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Letters from the Field - Excerpts
| 15 Oct 2004 | 20 Oct 2004 | 27 Oct 2004 | 30 Oct 2004 | 9 Nov 2004 |
| 13 Nov 2004 | 15 Nov 2004 | 25 Nov 2004 | 26 Nov 2004 | 3 Dec 2004 |
| 17 Dec 2004 | 9 Jan 2005 | 19 Jan 2005 | 26 Jan 2005 | 2 Feb 2005 |
| 7 Feb 2005 | 11 Feb 2005 |
15 October 2004
Things are good here in Nyala. The weather is hot, but dry and the pace is slow, especially since Ramadan started today. 90% of the people here are Muslim and during Ramadan, they fast from sun up to sun down, then eat and celebrate late into the night. So, during the hot long days here people move a bit slower and relax a bit longer, and generally that means everything in general is more painstakingly slow! The good thing is that during Ramadan the rebels will probably not attack any of the villages, as they will be observing as well.
There are many, many different political, social and historical reasons for all of the fighting that is going on here in Sudan . It is true that the Janjaweed are attacking and raping and engaging in all of the other atrocities that we hear about in America . They are basically terrorists and that is what they do. They are extremists and “real creeps” as my Country Director referred to them. He also described them as ghosts that just appear to be moving about the country, sweeping in and out of these villages.
So that leaves many people run out of their homes and living out in the open, with no food, little clean water and in very close proximity to one another (which leads to disease). That brings me to one of the first health related things that ARC has accomplished in conjunction with UNICEF, as of late. Like I said, the pace is VERY slow here, so it takes a long time to get things done. It can be very frustrating, but Susan (Primary Health Care Coordinator) has assured me that there will be a time soon when we will be so busy, we can barely keep up! Anyway, prior to my arrival Susan had coordinated with UNICEF to start a polio vaccine campaign. Previously there had been no incidences of the disease in Sudan , but there have been some cases reported in many of the camps, thus, it was decidedly an important vaccine to be given. So the polio vaccine was obtained (OPV) distributed to local vaccinators (i.e. local people who are health workers), and they went to the villages, clinics, and door to door to give to all children under the age of 5 years old. The campaign was a pretty big success. So, that all happened before I got here, 3 days ago.
It's hard to know where to start in explaining what we are focusing on, as I still am learning the ropes right now and feel a bit confused with everything. However, our main projects will be to start primary health clinics (PHC), and the implementation of mobile clinics. Right now, we are focusing on the corridor between Nyala and Girayda. It is hard to explain without a map, but I will try. Nyala is point A, and Girayda is point B. There is one road (if you can call it that) between the two and they are approx 4.5 hours apart. In Nyala, the people are okay, there is food, etc. and life is sustainable. However, in Girayda, there is only one water source for about 40,000 people and life there is very grim. The corridor between these two places is also filled with many, many small villages. Some that have been attacked and some that have not...this area is still considered “insecure”. It should also be noted that these small villages are a bit upset because they see humanitarian aid, fly right by them to get to other, big camps, and they feel that no one has seen them, or cares about them.
One such village, about halfway in between is called Donki Dreissa. Again, prior to my arrival, Susan had visited this place and found an old, abandoned clinic. So, this brings me to our first project: The implementation and construction of a PHC in Donki Dreissa. We went there yesterday to take another look at it. The water and sanitation people (with ARC) had already been there and are working on that. Our programs manager, Gideon, came with us and set up the construction. The deal is to hire a local staff and have them provide local materials to build a hut, and renovate the decrepit building that already exists. There will be 3 small buildings total, the stronger, concrete building will be used for drugs and supply storage, and the other two will be registration, treatment and examining areas. The people of Donki Dreissa are very happy to help told us that they would not require any money for labor or supplies. This not only cuts down on the cost for ARC, but also enthuses the locals, helping to make them feel a part of, what will be, their clinic.
Donki Dreissa is a very poor community, in need of assistance and better healthcare, but it became clear to me that it is not a camp. Perhaps, there are some IDP's in Donki Dreissa, but for the most part they have huts made of matting, sticks, and straw, and pretty clearly marked homes. This was NOT the case as we came upon a pretty clear “camp” on our way to Donki Dreissa. We stopped and through an interpreter came to find out that this area of people were run out of their village, after they were attacked 25 days ago (by whom I don't know). We talked with the “elders” of the camp and they told us that there were about 600 families in this particular camp, which was called Hereida. They said that no one had been to see them or help them. This stood out as a camp, because, while are all very poor and small villages, this one was desperate. Their huts were made out of sticks, and small pieces of plastic bags, or tarp, and they were very tiny, and very unstructured. Practically the entire camp came out to see us as we pulled up. They need help so we have decided to take this area, and do an assessment to see what can be done.
20 October 2004
Hey guys, just wanted to tell you all about my trip to the camp on Monday. I went to Kalma Camp which was just outside Nyala...HUGE. And I mean HUGE. As we were driving in at one point all you could see was tarps, plastic sheeting huts that just seemed to go on forever. I think it is estimated that there are about 70,000 people in this camp. I went to this camp actually as a visitor with MSF...MSF is actually Doctors Without Borders, you may have heard of them.
There were 4 beds for patients who were sick enough to stay (inpatient) and the rest of the people came through and most were sent home with antibiotics, or whatever treatment they needed (outpatient). There was a triage area, a structure thing for a waiting line outside, a “room” for dressing changes (people who had to come in frequently with wounds...i.e. burn victims, infections etc), there was an injection room for vaccinations or other, and there was a little pharmacy with metal cabinets that held drugs and other supplies. The pharmacy was basically this room (and when I say room I mean it had walls made of either the straw matting or the blue plastic tarp, and the doors were these homemade screen-type things with some linen and 2 sticks at the top and the bottom – think dressing rooms at dept. stores) and the pharmacy had a big rectangle shaped window cut out of one of the walls, which served as the counter that patients would go to get their scripts filled. Outside of this main structure there were also other straw huts for labor and delivery, prayer, and staff “break” hut.
The patients: there were about 3-4 patients that were in the inpatient room. Mohammed was a 9-year-old boy with severe malnutrition. He looked like a skeleton...lethargic, listless, barely moved unless made to. Pretty much like the starving kids with flies all over them that you see on television. I didn't see him smile, ever. And his eyes had this look of bleak hopelessness, or maybe it was just plain apathy....he never really made eye contact or seemed to focus on anything...he was pretty tough to take...never with a complaint, or even a word for that matter....I mentioned this lethargy to Megan and she informed me that he was actually worlds better than he was a week ago. One week ago, he just lay there....today he was able to sit up, swat flies away from his face on his own, he was being fed with these biscuits that are used to re-nourish someone....there are a few different types based on the weight, etc. At first he could only take milk, but has slowly been increased. His grandmother was the only family member there with him.
There was a mother and baby in the next bed, she was malnourished and originally the baby came in with meningitis. Small and thin this baby was, with the flies to boot. They were doing okay but the baby was spiking temps...there was a question of a UTI...probably okay to d/c soon, though.
The last patient that became inpatient for the day was another mother and baby. She came in for her weekly rations of food, but then the baby was found to have a temp, sunken fontanel (very dehydrated), and a pretty junky cough and poor breathing pattern. He was more lethargic than any baby I've ever seen: he wouldn't take the breast and would barely open his eyes. The mother was re-hydrated with oral re-hydration salt water, and continued to try to breastfeed (not to mention that she was not doing it right), she stopped fasting (Ramadan) and the baby was given amoxicillin. By the end of the day he was WAY more alert and awake, and eating more...she was sent home.
27 October 2004
You've got to hear this one: I finally figured out Abdullah's (my toothless houseboy) trick to ironing my clothes to perfection. I thought he steamed and ironed them like any normal person would; then when I actually watched him do it, I remembered I was in Sudan . He sits in his little corner on the ground where he takes all of our clean laundry to iron and I could hear the steam spraying from around the corner...HOWEVER, when I turned the corner I looked and realized it wasn't exactly steam that I heard. It was him. Spitting. On my clean clothes. Apparently Abdullah doesn't use the steam part of the iron. He just takes a sip of water out of a cup and sprays water on the piece of clothing with his mouth. Spitting. On my clean clothes. All I could do was laugh. In fact I laughed so hard I was almost crying. Who exactly taught him to iron, I wonder? Just try and picture it: toothless man spewing a mixture of his saliva and water in an effort to get these clothes just perfect. Somehow I don't think that Martha Stewart would approve. The part that makes me cringe the most is that when he hands me a pile of my folded clean clothes, often times I put my face right in them, take a deep breath and say “Ahhhh, clean clothes.” Not anymore, my friends. Not any more. This place is just unbelievable sometimes.
Next it was on to Greiga, which is only about 17 kilometers away from Donki Dreissa. I had been to Greiga the first time I went out into the field and it pretty much looked the same. Grim. Their shelters were small, their huts made of meager looking sticks and plastic bags, or trash, whatever they could find. We asked to speak with the “sheiks” or the elders of the camp and from them we obtained the exact situation of the camp...what are the biggest problems that they have, if they have access to anything, etc. Basically what we found out was that this particular group of about 3,000 people had moved to this area because their village had been attacked by the Janjaweed about 3 months ago. Since that time nobody has been by to see them or assist them and they are having some trouble, to say the least. The water that they showed us that they were drinking was brown. They said they had no food and that everyone was sick. There was a water source that was nearby (about 1 or 2 miles). We talked with one woman that only had one jerry can (jug to hold water) which held 4.5 liters of water for her family of seven. She said that she made about thirty trips to the pump each day. Keep in mind, this water is for cooking, cleaning, washing and drinking. Needless to say she simply did NOT have enough. As far as their health concerns, they told me that their children had “yellow eyes”(which is most likely Hep E), diarrhea, fevers, and malaria. They reported about 6-7 deaths in the last few days of children under 9 years. They also had these kids with some seriously gross skin ulcers from sand flies.
The people in Greiga were so happy to see us and the Sudanese in general are so grateful and friendly. To explain the people that I have seen in the field I would say that they are deeply religious people, who love their kids and their families very much. They are bright and warm-hearted people who smile easily. They are simply in search of a happy, healthy life, where they can live comfortably with their families and live without the fear of being attacked. I asked the Sheiks how security was in Greiga. They said that it was very bad. They said they were just attacked yesterday by the Janjaweed.
30 October 2004
I have started buying stuff for my mobile clinic. The mobile clinic is supposed to be MY baby. I'm kind of in charge of that whole thing. I bought two big metal boxes for drugs and medical supplies and stuff. I got them for a steal at the market (or “souk”...how's my Arabic?) and they are painted blue with this really cool colorful artsy, flowers kind of thing painted on them... Katie's Colorful Mobile Clinic. I'm trying to decide which music I should blast from the megaphone as well! Who says you can't mix art with health? Seriously though, we should be able to have our first mobile clinic run to Greiga this week...maybe Wednesday. Hopefully things will go well. I'm looking to help them with their “skin issues.” My guess is that there are going to be a lot of people with nasty, crusty, yellow wounds that need dressings. They have already showed me some of them.
9 November 2004
Douglas has a beetle. It's a freakin' monster. He named it janjaweed. It's screwing up his latrines. Douglas is our water and sanitation guy, I think I have mentioned him before....he is the smiley Kenyan. He's a bushman and a Kenyan through and through, which includes having a love of animals and nature. Kenya is a place of animals. He has taught me a lot about animals since I have met him, including lizards, snakes (after which I had nightmares), lions and tigers and he loves all animals, including bugs. Well, this particular, monstrous, gigantic, people eating beetle is about the size of my head (maybe I exaggerate a little bit). It burrows underground through the sands and is creating problems with the latrines in Donki Dreissa at our mobile clinic. When the holes are dug for the latrines the sides and the walls keep falling inward because of these damn beetles. Douglas caught one and brought it home. I'm not sure why exactly but it lives in a plastic cup next to my desk. I only came to know of this yesterday afternoon when I could hear his claws/tentacles/antlers/whatever scratching to get out.
13 November 2004
One of the things that we are talking about is developing some programs related to female genital mutilation. For those of you that don't know FGM is a traditional practice that still occurs in many parts of Africa where a young girl (usually 12 or 13 years old) is cut as a rite of passage. This cutting includes the partial or total removal of the clitoris and sometimes other parts of the female genitalia. Here in Darfur , we have asked around a bit and found that this still is a fairly common practice, especially in the villages. It is not known to be the most sterile technique, to say the least, and causes many, many problems with childbirth, sex, and infection. We asked one of the doctors in a hospital south of here about it and he said he had never seen a woman who was NOT cut. One of our next plans is to start throwing around ideas to increase awareness and see how that goes over...we shall see
15 November 2004
They burned down our clinic. All that hard work, down the tubes. I'm pissed. We heard this morning that a fight broke out between the Janjaweed/government soldiers and SLA (rebels). 28 people were killed...mixed janjaweed and SLA soldiers. Six were injured, including one civilian. Somewhere in the cross-fire our clinic was burnt. Granted this is all hearsay, and rumors, so we don't know the actual situation yet. Maybe, it's not as bad as we hear it is...we will find out. The African Union has been informed (they are the peacekeepers between soldiers). They are going to Donki Dreissa tomorrow to check on the situation and find out more accurate details as to what really happened. Damn soldiers. They shot themselves in the foot. This clinic was to be able to help them too....all the money spent and the efforts made, the energy spent.....makes you want to just throw your hands up.
The African Union went out yesterday to check the situation and sit down with all of the rebel and government leaders. The true story is that the government soldiers arrested 3 rebels and incarcerated them because they were walking around with guns on and uniforms (I am not sure why that is a big problem, because here in town there are many soldiers who walk around armed). Anyway, they incarcerated them and told them that they would be released in the morning. Before morning came, though, the rebels stormed the barracks to release their guys. I guess they used our cars, but took off the flag, and hid the license plates, etc. 10 soldiers were killed and 7 civilians were caught in the crossfire. Our clinic is fine, and our own safety is still secure. Unfortunately, there were some people who have gone missing from Donki Dreissa. One of them was Ibrahim, our vaccinator that we hired a couple of weeks ago. He was a nice guy. It is presumed that he is dead.
25 November 2004
Sorry I haven't written in a while...things have been busy. Let's see, where do I begin? Well, first of all winter is here. Yup that's right. It is down to about 70 degrees in the morning (still up to about 80-90 midday). For me, this is nice weather, but you would think that the Sudanese are expecting a blizzard. One of our drivers showed up this morning in a winter jacket with a hood on tied tightly. They have on hats, scarves, sweaters. I was like, “what's the matter with you people? You want cold, I'll show you cold...” ah well, winter is here...and I'm still sweating.
Another big thing that happened this past week was our first mobile clinic trip. You know Griega? The extremely poor area of IDP's that really, really, really needed assistance? Well, we went there for our first trip on Thursday. It was completely disorganized, total mayhem, but surprisingly enough, not a virtual disaster.
We didn't have enough plastic tables, so our pharmacy (the blue metal box) ended up being in the bed of the pickup truck, where Susan and I stood trying to keep up with the mass of people that were swarmed around us. At one point as I was trying to draw up an injection I saw a little brown hand reaching up beneath my arm. I looked down and there was a little toddler practically underneath my feet. I was like, “Alright, listen: keep your kids out of the drugs.” It was kind of funny, though. Sometimes all I can do is laugh. This one woman was right next to me coughing in my face just to prove how sick she was. “Okay, lady I get it. You have a cough, but the whole village does not want what you've got, so cover your mouth.” All the little kids coughing all around me...one woman acting out how she has been throwing up...and I even saw the same guy from a couple of weeks ago with some sort of foot fungus. I got real close and personal with it as he thrust his foot toward me. Let me tell you, it was a nurse's playground Keep in mind that this is all happening while Susan and I are trying to pour and pass meds. Again, I had to laugh. When the kids all coughed I would try and mimic them, while covering my mouth, and say very loudly “COVER YOUR MOUTH”. Then they would all laugh...silly white girl, there she goes again. It was a very effective teaching session for the prevention in the spread of infection
The nurses that were with us didn't speak English very well, so trying to explain triage to them was pretty much not happening and as for the waiting area: it didn't exist. I couldn't explain to Ali (my favorite driver) how to put up the canvas shelter thing, because he doesn't speak English, so we were stuck in the blazing sun, and the dressing changes were far from sterile technique (I did try my best though). Now, despite all this chaos, we did manage to find some method to the madness. It could have been much worse....and I loved every minute of it.
26 November 2004
We are in charge of coming and providing medical care, but the elders, sheiks, and community leaders are the ones who are supposed to maintain crowd control...hopefully in time we can fix that problem. My little map system did work, however, despite the mess around registration. The patient was seen by the doctor, then proceeded to the pharmacy where I was helping Ismael with prescriptions and dressing changes, and other such treatments, and all in all we were able to treat approximately 120 patients in about 4-5 hours. I saw my knife wound guy again...still looks infected. In our basic kits of medicine and supplies that we have received, we have nothing to put on wounds, or ulcers...no neosporin or bacitracin...so, I brought my own. Maybe in the long run, it doesn't help that much, but I just couldn't help but feel that these wounds needed some sort of ointment, or SOMETHING on them. I don't have that much, just a few packets that I swiped from MGH, but I at least felt better using something...so if anyone wants to send something, send that. The day was a blur, and a complete whirlwind, but again I loved every second of it. I don't think that Ismael or I stopped for a minute. Scratch that, he went off to pray a few times, but I didn't leave my spot for the entire time that we were there. Again, I did a lot of dressings and drained some little boy's abscess that he had on his hand. I made him cry pretty hard on that one. He still wasn't happy even when I gave him a happy face sticker afterward...oh well. One thing that I noticed, and I have noticed this before, but it still surprises me a little is the care that these people have for each other. In this male dominant society, I would have expected the woman to take the child to see the doctor, and the woman to comfort the child, etc. But in this case with the little boy and the abscess, like in many other situations that I saw that day, it was the father that took the child to be treated. When the little boy (about 9 or 10) started to cry from the pain in his hand (which he was desperately trying to fight), the father held him and comforted him with soothing words. Not only that, but our male drivers, and some of the other men even came over and were trying to comfort the boy. I think I have said this before, but the Sudanese are just people who love their kids, and love their families, and I am truly humbled by their warmth and kindness.
3 December 2004
It is sooooo hard to say no, but the fact is that we simply can NOT treat everyone. There are just too many people. One of my big problems with this clinic, besides the giant mass of people, is a lack of staff. If I had a team of 10 doctors, 20 nurses, 5 registrators, and an orderly line...then MAYBE we could see everyone. But as it is I have a team of about 5 people total. It's just not enough. It is very hard to turn people away. It is my least favorite part of this. Not to mention the people that we can't do anything for. A mother brought her baby to me with hydrocephalus...clearly hydrocephalus, his head was huge. I couldn't do anything for her except tell her to go to Nyala Hospital (which is far away, and not free....) Again with a little boy who had a huge tumor-like thing growing between his eyes, and another boy with limp, dead limbs...maybe polio? At any rate, there is nothing in my colorful metal box to help these ones, and it is hard to tell them that.
On a happier note, I think that these children are the cutest kids I have ever seen (besides my own 12 nieces and nephews of course). They are so giggly and they follow me EVERYWHERE... there was this little boy at the mobile clinic in Dito the other day that was just too cute. He followed me around and giggled when I made silly faces at him. At one point, after he got up the nerve, I imagine, he came into the “pharmacy” where Ismael and I were working to ask for a drink of water. Ismael said, “He just wants a drink from the cowaja...” Very true, as there was a water jug right outside that he could have used. Soon after that he came in again, and so I gave him a sticker. He was really happy with that...then all of a sudden I realized he was sharing my seat. I was sitting at the edge of the wooden chair and he had climbed on the back right beside me...I felt his warm little body on my back and he rested his chin on my shoulder so that he could watch everything that I was doing. I looked around at him and laughed, he backed off for a second, because I think he thought he was in trouble, but then five seconds later, there he was again....my little shadow He held the caps to the medicines while I poured, and if something fell on the ground, this kid was all over it. I gave him the sticker sheet, so that he could take another one for his hand. Then the next time I turned around, he was covered in the colored happy faces. He had three on his forehead, one on each cheek, one on his chin...I wish I had my camera with me, but unfortunately I had lent it to Douglas . He really was one of the cutest kids. I could have taken him home with me....I think his name was Yassin.
As far as the patients go, because I know MGH will want to know this, we see many anemic people in Dito and in Greiga; that skin thing with the sand fly is a real problem (leishmaniasis). There are many, many people with malaria, and fevers. Many respiratory infections, and of course...everyone's favorite....diarrhea. We try to avoid any IV use as it is just an opportunity for further infection, but the other day we had a real sickie. She was a young woman who was very thin with a high fever and was clearly dehydrated. Her eyes were sunken in and trying to get an IV in her tiny, dried up veins was almost impossible. She had been vomiting for I don't know how long. We got the liter in eventually and I sat her up and gave her some water and a Tylenol. She looked much better before we left. This is the kind of patient I like to see: one that we can help.
17 December 2004
The mobile clinic is a success in Greiga. We went the other day and things ran smoothly and we were able to see 106 patients. These little kids follow me around and giggle at everything I do. I think I have turned them fresh though, because I stick my tongue out at them a lot, and it has caught on. Now I have little kids sticking their tongues out at me left and right I was inside the tent where we see patients at one point and their were a bunch of little kids peeking at me underneath the bottom of the tent. Well, when I came out finally and walked around to the other side, I saw a few still looking underneath, so I crouched down next to this little girl and put my head next to hers as if I was trying to see what she was looking at. She finally looked to see who was next to her and I said “HAHA!” She jumped about a mile. I think I was laughing as hard as all the other kids who were watching (she laughed too, I didn't scare her that much). It was a good day.
We saw so many patients and there were a couple of old ones who were really cute. There were many people who, when asked their age, did not know. One old woman tried to convince me that she was 50 years. I was like, “yeah, right lady, maybe twenty years ago....put her down for 75.” When Sadia wrote 75 though the lady was like, “no...50...I said 50.” She wouldn't leave until we changed it. Another old lady, whose age I also had to make up, was trying to suck the thermometer like a straw and couldn't hold it in her mouth for lack of teeth. It kept slipping out the gap where her front teeth where supposed to be when she stopped sucking. Keep in mind that the whole village watches and laughs at all of this...even she was laughing. It makes me think of something Gideon said to me once, “it's amazing how they maintain their smiles. They have nothing, but they can still smile.” Then we had Crazy Man (who incidentally comes to EVERY mobile clinic complaining of illness...though he can't explain to me what exactly his “illness” is). He greets me every time like we are long lost best friends. Well, we put the thermometer in his mouth and the next time I turned around he had taken it out with his two forefingers and was trying to flick it like a cigarette. God, I really just love these people.
9 January 2005
I'm back...Back to the dust and
grime...back to the smells that seem to be
everywhere....back to the lack of water pressure
(though we now do have hot water now at least)...back
to the frustrating attempts at communication...back to
friendly smiles....back to toothy grins of
children...back to loving people.....and back to a
place that I have come to love.
I have received a very warm welcome back...Sadia (one
of the nurses) hugged me into her bosom like I was a long lost
child. It's nice to
be back though...everyone told me that they missed me,
and it was nice to feel missed.
Anyway, so now, they
are talking about sending me on a 4 day trip into the
bush for a polio vaccine campaign. It's not that they
need me for the vaccine distribution, but rather they
need 2 expats from a few different NGO's to go along
for security reasons. So, it looks like
me and Gideon will be going on Monday...safety is not
a concern...we are being sent by the UN with radios
and all that good stuff..
Well...I wrote that the other day, and then I wasn't
going, then I was going, then I wasn't because Gideon
wasn't and I wouldn't go alone, but now Gideon is....
Needless to say, NOW, Gideon and I will be leaving
tomorrow (Monday) morning for Jabal Marrah which is in
the mountains to support this vaccination campaign.
However, because the road between here and Jabal
Marrah is still rather unsafe they have decided to
take us by helicopter. It
will be a UN helicopter, and then when we get there we
will have to travel by camel or donkey. It sounds so
exciting. Not sure what the
accommodations will be like, but Dr. Malik from UNICEF
said that there will be a room and a bed for each of
the expats, so I guess it won't be that bad. I am
expecting that the bathrooms will be gross....but I
suppose I will live.
19 January 2005
Since
Jebel Marrah, I have been back in Nyala and this week
I went out with the mobile clinic to Tokomaya,
Barakatulli, and Greiga. The mobile clinic has
changed some since I left for Ireland. Ismael and
Mohammed went back to school, so we have had to hire
some new staff...in addition we are in need of even
more nurses and medical assistants so as to start a
second mobile clinic team to be able to cover our ever
expanding areas. So basically this week I just went
on the field trips to observe the staff and see how
the new people are doing. Also, we
have been talking about starting these children
friendly centers to provide the children, who seem to
just hang around the clinic with nothing to do, some
health education, recreation, and essentially just
something to do. It has changed here, though, I'm
surprised to see that in many of the places we go to
there are more kids in school, whereas one month ago,
there was no school. It looks like people are
starting to feel more secure and starting to rebuild
their basic community structures which is a good
thing. I'm not quite sure why they feel more secure
now, however...maybe it's the presence of all the
NGO's, but the security situation has not seemed to
change. At all. In fact we have noticed that there
are more camels along the roads that we travel to go
out into the field, and I mean like hundreds of camels
grazing along the fields. You look around, though,
and see no person. I asked about this and Mohammed
told me that is because they are hiding. I'm not sure
exactly what it means, all I know is that it's
unusual, which is not good. I think it means more
rebel movement...all the locals say, Danger! Danger!
When we drive by all the camels and then they laugh.
They tend to laugh at inappropriate times a lot
here...I don't get it. We also had another incident
when Gideon and I were in the bush. The polio vaccine
campaign that Gideon and I were supporting in the
mountains was also going on in Nyala and surrounding
areas. So we sent our vaccinators out with some
rented ARC vehicles. Well, our one vaccinator,
Ibrahim went to Salaam Naga ( a village), and was
stopped by some SLA rebels who proceeded to steal the
vehicle and the driver. Anyway, they stole the car, and the vaccine
(though they returned all of it intact), and kept it
for two days. So while this was happening, Dr. Dawaha
(one of our doctors) and Kip were driving out to the
field to do something or other when they were stopped
by SLA rebels...in our car. They knew it was our car,
because it had ARC stickers all over it. The SLA made
them get out, surrounded them with guns pointing at
them and asked where the cowaja was. When they
pointed to Kip, who is blacker than night, they
laughed, but eventually realized that he was
international. After they realized this, they became
friendly and let them all go. Kip, decided it best
not to bring up the fact that these soldiers were
driving in one of our vehicles...he just sort of let
that part go....I think I would have to! So, at any
rate...after that we have decided for our local
staff's sake that we need to travel with at least one
cowaja, or international.
So, back to my mobile clinic. I almost feel at a
loss, because they run it pretty well and they don't
really need me anymore. I'm like the parent sending
their kid off to college...it did however really give
me a chance to observe everyone and there are some
practices that REALLY REALLY need to be changed. Like
changing a big nasty dressing without gloves. So my next thing is that I am
going to have the staff take off one day maybe a week
and start some trainings with them: wound care, hand
washing, blah, blah, blah... The mobile clinic works
great, and if I could just change some things about
the staff and "capacity build" (this is an obnoxious,
but pertinent, term used by EVERYONE in this type of
work....)then it would just be great....perfect. The
thing is, they really want to learn, and they really
want to perfect their work, I just find it hard,
because I don't want to come in and tell them all what a bad job they
are doing. It's a fine line I guess...
So in addition to this, Monday we are going to have
our first training with the little kids in
Barakatulli. In Barakatulli, the school is not
functioning, so this will be a good place to start. I
have talked about this with the group and Susan
thought we should attach it to our new and upcoming
education program, but I didn't want to wait. I felt
like, why wait until the education program is in
place, when we could just bring a tent with the mobile
clinic, get some kids, and make some teaching
activities for them. What's the worst thing that
could happen? Some kids get scrubbed for an afternoon.
What a disaster! So I pushed for this...and now on
Monday we will have our test run. I can't wait. We
have asked for them to bring us 25 kids from the ages
of 5-10 years and teach them...hopefully it will all
go well. Inshallah.
The other new thing around here is the arrival of
three new volunteers. Kris Olsen, who was last year's
Durant fellow and his wife Erica (or as I like to call
them Mary Kate and Ashley...) and this PA from
Minneapolis, Rob. It's nice to have some more
people around and to get new perspectives on how
this whole program is really run. I have found that
some of my frustrations with the management of this
whole project is not just me. Kris and Erica have
also complimented my mobile clinics and it is really
really nice to get some positive feedback.
So, that's what is going on...today started a 6 day
holiday (Eide) for some reason or another, so things
are a bit slow...but we are still working away.
Fun Fact Culture Trivia That I Learned In Jebel
Marrah: In a group, if the men outnumber the women,
then they must bring a stone with them to "keep the
balance". They told Gid and I that if there is one
woman and one man, then it is okay, but if there are
two or more men (say in a car...)with only one woman,
then there must be a stone with them to maintain balance...otherwise you might get in a car accident
and die or something terrible like that.
Information That I
Recently Learned That Makes My Skin Crawl: When Donki
Dreissa was attacked back in April, before we ever got
here, it wasn't just the usual burning of the huts,
raping and pillaging, killing the men kind of thing.
They also took children and threw them into the fires
of the burning huts. I can't even imagine the horror
and terror that must be within their hearts, having
lived through an experience like that. We recently
just opened a water yard in Donki and there was a
celebration, where a bull was slaughtered and the
people danced all day and all night. They were asked
why they danced all night long...I mean, the clinic
has been open, and really it is just a water
yard....they replied that, "because up until now we
have just had nothing to dance for..."
26 January 2005
So, tomorrow we are headed to Barakatulli for our
first children health education lesson. This is to be
a "test run" to see how this type of program will be
received and generally how it will go in the field.
We had a meeting today to prepare for the lesson. Well, first
of all Mohammed (our child protection officer) and I
talked with the education leaders and told them to
bring us 25 children between the ages of 5yrs.-10yrs.
So, for the first half hour we will have an introduction...then the next hour will be the health
education lesson, next hour will be a recreation sport
( I wanted red light/green light...so we might do
that...), then the next half hour will be a quiz on
the material, and finally we will have snack before
the time is finished. The health education is basic
including health and hygiene, hand washing, covering
your mouth when you cough and brushing your teeth. We
made some great posters to have a visual aide (which
the locals were like, "I don't really know if we need
them,") but I think they are important, because if we
just get up there and lecture about health to a bunch
of kids, they will be bored. This way, there is a
colorful visual to reinforce the material.
Anyway...so the posters are great, we used my colored
Sharpie markers that I brought from home and made a
poster defining what a germ is...how germs are spread.
Then another poster showing how to prevent germs from
spreading, then another poster on hand washing, and
finally one on keeping your body clean. Fatima (the
education coordinator) wrote the info in Arabic and I
made little pictures to go with it. We are also bringing
some basins with us to make the kids lather up and
show them proper hand washing technique. Finally
after we have the "quiz" on what the lecture contained
(which we will give lollipops out for correct answers)
we will give them biscuits and juice for a snack.
Sounds great, right? I can't wait. I'll finish this
letter tomorrow after the training.
So, now it is 2 days later and the training was a
HUGE success! The kids really enjoyed themselves and
really absorbed a lot of the training....from what I
could tell anyway. Tahany is really great with kids
and they were just absolutely captivated by her. She
did the health lesson, then we did the recreational
activity...(which included relay races, a version of
musical chairs, and some singing, stretching and
calisthenics...) The kids really enjoyed it and the
winners of the activities were presented with an
awards bag which contained balloons, lollipops, and
biscuits. After the recreational activity we had a
quiz, lollipops for right answers (the kids did
great), and then everyone came up and washed their
hands in front of the group. One kid even washed all
the way up to his elbows...I loved that, so I gave him
an extra lollipop. Then we gave out juice and
biscuits, and then it was over.
There were a few things that I would like to change.
First of all, we had asked for 25 kids, but there
seemed to be so much extra room in the little hut we
used (the tent was unavailable). Next time, I want to
increase the number of kids. The
other 75 kids who were not part of the program and
showed up anyway, and were peering through the cracks
in the straw hut and watching longingly during the
recreational activities. I felt so bad....but I made
an announcement (with a translator, obviously...) That
we WOULD be back and all the kids who did not get to
participate this day, would be able to participate in
the future. Now I have to be good to my word, and
really make sure we get back there. At any rate, other than a few minor tweaks, it was
just great. It was fun, and it was educational, and
at least 25 kids had scrubbed their hands really well
by the end of the session if nothing else. So, today I am going over to Kalma camp to take a look
at some of the children centers and women's centers
there to see if we can't start up a stationary one.
So, hopefully these ideas will be implemented before I
go home...and hopefully I can create this program and
make it sustainable for long after we leave...that
would be the most ideal goal of all.
2 February 2005
Today felt like a productive day. Mohammed, Tahany, Fatima and I went to Elwoheida and SPCR to discuss children friendly centers. Elwoheida is our clinic within Nyala town that up until now I haven't been too involved in. However, now I want it to be the place for our first, stationary, children center. So we went to discuss it with the community leaders and the heads of the clinic to get their opinions and input. They were very excited about the idea and definitely felt that there was a need for it. We discussed if the center should be located within the clinic area, or if it should be outside this clinic. It was discussed and they decided that a good place for the center would be in the "playground" right next to the clinic. (By the way this clinic is one that was just started before I left for Ireland...it already existed, but had virtually no money, no drugs, and very little by way of supplies and furniture. So we are technically not running it, but rather "supporting it".) Elwoheida means "unity" in Arabic. Anyway, so we went outside the clinic to the playground. First of all, stop picturing monkey bars, see-saws, swings and slides. It was simply an area of uneven dirt with rocks and trash. I was like... "THIS is the playground???" It was nothing. Nothing. All there was to be seen was trash. As we stood there about 10-20 kids came running over to see "the cowaja". Proof that there are too many kids just hanging around, and need something to do. Their snotty noses, and dirty hands were proof that they need this health education also. I asked the community leader about "street children", and orphans....if there were many, if ALL children were enrolled in school, etc. He informed me that there were many, many children who are not in school, and many children who live on the street or have to work to find food, and many orphans. I think the need is great.
7 February 2005
So we finally arrived in Tokomaya, set up the clinic and started seeing patients. All the same children who jump in line complaining of a headache jumped in again. They like to come to the clinic for the social visit. There's basically nothing else for them to do...so why not go to the mobile clinic and stare at the crazy white girls for a while. At first when they said "oh, I have a headache..." I immediately said, "beat it." Then they got smart. When I say one kid with junky stuff in his eyes, I said, "ok, you stay." The next kid immediately complained of eye problems. His were fine. It makes me laugh and it makes me want to cry.
So after I picked and chose the patients (despite the fact that the minute I left, they all got back in line again and managed to make their way through anyway...) I went into pharmacy. Fatima told me we ran out of wrapping gauze...we had only a little bit of square gauze left. Then we ran out of gloves. Then we ran out of tetracycline eye ointment. Then we ran out of soap. So we spent the rest of the day doing dressings without gloves and really trying to stretch the little bit of gauze we had left. There were so many wounds, too. One little old man (who has come before...I soaked his feet in a bucket of soapy water to try to keep the nasty gash on the bottom of his foot clean, and he has been a friend for life. He gets so happy when he sees me and all he says is"shukran, shukran, hahahaha" he's wicked cute). Well...anyway, he wanted me to buy him a new pair of shoes. Can't imagine why. He only has a wound on the bottom of his foot, that inevitably gets dirt in it because his shoes are pretty much falling apart...they are a scrap of leather and that's it. We didn't have enough gauze for the poor guy, to even really wrap it well...so alas, it will be dirty again the next time I see him.
Besides that, things are going well....we are having our second training for the staff tomorrow on inventory of the box so they won't run out of things (obviously a necessary one) and patient assessment and triage. Should be good.
11 February 2005
I bet you are sick of hearing about this mobile clinic
by now...but here we go again. So on Tuesday I
prepared a training on patient triage and patient
assessment. We went through all the criteria of how
to determine if a patient is really sick or just
stopping in for some free pills and socializing. On
Wednesday we went to Tokomaya with the mobile team and
myself and Rob. Some three
hundred people showed up...most of whom complained of
a headache. Now, I understand they probably do have a
headache. It's hot, they are tired, probably
dehydrated. Any one of us would have a headache.
It's not as easy or as accessible to pop a couple of
tylenol for them as it is for us. I get that. But
there are too many patients for us to treat those who
really are sick as well as keep up with the headaches
too. So we put our triage into action. At least we
tried. Rob sat in registration with one of the nurses
to help her triage. I went out into the crowd to try
and sort the patients who were sick and who were not.
The medical assistants saw 303 patients the other day.
That is great, but most of these people are not that
sick, and the amount of time we spend in a village
divided by 303, meant that each patient had less than
a minute of time spent with the medical assistant.
Not exactly enough time to be called quality care.
I finally tried to take all the people
who were just complaining of general aches and pains
and treat them myself. I rounded up all the headaches
and brought them into a small unused hut for shade,
got them some water and gave everyone 2 panadol (same
thing as tylenol). I said, sit, have some water, rest
in the shade, take your panadol, and relax. We will
not be able to see you today, but thanks for coming.
Some people sat happily. 10 minutes later they were
back at me, telling me they still had pain. The pills
didn't work. I tried to tell them give it some more
time, but most people snuck back into line anyway, and
when Rob left the tent to deal with another issue,
many of them got through registration.
Then the teacher showed up with all of his students
that he wanted seen. Some were just headaches, but
some kids had some nasty wounds also. So we took the
wounds in a group and I took them straight to pharmacy
to do some dressings. I scrubbed these kids with soap
and water. And a scrub brush. You know, really gave
those feet and legs a good scrub. It took some
real elbow grease to get through some of those layers
of dirt. I don't understand how some of these kids
can even walk with all the dirt that is caked on them.
On one kid I was set to change his wound on his left
leg, and after I had finished scrubbing his leg, I
moved onto his feet. After breaking through the
layers, I found 2 more infected cuts that I would
never have even noticed before. It was actually very
satisfactory. At least I got some of them clean with
fresh dressings. About 10 minutes later, though, I'm
sure they were filthy again. Once we had them out of
the way, I was sweating, a complete mess with dirty
soap and water all down the front of me, but feeling
good about those dressings.
Anyway, I gave the teacher his chalk that he
requested, and even brought 2 footballs (soccer balls)
along to give to the school (course, now he wants me
to bring soccer jerseys for a team to wear, and a box
of red pens). So I played soccer with a couple of the
little kids and that was fun. Then, as we were
waiting for one of our trucks to show up at the end of
the day, I took one of the empty plastic water bottles
that one little kid was holding and filled it with a
little sand. I set it up and made all the kids stand
far away from it. I had a little bouncy ball in my bag
that my mom had bought and had the kids throw it at
the bottle and try to knock the bottle over. They
LOVED it. If one of them missed, I yelled MAFI, or "YOU GOT NUTHIN." They started mimicking me. By the
end of the game, everyone was laughing and the kids
were chanting "Katie tamaam" (Katie's the best).
Hahah, yeah, I almost have them trained as well as my
nephews are. The game ended, though, when the little
boy whose plastic bottle it was decided he wanted it
back. You remember how in soccer, as a little kids,
when the game is over everyone has to shake hands and
say 'good game'? Well, we did that too. "Goodgame,
goodgame, goodgame..." and on we went. It really was
a lot of fun. The kids have no idea what they are
saying, but they love it anyway.
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