Amy's Adventures in Darfur

I started this blog when I left for Darfur in June 2006. I was working as a midwife with MSF aka "Medecins Sans Frontiers" aka "Doctors without Borders" but this blog contains my own opinions and stories- not those of MSF. It is less political than I want it to be and I have been unable to post stories about certain topics due to the fact that this is on the internet and accessible to anyone. I wish I could tell you all of the stories but since I can't, I will tell you the ones that I can...

Friday, July 28, 2006


there is a more recent letter from Amy, but due to the risks involved to the key players I cannot post it on her blog. If you know her personally and would like to read it you can e-mail me (her mother) at and I'll send it to you. ps please pray for her safety

Thursday, July 27, 2006


the wings that we found all over the floor the next morning

hey all, just to let you know so you don't worry, the radio silence may continue for awhile. a number of factors are at play. the first one is that i just honestly don't know where to even begin. it seems like every other day we face some strange new crisis, many of them life or death situations (not for us- for our staff, our patients, etc). i get overwhelmed and don't bother writing because i can't tell it all. also, i have had very limited access to the computer lately (the guy who works on it is on it ALL the time). the only time i can get on is at night, which isn't going to happen for the next 18 days or so. we're in the midst of the most disgusting phenomena EVER. there is a huge flying ant-like thing that is going through some crazy life-cycle stage right now and at night the air is so thick with them that there is nowhere to go but into your mosquito net (and far away from any light source, like the computer). you honestly can't fathom how many of them there are, so i had to get out from the safety of my net to take a video and pictures to prove it. in the morning the ground is COVERED in huge wings (on our dishes, in our food, carpeting the entire floor inside as they come in towards the light) and dead wingless insects. this morning i poured myself a bowl of cornflakes and wings. then i decided that i actually wasn't that hungry. they say it only lasts 20 days and they'd better not be joking. last night i turned to gustavo and said "sorry but i'm leaving tomorrow". he says "are you serious?". i say "no, but i wish i was". then, to top it off, i was planning to write today, to get back into the rhythm, and our generator died. this means that we can only use our small one that can only run for 3 hours at a time and then has to rest for several hours. so now, the only time i have to write, the battery is running out and i have about 2 minutes left. adios.

Friday, July 21, 2006


yup, i had my first bout of bloody diarrhea yesterday. such a nice way to start your day really. i went to find carmenza and told her that i didn't want to take cipro because it makes me nauseous. she prescribes me an injection a day of an antibiotic for four days, which is fine with me. as we're walking to the pharmacy she says "do you want us to give it to you intravenously?". i say no, injections are fine. she says "are you sure? we can just put a cannula in and you can keep it in for the four days". i say that sounds a bit drastic, i'll just take the four injections. she says "are you SURE? it's really painful". i'm thinking that she thinks injections are painful (because she's clearly not as hardcore as me) and that she's sparing me 3 injections if they put in one i.v. cannula, so i say no, it's fine, injections don't bother me. milena and i go into the dressing room and she tells me she wants to put it in my thigh. i say i'd prefer it in my upper arm. carmenza says to put it in my butt, which i flat out refuse. we compromise on thigh. now i have to take my jeans down, which is more than i bargained for (not doing a lot of shaving these days), so carmenza guards the door. milena puts the needle in and all of a sudden she injects me with LIQUID FIRE. i was in so much pain i could barely swear. she kept injecting and i kept writhing on the table, biting my hand, covering my face, cursing her mother, trying to stay still enough that she wouldn't break the needle off in my leg. she apologized profusely, but the only thing i wanted from her was for her to stop injecting lava into my thigh. holy shiite. afterwards i had to lie there for a few minutes to get my breath. as i limped out of the room carmenza says "i told you it was painful". i tell her to shut up.
tonight i agree to getting the antibiotic intravenously so milena decides to just inject it straight into my vein, rather than putting in a cannula. i'm definitely nervous after yesterday, and for good reason apparently. she starts to inject and i immediately start to try to get away from her and her syringe of torture. she's telling me to stay still and i'm telling her to get it the hell out of my arm because it burns like acid. she takes it out and i do lamaze breathing for a few minutes. finally she puts a cannula in my wrist and injects it into that. it burns but not nearly as badly, so i sit and accept it as gustavo takes pictures of the look on my face (it was not a happy look). i tell them that next time i have dysentery i'm not telling them, i'm just going home.
yay africa.

note: about two months after this story happened, carmenza figured out why the injection is SO painful. we were dissolving the powdered antibiotic in a small amount of sterile water and injecting it. what we should have been dissolving it in is a liquid that contains an anaesthetic that numbs the site as you inject it. our other option would have been to dissolve the antibiotic in 1-2 litres of water before injecting it. good to know :)

Wednesday, July 19, 2006

natural "healers"

you may need to click on the picture of the baby to enlarge it in order to see the scars on his abdomen

this girl was burned with a cow's horn to cure her kidney infection

every sunday and tuesday from 3 till 4pm i train my nine tba's. we sit under the shelter in the waiting area and drink chai and i teach them about whatever topic seems relevant at the time. often the topic is chosen for me by my witnessing a practice that i want to talk more about. today's topic was one that has been a long time in the coming.... i wanted to talk about the extremely disturbing practices that i've seen employed in the name of tradition and natural healing.
the other day i had a patient come in complaining of fever and severe flank pain. she had the signs of a urinary tract infection and i suspected a kidney infection as well. i asked her to lift her shirt so i could determine the location of the pain. she lifted up her shirt and i gasped. "what HAPPENED?" i ask joyce. the entire area of skin around the kidney, front and back, is covered with large circular burns, each full of numerous blisters. some of them are necrotic. joyce explains that the natural healer had taken a bulls horn, had sanded the blunt end, had placed it in the fire and had used it to burn the girl. "what??? why???". to heal her, of course. i prescribe her a round of antibiotics and tell joyce to make sure that the girl knows that it is the medicine that is going to get rid of her pain, not the burns. and that was just the intro. the next patient i see who has experienced natural healing is a 40 day old baby whose mother died in childbirth. his grandmother brought him in as he was severely dehydrated after a prolonged bout with diarrhoea (thanks to bottle feeding). his entire stomach is covered in vertical scars where they cut him with a razor from below his nipples to below his bellybutton. again i ask why. "to get rid of the bad blood". "what bad blood?" "the bad blood that is making him sick". then there was the 2 year old diabetic whose parents circumcised her in order to "heal" her, and ended up killing her. then there was the little girl who had a bad cough who had her uvula cut out without anaesthesia and died. then our driver came to me and told me that his infant daughter was crying too much at night and his wife wanted to take her to be cut. i asked him to bring the baby in and we discovered that they weren't burping her and she was having gas pain. hind tells me about a man who broke his arm. he had it casted at the hospital, then went to a natural healer. the healer removed the cast, shredded his arm and packed it with wet mud. i ask hind if it worked and she says "i don't know. he is died now". today a child who had been transferred to the SFC was moved back to the TFC as her mother wasn't giving her the food and it was also discovered that she had been circumcised. i ask my staff what they think of natural healing and they're pretty divided. the "city" women think it's ridiculous, but the village women sheepishly defend it. hawa had hurt her foot before i got here and had had it treated by carmenza. she points to a scar where a woman had cut her foot open and thrown wet sand into the wound, and credits it with curing her. i say no, you had it treated by a doctor who then immobilized it until it was healed. all your natural healer did was expose you to infection. i ask them to tell me more about the common practices so i know what i'm up against.
at the training today i sat down and told my staff (midwives, nurse assistants and tba's) that i want to explain why natural healing doesn't work and is, in fact, dangerous and what needs to happen instead. we start with diarrhoea. diarrhoea is cured here by the healer pulling 4 of the child's teeth, with no anaesthesia and no sterile equipment. the healer decides which four of the teeth are the "bad" teeth, and they use their dirty instruments to yank those teeth from the child's gums. i explain that there is no medical rational to this practice and, instead of this, they need to know how to properly handle diarrhoea. i teach them how to make ORS at home, which is as easy as putting a pinch of salt and 4 fingers full of sugar into a glass of water, and having the child drink a cup after each episode to avoid dehydration. next i address the cutting of the uvula (the thing that hangs at the back of your throat). this practice is used to treat coughs, vomiting and oedema. the patient is held down and a sharp knife (from now on just assume that no anaesthesia is used and nothing is sterile) is used to slice the uvula off. occasionally they also cut out the tonsils for good measure. as someone who had their tonsils removed under anaesthesia and thought it the worst pain imaginable upon waking, this thought makes me literally nauseous. i explain that cutting anything out of the throat is not going to cure coughing or vomiting or anything for that matter. most coughs and vomiting will spontaneously resolve themselves given time, and the ones that don't need to be checked by a doctor. i decide not to broach the circumcision topic too much as i'm waiting for my trusty companion and right-hand woman (aicha) to get back to be my translator. i figure it's a sensitive enough subject that i want someone with a gentle spirit and a good command of the english language to translate for me. next i bring up the taking of the razors to people's skin. this is used for fevers, among other things. i tell them that rather than slicing people open, they should remove the clothing, sponge the patient down and fan them to cool them down. if the fever is high, during malaria season or recurrent, they need a medical checkup. as far as any other illness, there is nothing that is going to be healed by slicing someone open with a razor and rubbing wet sand full of animal excrement into them. the next practice is one that actually gives me shivers to think's the treatment for jaundice. the healer has a forked metal prong that is put in the fire until it is red-hot, then it is applied to the upper arm, the forearm and the freaking fingernails. i ask them if they realize that putting hot pokers on people's fingernails is a method of torture in some countries. they laugh, i don't. i tell them that jaundice equals doctors appointment. period. and saving the best for last... the treatment for headaches. there are many treatments for headaches here and none of them involve tylenol. one method has the healer wrapping both hands around the patients throat and squeezing tightly until the person starts to pass out. i tell them that in my country that's called attempted murder and it's highly illegal. the next method involves the healer making two deep vertical incisions in the patients temples, then smearing the wound with ash, which actually makes a tattoo that i thought was for decorative purposes. another method has the healer gather the skin in the middle of the forehead in order to bite it. another tradition has the person tie a string around a tree and then walk around it once in the morning and once at night. of all of the many methods they told me about, my favorite, by far, is the one where the person runs head-first into a certain kind of tree 3 times, twice a day. this was the point where i started laughing so hard i could only sputter "that is the WORST cure for a headache i have EVER heard of". they laughed at my reaction to every single remedy, but this one killed them. this is the point where i ask them if these remedies actually make sense to them. if my leg is broken, does it make sense to take a big stick and break it in 6 more places in order to feel better? they laugh their heads off, which is their response to almost every single thing i do, so i don't know if they grasp the absurdity of the cure or if they just think it's funny to shock me.

so that was the extent of my fight against the medical practices that i would, personally, rather die than be subjected to....

Tuesday, July 18, 2006

"you always think it can't get worse, and it always gets worse"

a search for blood donors

milena doing blood typing

mohammed prepares the car for an emergency transport to el geneina

after the bed collapsed beneath us

and again, where to start, where to start....
the day started slowly, with all of us sitting silent and bleary-eyed at the breakfast table. the night before, the dogs of habillah- every single one of them- had held some sort of dog symphony and we were all awake much of the night. by early evening we were splayed across the livingroom, each of us with our individual ipods blaring with earphones shoved in our ears, each pretending that no one else in the room existed. someone heard the radio and carmenza took the call. when she came back into the livingroom we removed our earphones long enough to ask what was up. she said that it was the hospital and that 7 patients had just arrived from Gobe. we wondered aloud what sort of fiasco could have resulted in 7 casualties that had to be referred from Gobe, and the only thing we could think of was that it was soldiers who had been injured fighting. we all got up and decided to join carmenza, partially out of a desire to help, partially out of curiosity and partially out of pure boredom. as we pulled up to the hospital someone pointed out that there was a huge truck in the courtyard. we got out of the car and entered one of those situations that causes you to look around for the cameras because you think you've stumbled into a scene from a movie. it was pouring rain and, thus, there was no moonlight. our hospital has no electricity, so we arrived to find a huge crowd gathered around the truck trying to unload patients by the light produced by weak flashlights. i was holding a fairly powerful lantern so i stood in the middle of the crowd and held it up over my head à la statue of liberty so my team could determine what the hell was going on. the truck that had backed into our courtyard was a huge flatbed truck, and the back of it held 6 patients, soaking wet, shivering, wrapped in large, bloody bandages. carmenza and milena started to order the men to carry the stretchers to the small, dark hall between the dispensary and the dressing room to get the patients away from the curious crowd and out of the rain. we asked the staff to ask the people what had happened and to translate for us. they told us that the patients had been at a wedding in gobe when someone had unleashed a hail of bullets into a crowd of dancing women, killing a woman who was 8 months pregnant and wounding 6 others. there's no time to really think about that, it's time to make sense of the chaos. triage begins: vitals are taken, i.v. lines are started, tetanus vaccinations are given, patients are sedated, wounds are unwrapped and exposed. at one point i looked over and watched milena crouched in a small, dark corner, trying to start an i.v. line on a little girl who had been shot, with only the light of a fading lantern, and all i could think was "this is insanity". the wounds were unbelievable. one small hole where the bullets entered and complete and utter destruction where they left the body. kalashnikovs. two of the patients are seriously injured and we know we need an emergency transport to el geneina, but the roads have been closed to us after too many attacks on ngo's. a couple of days ago an ngo about 140km away was attacked and one of their staff was killed. you probably didn't hear about it because it was "only" a sudanese national staff member. after an extremely long night that involved far too much carnage, the patients were as stabilized as they were going to get. finally we went home to try to sleep for the few remaining hours until daylight, when we could transport the patients. i think i managed to sleep for a couple of hours, and then i heard my radio. i curse the world and get up for the delivery. the delivery took awhile and then, at the last minute, the baby went from 'head visible' to 'head out' in about 10 seconds. the 4.2kg sumo baby tore his mother, in spite of her having had 3 previous deliveries. after the delivery i went to examine the tear so i could determine whether or not hawa could suture it, or if i was going to have to break down and do it myself. i opened the wound and cursed the world again- the woman had torn through her anal sphincter. i radio carmenza as i'm not trained to suture tears that serious, and she comes to join me. with carmenza and i busy in the delivery room, and gustavo meeting with local security people to determine just how high the risk was to travel, milena was left to prepare the patients for transport. once my patient has been sutured, we join milena who is frantically taking blood types from the patients relatives in order to send a donor with each of them. in the craziness carmenza cuts her arm open on one of the doors and needs stitches. gustavo is about to leave with the patients and none of us are allowed to go as he is not willing to put any of us at risk. he is going to take the patients halfway, to mornei, and then one of our cars from el geneina will meet them there and take the patients the rest of the way. i take off my St Christopher necklace (patron saint of safe travel) from sarah gem and hand it to him. he thanks me and slips it into his pocket. carmenza needs someone to suture her arm- gustavo the doctor is leaving, milena puts her hands in the air and says "i'm a nurse", and i say "well, it's not exactly the tissue i'm used to suturing, but i can do it". we go into the dressing room and i am so tired i can barely keep my eyes open. i set up the sterile field and i'm about to start suturing and carmenza stops me, saying "maybe i'll just clean it before you start stitching". i had been about to suture her arm without first CLEANING the wound. suuuuuuuuuuch an idiot.
finally we head home for breakfast, then it's back to the hospital to see patients. my national doctor went on holidays two weeks ago, then decided to stay home for an extra month and a half, which means that i see her patients all day long, then i'm on call for deliveries every night. when gustavo heard that i had been called to a delivery shortly after getting home the night before, he remarked "i think they're trying to kill you". i reply "i think they're pretty close to succeeding". i get home for lunch and i find carmenza at the table eating, and i see milena on her bed in the livingroom, facing the wall. it looks like she's listening to her ipod, which we all employ as a polite way of saying "pretend i'm not here", but when i look closer i can see that she's sobbing. i go lay beside her and throw my arm over her. it's the first moment that i've seen anyone show any emotion over what the previous night had entailed. somehow in the moment we had all turned off. we dealt with the injuries, not really allowing ourselves to acknowledge that 4 of these patients were little girls, that somewhere in gobe there was a dead, pregnant woman who had left 4 children behind and that someone had shot them with a kalashnikov as they danced.
milena is still crying when suddenly she yelps "there's an ant in my ass!". she jumps up, whips off her pants and starts frantically searching for the offending agent as carmenza and i take pictures of her. now we're laughing. the moment passes and she sits down and starts to cry again. i pull her towards me and she lays her head in my lap. i motion for carmenza to sit on the other side of her and she comes from the table and sits down. and the bed collapses beneath us. she says "i told you i gained 2 kilos on vacation". now we're laughing again. we get up and decide to eat lunch. as we're eating they tell me that the car from el geneina hasn't made it to mornei, and no one can reach them by radio. the required contacts are every half an hour and they haven't been heard from in 2 hours. we spend the afternoon tensely waiting for news. i pray that they were just robbed but that they're ok. we talk about the night before and milena says "you always think it can't get worse, and it always gets worse". she starts to cry and carmenza tries to comfort her, saying "only a week left for you". milena says "and a lifetime left for them". carmenza tells her that she can't let herself think about it, she can't let herself think like that or it will be too hard. too late. now carmenza is in tears. me? i'm far too tired to cry.
finally there's news. our car from el geneina was stopped by 4 gunmen who shot warning shots into the air. the staff pull over and are ordered out of the car. one of our staff is an arab and he is confronted by the men. they ask him why he is helping the "hawagas" (white people), who only help the masalite and not the arabs and they accuse him of working for the UN. he tells them that he is working for msf because msf helps everyone, including the arab nomads. they tell him that he should join them and he politely declines. they say that they'll be taking his driver and car but he asks them to allow them to continue because there is a medical emergency. they beat our driver for not carrying enough money and demand to know what tribe he is from. apparently his tribe has no problems with the nomads, so they stop beating him. they cut the radio; tell the men that they will let them go this time, but that next time they will kill them and release them. the staff make it to mornei where it is decided that everyone will stay until the situation has been assessed. the little girl, our youngest victim at 10 years old, starts to crash and needs to get to el geneina for surgery or she likely won't make it through the night. the drivers decide to chance it, and they transport the patients back to el geneina on the same road where someone had just very seriously threatened their lives if they were found on that road again.

and that, my friends, is enough.

Friday, July 14, 2006

random short stories

the other morning i was woken up at 2:30 by the squawk of my radio. the nurse tells me that one of my high-risk patients is at the hospital in labour, so i crawl sleepily out from under my mosquito net, pull on my msf t-shirt and go to find our on-call driver. awat stumbles out of his tukul and opens the car doors. we get in, we buckle up, i reach up to turn on the interior light as he plugs in the flashing red light on our roof (safety regulations for travelling after dark). we pull up to our gate and he stops as the guard reaches up and bends our huge antennae so we can make it out under the low gate. once we are outside of the gate he pauses, turns to me and says "hospital?". i say "no, mcdonalds. i really feel like french fries". he looks at me blankly and i sigh "yes, the hospital". seriously, where else would i be going in habillah at 2:30am?

gustavo once asked his driver in darfur why it was that you saw the women, not the men, carrying the loads here, and carrying those loads on their heads. the man gave him a lengthy explanation about how the girls were taught from a very young age to practice walking with things on their heads, and how women were more graceful and better able to balance things, etc etc etc (translation: the men here are lazy yahoos). they were driving as they spoke and they happened to drive by a man who was carrying a large load on his head. gustavo turned to his driver with a questioning look and the driver explains "that man surely has no wife".

milena "and then there are spiders, who have 6 legs..."
gustavo "how many legs?"
milena "6"
monica "well yeah, the handicapped ones"

gustavo, our fearless leader


our new fieldco is gustavo, an argentinian doctor in his late 20's. i love him for 2 main reasons (ok, more than 2, he's laugh-out-loud funny so he is clearly my new best friend). one, he paces. when he is stressed out or thinking, he paces around the courtyard like a caged animal. i love this because any kind of pacing reminds me of arin, who i love to be reminded of. two, he walks around singing "true colours" all day long. when i tell him that it's a bit unmanly to be singing cindy lauper songs he insists that he is singing the phil colins version. the gustavo set comes complete with an amazing girlfriend, monica, a doctor from spain. together they make up one of the funniest couples i have ever met. they are both bosses of our team (gus is directly in charge of the team here and monica is in charge of all of our medical activities) without being each others boss. occasionally during a meeting they will disagree about something and gus will end it with "monica, not in front of the children!". other times they will talk to each other in spanish, leaving the rest of us feeling like you did when you were a child and adults spelled things to each other so you wouldn't understand. one of gus' favorite stories is about the time he was doing rounds in argentina with a doctor who was notoriously bad at his job. as they stopped at one patient, the patients daughter told them that the man was having pain of some sort. the doctor replies "well you need to move your legs!". the daughter says "but doctor, he doesn't have any legs. you amputated them". without missing a beat the doctor says "then move the rest of your body!". now whenever gus says or does something stupid he says "then move the rest of your body!"

alright, can't write about what i actually want to write about, so you got this instead....

"there is a work beside which all else strikes me as useless. that is the work that seeks to raise the status of childhood everywhere. that every child, from pole to pole, would come into the health and happiness that is their due. if everyone who had ever loved a child would but do their part, this would come to pass"

"some days you just have to hate life"

"pa-ra-check hey!"

that quote was borrowed from my friend, erin stopes, who wrote it in an email from the philippines once. i think it quite adequately describes yesterday. the other two quotes that adequately describe yesterday were uttered by my team-mates... yesterday. one simply stated "this is an awful country". the other, as we crawled into our beds at 3am, said "today was a horrible day". i agree on both counts.
where to start, where to start..... well, the biggest issue is one that, for security reasons, i can't write about, which is far more frustrating for me to write than for you to read, trust me. it's a story that will play itself out however it plays itself out, and we have no choice but to see where the tide takes us. there are a number of ways that it could end, but for now we can only wait and see. when i am home and have access to communication devices that are available only to me, i will tell the story.
and then there are the parts of the day that i can talk about.....
at lunchtime i started to feel queasy and i wondered if milena had given me her sickness from a couple of days ago. by dinner i was lying on the bed in the "livingroom" (we don't have couches here in darfur, so we use bedframes instead) trying not to vomit and wondering how sudan could possibly get any hotter. milena woke me up and asked me if i wanted dinner. i declined, saying that i felt like i was going to be sick. she asked me if i had a fever and i told her that it was quite impossible to tell in this heat...that i have felt like i have a fever for the last month. she felt my face, then went to get a thermometer. when she took the thermometer to check it she was SO excited to discover that i did, indeed, have a fever. instead of the expected compassionate, nurse-like response, she throws her arms up in the air and yells victoriously "revenge!". i guess i should explain.... three days ago, as mentioned, milena was sick. when we took her temperature and found that she was feverish, we told her we were going to do a paracheck, which we were quite excited about because hey, it's something to do. the paracheck is a test for malaria and it sucks. the kit comes complete with the test and the lancet that you use to stab the fingertip hard enough in order to get a full drop of blood. she flat-out refused to let us do it, claiming to suddenly feel quite well. as she lay, sick and miserable, on the bed, gus, monica and i made up a "paracheck dance" that quite closely resembled 'the locomotion', complete with a chant "pa-ra-check hey!". milena's response was to get up and do her own song and dance, borrowed from one of the squirrel-like creatures on the 'madagascar' dvd, proclaiming herself to be "phy-si-cally fit! phy-si-cally fit!". as expected we won, and i had to poke her finger twice as she pulled it away the first time and it didn't go deep enough. she was so irritated and monica got a great picture of her giving us the finger and looking at us like she hoped we would die :) the test was negative and she recovered. now, of course, it was my turn for a paracheck and milena couldn't have been happier. i say, first of all, that no one is doing a paracheck on me until i see the dance. they happily oblige and do the paracheck dance around the room. my second stipulation is that they have to do a venapuncture (take the blood from a vein in my arm with a syringe) as they are NOT taking it from my finger. the last time i had a fingerpoke was in the philippines when grubb peer-pressured me into it because she needed to test the new glucometer. i accidentally called her a 'mofo', which i thought was mine and bones secret swearword. i don't know who was more surprised... grubb that i called her a mofo, or me that she knew to be insulted by it :) monica was totally shocked that i preferred a venapuncture over a fingerpoke and i explain that i have no problem with needles, and i let my students practice everything on me (i.v.'s, injections, venapunctures) except for fingerpokes- fingerpokes hurt like hell. i would rather that they took it from my eyeball than my finger. so milena takes my blood, the test is negative, and i lie back down to just let whatever it is run its course.
the only problem with my being sick was that the timing sucked- i had a patient in labour. right before lunch when i was still at the hospital hawa, one of my nurse assistants, came to find me. lacking the english to properly explain herself, she took me by the elbow and dragged me to the delivery room saying something about "moya" (water) and "bleeding". a woman lay on the delivery table, and joyce (one of my khartoum midwives) explained that she had been in the market and water had started to come out, with blood. i can see that there is enough blood to concern me, so i use a speculum to try to see if her cervix is open enough to see if any placenta is visible. the membranes are coming out of the cervix and joyce is looking over my shoulder and says "that's the placenta!". i say no, it isn't, it's the membranes. she starts pacing around loudly proclaiming "that's the placenta! that's the placenta!". i say no, it isn't, it's the membranes. she's now getting mad that i'm not agreeing with her and i finally say "joyce, you are a midwife and you know what a placenta looks like. this is not the placenta so please chill out". hawa looks over my shoulder and says quietly "this no placenta". i smile at her and nod. ok i say to my staff, her membranes have broken and she needs to deliver this baby so it's time for some labour stim. i tell her she can get up, walk around, eat, drink, shower, etc. as i was talking i stood by the woman and, like a total midwife, put my hand on her belly. that was when i realized that something was definitely wrong. i turn to joyce "didn't you say she was 9 months pregnant?". she says yes, that she's 9 months. i use both of my hands now and i remove her 600 layers of cloth so i can feel her bare stomach, and i wince. i turn to my staff and say "she's not 9 months. she's not even close". we measure her fundal height and it's 24cm (in north america you can usually associate the number of centimetres with the number of weeks pregnant the woman is- therefore a full-term pregnancy would be 40cm for 40 weeks gestation. here we assume smaller babies, but you would still expect a term fundal height to be at least 34 cm). maybe i'm wrong, i hope. maybe it's just so small because the baby is so engaged. i leave my staff to monitor the labour and i go home for a very long afternoon of meetings and being sick.
after the first meeting, when we took a break lest we all kill each other and/or ourselves, i go back to the hospital to check on the patient. the bleeding has stopped and her vitals are good. leimona listens for the baby's heartbeat and she tells me that it's too slow. she beats it out with her finger and i ask if she's sure it was the baby's heartbeat and not the mother's. i take the fetoscope, place it on her belly, and listen. nothing. i move it...nothing. i move it again and again, until there is nowhere left to listen. the mom says the baby is still moving, so i choose to think that it's just my hearing loss that won't allow me to find the heartbeat.
later that evening i hear joyce call me on the radio. i step outside for better reception and tell her to go ahead. "i can't find the fetal heartbeat" she tells me. "i know" i reply "i don't think there's one to find".
i went back to bed and fell into a restless sleep until i heard my radio at 1am. joyce tells me the patient is ready to deliver and i reluctantly pull a shirt over my tanktop, still sweating and feverish, even in the cool night. milena sits up in bed and tells me she's coming with me, which i had so been hoping she would say. i felt like crap and the last thing i wanted to do was a delivery, but the midwife on call was joyce who was, unfortunately, born minus the sensitivity gene. the moment i knew that we were going to deliver a dead baby i decided that i was going to do the delivery and i didn't care if i had ebola and was bleeding from my every orifice. i was not willing to subject a woman who was on the verge of a stillbirth to a birth that was anything other than gentle.

note: the rest of this story may not be something that everyone wants to read....

we arrived and i took joyce's place at the foot of the bed, as the woman had started to deliver there. in the low light it looked like the head was out, but it seemed misshapen. i took my lantern and turned it on, and i heard milena say "what is that?" it didn't look like a head, and with further examination i discovered that the baby was breech and that we were looking at her slightly malformed back/butt. the mom pushed until the body was out and then she gave up. we sat there for awhile, waiting for her to push again, staring at this lifeless body lying half out of her. after awhile i asked joyce to ask her if she wanted to push and joyce said no, she has no more strength to push. i told her that it was almost over, but she needed to push a few more times. no, she was done. it was hard not to understand. what motivation is there to work that hard when you know that your baby is already gone? i tried a few more times and still she shook her head, completely defeated. i finally reached inside and brought out the little arms, then tried to maneuver her head out while inflicting as little damage to it as possible. when she finally arrived we were all as silent as she was. "baby, you came too early" i whispered. i cut the cord and handed the baby to leimona, asking her to clean her so the parents could see her. the mom hemorrhaged and i ended up having to subject her to several injections, an i.v. and countless uterine massages. each time i would say "i'm so sorry", which was true on so many levels. when the mom was stable i got up and went to wash my hands. i asked joyce to bring the baby for the mom to hold, and she told me that they didn't want to see her and, in fact, no one wanted to look at her. she was to be wrapped up and buried without being seen. milena and i looked at her with surprise and walked into the delivery room where the baby lay, wrapped in gauze from head to toe and tied with string. we looked at the shrouded figure, we looked at each other, and finally i said "i think she deserves to be seen". milena agreed and we closed the door and unwrapped her. she was small, but not too small to have survived had she been conceived in a developed country. her head was damaged from the pressure of remaining in the birthcanal for so long, and from my efforts to get her out. her skin was raw and peeling in places. we touched her hands and her feet, so little and perfect yet so cold. she was beautiful. we looked at her, we held her and we acknowledged that she had lived. she left too soon, but she was here.

Tuesday, July 11, 2006

it's all about improvising

as much as i support the fact that our tba's deliver the women in the kneeling position, i had to find a way to explain to them that part of their technique was making the delivery harder on the women, not easier. as the woman kneels, the tba lies in front of her and puts both of her arms through the space under the woman, between her legs. with both of her hands she reaches up and cups the butt area, and pulls forward as hard as she can as the woman pushes. their reason for doing this is because of their concern that the woman will tear towards her rectum (i think- i didn't completely understand the explanation). in the first delivery that i saw one of them doing this, the baby was big, the mom was small, and the last thing we needed was a tba making the pelvic outlet smaller. the midwife with me was mariam, who doesn't speak english, so i couldn't explain to either of them why i wanted the tba to stop doing it. each time she would go to do it i would just say "lalala!" (nonono!), and she would look at mariam for an explanation, and mariam would just shrug. i radioed for one of the nurses who speaks english to come translate for me, and i tried to explain through him, but they still just seemed confused. dilemma: how do you explain to women who have absolutely NO medical understanding that there is only one moveable bone in the pelvis and that that bone needs the freedom to move back to make room for big babies? how do i get them to understand that, by pulling that bone forward, they are actually making the space available for the baby smaller, and are making it harder for the woman to give birth? i thought of showing them pictures of the pelvic bones in the obstetrics textbook we have here, but these are women who would likely have a hard time grasping the concept of visualizing the pictures in 3D. i thought longingly of the pelvic bones i had in afghanistan, and the life-sized pregnant dummy that i used to train my students there. i smiled at the memory of making cervixes out of playdough stolen from an operation Christmas child box, to teach them how to check the different cervical dilations. and then i got an idea.... i kept an eye out for a couple of days before i finally found something that would work. in our shower we have a small, white, plastic garbage can, and i stole it and replaced it with one of the bigger, coloured ones. the next step was finding scissors or an exacto-knife, of which we have neither in the entire compound. i finally end up borrowing andi's blunt swiss army knife, and i pray that i won't sacrifice too many fingers for this project. i sit in my room with my obstetrics book open, my pencil in one hand, the newly cleaned garbage can in the other. i sketch a pelvis onto the garbage can and i start to carve through the hard plastic. by the time i'm done, i have a plastic, anatomically correct pelvis. at the next lesson i had with the tba's, i showed them the baby's passage through the pelvic bones and, by manoeuvring the little plastic tailbone, i could show them the effect that their technique had. it was awesome- they totally got it and not a single one of them has done it in a birth since. the other benefit of the new pelvis has been that i can use it and our "baby" (the dirtiest, ugliest, most ghetto hand-made doll on the planet) to explain other complications- namely shoulder dystocias.

in my remaining 5 months i have to train these women as much as is humanly possible as once i leave my position likely won't be replaced. in a perfect world there would be births all day long and each of the midwives would be at enough births with me, and see enough complications, to be completely trained and competent by the time i leave. seeing as how births are notoriously unpredictable, and most of them prefer to happen at night when only the most competent midwives are on call, i don't see this happening. this has lead to my next case of improvising. if i don't have real patients giving birth to real babies, i will use fake patients giving birth to our ghetto baby. the last few afternoons i have taken the midwives into our delivery room and we have simulated births, with me throwing in random complications for them to "handle". one of them happily climbs up onto the delivery table and shoves ghetto baby up her shirt, and one at a time the tba's and midwives "deliver" the baby according to what i tell them is happening. "the baby's head is out but the body won't come, what do you do?" "there is a tight cord around the neck, how are you going to handle it?" "the baby isn't breathing...." "the mom is bleeding....." and so on and so on. my hope is that by practicing enough they will get a feel for things and when the time comes they will know how to handle it in reality, or will at least be comfortable with it enough not to panic.

my next project is one that has me wishing i hadn't cheated my way through sewing class in grade 8. i've decided to try to sew together a dummy like the plastic one i had in afghanistan. i figure if i can sew a pair of pants and a shirt together, then stuff the clothes with cotton or something, i can put my plastic pelvis in there and make a cloth uterus and vagina, and we can do some more realistic simulations. as much as my midwives and tba's are all very quick to whip a breast out to feed ghetto baby, i don't imagine they would be super excited about the idea of taking their underwear off in the name of training.

on a more serious note: the security situation around habillah is getting more and more tense. the number of ngo's being robbed on the roads outside of the village has increased a lot in the last week, and yesterday one of the drivers didn't stop when they were ambushed and their car was shot at, and hit twice, as they sped away. no one was hurt, but no thanks to the idiot driver. everyone knows that when you are held up you stop, you keep your hands where they can see them, you get out of the car and lie face down on the ground, you take the contents of your pockets and put it on the ground in front of you, and you do exactly what they tell you to do, with no sudden movements. if you want to get shot, you keep driving or you run. the people from unhcr came by the other day to ask us if we were travelling along a certain road as they had to get a message to some refugees there and no one was allowed to drive that road because of the security issues. we say no, we aren't allowed to travel on that road now either and the woman says "well if YOU guys aren't using that road then NO ONE is using that road". msf has a rep for being kind of hardcore. by the way we are now, officially, the only expats in habillah who haven't been attacked in any way. yes kate, i just knocked on wood :)

Sunday, July 09, 2006

uninvited guests

one of the things that i love the most about living overseas is the fact that every once in awhile you are assured an experience that is completely foreign to the life you generally lead. while each day often contains 23 hours and 55 minutes ranging from complete discomfort to mind-numbing boredom, you can almost always count on having at least 5 minutes that you can look back at and think "now THAT was new". i was called to a birth the other day and it was proceeding relatively uneventfully. i was standing at the back of the room, leaning against a supply table, when something in the corner of the room caught my eye. i look more closely and it appears to be a stuffed toy of some sort. it's roundish, about the size of my hand, grey, and covered in spikes. i prod it with the antenna from my radio and i jump back a bit when it hisses at me. "what the...?". there, in my delivery room, is a freaking hedgehog! a hedgehog. he's not disturbing anyone, in fact he appears to be in the midst of a siesta, but the midwives are all walking around in flip-flops and i don't think anyone would appreciate walking into our cross, spiky little friend by accident. i take our apgar chart and start to shoo him across the room, out the door and into the courtyard. he hisses at me the whole way, as i ask him to please not take it personally but i have just implemented a no hedgehogs in the delivery room rule. once we're outside i stare at him more closely. yup, you're really a hedgehog. random. the birth proceeds and the woman delivers. she is in the kneeling position on the table, the placenta is out, and i am watching leimona with the baby, leaving joyce, one of our most experienced midwives, to help the tba with the mom. i go to check on them and i find that joyce has walked away to do who knows what, and the tba is standing there continually cleaning the continual stream of blood that is trickling out of our patient and onto the plastic sheet. the puddle of blood that she is trying to wipe up just keeps being replenished, and she hasn't thought to lift her head and wonder what the source of it might be. i say "uh, ladies? i think it's time for a lesson on observational skills". after everything has been taken care of, we are transferring the mom to a bed and the tba is just about to hand the mom her new babe, and all of a sudden i look up at the wall and jump back about 3 feet (which is as far as i can go before i hit the other wall- it's a small room- or i would have jumped further). as i jump back i'm pointing at the wall and saying "holy shit! look!". the women all look to where i'm pointing and they all have the same reaction. no, not a spider.... a huge scorpion. our patient is right under it, and i grab her bed and pull it away from the wall. someone goes running for one of the guards, who comes in wearing thick rubber gloves and carrying a large stick. he slays the beast, but not before i got a picture of it. once it's over we're all outside and people are chatting excitedly about it. everyone wants to see my picture so i turn on my camera and they pass it around. zainab, one of our nurses, walks by and i say "hey zainab, want to see who decided to join us in the delivery room just now?" (of which she probably understood "hey zainab" and nothing more). she looks at the picture, jumps out of her skin, starts yelling excitedly in arabic, pointing to the picture of the scorpion, pointing to her foot, making expressions of pain and suffering... for about 5 minutes. finally someone turns to me and translates "she was stung on the foot once". i say "so i gathered".

upon discovering that my room is reknown for being an oven at night, i started sleeping outside in the courtyard under the tree. this means that i've taken the 5 minutes of the day that were my absolute sanity, and i have extended it to become my favourite hour or two of the day. the best part of my day prior to this was always those last few minutes of light before our generator was turned off. i would grab my toothbrush and head out into the courtyard to brush my teeth at our water source. as i stood in the courtyard, alone in the dark, looking up at the huge, starry sky, the words of a paul simon song would always play in my head. "joseph's face was black as the night. the pale yellow moon shone in his eyes. his path was marked by the stars of the southern hemisphere, and he walked his days under african skies". every night it played in my head, and every night i would stand there in awe, remembering that i was standing under african skies. now each night i set up my bed outside. my mosquito net falls around me, and i slip into my safe little cocoon. i lay on my back and stare at the moon through the branches of the tree, and that song plays in my head. my mosquito net ripples with each breeze, and it shimmers under the light of the moon. whether or not i sleep, i love to just lie out there and feel the cool night air on my skin, and i pray and i think and i lie there in awe of the fact that i'm in africa. it's a time of complete peace and comfort....most of the time. one of the first nights i was lying in bed and i had a moment of wondering what i would do if one of those spiders got in and was caught with me inside of the net. as anyone who knows me can attest to, even the thought of large spiders puts my startle-reflex on overdrive. as i was lying there contemplating what i would do in that circumstance i felt something on my forehead and, i kid you not, i almost wet my bed. the funny part, the part that i laughed my head off at as soon as my heart started again, was that what i had thought was a spider was actually my own hand- i had flung it over my head earlier.

Saturday, July 08, 2006

the children of the TFC

my gang of shadows




sunshine and raincloud

afternoons can be slow at the womens centre, especially on the days that aren't market days. after lunch the patients trickle in slowly, or not at all, and my staff have time to get other things done around the centre. once things have been cleaned, gauze has been cut and folded, schedules have been written up, drugs have been ordered, we have time to lie on the mat outside and relax. this is usually about the time that i wander over to the TFC tent and harrass the children.
there are now 21 children in our therapeutic feeding centre and when milena got here 5 months ago there were 3. to be admitted into the TFC program you must be less than 70% of what you should weigh for your height (severely malnourished). when the child first enters the program they may be admitted into the pediatric ward to treat all of the things that can go wrong with your body when you're that malnourished: dehydration, infections, hypothermia, hypoglycaemia, heart failure, severe anemia, etc. once they are medically stable they are put into phase I of the program. phase I is the stage that is meant to stabilize the child and restore their electrolyte and metabolic imbalances. you slowly introduce food back into their body to avoid shocking the system, which can kill them. this is done by giving them small, frequent meals of low energy food. this can be the hardest part as the children are often lethargic and have no appetite. watching their mothers pin them down and try to force life-giving food down their throats as the children scream is a definite low point of the day. daily, the children are weighed, have their vital signs checked and have a medical check-up. when they regain their appetite and lose their oedema, they are transferred to phase II. the purpose of phase II is to get the child to gain a lot of weight, very quickly. this is done by giving the kids a very high energy diet. children stay in the TFC until they reach 80% of what they should weigh, and then they can be transferred to the SFC (supplemental feeding centre). being in the TFC requires that the child spends all day at the hospital, and their mothers or other care-givers stay with them and are responsible for feeding them the food we provide. like i said before, this is to prevent the mother from taking the food that is provided for the most malnourished child and sharing it with her other children. some parents, upon being confronted with the fact that their child hasn't gained any weight, have confessed to being so hungry that they have eaten the food themselves. once the child enters the SFC, they become an outpatient. the family comes every two weeks to receive food and enough food is provided that the family can feed its other members as well, ensuring that the malnourished child receives enough. the children stay in the SFC program until they reach 85% of their desired weight, and then they are discharged (usually to fall back into a state of malnourishment and be readmitted).
while i love all of the babies in the TFC, there are some who, admittedly, are my favourites. one of them, abdel-razid, is one of the things here that makes me stay. he's 4 years old and has never spoken and never walked. we found him in his tukul when we were doing our milk distribution, alone, expressionless and naked on the floor. he was the first child i saw here who looked like the pictures you see on those informercials- the ones that make you turn the channel because who wants to see images like that and be faced with the inadequacy of your response? his arms and legs were long- the length that a 4 year old should be- but there was little on them other than skin. we convinced his mother to put him in our program, which involves her carrying him and her newborn the whole way to the hospital each day and leaving him with his two young brothers to care for him while she takes her newborn with her to collect firewood outside of habillah (her husband is absent- dead or not, i don't know- and i think that that newborn girl is a result of her collecting firewood). the two brothers, neither of which are yet 10, are complete opposites. i don't know their names so i refer to them in my mind as sunshine and raincloud. one is always smiling, and the other is the angriest child i have ever met. his face is set in an expression of permanent rage and he seemed physically unable to smile until the first time i tickled him and he collapsed on the ground in a pile of guffaws. he is now my shadow. abdel-razid sits on the mat outside, banished due to his inability to toilet himself. he sits on a mat and when he urinates it soaks through into the sand beneath him. there are times when i come to see him and he is so disgustingly filthy that i lift him under my arm (holding his urine-soaked shirt away from my clothes), traipse to the nearest water supply and rinse him down. when i am having those moments where all i want to do is go home, i go to the TFC tent and find him. i sit behind him and pull him to sit between my legs. he leans back against my chest and looks up at me with the purest eyes i have ever seen. when he looks at me he looks right into my eyes, he tilts his head to the side as though asking me a question and he smiles. i stroke his head, i tickle his feet and he laughs. sometimes when i play with him he gets so excited that he squeezes his eyes shut, tosses himself onto the mat and bangs on it with his fists as he howls with laughter. other times he lifts his hands to my hair to entwine his fingers through it. his favourite activity is to hold string and spend hours running it through his fingers, and my hair is apparently a welcome substitute. milena took the most beautiful pictures of us one day. my favorite is one where he is sitting between my legs, looking up at me. my head is bent down and he is touching my face with both of his hands. she and i were looking at the picture later and i remarked that i couldn't wait to hang out with him in heaven when he could actually talk to me. she looked at me with complete surprise and said "do you really believe that's going to happen?". of course i do.
along with abdel-razids two brothers there are 3 other children who make up my gang of shadows. one of them is ahmed, 5 years old and as tiny and frail as a baby bird (i can lift him over my head with one hand). he's ambulatory and has energy to run around now, and he just loooooooooooves to steal my sunglasses. his caretaker, and sister, is mariam. she's 7 or 8 years old and is the only girl in the club. the last one is a boy of maybe 13 who cares for his baby sister. he is bald and has a distinct tribal look that i see from time to time here. he tries to act like he's too cool for our antics, but he's definitely not too cool to run like hell when i decide to chase him.
it has become a daily ritual now, and pretty much the only exercise i get here. i sneak along one side of the tent and creep up on the 5 of them who are usually sitting out back with abdel-razid. the women inside have seen me coming and start to smile. i reach the back of the tent and once i round the corner i pounce on whoever is closest. they all scream at the top of their lungs and run for their lives. the one i caught is thrown over my shoulder and paraded out front for all to see. he/she is held upside down and tickled until i think they may pee. the first victim is released and i put on my sunglasses so i can scan the landscape without them seeing where i'm looking. the other 4 have inevitably crept closer, kind of hoping that i'll go after them next, yet kind of terrified that i'll go after them next. if i pretend not to see them, they slowly inch closer and closer. ahmed, the youngest of the group, often comes a bit too close (and if he doesn't, one of the other 4 will generally help him out by giving him a shove in my direction before fleeing) so he tends to be the one i catch the most. the rest of them i just chase around like the nutty hawaga (white person) everyone considers me to be. raincloud is too fast for me, so i have to ambush him if i want to catch him. getting him to laugh makes me feel like i've accomplished something that day. eventually the heat catches up to me and i go back to the mat and lie on it, dripping with sweat. my staff tell me i am crazy and i nod tiredly.

Wednesday, July 05, 2006

faith the size of a mustard seed

it was just starting to get dark when i heard a voice on the radio. i automatically perked up as there are only two people who get called after dark, one of which is carmenza, the other of which is me. no one called to me that i was wanted so i stopped listening to the rest of the call. carmenza came out into the courtyard a moment later and had her bag slung over her shoulder. like the eager future med student that i am, i asked her if she was going to the hospital and why. she said a child had been bitten and it was really bad. i, of course, told her that i was going to go with her. as i threw on a t-shirt i wondered what kind of a bite would be bad enough to call the expat doctor after hours. we had recently had a snakebite that had been near-fatal, so i thought maybe it was that. then again, there were also scorpions and all kinds of sketchy dogs around. all i really cared about was it not being a spider bite. on the ride to the hospital i asked carmenza what had bitten him. she replied "the father". i say "his father BIT him?" and she says "no, bit, bit" in a spanish accent and makes a punching motion with her hand. i say "beat?". she nods. i slink down in my seat realizing that this is not going to be fun at all. i want to get out and walk home but it's after dark and we're not allowed out after dark. we arrive at the hospital and enter the pediatric ward to find several people bustling around one bed. we step in and i almost vomited. a 9 month old baby lay, unconscious, on the bed. his father "accidentally" beat him in the head with a stick while he was "fighting" with the baby's mother, the staff tell us. i say "using the word 'fighting' implies that there were two active participants, which i somehow doubt, and can someone please explain to me how you ACCIDENTALLY beat an infant unconscious with a stick?". there's no answer, and i'm not surprised. carmenza gets to work checking the baby and with each discovery she looks more and more distraught. she checks his pupils and tells me that one is completely dilated, while the other is the total opposite. he has no response to pain and his hand stays limp as the nurse digs for one of his tiny veins to start the iv. part of his skull, a part that should be bony, is soft to the touch. carmenza tests his reflexes and he has none on the right side of his body. the baby's mother sits at the opposite end of the bed, perched tensely on the edge, watching with desperate eyes. i stood beside her and unconsciously put my hand on her shoulder. she surprised me by quickly reaching up and grasping my fingers. at one point i notice a man standing nearby and all of a sudden i realize that i am about to lunge at him. "is this the father?" i ask, and someone says no, so i decide to spare his life. one of the nurses tells me that the father was arrested right after the accident, so drunk he could barely stand. i tell them that if one more person refers to it using the word "accident" i am going to officially lose it. finally the iv is started, the examination is finished, and the staff clears out. i ask carmenza if he's going to make it and she says that it would be a miracle if he survived the night. we talk quietly, knowing that his mother can't understand us, and we agree that maybe for his sake it would be best for him to just let go. this isn't a country that takes care of its weak. those who are physically handicapped, comatose, brain-damaged or anything beyond the scope of normal are burdens to be borne. this is a country where people (around 20 children in habillah alone) with any sort of psychiatric issues are chained to a tree in the yard all day long. yes, you read that right.
the baby lay at the top of the bed, naked, unmoving. i gently prodded his mother closer to him, and showed her that she should talk to him, touch him, hold him. she was hesitant, but i sat beside her and stroked his arm, and told her that it was ok. as we sat there, just the three of us (carmenza had walked away), i wanted to pray for him to be healed but i hesitated. i knew that God could heal him, but a part of me just didn't believe that He would. maybe if it was some amazing Christian who knew what he/she was doing it would work, but i knew it wouldn't work for me. finally i decided that i had nothing to lose so i lay my hand on his head, over the part of the skull that had been caved in, and i prayed. i prayed that he would be healed and that he wouldn't suffer for the sins of his father. i prayed for compassion for the man who had almost killed him. maybe he's always been a violent alcoholic and is worthy of nothing but contempt, or maybe the events of the last few years have so emasculated him, and so destroyed everything good in him, that he can't help who or what he's become. maybe he was once good and noble and kind.
we arrived home that night and parted ways. carmenza went to bed to cry and i paced around the courtyard too full of some overwhelming emotion to stay still. i took a cold shower to cool off and angrily told God that i was done here and i was going home. i'm done being the witness, i'm done seeing this kind of crap, why do You keep calling me to these places? have i wronged You in some way, because i'm REALLY sorry if i did. forget my pride, forget not being a quitter, forget probably never working for msf again, i don't care what people think. i'm done. i went to bed early and put on my worship music (always guaranteed to chill me out), and at some point i must have fallen asleep and ground my teeth all night as i woke up with an aching jaw. we woke up the next morning and were surprised that no one had radioed during the night to say that the baby had died. we arrived at the hospital and were stunned to see that the baby was breastfeeding! the nurses told us he had opened his eyes briefly, then floated in and out of consciousness. i sat down again and smiled at his mom and she smiled back with a look of such relief i almost cried. i lay my hand on him again and prayed again. ok God, this was a start, but we both know You can do better than this. each time i came back to visit them, he was doing better and better. his mom and i became friends and we would sit on her bed and i would show her the pictures in my digital camera and she and the mother of the young boy in the other bed would sit and laugh delightedly. two days later the baby was awake and alert. physically he seems to have returned to normal. he's a bit young to ask him if he knows what day of the week it is, or where he is, but i have faith that in a few years he can answer those questions.

p.s. if you think you have some medical explanation for this, i don't want to hear it :)

"they say we are at peace now"

it was a slow morning at the women's centre and i had only had 3 official clients. my fourth, unofficial, patient wasn't on the books. this left me with a lot of time hanging out in the consultation room with "a", the masalite who, i hope, will take over the women's centre when i'm gone. "a" speaks fluent english, arabic and masalite and is, for all intents and purposes, a female mayor of sorts. as a woman who is educated, intelligent, compassionate, relatively rich and incredibly well-respected, she is privy to every piece of information that exists in habillah, and today she shared more of it with me than i could have ever possibly hoped to hear. it reminded me of the first night i arrived home from aghanistan, when kate d, kate v, peter and nathan were waiting at my house and stayed up late into the night with me. i showed them my pictures and told them story after tragic story until the point when kate d lay down and begged "please stop". that was the moment that i realized that i was numb to the point where they had just become 'stories' to me- i had forgotten that those words still had the capacity to hurt those who heard them. today as "a" was talking, i started by listened raptly, wishing i had a tape recorder so i could remain faithful to every word of it in this repetition. towards the end of it i just sat there, stunned, and the only words running through my mind were "please stop, please stop, please stop". (it took hours to tell the stories- they aren't all included here).

it all started when joyce, one of our midwives, came into the room and told me she needed to talk to me. there was a woman whose husband wanted to know how pregnant she was as they had only been married 2 months and she seemed much further along than that. thankfully (yes, i've learned to become thankful for these things) he was only planning to divorce her if it turned out she was pregnant with someone else's child. joyce did an examination and decided that she was around 5 months pregnant- and that's when she asked me to double check. the woman came in and i asked her to lie on the examination table. as soon as she lifted up her shawl i could see that she wasn't just 2 months pregnant. upon feeling the fundus and the baby, i wasn't surprised to find the heartbeat with the fetoscope. we sat down and "a" started to talk to her. she turned to me and told me that the girl said she had only been with her husband and there was therefore no way she could be more than 2 months pregnant. i told her that we knew she wasn't two months pregnant, but that we would never tell anyone that and she was free to tell her husband whatever she wanted. i asked "a" to ask the woman if she wanted to tell us what had really happened. they spoke for awhile and then "a" turned to me and said that the woman was going to go home and tell her husband that she was 5 months pregnant and if he divorced her, he divorced her, but he wouldn't kill her (they were masalite, not nomads). she had 5 children from her first husband who had been killed in the fighting and this man had married her anyways, so she hoped he would be understanding. she left and i asked "a" what the woman had said. she stared off into space and told me that the women whose husbands had been killed in the fighting were the ones who were the most defenceless. at night they had no one to protect them. during the day they had no one to help provide for their children. some of these women had given in and were now selling their bodies. it was going to happen anyways, and this way they could at least buy food for their children afterwards. girls were doing the same, as some of the older men used their desperation against them. in the name of survival, and the survival of their children, these women are forced to compromise everything they believe in and when they became pregnant they are ostracized for it.

i asked "a" how it was that habillah remained free from major attacks, and she told me the story. it was august, i'm not sure what year, when she heard the plane overhead. she went outside and saw it flying low over habillah and then she felt the first bomb hit the ground. she ran inside and told her children to lay on the ground and she gave them a verse from the koran to recite. the plane passed over habillah, dropping more bombs as it went. her husband had been walking down the street with a friend when one of the bombs dropped. he hit the ground and lived, while his friend stood standing and was torn apart. anyone who was on the main "street" was annihilated, men, pregnant women, children- they found many of their remains blown up into the trees. a male neighbour ran into "a's" yard and told her to take her children and run as they were going to level the village. she gathered her 6 little boys, the youngest just a month old, and ran for the forest. it ended and they cautiously returned, only to realize that it wasn't over and run back to the forest. when the bombing started again, two of her sons bolted into the forest and weren't found for hours. there was a woman there who was in such shock that when she finally went to give her children some food she looked at them, stopped short and started screaming when she realized that she had saved children who weren't hers, and hers were missing (her children were later found). they spent the night in the forest under a tarp that "a" had thought to bring and they slept in the mud.
the next day there was a huge nationwide uproar about the attack. many in the upper eschelons in khartoum had come from habillah and they were furious about the attack on their former village, family and friends. a helicopter was immediately dispatched for habillah, holding some high-ranking officials who were sent in to have a meeting and do some damage-control. during that meeting the paramilitary surrounded habillah and prepared to finish destroying the village, as was always the case. the planes bombed the villages into shock, horror and submission, and the next day the horsemen rode in to rape and pillage. the problem this time? there were government officials present in habillah that day, and one of the paramilitary commanders was at that very meeting. the officials, realizing that, for once, their safety was in jeopardy, demanded that the commander stop the attack. they then decided to convince the nomads to leave habillah standing as it would benefit them to have it still exist. where will you buy your sugar and your soap if there is no market? no, leave the village standing so that you can use it to your advantage. and so they did. and this is why habillah remains standing, one of the few villages that wasn't destroyed.
and now? now there is this tentative "peace" in the land. the paramilitary are still armed and are still in complete control of this area. they can beat and steal from the villagers right in front of the police and soldiers and neither of them care enough to step in. they can kill without consequence. no one will leave this village, or any of the other IDP camps, until the paramilitary are disarmed and controlled. many of the people talk wistfully of when the UN peacekeepers will arrive and protect them. then, they say, only then will they feel safe enough to return home. and yet... "a" told me that the paramilitary had already told them what will happen if and when the peacekeepers arrive. the moment their planes touch down in sudan, whether it's here or khartoum, the paramilitarty will kill every single black african that they can. their belief that the peacekeepers are here to fight them and protect the blacks has made them decide that they will take as many of the blacks with them as they can. you came here to defend the black sudanese? oh, sorry, there's no one left for you to defend. go ahead and kill us, you were going to anyways. suddenly people aren't so excited about the prospect of being "rescued". being rescued only sounds like a happy ending if you live to see it happen.

"a" finally trailed off and came back to an awareness of the room. looking at me she said incredulously "they say we are at peace now".

i relent

ok, forget my last email. seriously, in the last day i've received some of the most amazing emails i've ever read (some from people i don't even know)- all of them encouraging me to keep writing as is. some were inspiring and made me think, some were hilarious and made me laugh, and hence i have been persuaded (yeah yeah, make me laugh and i'm jelly in your hands. i'm just that cheap). as much as all of the letters were beautiful and/or funny, i'm going to include the two quotes that most cemented it for me. one is from my best friend kate and, although her Biblical facts are slightly off, the point she was trying to make is a sound one :)

"even Jesus used some naughty words there at the end when his scene got stressful. but think how different the story would be if he hadn't yelled about it, and if no one had written it down"

this is the girl who also gave me this piece of advice when i was first leaving for aghanistan...."i know in the Bible they're pretty clear about not doing this, but if it comes down to it...fall to your knees and pray to Allah- God will understand" (a quote that can still make me laugh out loud). the other quote was from my friend mayan, who said this:

"I will come to africa via sea turtle and break your femur if you try to hold back for MY sake".

as tempted as i am to provoke her to fulfill that threat, i feel that when push comes to shove, she wouldn't really come via turtle.

alright then, on with the stories........ but don't say i didn't warn you

Tuesday, July 04, 2006

a little self-conscious

one of the first conversations that i had with aurelie was one morning in khartoum. we were all sitting in the livingroom having coffee after breakfast and, although french is their first language, she and letitzia were having a conversation in english, trying not to be rude to steffan (german guy) and i. i waited for a lull before saying "feel free to speak french. i'll still understand you and steffan (whose eyes had glazed over by this point) isn't listening anyways". aurelie looked at me, a bit surprised and said "you understand french but you can't speak it?". i say "i speak it, i just don't speak it perfectly". she smiles and asks "a little self-conscious?". i reply "no, a LOT self-conscious". and that pretty much summarizes how i'm feeling right now. a LOT self-conscious.

i keep getting emails from people either asking me or telling me that either they're forwarding my emails, or their friends are reading my blog now, etc etc etc, and i'm starting to feel self-conscious. in my previous travels i have written similar emails and i wrote them imagining that only my family and friends were reading them, knowing that a) they loved me in spite of whatever i wrote or b) i couldn't care less what they thought of me anyways. in a way i was writing purely for myself (they were a diary of sorts), and in a way it was to allow the people who loved me a small glimpse into what i experience on these trips.

now?.....well, now i find myself starting to wonder what i can/can't, should/shouldn't write about. i filter, i censor, i second-guess. if random people are reading my stories because they want to know the reality of life in darfur am i boring them when i write about my own, personal moments here? if people who are hostile towards "religion" are reading them, should i refrain from telling stories about the growth of my faith? if there are conservative people reading them should i not swear or be honest about how much i want to kill people here sometimes? do i sound like a self-indulgent princess for those days when i feel like i can't bear to witness other people's suffering for the pain that it causes me just to see and/or hear it, when they are the ones who have to actually experience it? if there are days when i hate it here, hate my team, hate everything and want nothing more than to come home is one of my supervisors going to hear about it via the msf grapevine and suddenly my having a bad day/week/month becomes a huge deal?

the last few days i haven't felt like writing at all because i feel that everything i write is now subject to scrutiny. i fear coming across as a drama-queen or, worse, draining to the people who don't know and love me in spite of my inability to not take these stories to heart. i see people starting to resent the fact that i try to bring you to darfur, if only for a moment, to realize that these stories aren't fiction and that it's your responsibility as human beings to f***ing do something. i envision people opening their inbox in the morning and seeing an email from here and either not being able to delete it fast enough or, worse, reading it for the thrill of the brutality of the stories. i've never sent the hardest stories in the mass emails, but now i don't want to include any of the hard stories because i don't know where the line between témoignage and some strange sense of voyeurism lies. i hate feeling this way. i don't know what to do to now. i don't want to not feel like i can be open, and tell the stories that i want to tell. i'm thinking of scrapping the blog, and if people don't want to receive the emails they can just not read the stories. maybe i'll send some stories to whoever cares to read them, and designate some to only family and friends. i don't know yet. for now i'm just not going to write. maybe when i'm not sick and exhausted and frustrated and hating it here, i'll decide that i'm going to write whatever the hell i want, and anyone who has a problem with it can bite me. until we say in radio contacts....over and out.