A Vaccination for Decay

Malaria season has ramped up in the last few weeks. We went from 7 cases to 27 cases to 64 cases and we're still climbing. With the rains come mosquitoes. It's inevitable. I'd rather Malaria than malnutrition, though. If it's a drought year, then the rain doesn't come to make the crops grow and children starve. At least Malaria can be treated with drugs. Malnutrition takes time to overcome and stunts growth and brain development. Malnutrition is chronic whereas Malaria is acute. It's not without risks. In bigger children, Malaria can get into the brain and turn into cerebral malaria. It's almost always deadly and it progresses quickly. We've lost a lot of children to cerebral malaria in the past few weeks. Some days you ask yourself why you work so hard trying to save hopeless cases. Other days it can feel like too much to bear. But then, your hard work pays off and the kid you thought would never make it is sitting up drinking porridge when you walk into the ICU in the morning. That's when I remember why I do what I do. Seeing the smiles of relief on the parents' faces instead of the hard masks of grief is the biggest reward for us. A few days like that can make months of grim outcomes and poor prognoses not seem so long.
Unfortunately, not all my days are filled with victories over disease and adversity. Most days someone dies here. I get the feeling that many people die in Africa every day. I guess when it comes down to it, many people die everywhere every day. It's just how it is. I've heard a lot of sad stories and I'm sure I'll hear more before my time is up. Yesterday after a particularly sad story unfolded, one of the nurses asked me if I had given the patient a "vaccination for decay" before sending the body to the morgue. I thought that was the strangest thing I had ever heard, but then one of the African doctors explained that due to the oppressive heat in Africa it is common to inject the bodies with formalin or formaldehyde before storing them to keep the stench down. Given my affinity for cold climates, I never would have considered that the morgue didn't have some type of freezer in it. In fact, it's just another room. No special effects included.
I suppose you learn something new every day.

Kentucky Fried Chicken, Baseball, Simpsons, and Apple Pie

 

In a few weeks, I will be the only American here. I used to think that was a good thing and I still do to an extent, but I will really miss having someone who understands those subtle references from American culture. Someone whom I can speak rapid, American, slang English with and someone who will speak it back to me. It's nice, in a way, to not feel so alone in a sea of diversity, but it's also nice, I suppose to dive right in and not cling so dearly to what is familiar and safe.

Sit and Discuss: Week 8

Every Tuesday at 5:30 pm we have a meeting. We have many meetings in Meetings San Frontieres as I like to say, but no meeting is hated as much as the Tuesday medical meeting. It usually runs until at least 7 if not nearly 8. What we can talk about for 2 and a half hours is beyond me. We go around the table and each person talks about their department. What has happened this week. What was difficult. What the admission and discharge statistics were. Any changes or new patterns and plans for next week. Then, as if that weren't enough, because we are a democratic organization built on dramatic French style debate, everyone else goes around the table and discusses the information you have given and even if it is nowhere near their area of expertise, they "take your points, think on them, and then sit and discuss." This can go on for hours. Because like elbows and assholes, everyone also has an opinion.
So to combat boredom, anger, and the distinct possibility of fist fights, one of the doctors devised a plan to make the meetings much more entertaining. Say hello to Bullshit Bingo. Each square has a topic we anticipate will be "discussed" in it and when you get five in a row, stand up and say "BULLSHIT!" It has made things much more fun. I wouldn't say we look forward to the meetings, because really who looks forward to meetings? However, it's a welcome distraction from the painful fact that not only do all twenty of us live and work together, we also come close to killing each other on a daily basis. It goes with the territory. Of course, we'd need to "sit and discuss" which person was most deserving of an untimely end and how they should meet it. You know to continue with the idea of democracy and all. But first, we'd need to have a meeting to plan that meeting.

Aweilization: Week 7

Something happened in the last few days. I think I'm finding my place here. Now that I know I'm staying longer, I've begun to think in those terms. I'm finally feeling comfortable living in Aweil and the hospital feels more like where I work. I can see the need for my work and I understand what I need to do while I'm here. 
Another thing has happened too. I'm thinking about what I want for myself. Thinking about the future. Life after MSF. I'm happy to be staying, because six months is a significant amount of time. Time to think. Time to process all that has happened in the last few years.
I have learned a few things in the time I've spent here so far. I've discovered that there's not much of a life working in field level international aid. Your work is your life. Every day. No sex. No days off. Just work. It's a great learning opportunity, but I'm looking for a little more balance eventually. After a few years of doing it almost non-stop, it's slowly losing its luster.
Don't get me wrong, this has been my dream job for a while now. But that's the thing about dream jobs. They're always amazing and then you do them for a while. It goes with the territory. Like relationships. Like anything I suppose. There is good and bad. There is the dream and then there is the reality. Some realities are a better fit than others.

Maybe this life isn't for me long-term, but this whole career in global health does seem to suit me, so I feel like I owe it to myself to explore it a little longer from this angle. I'm focusing on what I can learn from this and how I can get better as a nurse, as a person. I think there are difficulties in any job and I felt a lot of difficulties a few weeks ago, but my "rest" weekend did give me some perspective. I feel better about what I'm doing and I understand the limitations of humanitarian aid. 

Now, I guess I'm just trying to decide what comes next. Do I keep going to war torn countries to deliver aid? Do I find a home and settle in? How does each choice affect my currently non-existent personal life?
Any choice, I think is a major life decision and not to be taken lightly, but I'm really trying to work out where I'm headed while I'm out here in medical aid purgatory. It's a perfect place to think.

Oy

Now I'm experiencing the same gut wrenching anxiety about what to do with the rest of my life as I did nearly 7 years ago. 
If nursing school cured me of insomnia, this experience has certainly brought it back with a vengeance. Late nights fade nauseatingly into early mornings. I'm grinding my teeth and clenching my jaw when I do sleep. Which leaves me with a mild headache and stomach pain from the lack of sleep. The nausea relieves me of any appetite I might have had. I suppose I've already lost a bit of weight. 
It's all the same. The summer I was 25, I'd just broken up with my serious live-in fiancée and moved into the inner city of Detroit. It was the most exciting time of my life and also pretty pathetic on the life experiences level. I had nothing. I took only my clothes when I moved. I lived in this big old house with three other people and loved every minute of it. 
I just remember lying on the floor (I had no bed) on a sleeping pad next to a fan listening to the low sounds of the horns of cargo ships as they came into the harbor. This experience is pretty parallel to those nights. Except this time I have a cot and a pretty substantial bank account, but a lot is the same. It's hot as balls, there are many night sounds, and I'm still available. 
There's still the deep seated agony over what to do next and sadly, I'm ignoring the fact that I'm supposed to be having the time of my life and instead focusing on the fact that this place feels like a prison. I'm sure it's all part of the adjustment.
At least it can only get better. 
C'est comme ça? C'est la vie.

How to Fight Loneliness: Week 6

So I have a confession. Those of you that know me well already know this: until now, the longest I've been single since high school was maybe 4 months, maybe. Ray moved out December 8th of last year. Things were over long before then. It's a little surprising given my serial monogamy that it's been over 7 months since I was officially single and I haven't found myself in a committed relationship yet. I think for the first time in my life I've actually been avoiding it.
Not that I don't feel some sort of external pressure. I'm nearly 32 and single. Supposedly this is the time in my life where I'm supposed to have it all figured out. Pregnant, married, etc.
Working for MSF is not exactly conducive to meeting and dating. It's an intense environment. I had thought there would be a lot of sex when I joined up, but I'm starting to doubt that. Let me rephrase that, I was told specifically by multiple people that there would be lots of sex. I have yet to hear of this promised sex. There is a lot of sex(ual) tension, but no sex. There's not time and even if there were, it's not wise to shit where you eat. That could cause some serious real tension.
In the past, I based a lot of my decisions about my future on what my boyfriends thought or who I was dating at the time. For once, it's nice to make my own decisions and hear MY  voice. I miss being in a relationship and I really hope I'm not single forever, but taking this time for myself is well worth it. I think I will look back and appreciate it in the long run. At any rate, I doubt I will ever be bitter about doing something so incredible for myself.

"I'm a pilgrim on the edge. On the edge of my perception. We are travelers on the edge. We are always at the edge of our perception."
-Scott Mutter

Bedouin and Breakfast: Week 5

So I'm here in Juba, the capital of South Sudan, for my weekend of "R & R." From the beginning, I didn't want to go. The house is made entirely of tile and echos loudly, the bathrooms are dirty, the beds are uncomfortable, and it's more hot, more humid and all around un-fun there. I think. Until this weekend, my only experience with Juba was a brief stop on my way to Aweil five weeks ago. I was jet lagged and sticky. I went to what felt like too many meetings and finally went to bed about 6 pm only to be wide awake again at 4 am. It wasn't particularly enjoyable and I'm not sure if I can anticipate this weekend to be much better.
So far, my predictions have been accurate. On arrival, we were taken to the office instead of the house. The office has internet so I couldn't complain. But while we were there, someone got into my bag while I was out of the room and stole my local currency and my MSF ID. Great. No money in one of the most expensive cities in the world. Yeah. Surprised? A beer costs nearly $8, a bottle of shampoo is $16, an "inexpensive" dinner out could be nearly $25, and on and on. It's a problem. At least I had stuffed a couple 50 SSP notes in the bottom of my other bag so I have a bit of cash to get me through. I feel like such a rookie though. I have been traveling for years and the one time I let my guard down I get burned. I thought I was safe inside the office. I thought wrong. Well, I hope that they needed it more than I do. I'm pretty sure anyone here does.
After a brief round of feeling sorry for myself, my friends dragged me out to dinner. Thanks to them, I feel better now. Maybe the weekend will be okay after all.
Besides, I need some time and distance to think this weekend. I found out just before I got on the plane that I have been granted an extension from 3 months to 6 months if I want it. Three weeks ago, the answer would have been yes, absolutely! But after the last two weeks, I'm not so sure. It's been unbelievably difficult the last few days especially. Deaths, disputes, politics, hours of pointless meetings. My frustration and exhaustion levels are at an all time high. I need to process all that has happened and consider what I will say carefully. Most of all, I need some sleep.

Lights out.

the Latrine

I've been fielding a lot of questions about the, um, facilities here in Aweil. Well in this case I think a picture is worth at least one thousand words. Fortunately, I can't really impart just how wonderful it is to be squeezed inside the Iraqi prison cell interior trying to pee into a hole full of cockroaches whilst watching a trail of ants crawl up the wall carrying dead bug carcasses. I'm sure it sounds lovely. Don't feel too sorry for me. I did sign up for this experience after all. I keep telling myself it's just like camping. It's just like camping. It's just like camping.

it's....just....like.....camping......

Kawaja

In sub-Saharan African, there are a few terms for white people. The particular term here in South Sudan is Kawaja. So basically everywhere we Kawajas go the people, especially children, point and yell Kawaja at us. "Kawaja, Kawaja, Kawaja." It's not racist, it's just to point out the fact that you look different from them and to announce that you are walking down the street. I liken it what it must be like to be a celebrity. I hear Julia Roberts, Julia Roberts!when they yell.
Then they ask, "How are you? How are you? Where are you going?" And often, also "Give me one pound." If they're really bold they will ask for two pounds. My response is usually to up the ante and ask for more. "No. You give me five pounds. Look I work for MSF and they don't pay me well. I need fifteen pounds." This usually results in laughter.
The funny thing about these interchanges is that they're all completely culturally appropriate. They ask the same questions of each other in their own language. How are you? Where are you going? What is your name? Can I have some money? The Dinka are incredibly friendly people. They like to say hi, shake your hand, and learn your name. They also think if someone they know has money they should give them some.
One of the drivers in Juba was telling me that when he goes home, he gets asked by everyone to buy them a beer. He said it can cost 200-300 SSP (about $100 or nearly a month's pay) to visit his village.
Funny how things work.

Royal Lather: Week 4

They are stealing the soap. I'm not sure who "they" are, but "they" are certainly stealing soap. It's sitting by the sink when I come into the ward and gone when rounds are finished. I don't like it disappearing right under my nose like that. It's like teaching high school sometimes. Nobody is talking, but everybody knows who's doing it.
Why soap? Of all the things in the world that could be considered a commodity, I'd never placed soap among them. Food, yes. Water, yes. Clothing, yes. Ahh. Now I see. You have to have the soap to wash the pots and pans to make the food. And the clothing gets washed with the soap, too. I'm starting to understand. But the hands? Do you wash the hands with the soap? No? Okay. I must have been confused by my first world priorities. I apologize.
Now I see why the soap is disappearing at the beginning of the day. Laundry gets done in the morning so it can hang to dry in the sun. A bar of soap costs about 5 SSP (South Sudanese Pounds) in the market, that's around $1.50 for people who make very little. Our nurses make about $200 a month. Imagine what less educated day laborers make. That's not even considering that most working people have at least a few dependents to support in addition to themselves. That's a lot of soap!
I'm slowly starting to understand things from a different viewpoint. Yes. They are stealing the soap, but I can see why. Actually, I'm surprised that they aren't stealing anything that isn't nailed down. Instead, soap is the prize.
I'm okay with that. As long as they wash their hands, too.