The End

Today is my last day in South Sudan. This afternoon I will get on a plane to Nairobi and fly away, slowly working my way west and home. I can't say I'm not looking forward to being home. HOME. Home in my own country. Where I can speak in rapid English and most people will understand. Home where MY people live. I never thought of myself as much of a nationalist or patriot or American, really. I don't think anyone would accuse me of being any of those things. But, it's true, I have missed home. There really is no place like it. It's nice to travel, but I've learned that it's even nicer to come home. Oh America, I've missed you so much.

Thanks for the memories, South Sudan. I'll never leave your corner as you try to stand on your feet as the world's newest nation, but the time has come for me to go home. 

We can only speak of the things we carried with us and the things we took away.
Barbara Kingsolver, the Poisonwood Bible

Decisions: Week 22

I've spent the last five months here in South Sudan thinking of the future. My future. What I want. Where I want to be. What I'm looking for. They're deep questions. After feeling so confused last fall, it's nice to have some time to reach a sort of clarity.

I know that I want to be somewhere where my career and my mind are advanced. I know that I want to have a home. I'll go even further. I want a place that I call home because it feels like home. I've been roaming too long. And I want to put down roots there. After all this African chaos, I want to buy a house, get a dog, meet a man, plant a garden... You know, something drastic. Although, I think I will start with the garden.

I always thought that I needed to be way out on the edge in order to become a better nurse. That I needed to be working somewhere really tough to get better. The thing is, you learn no matter where you are as long as you push yourself.

There is no perfect environment; no perfect place. It seems that just living is the best classroom and your teacher is the passage of time. Patience. Something I'm not good at. But I'm learning. Working in Africa has taught me that above all you must be patient. Everything moves much, much slower and yelling and shouting only serves to bring things to a complete halt as feelings are mended. Quiet and calm have permeated my time here. I have sought to understand what I can of this culture in the self-centered hope I can help them help themselves. I'm not sure what differences I have made on that front, but from this I will take so much.

Unfortunately, I will never know all there is to know. I can only continue to put myself in challenging situations and hope for the best. The next challenge is to go home and stay still for a while. I'm ready.

"Just keep following the heart lines on your hand."
Florence and the Machine

Spain-yerds

Today I am going north to the MSF - Spain camp. I'll be teaching the staff working in the clinic there how to do a proper newborn resuscitation. But mostly I want to take a look around. They are working in an IDP (internally displaced persons) camp nearer to the border. I've never seen an IDP camp before. I hear that they are absolutely horrible. It's curiosity that draws me in. I want to see how it is. How the people live. What they eat. How they get water. I'm curious and a little worried about what I may see. It can't be pretty.

Happy Howl-o-ween!

It's amazing what you can do with some gauze, flour and ketchup.

Today

The smell of stale urine is overwhelming in the hospital today.

The Fried Dough Diet: Week 21

I'm down to eating almost nothing. Nothing is really the only thing that looks good. I guess tough, wormy meat, moldy flour, and bug filled fruit never really did look or taste good. But 5 months in, it really doesn't look good, I can't speak on the taste lately, because I haven't attempted to try anything that I'm not sure I will be able to choke down. Which brings me to my current situation: eating almost nothing. Luckily my current lifestyle doesn't include much physical activity so I'm not in danger of wasting away any time soon and the daily multivitamins probably ward off rickets, anemia, and scurvy. Not to worry.

Earlier this week, though, there was a fortunate development in the calorie acquisition department: for reasons unknown, eggs became less affordable/available in the market (some details were lost in translation). So, to compensate for the absence of daily fried eggs the cooks usually make in the morning, they decided to make fried doughnut hole things instead. After the initial resistance, everyone seemed to be excited about the change. Soooo, they made them for breakfast AND dinner the next day. And now they're here, albeit badly burned, for breakfast again. I sense I may see more for lunch. Oh boy. Calorie requirements for the day met early. Check.
Previously in order to make my caloric ends meet, I had been reduced to finding some sort of nutrition in whatever I could scrounge from the cupboards and a few departed expat care packages. It's mango season so I subsisted on just those for a few days until we ran out. Then I raided the banana tree behind the laundry. Turns out they were actually very green plantains. Yeech. Other delicious "combinations": Pineapple and mashed potatoes, canned artichoke hearts and jelly beans, and my all time favorite cooking oil and salt mixed together that I then slather on the odorless, tasteless flat bread they sell here. It's okay though. Just two more weeks and I will have the biggest salad ever made in the history of salads.

In the meantime, this is a relatively safe exploration of the realities of food insecurity that many people experience on a daily basis. My neighbors here in South Sudan may never get enough to eat and have probably never eaten a jelly bean. I'd like to dedicate my first salad to them.

Ants sold separately.

Goat ROAST!!!

The Dream Team

The saddest part about leaving soon is having to leave behind my team. They're absolutely amazing. I've never met a group of staff that has had to overcome such adversity. They do it with such a positive attitude every. single. day. Incredible. I will miss them so much.

Polish and Shine

For some reason, young men and boys here like to paint their last two fingers with sparkly nail polish. I don't understand it. When I ask the staff why they do it, no one can give me a straight answer. The women I work with say they don't get it either. Maybe it's some kind of decoration. Men just want to feel pretty, too. All I know is when I'm in the middle of teaching Marko how to properly insert an NG tube and he starts to pick his nose, the shine of the glitter is more than a little distracting while he digs in his sinuses. And we're back to the importance of hand washing....

Smokey the Bear: Week 20

The neighbors are burning their trash....again. This time it's a little too close to my tukal's thatch roof for comfort. There's nothing like a big, roaring bonfire of discarded plastic a mere six feet away from a structure made entirely of mud and grass that contains all the clean underwear and the one spare pair of pants you currently own to unsettle a person. Besides, isn't their house just made of grass? What the heck? Where is the fire marshal when you need him? Oh right. Better move my pants.

Sweeping the dirt: Week 19

Every morning around 7 am, the ladies of Aweil begin to carefully sweep all the trash thrown on the ground into piles to burn later. This mostly makes sense, but it's what happens next that really baffles me. Using homemade brooms of dried sticks tied with string, they then sweep intricate patterns into the dirt while stooped painfully at the waist. They sweep yards, paths, roads all the same. The patterns, of course, are soon destroyed especially on the main roads in town, but they'll be there again tomorrow morning sweeping patterns into the street long before anyone else starts to walk on it.

More Ethiopia

The Adventure continues.... Today we're in Lalibella, an ancient kingdom in Ethiopia famous for ancient monolithic carved churches freed from the bedrock. Incredible.

Ethiopia!: Week 18

Today I woke up in Ethiopia! Pretty cool. I'm finally on holiday. I thought it would never get here. A much needed break from work, drama, and heat. It's 65 degrees and raining in the birthplace of coffee. I'm actually cold. I've already seen more fresh vegetables and bread in the last 12 hours than I have seen in 4 months. It's glorious.

Excuse me, Ma'am. Is that your chicken?

A few days ago a boy came into the hospital after being hit by a car. Other than a busted lip and a broken toe, he was completely fine. BUT lips bleed a lot and as it would happen, so did the toe. He was covered in blood and pretty dazed, but I again, I reiterate, completely fine. I can say without a shadow of a doubt that he would live.

As he had been shopping in the market with his family when the, ahem, incident happened, naturally it drew a crowd. Twenty people followed him into the hospital. He was carried by a stranger with his family and the rest of Aweil close behind. It was hard to figure out who exactly was a relative and who was just along for the ride. Tension was already building.

We get him into triage and onto the exam table to get a better look at the lip and suddenly this lady is next to me having a complete conniption. She's screaming in Dinka and in her hand, upside down, with its legs tied together is a live chicken. Her arms are up in the air and she's waving her hands around going absolutely nuts. We look around for someone to translate. She's screaming a) because she thinks her kid is dead and b) because there's a woman in the room that she doesn't like and she wants her out of there, her husband's other wife. Dinka men almost always have more than one wife and they often don't get along. Can you blame them?

Okay. So we tell her that yes, that looks like a lot of blood and yes, the lady you don't like can go, but no, your kid is not dead. In fact he is also screaming this whole time. In my experience, dead kids don't scream. Not usually. So we get someone to take the chicken and find a quiet place for mother and child until we can suture the lip. American Emergency Rooms look pretty tame from here. 

Man, oh man. And that was all before 10 am.

Tailor Made: Week 17

I would like to introduce one of my favorite people in Aweil: M'Barak, the tailor. He is personally responsible for keeping me in high Congolese style. Aweil doesn't have much for style so we have to look west to Brazzaville in order to keep up with true African fashion.

If neocolonialism weren't already rampant in central Africa with all our cooks, watchmen and drivers, the concept of having your clothes tailor made for you is completely foreign and old fashioned in the Western world. Despite the fact that is not only cheaper than buying Chinese mass manufactured garments in the market and widely accepted as the way most people purchase clothing it still feels a bit strange and extravagant. Well, when in Rome....err Aweil.

Totes Adorbs

Some days the kids are the only thing that keeps me going. It's a good thing they're so cute.

That's Officer Nurse to you.

So my job: Nurse Specialist or Clinical Supervisor or whatever the French want to call it this week is a lot like being chief asshole. Part of my work is following what is written in the patients' charts and the practices of the nurses caring for them and looking for aspects of patient care that could be improved and more importantly to intervene when patient safety could be violated. Which, sadly, is pretty often. Wash your hands! Did you just wear those gloves into the latrine? How much is in that syringe? Are those patients sharing a bed? That one has a rash. Do you want the other one to get the rash, too? Remember what we said last time, of you think the patient has polio, put them in a separate room.
It sucks. It's not fun and most days I don't like being the hand washing police. But it is what it is. I can't in good conscience allow Marko to wear his gloves to and from the latrine and then back to mix up medications. That's just not allowed. I'm sorry, Marko, but I'm going to have to write you a ticket for this one. You can make your case in court.
Maybe I can ask them to change my title?

Saving Money Builds Economic Stability: Week 16

Ok. I've talked about ironic t-shirts. Let's talk about the next level: Ironic messages on t-shirts that were never meant to be ironic.
Various aid organizations often distribute t-shirts to people with messages on them as a way to get a message to a nation without any steady news source. It's usually some sort of development campaign type slogan or public health announcement. Sadly the verbiage is often unwieldy and way beyond the average person's comprehension. Not to mention that the primary targets are usually unable to read English. So, the result is a brand of irony that makes me chuckle and want to cry at the same time.

It's not uncommon to see a shirt that says:
"Washing Hands Saves Lives"
"Nations Who Educate Girls Are Among the Top Economic Performers"
"Sleep Under a Mosquito Net at Night and Reduce Your Malaria Risk"
"Exclusively Breastfeed Your Baby for the First Six Months of Life"
and possibly the saddest one, "Saving Money Builds Economic Stability"

Too sad. Maybe if there was less corruption, girls (and boys) actually could go to school instead of having to work or farm the land for food just to survive, and there were fewer superstitious beliefs at work undermining the propagation of public health agendas then and only then could things really improve as the t-shirts suggest. Until then, my patients will be poor, uneducated, and forced by social mores to consult a sorcerer before they can come to the hospital. I'm okay with it. I'm not trying to force my agenda on anyone. I just want them to wash their hands a little more often. Small changes. 

Mmmm Coffee

Every morning I make a cup of coffee. Which isn't nearly as simple as it sounds. Right now because the stove is broken, it means that I have to use our well worn Italian coffee pot over the coal fire. Usually the cooks make the fire which is helpful and incredibly time saving, but I know how to do it if I have to. The water in the coffee pot takes about 10 minute to come to a boil. After I brave the thick, clearly carcinogenic smoke and potential for disfiguring burns to grab the handle with a piece of newspaper (we have nothing resembling towels or potholders here), I have hot espresso at the start of my day. It's the most amazing luxury that I have taken for granted all these years. Especially living in Portland where for a couple bucks you can get a really amazing cup of coffee MADE for you. Here I expected to go off caffeine cold turkey when faced with the prospect of only drinking Nescafe. This coffee pot has saved my life and my mornings. I think I'm in love.

Star Bar

Some nights, just any other thirty-somethings living in the big city, we go around the corner to have a beer at the local pub. Except our "pub" is a little courtyard fenced in with grass mats and flanked by a small grass hut housing a generator and a deep freezer. It's called the Star Bar because well, being outside, it has a great view of the stars. With only diesel generator fed electricity for the rich and no city power, few people can afford to power outdoor lights, especially those big enough to cause light pollution. The result is that you can see the stars here in Aweil very, very well.
The Star Bar has a pretty decent variety of beers (4) including the most disgusting Chinese made 13.8% alcohol malt beverage they simple refer to as "13" and it's Russian counterpart called "9" for the same reasons. They also offer french fries with the most fluorescent, vinegar flavored version of ketchup I've ever seen, greasy India style chapati bread, and their famous "half pizza" which is neither a pizza nor half of anything. It's a Spanish tortilla and it's pretty good when it's available which isn't often.
 The best part of Star Bar is the entertainment. Other than being owned by one of the hospital employees and getting to chat to his wife and play with his kid, there is also a generator powered TELEVISION!!! On which there is often and Arabic over-dubbed American movie or WWF fight DVD playing LOUDLY. Love it. My culture as interpreted by the Arab world and then in turn sold to developing sub-Saharan African nations. There's nothing like drinking really bad, warm beer and watching Predator on a trinitron surrounded by a crowd of displaced Eritreans and Darfurians.

.

Arts & Crafts: Week 15

So, I'm sure many of you are wondering what to do with your next baby's umbilical cord stump after it falls off. Don't worry. It's a completely normal thing to be concerned about. I'm sure you're not alone. In fact, I know you're not.
Luckily, there's a solution to your problem!!
And even better, it's just a simple Saturday afternoon project. You take the leftover umbilical cord stump that some wasteful people over concerned with hygiene and smell would throw away and you place it gently into an empty and not necessarily clean Coca-Cola or other used soda bottle. Then fill bottle carefully with a handful of pebbles. Screw the cap back on tightly and Voila! You have just made you baby's first rattle. Now the next step is to shake the rattle rhythmically albeit violently and sing loudly anytime the baby is crying especially times when others are sleeping and the baby is crying. This improves the effectiveness of the "rattle."

Heal the World

Every Saturday night we have a party. Unfortunately, lately it's been approaching the level of forced fun. Hey kids, enjoy a fun night of obligatory drunkenness!
I agree that it's good to let off some steam every once in a while, but when you only get one day off a week, you tend to feel more pressure to get completely wasted on your Saturday night. Which, of course, we try very hard to do. Of course.
At any rate, the night always ends with someone putting on USA for Africa's "We are the World." Then as children of the 80's, we stand and sway together belting out the lyrics we know loudly and often slightly slurred. This song permeated many of our childhoods. Oh the irony that we find ourselves here now doing the work that we do. But enough about that, we're not out of beer yet. Keep drinking and singing.

We are the world, we are the children
We are the ones who make a brighter day
So let's start giving
There's a choice we're making
We're saving our own lives
It's true we'll make a better day
Just you and me

Ironic T-shirts

Remember when all the hipsters were obsessed with wearing t-shirts with the ultimate ironic logo or phrase? Even better: Remember that time your local Christian Organization asked you to donate your (gently) used clothing to the starving children of Africa?
Well, it's all here. All those t-shirts you donated in 2005 after you ran that stupid 5k. BUT it's for sale. Yep. What the well intentioned "aid" organizations didn't realize is that someone takes those shirts and then sells them back to the very people who need clothing. Sure it's cheap, but it was supposed to be a donation, asshole. So, as a result, those that can afford shirts without holes have ones that say things such as:

Miller High Life, the Champagne of Beers
This is My Fucking Costume
My Sister is a Witch
Sam Houston High Seniors, Class of 2007
and my all time favorite:
Get Rich or Die Tryin'

Horrible. Absolutely horrible. I'm sorry South Sudan. I wish Americans had better taste in the the t-shirts they choose to donate. And I wish the African aid pipeline was less corrupt and the people who really needed clothes could get them for free.

The Death Flour: Week 14

 

Something died in the flour. I'm sure of it. If I wanted to go carb-free, now is a good time. It's been about 6 weeks since I stopped eating anything containing flour because the taste of death was just getting to be too strong. Every now and then I forget and take a bite of something or other only to be instantly nauseated by the taste of moldy dead mouse or rat. At least I assume that the vomit inducing flavor I'm experiencing is what could only taste like long dead rat or mouse. It has to be, right?

Well at any rate quitting flour-based foods which is nearly everything we eat here in South Sudan has been fabulous for my figure. I'm slimming down, err, wasting away quite quickly and with very little effort on my part. Anywhere else in the world I would have to work for these kinds of results. AND as an added bonus (because I'm really concerned) I'm finally detoxing from all the processed flour and refined sugar I used to eat as a part of my American diet. Atkins diet all the way. Love me some red meat. I hear it's good for you. You know, protein and such. Besides, the skin and bones look is really in right now. Right? Right.

Kuac

I want to tell you about one of my favorite patients. There's a little boy in the ICU that we've been taking care of for two years. His name is Kuac. Like Crotch pronounced with a lisp.
He has pretty pronounced lung disease and is nearly oxygen dependent. He can only go a few hours without it on before he gets breathless and tired. He requires constant medical monitoring, daily medications, and unless South Sudan gets some sort of home health care system and Aweil installs city wide electricity or Kuac's family gets a generator to run his oxygen machine and suction machine, he will never be able to be discharged in good conscience. So with us he remains. He's almost 3 years old and he's spent nearly 2 of those years in Aweil Civil Hospital under the care of MSF nurses and doctors. Before you start to feel sorry for him you should know that he doesn't seem to mind all the attention. Neither do his parents who have 24-7 day care for both him and his 8 year old sister that takes care of him and doesn't seem to go to school ever. They're fed, looked after, and we're even working on potty training Kuac. It doesn't get much better than that in Aweil. He is pretty cute though. Can you blame us for wanting him around all the time?

Spitting and Nose Picking

It's okay to pick your nose in South Sudan. In fact, it's not unusual to be having a conversation with someone WHILE they are picking their nose. It happens at least once a day. A least. They talk to you, pull something out of their nose, look at it, and flick it away. Not in your general direction thank goodness, but nearly. Eeek.
Then there's the spitting. Dinka people spit A LOT. And not whimpy little spits. No, it's a huge wad of flem summoned from the depths of their throat. Inside. Outside. It doesn't matter. We recently moved patients out of our corridor ward into a nice new tent to promote hygiene. The walls of the corridor: covered in spit stains. Absolutely covered from waist height down. Gross.

Halfway Point: Week 13

So I've reached the halfway mark of my 6 month tour in South Sudan. To be honest, it's both exciting and daunting. The first 3 months felt insanely long. I imagine living them over in mirror image and I'm not sure if I can do it again. Endure 3 more months of bad food, horrible smells, and endless frustration? No thank you.
BUT then I think about all the good things that have come from the last 3 months. I've met some amazing people. I've had an impact on their lives and they have made a tremendous impression on mine. I've learned more about Africa than I ever imagined possible (and it's just the tip of the iceberg). I have seen and experienced so much in such a short amount of time. I feel like I have lived several life times in just a few months. The world is a big place and I'm getting a very close view of a small part of it that is so incredibly different from where I come from. It's been unforgettable for sure. So today, I'm looking forward to the next 3 months and all the challenges and opportunity they will bring.

Tired

Today I am tired. Tired of feeling overwhelmed by the sorrow of this place. Tired of people touching me in the market to see if my pale skin will rub off on their dark hands. Tired of the old people, the children, and many other random strangers asking me for money or food on my short walk to and from the hospital. Tired of the whole town seeming to know my name. Tired of being called Kawaja by everyone who doesn't know my name. Tired of being a constant source of entertainment simply because of my differentness. Tired of being teased and harassed by my patients' mothers. Tired of the people I work with in the hospital asking for my possessions. "That's a nice watch. You give it to me. You can get more when you go home." "You give me your phone. You buy new one in the market." My phone isn't even mine. It's MSF's. Tired of finally feeling like things are running smoothly at the end of the day only to discover in horror that there were several deaths in the hospital overnight. Tired of everything I touch being dirty and fighting the constant swarms of bugs that bite or bravely fly directly into my eyes and mouth. Tired of there never being any soap or clean linen for the patients. Tired of eating rice. Tired of peeing into a hole filled with excrement. Tired of doing other things in that hole, too. Tired of feeling misunderstood by everyone. And tired of misunderstandings. Tired of the staff thinking that it's ok for me to work both night and day with no rest and complaining if I am not in the hospital every morning early and if I don't stay all day. I leave for one hour at lunch and everyone wants to know where I went. Am I not allowed to eat? Never mind if they show up late for their scheduled shifts or take a 2 hour lunch. It's exhausting. Tired of being asked to somehow produce an entire library of medical textbooks from somewhere and give a fresh set to everyone who asks. Tired of being asked to be both present in the ward and in the office. Tired of breakouts and bad hair days. Tired of no exercise. Tired of trying to explain to some folks back home that, no, I'm not having the time of my life. Tired of feeling irritated and irritable. Tired of never having any privacy. Tired of being tired of things.

Most of all, just plain tired. I'm tired, but I think I can go a little further.

Rebecca

I want to take today to recognize and remember a really special lady. I didn't know her as well as I would have liked, but I liked what I knew.
Rebecca worked as a TBA (traditional birth assistant) at Aweil Civil Hospital. She worked tirelessly in the maternity department making sure the mothers knew how to take care of their babies and that the babies got a good start in life. She really cared about mommas and babies and the world around her.

Unfortunately, her amazing life was cut short on Thursday night when she succumbed to Tuberculosis. She left behind four devoted sons. She will be missed by many.
Her funeral is today. Godspeed Rebecca. Rest in peace.

Bowling ball in my stomach, Desert in my mouth: Week 12

The last few days, I've been feeling as if I just got dumped. You know, empty and a little disappointed.

I think it's because my whirl wind relationship with NGOs and international aid is slowly coming to an end with this project.

Maybe we've outgrown each other for good or maybe we're just taking a break for a while, but either way, something in the relationship has changed. It's like the first time you realize that Saturday night has become sweat pants and ice cream night instead of a night on the town. Somehow it's all a little less sexy and mysterious than it was when we first started. 

And maybe that's not such a bad thing. 

"Now if you find yourself falling apart...then I'm sure...I could steer the Great Salt Lake."

-Band of Horses

DENG DENG deng: Week 11

Deng is the Dinka word for rain. And let me tell you, we are having one heck of a season. We're in a brutal cycle right now. The rains come, flood the town for a day or maybe two, then they stop, the scorching sun comes out....you know where this is going....dries up all the rain and the itsy-bitsy, no wait! Then when the roads are dry again, it is the hospital that is flooded. All the patients that couldn't come earlier when the rain was pouring down finally make it in. Sicker. It's an overwhelming onslaught of very sick patients coming in droves. Anxious families. Sometimes it's too late.
Then, just like clockwork, the rain comes again and the hospital falls quiet while we wait for the sun.

little things

It’s amazing how much validation the luxury of truly being listened to and heard clearly is. There’s something incredible about being able to speak and have someone understand EXACTLY what you’re saying. I haven’t experienced that feeling in weeks.

The escalating problems in communication came to a head yesterday in the form of what many would call a first world problem. For every three months of toil and strife, a field employee is supposed to receive ten or so days of vacation. They even pay for the flight. Pretty good deal if you ask me. However, the problem came when I and my vacation companion, the Pharmacist, elected to utilize the booking services offered by MSF. Why not, right? We asked the administrator if we could get a quote. The quote came back with a good price, but the wrong dates. We were more specific including dates, times, airport codes and flight numbers. We got a snarky email back saying that yes, they could fix it, but that they were not a travel agency. Wait a minute. Isn’t there a travel agent somewhere booking this? The answer was yes there is. Could we communicate directly with them? The answer was no. ???? So we continued the long drawn out game of travel telephone for a few more days. Somewhere in the colossal mix-up that followed, the administrator told them to go ahead and book the original flight. A mistake he now says is mine entirely because I told him that those flights were ok. Yeah. Right. So now we’re being charged a change fee for a flight we never authorized in the first place. Oy vey.

You’d think blatant starvation and violence against helpless women and children would upset me daily and it of course it does, but this is the last straw. The one thing I actually can control – my holiday – is already messed up. Ugh. Malnutrition, rape and malaria I cannot stop, but getting a flight to the right place I thought was within my reach. I guess nothing, even a restful week off, is certain in this place. 

"What are you changin'? Who do you think you're changin'? You can't change things. We're all stuck in our ways."

-Jenny Lewis and the Watson Twins, Rise Up With Fists