lost in the confusion (I curse myself later and vow to head back tomorrow to find her and bring her to hospital). And local health workers pitch in – we haven’t been paid in months, we have no supplies, please give us what you can. And so begins the routine that I was previously familiar with – but had pleasantly forgotten in the last year in Australia – sorry, we don’t have drugs for that, sorry we have to leave soon, yes I promise we will be back soon but I cant say when, sorry, you need surgery for that in the capital which means I may as well just tell you that there’s a clinic on Mars that will look after you.
But our day is done. We have to high-tail it back to our town before it gets dark, and our other Australian logistician (also Damien, also from Melbourne, also bald – so I am “Kangaroo” here) is trying to calmly explain to the nurses who have now ordered goat for dinner from a family that he will leave them here if they don’t get into the car in the next 30 seconds, but they refuse anyway. Our other logistician got given a chicken for our help here, which is too cute to eat I decide. I am dripping wet from sweat, the kids crowd around the car again laughing and smiling and we pull off back to town as I settle into my trance-like state for the ride home, waiting hopefully for the little chubby kid to do his foot-shuffle dance as we drive past.
Addit: the following day, I go to see our driver with malaria. He’s much worse. Take your tablets today? Yup. Last night? Yup. Let’s see the packet… its full! You didn’t take any did you? No. Well, may I hazard a guess then as to why you are worse….?!
Another day in another universe goes by.
posted by damien at 9:57 AM
Top to bottom: curious kids in rural Mozambique, fishing - a popular use for a mosquito-bednets, doing nutrition check on a clearly slightly over-nourished baby!, view out the window on the drive to work in the morning, dudes at a swimming hole, where's wally.
posted by damien at 9:28 AM
Shit-Magnet
Mopeia, Mozambique, 20 Feb 2008Within an hour of arriving in the field here in Mozambique, I had firmly cemented my reputation as a medical shit-magnet (although this trend does seem to extend into other aspects of my life as well). This time, unfortunately, literally.
After a dream-like boat ride up the Zambezi river, we arrived on a river bank to be greeted by a sea of inquisitive children, who were even more inquisitive of my apparent inability to be able to walk upright on the mud bank. The boat ride took us past villages of people recently displaced by the floods here, where a river normally at best a few dozen metres wide had now flooded land to be 5km wide. Any risk of the trip being boring for the regular guys was negated by my repeated mini-convulsions as I threw myself across the boat every time – and there were many times – the boat pilot pointed at my arm dangling over the edge and yelled “Crocodilla!!” Standard new-guy gag I’m sure.
After a half-hour walk through some small villages to reach our mobile medical clinic in a clearing, I was introducing myself to the staff, trying to get some sense of the layout having never seen a clinic like this before (in essence, a large tent under an even larger tree where patients can wait in the shade, basic medical essentials, some Mozambican nurses, the all important crowd control dude, and a clueless doctor – me - supposedly supervising the whole thing whilst grappling with the heat and humidity and insects the size of small birds trying to molest me from every angle). Whilst exchanging pleasantries in (déjà vu) bad Portuguese again, three guys ran towards us carrying the limp body of a man lapsing in and out of consciousness. For f@#k’s sake… not even here half an hour. As they lay him on the floor of our tent, I struggled to get an IV into him. Eyes sunken, no recordable blood pressure, I pinched his skin and it just stayed there, twisted, for minute.
Cholera for sure, and he’d undoubtedly shat 10-20 litres of fluid by now. Somewhat short of the 2 litres of IV fluid we had on us. So we spent the afternoon watching this guy trying to die, puking and shitting everything we gave him IV or to drink with interest, lapsing in and out of consciousness, while the boat raced off to get more supplies from our base. Fast forward to the following morning, when he is eating and wants to go home after having had more than 10 litres of fluid, plus more to drink. Another testament to the resilience of the human body (and another gentle reminder for me to bite my tongue when I go home to work, forget all this and reset my threshold for concern, when a 15 year old who has vomited once that morning is brought into the Emergency Department by his anxious parents…)
My time here so far has been ridiculously and overwhelmingly pleasant, and I must confess I feel more than a little guilty enjoying myself so thoroughly on an MSF mission, especially given I should be in Somalia confined to a compound facing the most woeful of crises. Mozambique here is so green, it’s as if a plane carrying all the fluoro-dye for a 1980’s ski-wear manufacturer exploded over the country-side and coloured it. ‘Lush’ would be an understatement. Its safe, and instead of confronting drunken soldiers and avoiding landmines on my evening walks, I refuse offers for a lift on the back of locals’ bicycles. I may also in fact be the first person to come back from a mission fatter than when they left.
Our daily ‘routine’ for the last week has been to hit the road at a sparrow’s-fart with 2 landcruisers of medical supplies, drive out to the selected location for the day (1-3 hours), and see as many people as we can, in the new camps of displaced people.
The drive itself is a highlight, excluding the orthopaedic issues of being tossed around an old landcruiser on bad roads with “anti-suspension” (a sarcasm/irony-based suspension system that seems to exaggerate any of the billion potholes and bumps).
Cotton fields and maze fields dominate the horizon, punctuated by kids chasing down the car and women working on their back problems in the fields (I have noted three types of kids here, as defined by their response to a car with a Mizungu (white bloke) cruising past in it. Firstly there are the startled ones - those that stare wide eyed, as if you had just landed from space. Some run and scream, others remain fixed to the ground paralysed by fear/intrigue. A wave does nothing to disarm them. Secondly, there are those whose day you’ve just made; they are waving so frantically before the car is even in site that you worry they may dislocate their shoulders. They beam, they chase the car, and occasionally (usually a podgy-bellied young boy) will do a little dance on the spot before giving chase. These kids can be dangerous – if you don’t wave back, they may quite possibly chase the car until its next stop demanding an explanation. And the final group – my favourite – fits between the two. They start off in the first group. They look petrified. Then a little hand tentatively goes up to wave. There’s a flicker this way… then that…. Wide eyes…. And then (you wave back)… they erupt. ‘Whooooaaaaa!!! Mizungu’ and off they go chasing us). I could spend a year just driving around the countryside here just watching these kids.
Fortunately the health (so far) of the refugees here is not too bad – food and blankets have been distributed, clean water is now mostly available, and the population seems as healthy (or unhealthy) as any rural group. A fascinating observation (well, I think so) is that no matter where you go in the world, patients will still present with seemingly trivial, well, bullshit. I suppose that a backache or a headache is equally annoying for a patient whether you are waiting in Geelong Emergency Dept, or in a clinic in a refugee camp. So there I am buggered and sweating more than I can manage to drink in the medical tent, seeing kids with malaria, ulcers bigger than the feet they are destroying and other horrendomas, when a bloke sits in front of me and complains – in all sincerity – that his eyes hurt when he stares at the sun. I suggested sunglasses, but he recommended that I prescribe him antibiotics instead. Just be nice. Just be nice… (I did suggest an opthalmology mobile clinic to MSF to follow up on this guy in my weekly report, but as yet no feedback).
The state of health being what it is here, we will be shutting up shop soon, which means I may have in fact grabbed the trifecta of the three shortest missions in MSF history – about 12 minutes for Somalia (made it to the airport hall and briefing), 36 hours in west Kenya (although the umbrella we got sucked into the aircraft propeller certainly made it a worthwhile trip), and now a few weeks here. Lets see if I can break the one month barrier in the next one. Or at least make enough frequent flyer points to fly to the moon with Virgin Galactic.
posted by damien at 9:19 AM
Umbrellas and propellers
Nairobi - 6 February
I would like to be able to – at this point of the mission, having been gone for a month – recount stories of lives saved and interventions intervened. Alas, mine is a tale of weeks in the compound in Nairobi, working on my love-less handles in various restaurants, the world’s second shortest field-trip with MSF (48 hours in West Kenya, versus an airport hall only for Somalia), and almost destroying a light plane...
The situation in Somalia has not improved since I last wrote, and despite daily updates from the Somali clinic I am supposed to be at (where there are now NINE HUNDRED children receiving treatment for malnutrition, and overwhelmed Somali staff), it is impossible to go back. An immensely frustrating situation, but potentially currently a game of Russian Roulette regarding security (when the five blokes next to you have already shot blanks, and then hand you the gun).
My trip to West Kenya (Eldoret), where there was some of the worst post-election violence here was an eye-opener to say the least. 20 000 people crammed into the showgrounds in this one town alone, living in makeshift tents, on mud, with the rain season about to hit. Imagine the indignity for a proud father to bundle his family into squalor with a pot and a pair of underwear as your worldly possessions, because your neighbours of 50 years turn around one day and torch your house and take a machette to you. Its unfathomable. You see selective houses burned, you see huge rocks lining the side of the road where roadblocks were set up and people were dragged out of cars to a fate I cant imagine, and then you drive through towns where the likely perpetrators were, and everyone’s friendly, they’re approachable, they’re smiling and buying mobile phone top-ups and selling vegetables and reading papers. So who did this? These guys? And then you go back to one of the refugee (IDP) camps, and all the kids are running around playing football and doing general kid-like things, absolutely oblivious and seemingly unfazed by the whole thing (in fact, possibly even stoked – a playground with 10 000 other kids…!).
On the positive side of these camps, from what I saw they were very well organised, clean, there was adequate water and food, and unbelievably a dozen or so massive tents in one camp where 2500 kids were attending school daily. There was no medical work for me, as the Kenyan hospitals are coping, at least for the moment (but MSF have stuck around to monitor the situation).
On the purely fascinating side, I had my first insight into the petty and ultra-competitive world of aid agencies (MSF entirely excepted from this). Being Kenya, most agencies were present anyway, and they were literally scrambling to get their flag in first, to find some other group of refugees or some other thing they could build. Arguably great for those affected, but financially and logistically ridiculous – at a meeting, groups were refusing to share information with each other, and some actually lied about the location of people/needs in order to maintain the ‘monopoly’. Imagine at least a dozen groups, all in hotels, all with drivers, nice 4WD’s (except MSF – we had ye olde Corolla), all reporting on pretty much the same reports about the morning’s reported changes, calling overseas…. Big money. Monty-Pythonesque moments (popular people’s front sketch); “so, do you look after water systems…?”. “F@#k off!! We look after systems that provide water!”. On my last day there, another agency’s car almost ran us off the road to beat us to a small camp.
On the way back from western Kenya as I boarded the airplane after being recalled to Nairobi, I was wildly frustrated. Nothing could have lightened the mood, least of all climbing into another shit-box plane (if someone glued wings onto the side of a Datsun 120Y I would have been more convinced) to take off into a thunder storm pounding the not-too-distant horizon. Nothing that is, except for the actions of our logistician next to me (a logistician is the general dude-about-town in the group, the Hire-a-Hubby, the Mr Fix-it. They are responsible for all the technical things on a mission, including the seduction of female team-members. So it would seem obvious that if anyone was going to do something stupid on boarding the plane, it would be me, not the ‘log’).
The airline kindly issued us with over-sized umbrellas to walk out to the plane, as the storm was now almost on us. As we queued to climb the stairs, people diligently closed their umbrellas and handed them to staff at the door. Except for our Log.
I remember thinking that it wasn’t a good idea as I watched him place his open umbrella on the ground next to the attendant. As the breeze gently toyed with his umbrella, threatening to send it this way then that, the pilot revved up the prop engine on the other side of the plane. I stood entranced. It wont… yes it is…. No it cant…. But what if it does….?! Ever so slowly the umbrella sailed under the plane toward the engine, my morbid fascination matched only by the attendant’s morbid fear (of loss of job or life I wasn’t sure at this stage)…. And then F@#KING-WHOOOMMF!
An explosion of metal, ribbons and colours maybe a hundred metres into the air… a mesmerisingly beautiful dance of propeller, nylon and umbrella handle. The engine stopped, the pilot rushed out, and passengers followed him. And as we stood in our MSF T-shirts on the runway in a truly fine advertisement, I worried I may actually stop breathing due to laughter (anxiety-driven to be sure). Although the plane was fine, mechanics checked it out, and we were off minutes later.
As expected, the group of expats evacuated from Somalia (fantastic bunch) still stuck in the house in Nairobi started to go slightly mental towards the end. Nudy-swims were swum, tears were shed during “Atonement” (a serious sign of losing the plot), and Kenyans were shown how to really dance by the hip-hop masters that we found ourselves to be (read: unco tools that we were) after a Tusker beer or six.
So…. What now?
With Somalia looking dubious, it’s off to Mozambique in the coming days to help with mobile clinics being run after huge floods there. Could think of worse places to go. Although until I’m actually facing a patient in the clinic, I wont assume anything again...
Let’s see.
PS – sketchy if any internet access in the coming weeks, so if I don’t respond for a while it’s not because I’m recovering from my kidney-harvest after a big night out in Maputo. Hopefully. Photo is an IDP camp in Western Kenya... a mere 20 000 of the 300 000 people.
The situation in Somalia has not improved since I last wrote, and despite daily updates from the Somali clinic I am supposed to be at (where there are now NINE HUNDRED children receiving treatment for malnutrition, and overwhelmed Somali staff), it is impossible to go back. An immensely frustrating situation, but potentially currently a game of Russian Roulette regarding security (when the five blokes next to you have already shot blanks, and then hand you the gun).
My trip to West Kenya (Eldoret), where there was some of the worst post-election violence here was an eye-opener to say the least. 20 000 people crammed into the showgrounds in this one town alone, living in makeshift tents, on mud, with the rain season about to hit. Imagine the indignity for a proud father to bundle his family into squalor with a pot and a pair of underwear as your worldly possessions, because your neighbours of 50 years turn around one day and torch your house and take a machette to you. Its unfathomable. You see selective houses burned, you see huge rocks lining the side of the road where roadblocks were set up and people were dragged out of cars to a fate I cant imagine, and then you drive through towns where the likely perpetrators were, and everyone’s friendly, they’re approachable, they’re smiling and buying mobile phone top-ups and selling vegetables and reading papers. So who did this? These guys? And then you go back to one of the refugee (IDP) camps, and all the kids are running around playing football and doing general kid-like things, absolutely oblivious and seemingly unfazed by the whole thing (in fact, possibly even stoked – a playground with 10 000 other kids…!).
On the positive side of these camps, from what I saw they were very well organised, clean, there was adequate water and food, and unbelievably a dozen or so massive tents in one camp where 2500 kids were attending school daily. There was no medical work for me, as the Kenyan hospitals are coping, at least for the moment (but MSF have stuck around to monitor the situation).
On the purely fascinating side, I had my first insight into the petty and ultra-competitive world of aid agencies (MSF entirely excepted from this). Being Kenya, most agencies were present anyway, and they were literally scrambling to get their flag in first, to find some other group of refugees or some other thing they could build. Arguably great for those affected, but financially and logistically ridiculous – at a meeting, groups were refusing to share information with each other, and some actually lied about the location of people/needs in order to maintain the ‘monopoly’. Imagine at least a dozen groups, all in hotels, all with drivers, nice 4WD’s (except MSF – we had ye olde Corolla), all reporting on pretty much the same reports about the morning’s reported changes, calling overseas…. Big money. Monty-Pythonesque moments (popular people’s front sketch); “so, do you look after water systems…?”. “F@#k off!! We look after systems that provide water!”. On my last day there, another agency’s car almost ran us off the road to beat us to a small camp.
On the way back from western Kenya as I boarded the airplane after being recalled to Nairobi, I was wildly frustrated. Nothing could have lightened the mood, least of all climbing into another shit-box plane (if someone glued wings onto the side of a Datsun 120Y I would have been more convinced) to take off into a thunder storm pounding the not-too-distant horizon. Nothing that is, except for the actions of our logistician next to me (a logistician is the general dude-about-town in the group, the Hire-a-Hubby, the Mr Fix-it. They are responsible for all the technical things on a mission, including the seduction of female team-members. So it would seem obvious that if anyone was going to do something stupid on boarding the plane, it would be me, not the ‘log’).
The airline kindly issued us with over-sized umbrellas to walk out to the plane, as the storm was now almost on us. As we queued to climb the stairs, people diligently closed their umbrellas and handed them to staff at the door. Except for our Log.
I remember thinking that it wasn’t a good idea as I watched him place his open umbrella on the ground next to the attendant. As the breeze gently toyed with his umbrella, threatening to send it this way then that, the pilot revved up the prop engine on the other side of the plane. I stood entranced. It wont… yes it is…. No it cant…. But what if it does….?! Ever so slowly the umbrella sailed under the plane toward the engine, my morbid fascination matched only by the attendant’s morbid fear (of loss of job or life I wasn’t sure at this stage)…. And then F@#KING-WHOOOMMF!
An explosion of metal, ribbons and colours maybe a hundred metres into the air… a mesmerisingly beautiful dance of propeller, nylon and umbrella handle. The engine stopped, the pilot rushed out, and passengers followed him. And as we stood in our MSF T-shirts on the runway in a truly fine advertisement, I worried I may actually stop breathing due to laughter (anxiety-driven to be sure). Although the plane was fine, mechanics checked it out, and we were off minutes later.
As expected, the group of expats evacuated from Somalia (fantastic bunch) still stuck in the house in Nairobi started to go slightly mental towards the end. Nudy-swims were swum, tears were shed during “Atonement” (a serious sign of losing the plot), and Kenyans were shown how to really dance by the hip-hop masters that we found ourselves to be (read: unco tools that we were) after a Tusker beer or six.
So…. What now?
With Somalia looking dubious, it’s off to Mozambique in the coming days to help with mobile clinics being run after huge floods there. Could think of worse places to go. Although until I’m actually facing a patient in the clinic, I wont assume anything again...
Let’s see.
PS – sketchy if any internet access in the coming weeks, so if I don’t respond for a while it’s not because I’m recovering from my kidney-harvest after a big night out in Maputo. Hopefully. Photo is an IDP camp in Western Kenya... a mere 20 000 of the 300 000 people.
posted by damien at 9:06 AM
Sunday, February 03, 2008
sticker thieves
Note for the unwary - this is why you should never turn your back on the sticker supply in an Emergency Department in the Northern Territory. Accomplished thieves clean out Tennant Creek ED....
posted by damien at 12:47 AM
Nairobbery; 3 Feb 2008
Finally made it to Africa. Although, as the universe has been yelling at me for the last few weeks, perhaps this is a trip I shouldn’t have made. In light of the news to follow at the end, this is about to be a largely selfish rant, but indulge me anyway.
January was looking good. Summer in Torquay, a wedding, all to be followed by my long awaited and heavily anticipated next mission with MSF (Doctors Without Borders), this one being a dream job in a nightmare destination… a feeding centre for malnourished children in Somalia (which, contrary to some rather misguided questions from occasional people I have met, is neither a surfing nor holiday destination – jihadi’s excluded). Overwhelming needs in a country I had previously sworn I would never visit; ongoing clan rivalries, a gun-toting culture superimposed on a civil war, and recent viewings of Black Hawk Down playing no small part in that decision.
Then things started to unfold. I got a call from the office in Europe to say I needed to be there sooner. This entailed missing the wedding and messing work around, but hey, I’m no stranger to burning bridges at Aussie hospitals (Eg 1: Geelong. Eg 2: Geelong), and this is one job I did not want to compromise getting. So sure, a few phone calls, a hurried move out of a house and cold sore inducing bout of anxiety-to-get-it-all-done-in-time.
Then the problems began…
On the flight to Europe, in a momentary failure of his brain to function, our pilot… “ladies and gentleman, theres been an, errrrr…, problem at Heathrow; we have extra fuel in case… it’s a runway, and…. Uhhhh… a plane, errr… uhhh, we may not land in London. It’s a, ummmm…. Yuh. I’ll fill you in more later.”
What .??!!! You just alluded to a plane crash as we hurtle towards said runway with extra fuel – ie explosive - on board? Why not just take on dynamite? Perhaps a shoe-bomber next time..?
And a poignant moment for those of us on the verge of a complete panic attack as we approached the runway hours later – in the second (and this time thoroughly more complete) failure of his brain to function – the pilot actually pointed out the wreckage of the plane to our right as we landed! Great!! “So, Damien, what was the last thing that went through your mind as your plane careered into the runway at Heathrow?”
‘Well, I’d have to say I was probably distracted thinking about the last thing that went through the people’s minds in the crash just below us…’
Ensue delays, cancellations and tantrums.
Geneva. I walk in to MSF headquarters. Actually, I strut in. Big grin. I’m back baby! Give it to me, here for my next mission. “Allors, Damn, you are here already! No. We were hoping next week…”. Not the enthusiastic Gallic kiss-on-the-cheek greeting I was hoping for, and certainly not after high-tailing it here. Turns out due to various ‘security’ issues in Somalia, my briefing had been pushed back a week. F@#ken brilliant. Could have made a good friend’s wedding, could have enjoyed summer in Oz. So followed 11 days of inhaling entire colonies of dust mite in a two star hotel (overlooking the sewer that overlooked Lake Geneva), Starbucks, CNN, countless hours at the MSF offices waiting for people, and trying not to spend all of my savings (that weren’t misappropriated by the Aussie Tax Office or my intellectually disabled accountant – who I would like to re-iterate should be the one going to Somalia, not me). The shittiness of the prices surpassed only by the shittiness of the weather, Geneva ain’t no place for a less-than-billionaire to kill time.
Monday evening. Ecstatic, I step off the plane in Nairobi – finally en route to Somalia - with a senior MSF guy. He checks his message bank, then says to me, errr, big problem with Somalia. Drive from airport – inhaling Africa (literally – it was a dirt road), absorbing it again. Awesome to be back. My brothers from another mother. Its good. And that feeling decimated in a second at the guest house. ‘You’d better sit down’. Oh really? Well not a lot of good news starts out like this. I presume its not because you’re intimidated by my overwhelming height and/or woolly mass of hair. What up? I’ll play along. ‘MSF staff were killed in an attack in the south of Somalia this morning’. I understand for possibly the first time the origin of the phrase ‘a chill down your spine’.
The devastating thing is that there are so many devastating things. Volunteer workers dead. That seems a wickedly cruel twist of fate for a person that puts themselves out there. The other expats in that mission scarred for life in ways I cant imagine. And as 100 expat staff are immediately evacuated from all over Somalia, millions of Somalis are the ones left to suffer as essentially the only organization providing medical care is forced to leave – in a show of solidarity, hundreds take to the streets in the town where this happened in support of MSF.
Blah blah blah, heard it all before, another shitty African crisis. I get tired of reading about it all myself. But heres (hopefully) some food for thought (potentially poor choice of phrase) – In one small town alone that I am supposed to go to, THREE HUNDRED THOUSAND people (that’s everyone in Geelong or Geneva) are sleeping under sticks with a cloth or two thrown over it, with no latrines, running water, very limited food, the worlds media still obsessed with Darfur, etc etc. The clinic the staff left in that camp alone had 90 severely malnourished children in the hospital at that moment, with 800 malnourished children on outpatient treatment, among other patients (left with local staff and food, certainly not abandoned). That’s ONE camp. There are dozens, not to forget towns and cities.
So then the BIG question… how do you quantify risk, and how much risk is too much? If it turns out that this attack was likely to have been a local issue rather than a widespread threat, MSF will go back in the next few weeks. For the volunteers - courage-of-your-convictions humanitarianism, or blind optimism? Where - and how - do you draw the line between the needs of a population in the throes of the biggest evolving humanitarian disaster around, versus the risk you expose yourself to?
Oh, so the cherry on the cake? All the expat staff are stuck in Nairobi, normally a regional oasis of good restaurants, bars and shopping, only now it’s deteriorating around us. We have been confined to the compound for the most part, as riots step up in town. Caught views of the police helicopter in the last few days, which has apparently been firing into crowds during some protests. A photographer staying with us went to see the protests, and had some rather interesting photos (interesting at least that he could push the shutter-release, although perhaps that was just the tremor overwhelming his camera) – of youths with machetes opening a can of whoop-arse on his car.
So in the meantime, whilst 2 countries descend further into chaos around is, we play volleyball and drink bad Kenyan wine to pass the time in our hotel’s compound whilst the bigger cleverer guys try and assess the situation. I am off to the west of Kenya in a couple of days to help in the new camps there, whilst we all wait for the dust to settle – if it ever does – on Somalia.
On the plus side, the thirty or so expats stuck here are a great bunch. European-with-the-token-Aussie Big Brother Season 7. Perhaps even Fantasy Island if we don’t leave soon. (Ed – that’s a joke mum. I would leave if it got to that. You know I would).
January was looking good. Summer in Torquay, a wedding, all to be followed by my long awaited and heavily anticipated next mission with MSF (Doctors Without Borders), this one being a dream job in a nightmare destination… a feeding centre for malnourished children in Somalia (which, contrary to some rather misguided questions from occasional people I have met, is neither a surfing nor holiday destination – jihadi’s excluded). Overwhelming needs in a country I had previously sworn I would never visit; ongoing clan rivalries, a gun-toting culture superimposed on a civil war, and recent viewings of Black Hawk Down playing no small part in that decision.
Then things started to unfold. I got a call from the office in Europe to say I needed to be there sooner. This entailed missing the wedding and messing work around, but hey, I’m no stranger to burning bridges at Aussie hospitals (Eg 1: Geelong. Eg 2: Geelong), and this is one job I did not want to compromise getting. So sure, a few phone calls, a hurried move out of a house and cold sore inducing bout of anxiety-to-get-it-all-done-in-time.
Then the problems began…
On the flight to Europe, in a momentary failure of his brain to function, our pilot… “ladies and gentleman, theres been an, errrrr…, problem at Heathrow; we have extra fuel in case… it’s a runway, and…. Uhhhh… a plane, errr… uhhh, we may not land in London. It’s a, ummmm…. Yuh. I’ll fill you in more later.”
What .??!!! You just alluded to a plane crash as we hurtle towards said runway with extra fuel – ie explosive - on board? Why not just take on dynamite? Perhaps a shoe-bomber next time..?
And a poignant moment for those of us on the verge of a complete panic attack as we approached the runway hours later – in the second (and this time thoroughly more complete) failure of his brain to function – the pilot actually pointed out the wreckage of the plane to our right as we landed! Great!! “So, Damien, what was the last thing that went through your mind as your plane careered into the runway at Heathrow?”
‘Well, I’d have to say I was probably distracted thinking about the last thing that went through the people’s minds in the crash just below us…’
Ensue delays, cancellations and tantrums.
Geneva. I walk in to MSF headquarters. Actually, I strut in. Big grin. I’m back baby! Give it to me, here for my next mission. “Allors, Damn, you are here already! No. We were hoping next week…”. Not the enthusiastic Gallic kiss-on-the-cheek greeting I was hoping for, and certainly not after high-tailing it here. Turns out due to various ‘security’ issues in Somalia, my briefing had been pushed back a week. F@#ken brilliant. Could have made a good friend’s wedding, could have enjoyed summer in Oz. So followed 11 days of inhaling entire colonies of dust mite in a two star hotel (overlooking the sewer that overlooked Lake Geneva), Starbucks, CNN, countless hours at the MSF offices waiting for people, and trying not to spend all of my savings (that weren’t misappropriated by the Aussie Tax Office or my intellectually disabled accountant – who I would like to re-iterate should be the one going to Somalia, not me). The shittiness of the prices surpassed only by the shittiness of the weather, Geneva ain’t no place for a less-than-billionaire to kill time.
Monday evening. Ecstatic, I step off the plane in Nairobi – finally en route to Somalia - with a senior MSF guy. He checks his message bank, then says to me, errr, big problem with Somalia. Drive from airport – inhaling Africa (literally – it was a dirt road), absorbing it again. Awesome to be back. My brothers from another mother. Its good. And that feeling decimated in a second at the guest house. ‘You’d better sit down’. Oh really? Well not a lot of good news starts out like this. I presume its not because you’re intimidated by my overwhelming height and/or woolly mass of hair. What up? I’ll play along. ‘MSF staff were killed in an attack in the south of Somalia this morning’. I understand for possibly the first time the origin of the phrase ‘a chill down your spine’.
The devastating thing is that there are so many devastating things. Volunteer workers dead. That seems a wickedly cruel twist of fate for a person that puts themselves out there. The other expats in that mission scarred for life in ways I cant imagine. And as 100 expat staff are immediately evacuated from all over Somalia, millions of Somalis are the ones left to suffer as essentially the only organization providing medical care is forced to leave – in a show of solidarity, hundreds take to the streets in the town where this happened in support of MSF.
Blah blah blah, heard it all before, another shitty African crisis. I get tired of reading about it all myself. But heres (hopefully) some food for thought (potentially poor choice of phrase) – In one small town alone that I am supposed to go to, THREE HUNDRED THOUSAND people (that’s everyone in Geelong or Geneva) are sleeping under sticks with a cloth or two thrown over it, with no latrines, running water, very limited food, the worlds media still obsessed with Darfur, etc etc. The clinic the staff left in that camp alone had 90 severely malnourished children in the hospital at that moment, with 800 malnourished children on outpatient treatment, among other patients (left with local staff and food, certainly not abandoned). That’s ONE camp. There are dozens, not to forget towns and cities.
So then the BIG question… how do you quantify risk, and how much risk is too much? If it turns out that this attack was likely to have been a local issue rather than a widespread threat, MSF will go back in the next few weeks. For the volunteers - courage-of-your-convictions humanitarianism, or blind optimism? Where - and how - do you draw the line between the needs of a population in the throes of the biggest evolving humanitarian disaster around, versus the risk you expose yourself to?
Oh, so the cherry on the cake? All the expat staff are stuck in Nairobi, normally a regional oasis of good restaurants, bars and shopping, only now it’s deteriorating around us. We have been confined to the compound for the most part, as riots step up in town. Caught views of the police helicopter in the last few days, which has apparently been firing into crowds during some protests. A photographer staying with us went to see the protests, and had some rather interesting photos (interesting at least that he could push the shutter-release, although perhaps that was just the tremor overwhelming his camera) – of youths with machetes opening a can of whoop-arse on his car.
So in the meantime, whilst 2 countries descend further into chaos around is, we play volleyball and drink bad Kenyan wine to pass the time in our hotel’s compound whilst the bigger cleverer guys try and assess the situation. I am off to the west of Kenya in a couple of days to help in the new camps there, whilst we all wait for the dust to settle – if it ever does – on Somalia.
On the plus side, the thirty or so expats stuck here are a great bunch. European-with-the-token-Aussie Big Brother Season 7. Perhaps even Fantasy Island if we don’t leave soon. (Ed – that’s a joke mum. I would leave if it got to that. You know I would).
posted by damien at 12:36 AM
Monday, November 20, 2006
coming home...
All over. Back in the land of hotmail, hot-meals and hot-pants (Actually, I'm in Switzerland where winter fur coats are more the rage).Its been a ridiculous ten days... from emotional goodbyes in Mavinga, goodlucks to a population soon to be left to the devices of their apathetic (and officially third most corrupt on earth) government, witnessing the mayhem of a massive cholera outbreak (and helping the new MSF team as an interpreter for a day - full circle or what?!), to boozy dinner parties and nights in trendy nightlcubs in the Angolan capital with wealthy oil-workers, to the most ridiculous sunburn in history attained lying on a beach in Luanda (resulting now in the raw pink patchwork quilt thats is my back - the type that would make a first-time-English-backpacker-to-Oz very proud), to fondues and strolls along Lake Geneva here in Switzerland, contemplating which of the ten-thousand dollar watches takes my fancy.
If i come home confused, you'll forgive me.Will be back in Oz this weekend. Looking forward to catching up with people. I may talk a lot. Its been a while.
More photos at www.dambro2.blogspot.com. (Yup, thats two internet sites. Looking at a Google takeover bid. All in the pipeline).
posted by damien at 7:11 AM
Links
- More recent photos of mine from Mavinga
- Crisis Tour - Friend's account of work at the clinic
- Mel Thompson's acount of work on the border
Previous Posts
- Sudan pics
- Sudan pics 1
- TB Village
- A day on call in Nasir
- Months of shit food
- Beaten with the olive branch
- Evacuated - medically and literally
- Mozambique pics
- a nutrition survey: reflections on faffing
- Top to bottom: curious kids in rural Moza...
Archives
- February 2006
- March 2006
- April 2006
- May 2006
- June 2006
- July 2006
- August 2006
- September 2006
- October 2006
- November 2006
- February 2008
- March 2008
- April 2008
- May 2008
- June 2008
