Nursing for a cause.

Surrealist Life, Part 3

Having fallen into a fitful sleep after waking up at 4 am thinking that the rebels were taking the city my alarm sounded at 7 am. I got up to prepare to check in for our ICRC flight. There were 7 of us traveling that day, 5 from MSF Spain & two from MSF France. We first went to the ICRC compound to have ourselves & our baggage weighed & to check in. This is at a completely different location than the airport. A new experience for me but I rolled with it. After being weighed we took all of our things & ourselves to the airport where we went through the exit visa process. One of the officials asked us some questions about why we were leaving. He didn’t seem surprised to see outsiders fleeing his country due to violence. Then we were one by one taken into a room to have our papers checked & stamped. Once again I was asked if I was married & the man suggested I should invite him to my home in the United States. And I just thought, please, not again. I can’t take this kind of weird flirting by authorities a second day in a row. Thankfully, this is where my bad French can get me a little break because I can just pretend that I don’t understand with a look of confusion and a shoulder shrug “je suis vraiment desolee mais je ne parle pas beaucoup de francais. Okay, merci ! Au revoir !”

We all finally got through & we waited in the area where the incoming passengers normally arrive. I’m not sure why we didn’t wait in the designated area but we didn’t go through any security screening checks or anything. The plane arrived (slightly late, of course) & someone motioned to us from the runway that we could board the plane. We walked over & got on. We didn’t have boarding tickets, weren’t required to show our passports, nothing. Very weird. Two South African pilots flew us the short 2 hour & 45 minute flight, which was fairly uneventful until the end when we all woke up due to intense turbulence. Whenever that happens in these little planes I think “those wings are going to come right off”. They never do though, thankfully.

Flying into Yaounde, Cameroon was a lush & green affair. The airport was by all accounts sleek & modern compared to anything in CAR. We went through the security procedures on that end & then made our way outside where we waited a quick minute before two MSF Swiss drivers showed up to take us away. The cars had air conditioning. I thought I was dreaming. I was still quite dazed & confused from not sleeping well & the ordeal the day before and driving through the city everything just seemed so organized and magical. We stopped off to get something to eat — delicious fried food & coke (there is no coke made in RCA so you can only by it near the border & in Batangafo we are not close enough to get it. This could be one of the reasons I lost 10 pounds in the month I was there — that & the stress vomiting that I did for the first 10 days after I arrived but more on that later !) & then we were welcomed heartily by the staff of MSF Swiss. If only all refugees were treated so well. We were given welcome packets, sim cards for our cell phones, and the code to the wifi. What else could we want? The entire briefing passed me completely by because I literally could not process the french at that point. I was numb, mentally, physically, and emotionally. I couldn’t feel or understand anything but basic commands. Even when people were speaking in english I didn’t comprehend as well as I should have. For the entire first 36 hours or so I jumped at anything that sounded like it could have been gunfire & every time I heard someone yelling or shouting I thought ‘it’s the rebels’ or ‘it’s the military’.  Still, several days later I have to remind myself ‘it’s not gunfire’. I went back to the house after checking in & telling everyone back home that I was fine & I took my first hot shower in 5 weeks.

On Friday evening our hosts decided to take us out to dinner to start the 4 day weekend off right & to show us how lovely Cameroon can be. We went to a restaurant/cabaret where you pick from your choice of delicious-looking fresh fish. Someone asked if we could go downstairs to the nightclub & we did. The music was blaring & the dancers were preparing for their shows — all young male africans dancing. It was sort of cool & interesting to watch for a few minutes but as the minutes and hours passed & young, beautiful, hip Cameroonian people streamed in & I saw my colleagues drinking and smoking and laughing, I just thought this is too weird. Not 24 hours after I had seen the worst of Africa I was seeing the best of it. The two faces of Africa in such quick succession just made my head spin. One of our hosts kept looking at me and mouthing something (in French) & I still have no idea what it was but I think it must have been something about the look of utter shock and dismay on my face. I talked a little bit to a few people but it was so loud & so discordant that all I could think is that I wanted to eat & leave as soon as possible. I was truly in a mild state of shock. With two nights bad sleep (and honestly, so many more than that because various things make it impossible for me to sleep in bata & I often woke up by 4 am) & such a stressful two days I just wanted to retreat into my shell. We eventually worked out the bill & paid & I came home & turned on the fan and fell in a blissful, deep, and amazing sleep.

The next morning I woke up & walked to the supermarket with a friend to get some supplies & some breakfast. The shop was traditional expat shopping in a 3rd world country, which usually makes me completely overwhelmed when coming from the field but this time I just sort of drifted around in a normal state of incomprehension. I think I was so shocked by so many things that I couldn’t really draw forth energy to be shocked anew at the huge array of products available. I didn’t know what I needed or wanted so I just put some things in my cart & hoped that I’d bought something that would work for breakfast.

I came home & did some yoga & mostly stayed to myself. Later we decided to go to another grocery store that was supposed to be cheaper. That place was a mess. People everywhere asking for things, terrible traffic, a mad hot mess of humanity. As I got out of the car I slipped my iPhone (already smashed into a million pieces from a little pre-christmas incident so not worth much anyway) into the front pocket of my bag since I had to hop out quickly as we were holding up a line of traffic. As I got out a man held out a t-shirt, trying to sell it (or so I thought). As I moved further out of the car he made his way back and flipped the t-shirt up and over his hand & tried to slip his hand into my bag. I grabbed his arm and said I don’t think so & shoved him away (no, sadly, I don’t have the forethought to say it in french). He walked away without a backward glance and I crossed the street to the store feeling a little shaken and a lot pissed.

Later that night I got an email from my head of mission asking me if I could accompany a medical evacuation from Yaounde to Berlin. I said I could of course and awaited further instructions, mentally preparing what in the heck I would wear since I left all but my warmest weather clothes in CAR. Socks on the hands is a trick I’ve used before & I was sure I’d have to use it again. I also mentally prepared myself for an 8 hour flight & then an immediate return (that’s normally how it goes — out & straight back again). By the next morning I was sort of exhausted at the entire thought of it & I heard that the patient had gotten better & there wouldn’t be a need for me after all. I was a little disappointed but a lot relieved. I didn’t think I really needed such an extra complication to my emotional landscape. We also learned that night that things seemed to be heating up in Bangui & we should expect two more colleagues (initially slated to leave on Monday but coming now on Saturday just to get as many people out as soon as possible). I was in contact with friends in the capital & worried about their safety as it seemed the rebels would be advancing quickly & it could get ugly.

All day Sunday I was still completely dazed but was beginning to realize how completely on hold I’d put most of my emotions for the time I’d been in CAR. There is always a little of that for me because so many things are coming at me all at once & I have to figure out a way to slow the flow or else I’d go crazy but the extent to which I did it in CAR (and to which I didn’t even realize I was doing it) — that was tough. Sunday night everyone went out & I just couldn’t bring myself to be *at all* sociable so I stayed home & was glad for it. We had done some planning for a NYE party but it all just seemed crazy to me. How could we be planning a party in the midst of this nonsense? How could we celebrate when we knew that our colleagues were possibly facing down a rebel take over of their town? I was just not into it. And on the night of the party, sitting next to the pool & feeling completely separate from the goings on I wish I just hadn’t come. I felt like such a drag. I spent most of the first hour or so chatting on my phone with people at home. After more people started arriving & I realized that almost everyone felt the way I did but that we were all trying to make the best of our situation and our celebration or non-celebration would not mean anything in the outcome of the situation in Bangui. In the end I am glad I stayed & saw the start of 2013 in the French style (one kiss on each cheek & a bonne annee for all 30 or so people at the party!) & the Spanish style (12 grapes in the 12 seconds before the gong strikes midnight & making sure the first step of the new year is on the ‘right foot’), a little bit of dancing, a call to Edward & texts to my family to say happy new year & I was ready to sleep. Much of the rest of the group went on to party the night away but I was blissfully happy to be in bed and sleeping.

And that is the full story in three short pieces.

surrealist life part 2

Late on the evening of Wednesday it was decided that we would travel by what’s called a kiss contact — a car leaves from one direction & another from the other direction & they meet halfway and trade passengers, supplies, etc & the same drive & car head back home. This is a common practice. Normally the kiss from bata leaves at 6 am but it was decided that we would leave at 630 to minimize the amount of time we had to wait for the cars coming from the other direction and, theoretically to limit our exposure to rebels, military, or any other actors that might be in the area. Again theoretically, it was a good idea. However, we didn’t leave until 7 am & we still ended up waiting for half an hour for the other cars because they were stopped & searched about 70 km outside of the city (in a town that the rebels now control). A satellite phone was confiscated because ‘that’s what the rebels use’. Okay …

The first 5 or so hours of the trip passed by fairly normally with just the regular annoyances & dangers: the drivers driving too fast; huge divots in the road (making it necessary to swerve & leading to constant, intense joggling — we all finished the trip with sore muscles); bridges that seem impossible to pass (including one with a huge truck lying on its side to prove how treacherous the passing really was); dogs, chickens, pigs, and people darting in and out of the road willy nilly. We were traveling that day with an expat with malaria, a 7-months pregnant woman, and a woman who couldn’t stop vomiting. I was worried that the poor baby was getting brain damage in its mother’s womb from the bouncing. I kept checking on her to make sure her waters hadn’t broken & making a mental plan of what we would need to do in case she went into labor. We were going so fast that it seemed to me that we would rupture a tire (the car behind us did puncture a tire which lead to a delay) or break an axel & I asked the driver to slow down. The driver accused me of being afraid and refused to change his speed (this is a huge issue with me in every project. The driver’s have no respect for the speed posted by MSF regulations & road accidents are the number 1 way that expats die in the field. I cannot tell you how many fatal accidents I’ve passed in my few years in the field). Eventually we made it to the meeting point & we waited for the other car to arrive. When they arrived they told us the story of being searched & having the satellite phone stolen.

Traveling in that car was a woman & her two children (the local family of one of our inapt staff who was being evacuated with us). One of the children was 3 months old & I could not imagine having him & his little delicate head traveling on the roads we just came from. Of course there are no car seats. We watched as a huge barrel of petrol was shifted from one car to the other & then I watched in horror as the woman & her two children got into the back of the car in which the petrol was loaded. I could imagine any number of situations in which that petrol could be come a huge explosive agent. I was dismayed. Meanwhile we started an IV on the woman who couldn’t stop vomiting & gave her some medication to stop the vomiting. Unfortunately it didn’t work at all and she vomited the entire way. The expat with malaria who had been doing more or less okay once again developed a fever and so we were concerned about that as well.

Once we were under way again the new driver was going even faster than the previous one. I reminded him of the maximum speed & he groused as well saying that we had to go as quickly as possible in order to make it back before dark & worrying about the FACA & the rebels. These were not highways we were speeding down, they were one lane dirt roads filled with potholes & living beings that we had to swerve to avoid. Several people hit their heads after particularly deep potholes. I felt like the brothers from the Dukes of Hazard blazing down country roads.

When we stopped for our afternoon break someone pulled my friend aside and said “Tell Ella to calm down & let the driver do his job”. I was extremely frustrated at this belittling attitude from one of my staff (little does he know that in the coming months I will be his boss): it was the equivalent to ‘tell the woman to stop her hysterics & let the man do his job’. By then the roads had gotten better and the driver was more or less following the speed limit so I felt as if I could let him do his job. However, the stress kept mounting as we realized that we had really left too late to make it back to Bangui before dark no matter the circumstance. So we were faced not only with two sick people & a pregnant woman but the prospect of traveling after dark, when all of the dangers increase exponentially AND we knew that there was at least one checkpoint to cross & possibly more since they also increase after dark. We were all becoming more & more agitated and concerned.

After about 3 hours of this tension we were going at a pretty good clip down a very narrow dirt road when we spotted another car about 30 feet in front of us. The car did not even slow down & there was no where for us to go but into the tall grasses on the side of the road (thankfully we were not in the area where there were only trees at the side of the road). As the blazed passed us only then did we see that it was a truck full of rebels. The driver quickly picked up the radio to communicate to the 2nd car that they needed to get out of the way. Thankfully they did & all was well. As the second car pulled up behind us we set off again slowly & not 5 minutes later a second truck of heavily armed rebels pushed us off the road again. This time we were all really jangled and I wondered if they were being chased by FACA and if we could expect a truck full of military to follow & whether or not they would be chasing the with guns ablaze. After about 15 minutes we relaxed a little feeling confident that at least there were no other armed people following.

Meanwhile all throughout the trip there were places were people had set their fields on fire (slash & burn agriculture, burning the bush so the rebels had no place to hide, something else?) so we had to drive through these areas where we could feel the intense heat of the fire & hear the snap & pop as we drove by. yet another small danger on the road.

Darkness comes at more or less 6 pm all throughout the year on or near the equator and CAR is no different. By 4 o’clock we were really starting to doubt whether we would make it to Bangui by dark and we couldn’t gauge how far we were. The driver said 200 but that couldn’t be right. I still don’t know how it took us so long to get that second half of the trip but I know that it wasn’t because I asked the driver to slow down a little bit.

When we came to the first checkpoint it was already almost dusk. There were about half a dozen heavily armed men & one of them came up to JC, the only expat man in the convoy & asked him his name and then told him to get out of the car. As I watched him walking further & further away I wondered what they were going to do with him. All of my worst fears ran through my mind. When you see a friend & colleague being led away with an armed man you think that anything could happen. I tried to keep my eyes on him at all times to make sure he was safe not knowing what I could possibly do in the case that I thought he wasn’t safe but feeling better just having visual contact. Meanwhile the other men told us all to get out of the car & demanded our mission order (for any road movement in CAR you must carry a document giving you permission to travel with the names of everyone in the vehicle). Our mission order included the two drivers who went back to batangafo and this caused a problem as there then seemed to be two missing people. The authorities wanted to know where they were and we tried to explain how a kiss works & that the other drivers returned to Bata. They were not happy & told us that this could be a reason to keep us from traveling. As they called our name one by one we got to step to the other side of the barrier. After we sorted everything out the took all of our baggage out of the car & searched each one and then searched inside the cars (I’m still not sure for what). We had heard that they often felt free to take whatever it was that they saw & wanted from people’s personal belongings but we were lucky in that they didn’t take anything. It was still a little nerve wracking to be surrounded by men with guns going through your belongings. And still JC was gone & I kept checking to see if he was fine. He seemed to be talking to the head of the authorities with only one armed man nearby so we were attempting to engage the other armed men so that they wouldn’t be around to hassle him any more than he was already being hassled.

When the military men found out that we travel with an emergency box they started asking for medication for various ailments — sick stomach, malaria, yellow fever, headache. At this point it was just the expat doctor and I. The sick expat had mercifully been allowed to lie down in the car & all of the inpats had been moved to the side where they were being more or less left alone. That left the doctor & I with 4 or 5 armed men asking for medications. My initial thought was to give them whatever they wanted & get the hell out of there as quickly as possible but as I kneeled down to open the emergency box I realized what a mistake it was. We had created an opportunity to engage them & keep them away from JC in a way that made them more or less happy and in a way that we (as a doctor & nurse) could more or less manage but as we answered one question about medication everyone else had a question or an ailment and the emergency box was not as well stocked as normal and we had almost nothing we could give them that would make any of their ailments go away. As I’m on the ground searching through the medical box one of the soldiers decides to start flirting with me. He asked me where I came from (this is all in french by the way) and when I told him the US he said (in English) ‘ah, Ella, beautiful american woman. You are beautiful american woman. Ella Gray” (remember he knew my name from the documentation we had to provide) and then he asked me where I live in CAR. I am just thinking, can this really be happening? Can this guy really be flirting with me? Where do I tell him I live? If I tell him I live in batangafo will he come there? Will I be in danger? I was not thinking rationally at this time & meanwhile one of the other soldiers was flirting with the doctor & it flashed across my mind that there was nothing from preventing these men from doing whatever they wanted with us. Again this way probably not a rational thought but it was there none the less. The man then asked me how old I was and I told him & he was shocked & dismayed & kept asking “sure?” and saying, it can’t be. Basically you can’t be that old and when I said I was certain he was just more & more shocked, reiterating that he thought I was 10 years younger. Again I am thinking this cannot be happening. Because while trying to manage his advances I was also trying to manage the demands of the other soldiers asking for medication & tell me their symptoms, etc. remember this is all happening in FRENCH. Not only are they armed, not only are the demanding things from us, not only am I concerned they might rape us, not only am I worried that JC might be shot or taken off and harmed at any moment, not only am I concerned about our sick people & pregnant woman, not only am I afraid they might steal something, not only have I been in the car for 10 hours, not only did we almost run into not ONE but TWO trucks full of rebels, not only was darkness falling, not only did we have the promise of at least one more (and from all stories much more thorough) stop, not only was I being flirted with by someone with a REALLY CREEPY STARE & a weapon I WAS DOING IT ALL IN FRENCH.

The guy continued to ask me for my phone number (I put that off because I said I only had an MSF phone & I would be leaving it behind in a few days when I left CAR — true) but then he asked for my email address. I thought about giving him a fake one but I didn’t want that lie to negatively affect other expats that might have to come this way. I was already disturbed that he knew my full name & that I live in Batangafo. I did tell him I was married (a lie I almost always stick to in the field) but he didn’t seem to mind. In the end I gave him a secondary email address & he gave me his & his phone number. They finished searching all of the bags & we were allowed to walk with our luggage across the checkpoint and wait. It was at this point that I was finally able to walk down to check on JC. I wanted everyone to get the hell in the car so we could go. We had already been at that checkpoint for an hour & it was close dark by now and we still had several kilometers to go. We were not sure exactly how many because we had varying stories from the military and from the drivers but it was anywhere between 75 & 115. Two days later we learned that this town was taken by rebels so we have no idea what happened to the men who questioned us, perhaps they ran away or engaged the rebels in a fire fight. It’s hard to know. As I was standing on the other side of the barrier more armed men came out (from where?) & they also were asking my for my phone number, email address, etc. I could not believe that this was happening. Was it not enough that you searched everything, menaced everyone with your guns, etc you also had to flirt with me? That was just the straw that broke the camels back.

Eventually we all got on the road again a little shaken but alive & with nothing of value taken. That’s when JC began telling me what he had gone through, sitting and chatting with the military (who ever so kindly ‘asked’ him to pay for their beer — men with guns under the influence always makes me feel safe). They assumed JC was the head of mission and wanted to talk with him about various things. When JC insisted that he wasn’t the HOM & gave him the name of our HOM they still weren’t satisfied & then the driver confirmed that he wasn’t the HOM but was the head of the convoy (much to JC’s dismay) and so the questioning continued. Thankfully JC’s native language is French so he didn’t have the additional strain of speaking in his second tongue. They told him that they had been warned that a man with his name & his description would be coming through & also that there were told 4 mercenaries traveling in convoy today (there were 4 expats so he was subtly accusing us of being mercenaries) and also that there was a witch hunt against French (JC is French) & American citizens in Bangui. We assume that most of this was just to mess with us because he seemed to like playing power games but still it was a bit unsettling. After the tough guy act the man changed his entire demeanor and told JC that his wife was French & he had two mixed race children (like JC) and then he invited him over for dinner the following week. Truly bizarre. At some point I thought maybe I could use the flirtation of one of the military men to give us safe passage through the other checkpoints but that quickly turned out to be a delusion.

After about 20 km we came upon another checkpoint & we tensed. As we approached the guard opened the gate & we passed through unmolested. We breathed a sigh of relief. Another 10 km there was another barrier. We were stopped. They demanded our mission order. they let us go through without a problem. Another 10 km we were stopped again. They searched our bags again. they let us go after about 20 minutes. 10 km later there was another barrier & they let us go through without a problem. Another 10 km and there was another barrier. This time the men not only had guns but shoulder mounted rocket launchers. They asked half of the people to get out & took the inputs for questioning. They searched our car again. Let us go fairly quickly & without many problems. All in all we were passed through something like 6 or 7 checkpoints & were searched at 3 of them. We knew that the checkpoint that had given the most problems earlier in the morning was still to come so we were still nervous about what would happen there. We finally arrived at that checkpoint & were waved through without a problem. At that point we stopped every few minutes to let inpats out nearer to their home & at some point we met up with a car from the capital with the Logistics Coordinator & a few other capital staff. Even though we had been in contact by radio no one in the capital really knew the details of what happened and everyone was worried. The city was getting more dangerous, movements were becoming trickier to manage, and they wanted us safely ensconced in an MSF house as quickly as possible. We arrived, dazed & confused and dirty & sweaty after 13 hours on the road and we were all completely lost. We quickly told the story of what happened & were giving several debriefings (all I could keep thinking is, I can’t believe I still understand French at this point). I really could not speak a word even though I understood. We had further briefings & debriefings and were told that we would be on an ICRC plane the next morning. Check in at 8 am. We were given fresh water & some cookies (I hadn’t had a real meal at all that day and was shaking from hypoglycemia) and our per diem for the month of January & then we were taken to the house to rest. I had a shower & dinner & fell into a quick sleep. I woke up at at 4 am to what I thought was gunfire & all I could think of was, oh shit, we didn’t get out soon enough. the rebels are here. this is the start of a gun battle, where can we hide? I heard what was clearly chanting and wondered if it was the rebels advancing past our house. I went out to ask the guard. He said that everything was normal and the chanting was ‘sportif’ (related to sports). It was hard for me to imagine this being true but he assured me that everything was normal and that there was no gunfire. At around 6 am I feel back into a fitful sleep.

Details tomorrow or the next day about the evacuation & how surreal it was to be one moment in the middle of a coup d’etat & the next in a tropical paradise.

Surrealist life

I have been trying to write about these events for a few days but things just keep getting more & more surreal and it seems impossible to really, truly convey what happened & what continues to happen with this whole business. Surreal is the only word I can think of. As I landed in Cameroon & drove through the streets here I realized how tense I’d been & as the days wear on I realize how numb I had become. How often I woke up in the middle of the night & couldn’t go back to sleep because I was mentally planning what I would do if the rebels attacked our compound. No matter how unlikely this event seemed I thought about it frequently. I made a mental plan of the safest places to hide in the office & in the house. I worked to prepare the medical supplies in the house & in the hospital in case we received casualties.

The day after I arrived in Cameroon every time I heard a noise I jumped & thought it was gunfire. Still, a few days later I have that instinct even though I can at least catch myself before I express the action physically. I can begin to understand PTSD on an entirely new level. In the grand scheme of things what I went through was absolutely nothing (I’m thinking of people who have lived through genocide, combat, etc) but still the effect is undeniable. 

This is how I spent my Christmas. No, wait, let’s go back a bit. A few weeks ago we received news that the rebels were advancing on our town. They had taken a town a hours north where we also have a project & there had been a battle between them & the FACA. We waited, alert. We hurried to prepare the hospital to receive possible casualties. It was my job to make sure that the medical supplies were in place & I did my best to give clear & comprehensive instructions in French and we put in place the necessary items to treat gunshot wounds & other war-like injuries. Our worst fears did not materialize because the FACA, police, and even civilian authorities fled the town the night before the rebels arrived. The rebels came in fairly peacefully. They came to our compound, took some money from one of the expats, stole a motorcycle from my pharmacist but all in all they were okay & reiterated their stance that they would allow us to do our job. Our field coordinator was constantly negotiating with their leaders for various things & eventually got the motorcycle back but by then they had gone to another NGO (one who was evacuated several months ago) and stole all of their motorcycles as well as other equipment. We settled into a new normal of being alert but not so worried. We would see rebels occasionally and there would be gunfire at night. There would also be rumors that the rebels kidnapped local women and various other things but we didn’t know the validity of these claims. Some local youth took advantage of the rebel presence & the lack of other authorities to menace the local population, stealing things and creating a general sense of disorder but as expats our lives were relatively unchanged. The rebels brought their leader to our hospital to treat a gunshot wound (in the shoulder, out the mouth — none of us could fathom how it made that trajectory) and we supported the doctor as best she could in attempting to explain to his men that he needed a blood transfusion and to explain the care that we would give him. All the while we wondered if we would receive retaliation if the military came back or if the FACA would make us a target for treating rebels. We are neutral so we treat all sides but these principals sometimes get muddled when we try to explain them in the field. 

Meanwhile we had news that the FACA was advancing again. This was Christmas Eve. We mentally prepared for a battle (again). On Christmas Day we had a meeting that said half of our team would be evacuated because even though things were not expected to go horribly wrong in our town, the capital was a different situation and things on the ground there were difficult to manage & it was possible the capital team would be evacuated, making it impossible to send supplies to the field & impossible to evacuate the field if that needed to happen. There was also some worries that the airport would be seized by the rebels as this seems to be the first thing they do when they take a town (another story was that we all came into the office on Monday — or was it wednesday? my days are all messed up — morning to the news that a plane would be landing with supplies & HR personnel — the hospital was operating with 2 doctors instead of the needed 5 at that point — and the logistics and field coordinator freaked out. YOU DO NOT SEND A PLANE INTO REBEL HELD TERRITORY WITHOUT FIRST ASKING PERMISSION FROM THE REBELS. So we worried if we could reach people in time to cancel the plane because we feared that the rebels would fire on the plane leading to a HUGE incident. That was thankfully avoided but sadly meant that I didn’t receive severely-needed medications that I was awaiting. Meanwhile my nerves were a jangly mess due to the banging of hammer & nail as we added MSF banners to the roof of our buildings. The only reason to do this is if you are anticipating an air assault. At that moment all of my ability to concentrate on the work I needed to do went out the window. The incessant pounding a reminder of all of the possible dangers awaiting us ). We were busily working with the capital team on Christmas day to arrange a flight to evacuate the people on the team who had been identified to leave. I was identified to leave so I packed my belongings & waited. We learned at 8 pm on Christmas night that a key piece of information did not get to the right person in the capital & so no one had booked our flight for the next day. The capital team was hurriedly trying to negotiate with the airlines but it didn’t look good. On Wednesday morning we still didn’t know if the plane was coming. The UN was attempting to decide if it was safe enough to fly. At around 10 we heard that we would not be going that day. At 1 we were told the flight would be coming & we should be ready & await a time. We went to eat a quick lunch. When we arrived back at the office we still had no word about what time the flight would be. As the afternoon wore on we knew it would be too late for a plane to flight. They cannot risk landing in the dark on a dirt airstrip in possible rebel territory. I wouldn’t be leaving batangafo after all. 

Meanwhile, at around 8 am we started hearing heavy gunfire. I could see over the fence of the compound as people ducked and fled in every direction. No one was sure of what was going on. The gunfire kept getting closer & closer & nothing was clear — who was firing, was it one sided, was it a battle, would there be casualties. We all stood in doorframes or just inside wanting to keep abreast of the situation but out of the line of fire. As the gunfire kept getting closer & closer we all moved inside, as protected as we could be. Over the course of an hour or so we came to realize the gunfire was just the FACA (along with troops from Chad) arriving to the town with a show of force. The was no battle as the rebels had run away the night before. Trucks & trucks of soldiers filed past our gate & stopped. The town was now no longer afraid & the people were lining the streets, giving these men a hero’s welcome. There was chanting and cheering. I went to the gate to see, certain that we were safe at that point & found rocket launchers, automatic weapons, and dozens of men that looked more to me like a rag tag bunch of rebels than an international coalition. I had the confirm with the local staff “these are the FACA? With the chadian forces?” Yes, yes. And the people are not scared? No, they are used to this. The FACA is normal. It means stability has been restored. Weird. 

Meanwhile the capital team was still trying to arrange a way for us to get out of the town & then out of the country to minimize the number of expats at risk. There was the possibility of a flight on Friday but they wanted us to be out of the country by then so they decided to arrange a road movement. Two expats refused to go & wanted to wait for the flight. I said I didn’t care either way but I didn’t want to be the only expat (it seemed I would be a bigger target & with my elementary french …). The other expat who said she didn’t care either way had come down with malaria so it looked like we would wait & take a plane on Friday. However, we had news at 9 pm that we had a direct order from the head of mission that this was a security decision & not to be question. We were told that this time we could take even less stuff with us (the flight allowed 17kg) but since we were trying to get 17 people & all of their luggage into two trucks we had to minimize all personal items. I left with a small duffle bag, my yoga mat, and my computer. 

Details about the harrowing road journey tomorrow. I think this is enough for today. 


Rebellions & stars

I keep trying to write a blog entry but I just can’t seem to do it. A month into a mission without one is unheard of. Even when I didn’t have internet I posted through a friend & found a way to keep everyone updated. There is a lot going on here & it’s just very hard to pinpoint one interesting thing to make a story out of so I’m just going to write a few vignettes. I’ve sort of had this image of myself as a giant sieve — everything is just filtering through: the language, the people, the stories, the experiences — nothing is really sticking and I’m not quite sure why that is but here it goes:

What is the first thing that you notice about Batangafo? The pigs. Baby pigs are everywhere & they are hairy like little short-haired dogs. I love them. That and this place is lousy with mango trees & I am going to make myself ill on them come fruiting season. 

How are things going with the french? The predominant image I have of myself & french is this: I am trying to compete in a highly important and stressful marathon and I am dragging my useless legs behind the entire way. The legs are my french skills for those of you playing the home game.

What’s it like being in a town occupied by rebels? Not that bad actually. The few differences have been: I always wear my running shoes everywhere (never flip flops) in case I need to book it. This is unlikely but it makes me feel better & Ive convinced other people that they need to stop wearing flip flops too. I have a bag packed wherever I go. I hide my iPhone deep inside my purse so they cannot find it if they stop me. I have some money on me at all times in case someone stops me and I need to bribe them. I try not to walk alone. I always come home by car after dark. I check the news obsessively.

There are rumors from the cook that the rebels have started stealing money & that last night they kidnapped some local women. I can’t confirm the story but I really hope it’s not true. This is the problem. The longer the stay the more relaxed we all get but then they start doing this kind of shit and making everyone nervous again. We will not evacuate unless we become a direct target or unless people are so scared that they all run away and stop coming to the hospital. Otherwise we will stay and why not? The people here need support & medical care and yes having men around with guns makes things a little dicey but I literally haven’t even seen any rebels except once or twice and they tend to make themselves scarce around us. Still, I am hoping the peace talks go well & they disband and become productive members of society (one can dream !). 

What’s the biggest logistical absurdity: I have five health centers to manage. Three I can’t get to because the little ferry across the river (called a bac, I don’t know why) is broken. One of those three no one has been to since August because it’s near the boarder of Chad & we have decided we can’t go there for security reasons. The other two I can go to regularly but not this week because of the rebels. There was a part missing for the bac (two but the same part). They sent one. By the time they finally sent the other someone had stolen the chain. When we finally got a new chain the rebels arrived and I couldn’t move due to security. Now the rumor is that the rebels have stolen some pieces & it’s not working again. If I ever get to those other health centers I will be astounded. Now I strap medical supplies onto the back of mototaxis & send them with a wing & a prayer. Even if bandits stop them they usually just take the money of the driver and maybe the cell phone but they usually leave the supplies in tact. What nice people they are. 

what do I like about Bata? The pigs (see above). The stars are amazing & when everything is calm we get to walk home under them and admire their beauty and brilliance. My team is quite good. There is always salad. I don’t have to leave the house to go to the bathroom at night (huge !). 

Children all over the Africa have an equivalent to “hey white person, look at me !!” here it is ‘munju’ which I never fail to hear as Moon Juice & never fail to think “man, I could use some moon juice about now.  

Crazy medical stories: a woman came in by mototaxi with a baby hanging out of her. The baby was breech & the head got stuck. We were all wondering what in the hell we did wrong. This woman came to our prenatal clinic (more than once!), she lives close to the hospital, she has shown some education and affinity for medical care yet when she went into labor she went into the bush (literally just out into the middle of the woods) to deliver on her own. Things went terribly wrong & by the time she came to us the baby was dead. For those of you not in the medical profession you don’t want to know what has to be done to a baby to get it out at this point. It’s horrifying & I highly recommend not thinking of it ever again. Another woman arrived with the baby crowing, also by mototaxi. According to the story they had shoved the baby’s head back inside in order to try to make it to the hospital. This baby was coming just fine without our assistance and they shoved it back to wait for us ! The other one desperately needed intervention and didn’t come. My question is still: how does a woman sit on a motorcycle with a baby coming out of her body? It seems logistically impossible & very unhygienic. Of course there was the tetanus woman who arrived to the health center on a motorcycle sandwiched between two men, one holding her neck upright and when they took her off she was completely rigid and unable to bend any of her limbs. Again, how did they get her on the moto? There is also the man with the hernia that made his penis swell to the size of a watermelon. And the rebel leader who somehow got shot in his shoulder and the bullet came out of his mouth. How this works anatomically none of us can guess. There are the polio cases and the meningitis outbreaks, the snake bites, and, before I arrived, MONKEY POX. What even IS monkey pox? I have no idea. There is the little boy that I saw in the clinic who has had a headache for 2 months with progressive blindness & no saliva. Oh, and all of the skin on the bottom of his feet is peeling off (unrelated, I think). What the hell is this? I have no idea. My best guess is a parasite in his brain. 

Hopping Mice and Other Observations

The other night I was pulled from a deep and satisfying sleep by the
oddest sound. It was a weird hopping noise and in my half-awake state
I couldn’t imagine where it might be coming from. At some point I
realized it was coming from the bucket under my chair and I looked
over to see a tiny mouse jumping up and down, trying to get out. The
question of how he got in there remains but I’m certain he had
probably been lured to the chair out of a desire to eat my toothbrush
(I don’t know why they are so drawn to it but they have actually eaten
through my little plastic cover although I refuse to let myself
believe that they got to the toothbrush itself. Lesson learned – bring
something more impenetrable for this task from now on). I wasn’t
really sure what to do because I didn’t have anything big enough to
really cover the bucket to take it outside and he was so close to
being able to jump out that I was afraid if I tipped it in anyway he
would jump out and run all over me and I just did not need that at
that hour. Eventually I covered the bucket with a towel and took it
outside, finding a piece of metal to cover the bucket. I could still
hear the damned thing jumping up and down as I finally fell back to
sleep an hour later. At about 5:30 in the morning I was awoke by a
loud clanging and was satisfied that the cat had probably discovered
the mouse and had attempted to earn its keep.

Last night was Saturday and I was happy and wanting to dance and enjoy
my colleagues and let loose a little. I had dinner and decided to go
to my tent and watch an episode of Modern Family before the party
really started. After about 30 minutes I started shivering. In the 90
degree heat I was freezing and my body was wracked with chills. My
neighbor came by to check on me – why had I disappeared? And I asked
him to bring a thermometer, blankets, and water. Instead he brought
the cavalry – a nurse, doctor, field co, five people in total in my
little tent. Almost every other expat was there trying to figure out
what was wrong. I just wanted to cover up with a dozen blankets and
sleep.  No fever. Malaria test—negative. I started throwing up and
shivering, alternating back and forth. At some point I was hot and
cold together. When someone came to check on me I asked for an ice
pack and so I was under three covers with an ice pack and that felt
pretty good. By then I had a 101.5 temperature and all I wanted to do
was put the mosquito net down so they would stop buzzing in my ears
but my bones and joints hurt so badly and I was so tired that I could
not move. I finally feel asleep and when I woke up I was so hot I felt
like I was on fire. I had the energy to get up and go to the bathroom
and get ice packs, which I put under my arms and between my thighs,
hoping to cool down but still I was unbearably hot. Meanwhile the
Saturday night party was raging and I was thinking how unfair that
they were finally, after weeks, playing songs that I wanted to dance
to and also how cruel that I had to be sick, basically in the midst of
a dance club, making sleep next to impossible. My heartbeat was
thumping in rhythm to the music and I just wanted to be out with my
friends, enjoying one of my last Saturdays here. I woke up this
morning feeling fine and the quickness of onset and duration of the
sickness is a complete mystery. I must have eaten something bad but I
had the exact same thing as everyone else. Maybe the universe just
wanted me to miss the party.

As I count the days until I leave this mission I am thinking of all of
the things I’ll miss. We have an expat here who plays the guitar and
my loveliest times here by far are when he and I sit in the space near
our tents and he plays the guitar and I sing along. There is
absolutely nothing equal to it here to make me happy and absolutely
silent inside. The willingness of my English students is another joy
and seeing them around the campus where they say “hello, how are you?”
and “I am fine” and “hello my teacher”. They greet me and show off
whatever they remember learning from the last class and we have one
small moment of connection in those few words we share – an American
woman and a Somali man (most of my students now are the Somali guards)
from worlds as different from one another as a an apple is from a
duck. That is the beauty of this life. As often as I am perplexed by
the differences and the culture I am just as often reminded that at
our core we can always find something to connect. I love the water
tower that rises above the compound and from which you can view the
whole area including the lights of the nearest refugee camp, twinkling
in the distance. This is one of those experiences that I will be much
more grateful for in retrospect, I’m sure. Although despite the many
frustrations and obstacles I am more okay here than I imagined I might
be. I have found a strength within myself, a self sufficiency that I
didn’t know I possessed. I feel in some ways transformed. Maybe it’s
the yoga I do every day in the dusty “supermarket” where we keep our
food supplies and which always seems to be overrun with mice and
crickets and other crawlies swirling around me as I move from plank to
cobra to downward facing dog and back again. Maybe I’m just getting
older and am more patient with the circumstances of life.

One thing I won’t miss is how this place wears people down, especially
the expats who get the brunt of the security regulations (we can’t
leave the compound for social reasons but the inpats can) and of
dealing with a difficult local government who really does not want us
here and demand all kinds of unrealistic things of the expats (like,
for example, an Ethiopian passport for a three month stay!). This
difficulty I can see in the faces and interaction of the expats who
have been here the longest, myself included. We’re less social, laugh
less easily, we’re more tired, and we are counting the days. I saw it
in the expats who were leaving before me and I wondered how and why
this place could do that to a person so quickly; it didn’t seem that
bad. But now I know, slowly, day by day, eating the same exact food
every single day, having the same options for social interaction,
seeing the same people combined with the other circumstances just
brings you down slowly by slowly until you think, only 8 more days and
you count over and over again on the same day how long it is until you
leave hoping that something would have changed between 8 am and noon.

God is Bowling

Dear readers, it’s been a hell of a week. I’ve been back from R&R for 8 days and I was under the impression that the rest of my mission would sail by with ease. I was half right. It’s sailing by but with ease would be a serious understatement. Those of you who know me personally will get the full story, complete with a dramatic raising of my voice, hand motion, and full-on facial flush. For those of you who don’t know me it will just have to suffice to say (cue flat facial features and monotone voice) ‘this has been a difficult mission’. Overall my spirits are quite okay although we have noticed a general decrease in joviality among those of us who have been here 2 plus months. The absolutely annoying part is that this could be an excellent mission where people leave feeling fulfilled and happy about the work they’ve done. However, many factors beyond our control (at the individual, field, or even organizational level) make this completely impossible. Of course, if I ask myself if I’d do this again I unhesitatingly say yes. 

On a fun note:
27% of my Community Health Workers have some form of Mohammad somewhere in their name. Sometimes they have it twice. I haven’t counted these in the statistics. This suggests several things (1) Mohommad is a very popular name in the Somali culture. (2) I am slightly obsessed with statistics at the moment. (3) I am also sufficiently in need of distraction that I resorted to counting how many Mohommads I have on staff. 

I started my English class ! The first one was before my R&R and the second one should be today. It was great fun but very challenging – it’s essentially an immersion class because I don’t have a common language with any of the students and I have no textbooks or any other teaching material but we plug along and we had a conversation about the difference between consonants and continents. I love these homonym type things; they’re very fun to explain. Today I am going to try to explain dates and time which is going to be a WICKED challenge because I’ll use a western calendar (I don’t have an Ethiopian calendar) so when I try to tell them today, yesterday, tomorrow they might be very confused when I point to May 10 and they know that it’s really May 2 but I can’t say it’s May 2 because some of them will assume that I’m using international time and will know it should be May 10. It should be a fun “conversation”. 

I don’t know if it’s Ethiopians in general or just the Ethiopians on this compound but we celebrate ANYTHING. We are always arranging a party for one thing or another. An expat is leaving or it’s the first of the month (which the celebrate on both the European and Ethiopian first of the month so you have a party every 10-12 days or something like that), saint’s days, etc. For easter they celebrate good Friday, easter Sunday, and then the second resurrection (I’ve never even heard of such a thing !). Anyway, I’ve been to more parties on this compound than I have in the entire rest of my life ! 

Today here it was raining in one place while perfectly sunny in another place and I commented that it was odd. Someone explained to me that they say when conditions are like this a hyena is having a baby. Then he was quick to say that they don’t really believe it. I explained that sometimes when it’s thundering very loud we say that god is bowling but of course we don’t really think he’s bowling. Then everyone around us asked what in the heck we were talking about and for several minutes we were trying to explain the context and I was trying to explain “bowling”. It’s funny to hear a bunch of Amharic and then hear “god is bowling” in heavily accented English. ☺

*#*@&!)! CRICKETS!

I was thisclose to tears this morning about the cricket situation. This is not a dramatization. Yes, I now know that of all of the difficult circumstances that we face here it is the CRICKETS that will crack me! Last night was Saturday night and I wanted to stay up a bit and drink a rum and coke and socialize or read my book or play a game, whatever – just have a nice relaxing evening after a fairly frustrating week where I’ve been told that one of the one of the main things I was to accomplish here is being put on hold. But it’s impossible here to stay outside for very long at night because of the crickets. They constantly dive bomb you and you are jumping around doing a dance trying to get them off of your clothes or out of your hair or out of your shirt or dress or pants. They somehow literally get inside of your clothing and you feel something crawling around in there – they go in via the armholes, neckline, they fly up your skirt, crawl up your pants. It’s insane. You can’t eat or drink in peace because they fall into your drink and your food. We’ve removed all of the lighting from the entire compound so the place is in almost complete darkness but still they come ! And it’s pitch black so you have to take a headlamp or something whenever you go from one place to the other – and the entire way you are battling crickets flying at you, dozens of them at a time hitting you or landing and trying to hitch a ride. Just to go to the toilet or to get a drink of water you have to deal with this onslaught. Eventually they just chase you inside because you’re so weary of fighting them. Even my tiny light for my book caused them to jump all over me so it is impossible to do anything at night besides sit in the dark and try to talk to people you can hardly see. And still they come ! And you have to check your drink for floaters and bat them away and try to keep a coherent conversation. So not only are we prisoners here on this compound, unable to leave without permission and then only to go to the camps (or our weekly sunset walk) but we are then prisoners in our tents. But do we have peace in our tents? No, they are dive-bombing our mosquito nets or sometimes they get inside and they are jumping on you while you sleep or while you try to rest. They’ve taken over our only area to “chill out” – the place where we usually relax or sleep on Sunday afternoons. You can’t relax in your tents during the day or you sweat so much that you have to take ORS to recover the lost electrolytes and then you feel like someone put you through the ringer. So at the moment there is literally no real, dependable place to just relax. We have been bested by crickets. And now the others are coming – moths, beetles, ants, on and on.

And then AND THEN if this was all not enough I was clearing out my luggage to pack for my R&R on Tuesday and I discovered a family of mice living there. One leapt out at me, skittering across my lap to freedom and the other did frantic circuits around the interior of my suitcase, searching for an escape route. For weeks I’ve been hiding my computer in that space and it’s been compromised by RATS ! Dear god. The other day I accidently left my toothbrush in the office and came back the next morning only to realize that there was serious evidence that a mouse had been nibbling on or near it. I cannot go into town and therefore cannot simply buy a new one. I sterilized it with chlorine and refused to think about it any further. But this ! This is absurd.

So, after all of this and after a night of being woken up every 20-30 minutes from 11 pm until 1 am and then again this morning by the noise of the cleaners and cookers and various other people up and noisy at 7 am on a Sunday I simply felt the need to break down and weep. I did not however because I stepped outside of my tent and spied my neighbor, in only a towel, furiously sweeping and cursing the crickets that had collected there overnight. I guess, at least, I’m not in this fracking mess alone.

We have a child in one of our stabilization centers that is 1 year old and 4 kgs. 8.8 pounds. I was 9 pounds at birth. The child has all of the signs of severe and persistent malnutrition, her hair is a ruddy color, she has no teeth, her skin is saggy, she has a desperate, high-pitched cry. We are treating her medical complications and she will survive but it’s difficult to judge what long term complications will be from such a deficit while her precious brain was developing.


I’ve been dreaming of having my own kitchen again. I know I’m about halfway through a mission when this starts; I envision buying a house somewhere. Something that I could come home to. A place I where my things could live instead of an anonymous storage unit. I try to figure out ways that I can have a place of my own to come home to, just a little cabin or something small. Cozy and decorated just so. A true retreat and relaxing place to descend on between missions. Recently I was wondering if someone I knew would lend me a bit of land to put a yurt on. In my entire life I would never consider living in a yurt. It’s just not me. But I guess now that I’ve been living in a tent infested by wildlife a yurt all of my own is looking pretty appealing.

Ethiopian Easter !

SIDE NOTE: You know you’re an expat if… you consider bug repellent sort of, kind of, like a perfume.

So, Ethiopian Easter was last Sunday and we all celebrated in the traditional way. In Ethiopia the Christians are very Orthodox and therefore the do not consume any animal products for the 55 days proceeding Easter Sunday. That means no milk, no cheese, and no … meat. For most Africans this is a major freaking sacrifice (when I was a vegetarian and living in Kenya the people took great pity on me thinking that I must be allergic because there could be no other reason on earth not to eat meat) and Ethiopia is no different. One of our nurses told us “this is a major holiday for ethiopians because we get to eat meat again.” Um … was there also something in there about a savior or … I don’t know, death and rebirth or something?

Anyway. The way we celebrated (and I think out experience is common to greater or lesser degrees) was by buying a cow. Our logistician was very surprised to sleepily stumble to the latrine in the middle of the night on Saturday and run (literally) into a cow. Shortly after midnight they slaughtered and ate a few chickens (the expats were all in bed for this) and then after that they began the slaughter and butchering of the cow. At around noon I saw someone carrying a tray of raw meat from the kitchen and I thought it was quite odd and wondered where they were planning to cook it. I sat down to eat a bit of whatever is normally for lunch (rice and beans and injera) and one of the local logisticians came over and offered us the very traditional ethiopian easter food — raw meat. It all suddenly made sense — the cow, everyone cleaning and sharpening knifes, the general merriment. After 55 days of abstaining from meat they don’t even want to take the time to cook it. They just eat it raw. I looked around and realized that indeed everyone was eating raw meat. Normally here we eat in a very western way — each person has their own plate and we eat with a fork or spoon. But traditionally here you are served a huge platter with inejera on the bottom and a variety of foods on top and you share with everyone at your table, eating with your hands. And that was what everyone was doing that day (or, the men mostly. The women more or less ate from a singular plate — not sure why). And of course it had all of the stereotypical absurdity of any group of men eating raw meat — hanging huge pieces of meat from their mouths and then cutting it off with a gigantic knife, seeing how big the pieces they could eat, etc. I took the tiniest, tiniest piece just to see what it was like and it was okay. If I didn’t have my built in disgust-o-meter running I might have actually asked for more. After the raw meat we drank a homemade gin (brilliant, I think, considering it probably killed whatever pathogens were in the meat) — just a tiny lid full. After that there is a lot of traditional ethiopian dancing and a very elaborate coffee ceremony, involving small pieces of sweet fried dough and, oddly enough popcorn. All in all it was quite an interesting cultural experience.

The creatures will prevail !

For weeks we’ve been talking in hushed tones about the approaching rainy season. We’ve said things like They say it’s been raining in Filtu. And It rained in Malkadida today. And The rain has to arrive soon. Look at those clouds and It’s so humid; where is the rain?! We’ve been begging for rain, needing the relief from the oppressive heat and wanting to see for ourselves the great beauty of watching the dessert transform into a lively, green-laced thing. And now it’s here. The rain has arrived every morning between 5 and 7 am and it lasts longer and longer every day. On Tuesday it was about 20 minute and then an hour on Wednesday and today it rained—pouring, pounding rain—for almost 4 hours with some moments of drizzle or merely heavy rain. We have discovered, however, the drawbacks of living in a mostly open camp. Also, living in a tent during the rainy season in Africa is, shall we say, sub-optimal. My tent floods. Thankfully I stealthily acquired a shelf a few weeks ago so only my shoes are on the floor. Oh yeah, and my mattress. My mattress is on the floor because the thing they’d provided as a platform was killing my back and everyone said that moving to the floor was actually *quite* a bit more comfortable. They were right but now every time it rains I watch the water slowly advancing toward my mattress. So far it hasn’t arrived but you never know; perhaps one morning I’ll wake up soaked or floating around the compound. Everyone keeps telling me that I should move but I don’t want to move. I like my ‘neighborhood’. It’s fairly quite and I like my neighbors and I’m all settled in and cozy. ☺ Ironically when I was given the tent the logistician said ‘you’re lucky, the other side of the camp floods and the rainy season is coming’. How right he was, and how wrong. My tent is one of only two or three on my side of the camp that floods during the rainy season. Lucky me !

We were right though, it is much cooler now. I’m even wearing jeans today, which on any other day would make me want to run screaming through the camp without any clothes on rather than endure their constricting misery. I’m actually considering a long-sleeved shirt. The fact that I’m wearing a shirt with sleeves at all is a slight miracle considering that it’s mostly been so hot that I would wear a sports bra and a pair of boy shorts if I could get away with it.

The other thing about the rain is the creepy crawlies. There were bugs around before. Plenty of them, and some weird, although mostly crickets. But they have increased 100 fold. There are now tens of thousands of insects flying, hopping, and causing general mayhem. I am not exaggerating. I have found crickets in my clothes, my shoes, my bed, the latrine, the shower, tangled in my mosquito net, in the basket where I keep my toiletries, in our food, in file folders, in the freezer. This morning I tried to count the number of crickets in the shower with me. I stopped at 100 out of sheer disgust. Hovering around the lamps at night are clouds of thousands of tiny little bugs, so many that it sounds like it’s raining as they ping against the side of the iron sheeting. Doing yoga is almost impossible because I spend so much time fighting off the crickets and other tiny bugs. They attack while you’re eating and while you’re attempting your afternoon nap, they fly down your shirt and into your drink and get caught up in your hair. You can’t speak to anyone for more than a minute without one of you swatting at something trying to beeline to your mouth or eyes or hair. I’ve never seen anything like it. All night long they’re hopping around, making little clicking noises in my tent and pinging off the iron roof so it sounds like it’s raining all night long. And they just appeared, seemingly out of nowhere. Three days of rain and suddenly the place is overrun. I have a mosquito net over the door of my tent so that I can sleep with the flaps open to attempt to make it a little cooler. Last night there were so many creatures around I slept with the flaps closed, fighting for at least the first 20 minutes to get all of the crickets out of my bed and myself safely ensconced in the mosquito net covering my mattress. But still even with the flaps closed and the net over the door, I woke up with no less than 40 cricket bodies strewn between my bed and the door. The net is impregnated with prometherine (or however it’s spelled) and so once they pass through it they don’t have long left in this world so I wake up to their dead or in-the-throes-of-death bodies littering the floor.

I don’t think there is a place that I have lived where I have collected more man vs nature stories and I don’t think I have ever looked more intensely forward to a silent night’s sleep in a cozy bed, an enclosed shower, and a western toilet where I can sit and not squat.

Ring the Bell !

Happy Easter? I didn’t realize until yesterday that today is easter in the rest of the world. In Ethiopia the ‘orthodox’ easter is celebrated so it’s not until next Sunday. This place is some sort of bizarre time warp, I’ll tell you. With the time and date differences that I mentioned earlier and the different holiday schedule (including the new year) … it’s very weird.

OMG BIG NEWS OF THE WEEK : We were allowed to go to the market. I’m still drunk with freedom ! I’ve been lobbying for a few weeks for us to be allowed to go to the market and finally today everything aligned to allow us to go. The logistics and complication of herding 7 expats plus finding a local person to ‘babysit’ us made me think it might not be worth it but just being able to walk around the market and greet the children and talk to the people and see all of the lovely fabrics was more than worth it. You should have seen us getting into the truck to go – we were singing Spanish victory songs (or everyone else was, I was just listening) and you would have thought we were on a mission to Disney World or something. In the end we were only there for 90 minutes or so but the effect it had on our spirits will be much longer lasting. You can hear what it’s like to live under the conditions here – I did before I accepted the assignment – but until you really live with the reality of so little freedom it’s difficult to really grasp the effect it has on you. Mostly the weight of not being able to go out is manageable and we don’t complain too much but then you go out into the wider world and you remember all of the things you’re missing and it simultaneously buoys you and makes you quite sad because you know that you won’t be able to move freely again for several weeks. I wonder what affect this will have on me finally when I land in New York City (or even Addis Ababa) and the huge wide world is there and I’m used to living in 300 square meters. I already usually weep at the diverse items available in the grocery store and that’s when I can move freely and buy as I like. Who knows what it will be like after living here for 3 months. 

I sort of feel like I’m sending these posts into the darkness because I can’t hear back from any of you. Being without access to my own email is one of the most challenging part of this mission. If I had internet access I could probably stay here six months and not have a problem.

I went to one of the stabilization centers this week and there was a little five month old baby. This was her fourth time in the center. She had gotten better and gained a little weight and had been discharged each time. But here she was back again. Five months old and 2 kgs. That’s 4.4 pounds for those of you who didn’t grow up with the metric system (like me). Can you imagine? Most of the newborns that I delivered when I was a nurse were way more than that. This kid was one of those typical horror stories that you see on the news – emaciated, too weak to suck, severely increased respiratory and heart rates. This time we have to assume that the baby has HIV or some other underlying serious issue or that something is going on at home. Because she gets better, is discharged, and then is back again in a week or two in the same horrid condition, or worse. Just to be clear, we’re not discharging this patient at 10 pounds and she comes back at four. We just need so see that she CAN and IS gaining weight and her medical complications are gone before we discharge her to an outpatient program. But still, it’s worrying. When a baby that small loses a few hundred grams, it can mean all the difference. Also, she has an older sibling that has fat little cheeks and runs around like a crazy person with so much energy and life that you can hardly keep up. So what’s going on? It’s a mystery. We have many of these mysterious cases because the people here are coming from places where there is almost no medical care. No prenatal care, no primary health care, no vaccination schedule, nothing. It’s fascinating and heartbreaking for a medical person to work here.

To say the accommodations here are rustic would be a fairly accurate statement but more or less we are comfortable, the food is edible if repetitive, and I’ve gotten used to getting dressed, doing yoga, and performing all other morning and evening routines in the dark. The one thing that I cannot seem to get used to is how damned hot my tent is. It’s actually fairly pleasant in the evenings these days so one would think sleeping would be better but the tents are these thick, dark military issue things that trap all of the heat inside. And my tent is abutted against two other tents and so I have no air flow around the tent at all. Every night I was up and feel like I’m on fire. I have revived my old Haiti technique of sleeping with an ice block but that only lasts a few hours. Going into the tent for any length of time during the day is impossible because you come out sweating and gasping for air. I should probably try to move to a tent with more space around it but I just don’t want to. I’m settled there and I like my ‘neighborhood’.

On my way to the camps I often see huge herds of camels and it’s always very exciting to me. I don’t know why. They are so cool and quintessentially ‘dessert’ animals that they are just a small reminder of where I am because being locked on the compound so much it’s easy to forget. We have a mental health project and one of the components is dealing with sick children in our centers. One time I stopped by the ‘playground’ and engaged in an extensive conversation about snails and chameleons. Someone had a small notebook and on the front cover was a snail and on the back cover was a chameleon. No one had ever seen either one of them before and the addition that both animals were hanging out on an impossibly green, lush blade of grass made everything even more intriguing. Everyone had so many questions that the interpreter had to tell them all to be quiet and to ask one at a time. It was super fun to answer their questions but it seemed so funny to me that they would find something like a snail so exotic. And then I remembered my delight every time I see camels and I fully understood. I’m going to try to take a national geographic that we have here to show them some strange animals like polar bears and such.

The official language in Ethiopia is Amharic. In the region where I work most people speak Somali (of course the refugees mostly speak only Somali). Whenever I have to talk to my community health workers I have to speak in English and then the supervisor translates into Amharic and then the refugee supervisor translates into Somali. You can imagine this takes some time. Many of our lower level staff speak no English at all, so drivers, cooks, guards, cleaners… It’s interesting and funny to try to communicate with them. Some people have expressed an interest in learning English so I’ve volunteered to start teaching a few times a week. I’m really excited about this for some reason and I can’t wait to start. We have to figure out what time and if there are any English/Somali or English/Amharic speakers who are willing to come and do it with me since I think a total immersion is not really realistic since I have no teaching supplies, no books, etc from which to start. I have a few magazines and I will look up interesting things and try to use it as a teaching tool. I’ll let you know how it goes !

Not much else other than I found out this week that the forms I’m designing for my CHWs to do disease surveillance is getting a lot of interest from the alphabet soup (UNHCR, UNICEF, etc) and the weight of what I’m supposed to do is pretty intense and exciting. The method I design and the way I train my CHWs will determine whether or not we will be able to detect and intervene in an emergency before too many lives are lost or too much illness occurs. That’s our job; that’s *my* job – to make sure the systems are in place and the people are trained well enough and that I’m alert enough to take all of the information I receive and ring the bell when it’s needed.


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