Friday, January 4, 2013

Winding down

My replacement has been named and her arrival date has already been changed, delayed..., so no concrete date,as yet as to then I will be leaving. Am of mixed minds and feelings...I know I will miss this place, mostly the people and just the uniqueness, but I know I am tired. The heat is coming on with a vengence, over 100 daily (saving grace, cools down at night, nice early mornings) and will just get hotter. Energy sapping heat, no real escape, other than shade...I sweat constantly..even thinking, not kidding.

Saturday, January 14, 2012

A day in my life

I am awake around 6...the night has again been busy, with vivid dreams. It is cool, almost cold, but I don't add another layer, just wear the same combination of clothes, I have been wearing for months, a T-shirt and scub pants. Brush my teeth at the outdoor sink facing the lightening sky to the East, overlooking the Dura river. Daily the level is dropping. I can see the vague outline of a woman who has come to get water. No other activity right now, but later today the river will be teeming with children swimming and playing, people bathing, washing clothes and fishing. It is still passable by cargo boat, but only just barely. We have moved our boats down to Otum, the confluence with the Baro and if we need to transfer a patient to Nasir we will drive them to Otum.
I head to the kitchen, to start the hot water for tea and coffee, open the offices, and then go to the Health Center to open up the locked rooms. It is a short walk to the HC, passing mostly quiet tukals, with sleeping dogs curled up in the ashes of last nights fires. Cattle are tethered to their sticks in the ground, and there is a young boy spreading cow dung on the ground to dry. I enter the compound, greet the guard and make a quick walk through all the wards, and check in with the oncoming nurses, restocking any medication they might need. Back to our compound for tea and our early morning meeting. A roundtable of brief plans for the day by the members of the team. A mix, British, French, Nigerian, Rwandan and American A good mix a good team.
Then back to the HC at 8 am to make sure all the staff has arrived and the clinic has started registering and seeing the morning patients. The staff are all so polite, greeting me with enthusiasm and always a handshake, a nice way to start the day.I work closely with the nurse supervisor who positions the staff. The roster has been made up for the entire month, so most people know what they should be doing, and most are but there are often last minute alterations to be made, people are sick or they just don't show up. Mystifying in one sense, but I am used to it by now and so we are pretty good at juggling staff. The clinic sees 150-250 people a day and we work 6 days a week. Mondays and Friday are busiest,and right now the majority of the patients coming have malaria. The numbers have been increasing week after week. Making sure we have adequate supplies to deal with this is one of my jobs.
My days vary, meetings, security issues,staff issues...requests for leave, or sick, or complaining, or diciplinary actions, patient referals to Gambella or Nasir, reports, pharmacy orders, stuff like that. These fill my days in varying degrees. We work till noon then a two hour break, resuming at 2pm to continue until 6pm. By now the heat is oppressive, like being stuck in a room right in front of heater on full blast, no escape. I lock up at 6pm and head to take a long awaited shower, passing the families gathering around their outdoor fires. Dinner follows, prepared by our cook, predictably, pasta and sauce, tomato salad, lentils, fried potatoes, sometimes a meat dish and if lucky a fruit salad (bananas,papaya). Usually we watch some TV (satellite dish of course). We don't have internet or cell phone access but we can watch Master Chef and The Doctors...go figure.
Still hot and now the bugs are out. Not something I can explain, just how significant the bugs are, attracted by the clouds. They find their way into my hair, on my face, down my shirt,up my pants...truly disturbing. If they are too bad I just go to my room to read, encased in my mostquito netted bed. Brushing my teeth at the sink, I try not to dodge the bats that swoop around my head, and watch the lightening bug show in the darkened sky. I usually am able to fall asleep once it starts to cool down around 11pm.
It doesn't sound very exciting....and it isn't...but it is unique, interesting and challenging and we do good and important work. It feels right.

Wednesday, November 16, 2011


I still am in awe. Such a feat of human (and apparently divine intervention) ingenuity and just shear physical effort to say nothing of technical skill, proportion and decoration as well as remarkable variety in style. I found myself wondering over and over did they do that? There are 11 churches carved from rock....and not one of them is small. The largest being 40 ft tall. Most have several rooms supported by pillars that were also carved. Many have frescos and each has a priest, guarding it day and night. According to our guide, Bihran,they were built (is that the right word?...carved, chiseled?) over a 23 year period by request of King Lalibela, although there is some debate as to that being fact...but essentially starting around 1100. Also according to Bihran, when the workman clocked out at the end of the day, angels took over at night.....something, after seeing these churches, I don't have any problem believing...really wonderful. What also was wonderful is that the first night I witnessed a ceremony celebrating King Lalibela's birthday.....white robed priests chanting (in Ge'ez-the Afro-Asiatic language that laid the foundation for the modern Amharic, as Latin did for Italian's), swaying to beating drums. The next morning we also witnessed a similar "service" glorifying Mary, and the replicas of the Ark of the Covenant were included. This area, as is much of Ethiopia, is steeped in history that is still very much alive today.
In a few days I head back to Nuerland, which s a world unto itself and so very different. The Nuer essentially never made it into the stone age, nor the iron age, (until relatively recently....late1800's, early 1900's) mainly because Nuerland lacks the two raw materials, stones and iron, that played so important part in the manufacture of primitive tools. Instead they overcame the natural poverty of their environment, by using plants and animals to furnish technological(if one can call them that) necessities. The contrast is stark and it makes me marvel even more at being human.
None of the Ethiopians I have spoken to in Addis have heard of Mattar and when I explain it is in Gambella state, on the Sudan border, they then all nod and say....oh....but that is very hot. Yep.
No internet, no cell phone service and now no ability to even send emails via the very expensive satellite phone. But...we can receive emails at So until 6 weeks or so....ciao.

Thursday, November 10, 2011

The contrast

I'm cold. I haven't been cold in months, at least not this's pleasant. I'm not sweating. I'm in Addis, the capital city, and compared to Mattar, chaos rules here. I am on my 3 month break from work and I got a massage yesterday and will get another one today....she said, "I am doing this place (my shoulders and neck) hard because it is very thick" .....I think she meant tight...and yeah.
Tomorrow I go to Lalibela, where there are churches carved out of stone. Apparently about 1000 years ago a man who was poisoned was taken to, not one but three (who knew?) heavens by angels and shown a city of rock hewn churches. He was then instructed by God to return to earth and duplicate what he had seen...building a new Jerusalem. This vision of heaven still exists today, however, someone cut out the pages of the guidebook description, so I am going to see for myself.

The boat ride and drive to Gambella from Mattar took 5 hours....we hit a huge rainstorm, thunder and lightening and torrential rain. The road turned into a river....literally and quite impressive. But the boat ride and the drive are the best. That area is teeming with so many birds, pelicans, egrets,storks,herons,hawks, eagles,doves,bee-eaters....aaannnddd we saw baboons, monkeys, some kind of antelope and a serval cat. then a two day drive from Gambella to Addis along zigzag roads through eucalyptus forests, across open high valleys blanketed with soft,waving fields of teff...the grain used to make injera (traditional and delicious) huge flat spongy bread, a staple in Ethiopians diet.
The trip could have easily been made in one day but for the fact that vehicles are not the only occupants of the roadways.....people...walking, standing visiting, sitting, with little regard for traffic, horse drawn carts, sheep,goats,donkeys, cattle, dogs, all view the road as theirs.
Addis is a mass of cars, minibuses,trucks, with people everywhere. With the road washed out to Mattar, we have one of the few vehicles, but on any given day there, there might be 10 total.
Right now I am heading out to go shopping for a pair of pants. I only brought three and one pair is scrubs, which I wear every day working and refuse to wear while on break. Next mission I will disregard the "advice" given by an "experienced" MSF person who said they only brought one pair of scrubs and three T-shirts on their mission. I thought I was being extravagant bring 4 T-shirts and 3pairs of pants! Thankfully I didn't pay any attention to the number of underwear they suggested:)

Hopefully I will be able to figure out how to post pictures....soon.

Saturday, October 8, 2011

Maaley from Mattar

Greetings from Mattar, Ethiopia...I've been here two months, with another 4 to go. I went to France to study French and on my return passed through the MSF New York office and was offered a 6 month mission here in Mattar (English speaking mission...oh well). Remote, hot, humid, managing a health center that is a clinic/hospital (25 beds) serving the Nuer popultion in South Western Ethiopia, just a few kms from the Sudan border. Access is 3-4 hours by car, or right now (the rainy season, the road is washed out in a few places) by a 5-6 hour boat ride....which is what I just did in order to take my 2 day break in the nearest town, Gambella, where our support log is based and where there is internet and cell phone coverage...neither available in Mattar. I work with a great team, mix of French, Nigerian, Rwandan,British, and American, We work 6 days a week, hard work, never boring, and I think we do good work. the Nuer people are pastoralists, big cattle herds, very friendly, very tall, very skinny and very tough. Life is pretty basic for them. We see about 2000 people a month at the health center,lots of malaria right now and repiratory problems...due to the rains. I am seeing a few things I have never seen before, like tetanus (most die), kala zar (he lived) but not much else that is new.
The heat was the first thing I noticed, oppresive, I was and still am a sweat ball most of the time. The first two weeks were the hardest, and now after two months I sometimes sleep with a blanket...who knew? It's the rainy season and the rain is significant. It turns the earth into tar-like mud, washing out the road access, so now travel out of Mattar is by river only. The river is beautiful and tempting, but we don't swim in it even tho the Nuer people do...we aren't allowed, crocs, which until I made the boat trip, I was doubting, but after actually see 3 on the banks, I am now a believer.
My job is managing the person I work with likened it to herding cats....amazingly accurate description and I love cats, but dumbfounding none the less.
When I first arrived I wasn't impressed...but I thought...I can do this for 6 months, I can do anything for 6 months...but now, it has grown on me. I feel useful, which for me is important. I have no illusions about making a significant difference, but a small ripple is enough and OK.
I'm impressed with MSF and honored to be here.
Will post pictures when I can...

Friday, December 10, 2010

Heart of Darkness

This post for some, will be difficult to read, so please be forwarned. I wrote this while in Hinche at a cholera treatment center. It is not pretty...but perhaps it will give an accurate picture of what this disease is like.

Cholera is a very dark hell. Not like anything I have ever seen or could have imagined. The urgency to perform is so damn constant, there is barely a moment to breathe…it is just work and sleep and sometimes eat.

Hydrating them is the key, they come in often close to death and look like they are dead except that they are puking and shitting volumes. IVs are a major challenge to start and keep going and patent. Their clotting factors must be way off, have to constantly fiddle with the IVs, often restart them and they have no veins, their bodies are shutting down and they are as cold as ice. Then getting and keeping them drinking the oral rehydration solution, even though they just vomit it back up. And keeping them clean…oh the inhumanity. There is no dignity involved in this disease other than the compassion that we feel, and them saying an occasional quiet merci, or just making eye contact…but mostly they are too sick to really care.

Most of our patients are on cots that are soaked with liquid cholera (looks like rice water…sortof…it’s the lining of their intestines ) and bleach, with a bucket alongside to use if they can. We try to keep a plastic barrier between them and the cot…yeah, not entirely successful. Some are on the wooden cholera beds… plastic covered benches with holes cut in them, the bucket underneath. The smell of cholera really isn't that bad...kind of sweet and slightly fishy, weird, I was expecting worse. I think the sound of people shitting leaves more of an impression, it sounds like a faucet had been turned on full force. They can fill half a bucket in one sitting. And yes we do use buckets. Rather an efficient method and the only one that makes sense. Cholera is a very practical disease, so simple to treat....but it is a full on battle. There is so much ignorance and suspicion surrounding it. The lack of education amongst the people in regards to the disease is resulting in thousands of people dying when it’s completely preventable. Severe diarrhea is prevalent here anyway, so when people get the symptoms of cholera they don’t react much differently because Haiti hasn't seen a disease like this in over 50 years. Cholera is 100% treatable as long as you get to the hospital in time. Unfortunately, people wait too long to bring their loved ones to the hospital, and once they arrive it’s too late, or they just don’t have the means to transport them, and they don’t make it to the hospital at all. Also public transportation, tap-taps or motorcycles are beginning to refuse to transport people with cholera.
Another level of frustration and quite honestly sadness, is the incredibly low skill level of the Haitian nurses and their is mindboggling. They refuse to clean the patients, or to give them ORS...and I mean flat out refuse and often let the IVs run dry...which often resultes in the IVs clotting off....which then takes a major effort to save the site, or having to start a new one. They even go so far as to shut them off, and hide the clamp under whatever is covering the patient. So, if when making a quick check we saw a full or partial bottle of LR we would think it was good for the time being. We learned that trick early on and learned to look for the drip. No drip, find and check the clamp. I eventually have just detached myself from those nurses and worked around them. And fortunately there are some that really shine, are so smart and so dedicated. But I know that if we weren't here, many many many more people would question. Pretty much everyone is naked because they have soiled their clothes and those have been burned. We cover them with whatever we have, mostly plastic surgical gowns…and at night they are freezing. We used to diaper most patients when they first came in because they are too weak to use the buckets, yes adults …but we have run out of those, so you guessed it…naked…what I would give for a Pamper.

We wear the plastic gowns as barriers… and gloves…at all times, I probably change my gloves at least 50-60 times in a shift. I also wash my hands and arms often with the ever present bleach solution.. and do not get my hands near my face....for any reason. I wear rubber boots several sizes too big…and even though it is the middle of the night…I am dripping with sweat. Hard not to touch people skin to skin, but I just don’t. We try to clean people with baby wipes, but I’m not sure there are enough of those on this planet for this disease….we always run out. The smell is…well, it is distinct and am sure I will recognize it anywhere…right now I am used to it and it is what it is and I don’t think about it. I actually don’t think about much except checking IVs, keeping them going, keeping people drinking, keeping them clean, and then hydrate…checking IVs, drinking, clean,…..hydrate….IVs, drinking, clean….simple, simple, simple yet exhausting…BUT when I see someone go from death to life in a matter of, sometimes, hours…it is all good and for a moment I remember that life really is beautiful….and I take a breath and….hydrate…..IVs, drinking, clean……
I am falling asleep as I write this, hitting wrong keys, but not really caring. head nodding…slight drool coming out of the corner of my mouth but by now I am so conditioned not to touch my mouth that it takes me a moment, while I try to figure out what to do about it. Finally I turn my head and wipe my mouth on my shoulder…on the inside of my shirt.

There are images:…locked in my brain, I suspect, forever…
The cleaning person moping the cot and the patient’s butt with the mop used on the floor (!!!….so wrong)
The woman walking around the camp fully dressed with her IV bottle on her head ( tubing attached and inserted into her left hand).
The old man sitting on the commode chair all night outside Tent 2 (wearing only the plastic gown) because, when he got up off his cot to walk outside, it was immediately filled with another (sicker) patient.
The perfectly formed tiny fetus between the woman’s legs I found when I was checking to see if she had soiled herself.
The old woman I talked with(well, that’s being generous…me:ca va? Her:ca va bien,me: pas vomit?..her: pas vomit…me: dyrea? Her: wi deux fois…) as I restarted her IV just a few hours before, only to find her cold and stiff and looking very peaceful and very dead.

The news of cholera spreading rapidly in Haiti is the worst possible. I don’t want to leave

I am praying that MSF sends me back to Haiti.

Sunday, October 17, 2010


I don’t look at her or get too close because I will make her cry. She already feels awful and I don’t want to make things worse. She is suffering from malnutrition,such skinny skinny arms and legs, with a huge taunt belly...which is complicated by the fact that she has diarrhea, worms, maybe malaria, maybe Tb, maybe is HIV positive….maybe maybe maybe…we will do the tests, we will treat and we will start her on the milk formulas F-75, then to F-100 and then to plumpy nut (ready to eat mix of fortified peanut nut butter), hoping we got her soon enough…all the while giving her deworming medicine and as prophylaxis a broad spectrum antibiotic…and once she starts feeling better….we will be friends and she will smile and play with me, let me hold her…. but right now, day one, I’m too scary and she is too sick.

I hate to make them cry but it is inevitable and rare that I don’t….on day one….or two or three…but it is also rare that I don’t fall over and over again in love. Who knew? Certainly not me…I would have been the last to have predicted such an incredible pull on my heart for malnourished babies and children. I was never much for working in the Pediatric wards in the States. I love my kids to pieces, but other people’s? and sick ones at that?…not for me. But here, in the malnutrition ward in Kigutu, Burundi, I am like a moth to a flame…who knew?

She is sitting on my lap and I start the Village Health Works Waka Waka video and she starts singing along, this little voice...filled with such joy! Her face is lit and I am in awe. They are all special but this one has me wrapped around her little finger. She is so smart, so independent, an old soul with such a fighting spirit.
I tell Crystal all about her and she asks…”Mom, are you going to adopt her?” That is apparently how transparent I am. I do hesitate, I do imagine and then say, ”No, no I’m not.”

I will be leaving soon, far too soon, not enough time…which as I knew even before I came, that it would not be enough…but all that I can do is be present and enjoy the moments, the precious moments as they unfold.