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Letters from the Field - Excerpts
3 November 2004
It's hard to describe what it is like here. The streets are made of sand and the houses seem to have sprung up from the very dust they are resting in. Most people have seen the pictures of children in Africa ; dirty and dusty, flies resting of their faces. And I won't say that this isn't a very accurate portrayal. But, I think the thing that most people don't realize is that it is impossible to stay clean in Africa . It is really dusty and really hot. I know this may sound very simplistic but it's true. I'm covered in dirt and to be honest, I don't even notice the sweat that constantly runs down my back anymore. And the flies. Oh my gosh, the flies. There are so many flies that I've had to forgo swatting them away because inevitably they will just land again and one could spend an entire day doing nothing else but swatting flies. I sleep under a mosquito net and go to the bathroom in a hole in the ground. We drive around in battered cars that are decorated with plastic florescent flowers on the dashboard, and carpeting and gold tassels on the ceiling. The water in our compound is brought by a man with a donkey and at three in the afternoon all the men drop whatever they are doing and pray. At night, the sounds of donkeys, dogs, gun shots, singing, and praying all become normal. I could go on forever but the best, and perhaps the only way to describe the experience is surreal.
Yet, aside from all the apparent surface differences, I realize that the most surreal aspect of my time here in Geniena has been the laughter. I never expected to laugh so much or to hear so much laughter. Seven weeks ago when I drove into my first refugee camp I expected to see naked bodies, skeleton-like, too weak to move, lying strewn across the sands. I expected wails and tears and heartbreak. But these people are amazing. Yes, their children are half-naked and dirty, they have the characteristic swollen bellies and tiny limbs of malnourishment, they live in hovels made of sticks and rags, and moreover, these people have the most horrific stories regarding their own recent histories. But somehow, they have found a way to hang on to laughter and smiles. It is an inspiration to witness how freely and easily these people give the only thing they have left to give; themselves. How many of us can say that we could wait for fours or five hours at a stretch, in 120 degree heat, with at least one crying baby on your lap, joining a chorus of 300 other crying babies, for a bag of porridge and then be pleasant and ready to laugh when you finally arrive at the front of the line? I wouldn't. But the people that I have been working with over the past few weeks are.
I am in awe of this gentleness of manner and strength of spirit in the face of such horrific trials. I am in awe of the graciousness of these mothers when they are told that, although they have just walked for hours to get to a distribution site, their child does not fit the criteria to be in our nutrition program. I am in awe of the ex-patriot who throws the criteria for the program out the window because of “extenuating circumstances.” I am in awe of the Sudanese nurse who reaches out to a new mother and teaches her to breastfeed because her family and friends have all been killed in the turmoil. I am in awe of the Sudanese man who has given up his career in engineering to weigh and measure malnourished children just because “He wants to help.” I am in awe of the Sudanese and ex-patriot staff, alike, who have immeasurable patience in the face of language barriers, criteria, and red-tape. I am in awe of the children who run around with a belly full of worms and play with a plastic bag as though it were the most entertaining thing in the world. Most of all I am in awe of the easy laughter of the people who have been driven from their homes with nothing but literally the clothes on their backs.
I suppose we all laugh because if we didn't, we would have to cry. But I think that this moment in time, when we are all laughing about the silliest things in the world, it is actually bigger than just laughter. We have found a common ground. A thing – whatever that thing may be – that we can all relate to whether national or international staff, refugee or host population. And I realize that I am surrounded by the most beautiful children and most inspirational people, refugees and staff alike, that I think I will ever encounter and I find that I feel blessed in having the opportunity to be here.
Forr the past several weeks I have been working with the nutrition team here in El Geniena, Northwestern Darfur , assisting in the training of local staff members to the different components of Community Based Therapeutic Care (CTC) operation and management. Concern runs CTC programs in five different refugee camps in and around Geniena Town (along with another four CTC programs north in the Salea area and a new CTC program starting in the south in Mornia). A relatively new approach to malnutrition, the CTC program brings the treatment of malnutrition into the community rather than extended periods of time in the hospital. Historically, a child who is malnourished is treated within a Therapeutic Feeding Center (TFC). Treatment in a TFC can take up to a few months depending on the child's rate of recovery. This poses a problem for parents as the child is required to be accompanied by a caretaker 24 hours a day. This prevents the caretaker from working and/or taking care of subsequent children in the household who require attention and care, a large sacrifice for a parent with many children in the household. Some parents are forced to forgo treatment of the malnourished child for the good of the family as a whole.
With the CTC program severely malnourished children with medical complications (ie: edema, loss of appetite, severe dehydration, etc.) are still admitted into the TFC but once their condition has stabilized, usually a matter of weeks, the child is then admitted into CTC. Severely malnourished and moderately malnourished children with no medical complications can be admitted directly from the community, into the CTC program, forgoing hospitalization altogether. So, what does CTC involve? In the CTC program the malnourished child is required to come to a center, within their camp, once a week for a minimum of four weeks. Here, the child receives a medical check-up, medications, and their weight and height are monitored. Additionally, a week's ration of “Plumpynut” and a week's ration of corn soy blend (CSB) are distributed. “Plumpynut” is a food product specifically designed for the recovery of severely malnourished children (and I'm told tastes a bit reminiscent of peanut butter) and CSB is a corn-soy flour mixture that is made into a kind of fortified porridge.
This program has a two-fold, positive effect; the child is being medically monitored i.e. receiving “Plumpynut”, CSB, and medications that would normally be given in the TFC, less time commitment is needed by the caregiver which results in increasing the numbers able to participate in the program. Bringing the treatment of stable malnourished children in to the community also prevents overcrowding of the TFC allowing space within these facilities to treat the more complicated cases. The importance of this is realized when looking at the numbers. At the moment we are treating up to and including 500 children at a single CTC site.
In the long term, the goal of CTC is to bring the treatment of malnourished children into the community and have the community running the CTC program- a sort of by the people for the people idea. Thus, the program is very focused on the training of community volunteers and involving the community at all levels of the program. Hopefully, if all goes as planned, the ex-patriot team here in Darfur will have worked themselves out of a job.
4 December 2004
I have been here for three months and haven't cried. I didn't really expect myself to. I haven't really cried in years. I think it has something to do with being a nurse. Seeing so many sad things everyday, you find a way of detaching yourself on some level. And so you adjust, and although, intellectually you recognize the sadness in a situation, you don't feel it the same way that you did in earlier years. But with all that being said, I cried today. Yet, ironically, it wasn't a situation that one would think would inspire tears. It wasn't for the man on our nutrition team who lost his two brothers in an attack on the road going north; and it wasn't for the woman who was raped nine months ago and then driven out of her home, with her eight children, by her husband because her child was born with Arab features; and it wasn't for the baby who couldn't open her eyes because her conjunctivitis had gotten so bad, and her mother did not possess the knowledge or the resources to treat her; and it wasn't for the fragile little grandmother who was caring for her two orphaned handicapped grandchildren – carrying the seven year old on her back because he had never learned to walk. I felt so sorry for all of these people but I never cried. Ridiculously enough, I cried during a demonstration of how to make Corn Soya Blend into porridge.
The national staff members were well into a demonstration for a small group of mothers - laughing and chatting as they waited for the porridge to thicken. I admit that I was a bit distracted and as the mothers and staff chatted away in Arabic, I was contentedly watching the four cutest little boys outside of our shelter. Knowing they were being watched, they were waving and shouting and jumping off things, as little boys do. The oldest of the four was only about five years old. When the porridge was done we decided to invite the boys inside to eat. Amani, our Health Educator, called them inside, and slightly unsure, they conceded. Using a mug full of water and a sandy bar of soap, Amani washed their hands and faces, sat them down on a grass mat and placed the plate of porridge in front of them. I sat in the corner, idiotically beaming and thinking “THIS is what it is all about.” And I watched them eat in silence. They ate with their hands - as they do here – the five year old scooping up a handful and putting it into the hand of his two year old brother before taking another handful for himself. I watched as silently they scraped the plate clean and then allowed Amani to wash their hands and faces again. Then the five year old stooped down to allow the two year old to climb on his back and silently the boys walked away.
It was such a lovely thing to witness and I don't know at what point it all became so sad to me. I just started thinking about the children at home and comparing them to these four boys and suddenly I had a lump in my throat. It was so many things. I watched the kids eating porridge and thought... Do children at home even eat porridge anymore? And if they do how much do they complain about it first. Perhaps, they want Coco Puffs or Sugar Bears or “something else”. And I realized I had witnessed one of the realities for the children in Darfur . Eating will never be about choice, it will always be about opportunity. This realization seemed amplified by their silence. They never said a word. I noticed the silence and it filled me with a deep sadness but I didn't figure out why until the children had gone. I realized then, that it was the intensity in this silence that was so disturbing. A fearfulness that perhaps, if they made any noise or moved too quickly, the food would disappear or the provider would change their mind and take the food away. A learned reaction to a desperation that I never knew as a child, and therefore will never truly understand. I thought of all these things and cried. And as I cried I asked why. That impotent sort of why that you know has no answer. And I found that once I started crying I couldn't stop and now I was crying for the man and his brothers, and the woman who lost her place in her community, and the baby who may loose her sight, and the grandmother who is so alone in her burden.
But then Amani put her hand on my shoulder and as I looked at her I thought about how beautiful it was to see her wash the children's hands and faces. The natural tenderness and compassion in the way she interacted with them as though those children belonged to her. And I thought of the embraces for the man who lost his brothers, and the national staff's impromptu collection for the woman with eight children, and the neighbor of the grandmother who carried her bag of porridge for her, and I remembered. I remembered that the world is not perfect but it is those things that seem so small that really make a difference. I remembered that a compassionate hand on a shoulder may not bring with it the power to heal but for a moment it just might feel like it.
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