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

BOOBS!

I realized the other morning that I grab my boobs A LOT. In a given day, I'd say probably ten or more times. But before you think I'm a weirdo, let me explain:
I spend the majority of my time checking on the low birth weight or septic babies. How are they doing? How can we help them survive and thrive? And - most importantly: How are they breastfeeding? In a world where malnutrition is a serious source of mortality in children under 5, breast feeding well shortly after birth is the only way to guarantee any chance of survival for infants. I have to assess and help quickly if the baby is to stay alive.
This is where the boob grabbing comes into play. "Ok. Good momma. Can you please show me (grabs breast) how you feed your baby?" I obviously don't speak the same language as the vast majority of the mothers and I cannot always get a translator to help me with my rounds. So I resort to the universal language of grunts and hand gestures. Grabbing my own breast and holding it like I'm about to feed a baby seems to be the best way to communicate my questions to the mother. It definitely seems to get the point across. If that doesn't work, I have been known in the appropriate context to reach into the mother's blouse, remove her breast, and put the nipple in the baby's mouth. Only in extreme circumstances, of course. Usually they get it right away. When they complain of not having enough milk, I often give their breasts a squeeze to express the milk and show them it's there. In this culture, breasts are completely utilitarian and not considered sexual objects. Women often are topless as is the norm in the villages and out in the bush. It's not unusual for me to walk into the ward and see all the mothers shirtless. Breasts serve one purpose - feeding babies. My job: make sure those breasts are doing their job.
I never thought in a million years, I would become a sort of African lactation consultant, but that is one of my many roles here. Honestly, it's not as bad as I thought it would be. I just hope no one snaps a picture of me pantomiming feeding a baby with my boob in my hand. It would look a little strange.

How many cows?

Today the mothers in the ICU told me that they want me to get married to a Dinka man while I am here so I will never leave them. I'm feeling quite flattered at the moment.

Culture Club

Today Santino called me Kawaja in rounds. I explained to him that Kawajas don't like being called Kawaja. He explained how during the war, Kawajas came from MSF and other NGOs and saved the people and that Kawaja is a term of endearment for the help the Kawajas gave when the people had no homes or food or living relatives and all hope was lost. Wow. I feel bad.

Small Town Charm: Week 10

Today I cut through the market on my way to lunch. I like to take the long way through the market on my way back to base whenever I have the time. I've always felt that the market is where a town feels most alive. Aweil's market is no exception. It's a vibrant, loud, stinky, maze of open air stalls and shops selling all manner of Chinese made imported goods, whole goats, chickens, and local produce. My favorites are the places that sell music in the form of MP3s you can get on CD, thumb drive, or put on your phone (the most popular option). They blare these loud low-fi recordings of synthetic steel drums and a man singing in falsetto very far away. Maura says he sounds like he's going through puberty in a tin can. She's right. The idea is to advertise their homogeneous cataloge to passersby. If you hear a song you like, you give them your phone and they put the song on it. Then you can blare the song at passersby too!
There are the stinky dried fish stalls selling thin strips of dried something or other covered in flies. I can't even imagine how far it's traveled to get to the table it's sitting on now.
There are stacks of every kind of fruit and vegetable grown in the area. Potatoes, tomatoes, eggplant, peppers, carrots, lemons, greens. It's a beautiful sight when the displays are first set out in the morning. Pyramids of apples and designs made with different colors and types of peppers.
There's the nuts and spices area, thick with Arab style tea huts selling little glass cups of tea with a half inch or more of sugar in the bottom. At any time, there always seem to be enough men to fill every chair in these little houses or roped off areas. I wonder when they work.
I also love the crowds of guys that work in the plastic flip flop section of the market. Some are working, some are just there to hang out with their friends. They sit around in plastic chairs and yell really bad rap lyrics at you when you walk by. "How the hell are you, baby? Are you thinkin' what I'm thinkin'? Wasssap tonight baby?" Makes me feel so captivating. 
The best part about living in such a small town is the opportunity to see people you work with outside of work. I saw five different people than I knew just walking through the market. It's always a warm Dinka hello here for anyone you know and often for people you don't. There's a lot of handshaking, baby kissing, and small talk. I feel like I'm running for office.
After lunch, I spent almost an hour sitting in the Maternity department talking to Grace about Uganda, where she's from, and listening to Ugandan gospel music. It's so rare in my regular life that I take any time to be still and just enjoy the world around me. It's nice to remember to slow down once in a while.

Corrections & Retractions

I hope that last post wasn't too much. I think when people read what you write out of context, it can cause some concern for your well being if it is particularly intense. However, I feel remarkably stable. Really, I do! In my psychological evaluation before departure, the lady said I was incredibly emotionally mature. See. I'm completely fine. No trouble here. I think in the typical day, my emotions rise and fall much more severely than they would in my real life. That's right. I'm only having fake life emotions right now.
But seriously, I feel like there's quite a bit of catharsis in writing things down. Especially when you're upset or mulling something over. Often I need to talk or write about my frustrations in order to properly process them. The last post definitely helped me evaluate how I was feeling about things and settle myself. Process complete.
I am still upset about the way some things are going. SOME things. That being said, a lot of things are going well and I'm fairly certain the frustrations I am having with this organization will persist throughout my assignment all the way until I leave the New York office in December. Fairly certain. Some things cannot be helped.
For now, I will, like all good recovering alcoholics: "accept the things I cannot change, have the courage to change the things I can, and look for the wisdom to know the difference."

Waiting on the World to Change

 
 
It never occurred to me that the difficulties I would face working here would be primarily organizational and professional. Maybe that was short sighted. I thought that I would see horrible tragedies and hear sad stories. I thought the number of deaths would be overwhelming. That I would struggle with the sadness of it all. Maybe fight with the expats over typical roommate type things. But it never occurred to me that the main irritation would come from disagreements over medical management by expats. Or that I would become so frustrated at times that I could not even find the words to express the emotions. That my anger at decisions in patient care made by my colleagues would be so extreme that it would keep me up at night, take away my appetite, and cause me to storm out of the ward in a blind rage.
I'd like to think that am a rational human being. Usually (usually) calm and collected even in the midst of chaos. But here, I am a bitch. Hot headed, hard to handle, straight up BITCH. I'm a Rottweiler. I know that in this life we must pick the battles we fight, but lately I cannot seem to let the things that are happening go. In the past 6 weeks, I have worked with a new doctor about every 2 weeks. Someone rotates in, then someone else follows after and then repeat. Enough already! I'm tired of learning a new style of patient management and training the new one on the protocols only to have them change a few days after we get comfortable. It compromises patient care by destroying any continuity of patient management and not mention is a pain for all the staff, not just me.
I'm very protective of my patients and the national staff. I am vigilant in shielding them from situations that might compromise them in any way. And I am certainly not a fan of anyone practicing developing world experimental medicine. Just because someone has less money or fewer resources than you doesn't mean that you can take advantage of that by providing substandard medical care. You'll find that nurses everywhere are generally are united in this school of thought. Equal care for everybody. But others tend to be a little more opportunistic when it comes to the weak and the voiceless. This is where I get all riled up. Operating without anesthesia, touching a patient without asking first, and walking into my ward without washing your hands means automatic trouble from me. And if you don't know how to do something, ask for help don't try to figure it out. I'm serious. Watch out world. I'm on to you.
My friend Wendy says the universe is trying to teach you a lesson when the same situation keeps getting thrown in your face. I'm wondering what I'm supposed to be learning, because this is the sixth week of general daily bullshit. I'd really like to move on to the next lesson.
Maybe I'm meant to find a way to calm myself. Be more Zen. Don't I already do enough yoga? Maybe if no one was getting hurt I would calm down. But not just yet. I've got a few more battles in me.

I know I can't change the world, but I can't wait on things to change either. 

Under African Skies: Week 9

The sky here is amazing. It's hard to believe how much it changes from moment to moment. It's so wide and big. One moment it's sunny and the clouds are fluffy and white, then the wind blows in a terrible storm with big, black clouds and lightening striking everywhere. It looks a bit like west Texas out here. Big skies all around, flat as the surface of the moon, and when the storms blow in, it rains so hard it comes down sideways. But the sunsets after a storm are incredible. And the stars, the stars make it all worthwhile.