i’ve moved

September 13th, 2008 by juliap

to here… my new blog for msf while i’m in png!


July 15th, 2008 by juliap

i’ve been out for a month now, and thought a lot about what i would like to say here to end things. and i’m still not sure, but i’ll try to sort it out before this is too rambly.

leaving dhaka was what i expected; sweet relief mixed with intense sadness. and after 24 hours of travel i made it to amsterdam, with plans to drink beer on a patio, instead, i went to sleep. de-briefing with the team at headquarters was manic to say the least. i had agreed to brief for my next mission at the same time so that we could save on time and flights. and since that was done last minute… there were a lot of people i wasn’t scheduled to see. i pretty much spent the two days running between floors, tracking down advisors, and cornering people in hallways. i really did get a lot of info in a little bit of time though, so was a success.

and then, boom! here i am. back in canada. back with friends and family. i got to meet my nephew! (and i think i can safely say i have the cutest nephew in the world – trust me! or at least don’t challenge me… i’m a new auntie, i’m fairly infatuated with him). was even home in time for my dad’s surgery, which i am so happy to have been able to be here for (all went great).

i’ve emailed back and forth with my former colleagues in the field – and knowing what was going on was both wonderful, and devestating. my family and friends are great, they don’t mind when i feel the need to share with them stories from across the world. but i don’t know if you ever really leave properly. there’s a distancing process for sure, but i never stop feeling connected to the people i’ve worked for.

but i don’t find reentry to be particularily hard. i relish being back home with friends and family. i’ve done this enough times that i know things won’t be the same. i mean, my sister turned into a mommy! wowza! but here are a few things that did strike me when i came home, and i’ve decided to share them with you.

a supermarket in the heart of a refugee camp:

while hanging at my sister and her husband’s house (taking care of baby so they can do things like shower, talk to each other), i felt the need for snacks. so off we went to the little corner store by the house. and it was insane! it had so much food, so much Stuff! it was overwhelming, and we grew up here. so a bit later when i saw a sign for a refugee resource group, i couldn’t help but think just how incredibly overwhelming this country must be for people. if 15 months in bangladesh could set me up for the supermarket shock (and i lived in dhaka), what would a lifetime in tal camp do? i can’t imagine the shock, confusion and bewilderment a city like mine would create. so while i’d never dismissed them or thought them to be unnecessary, my respect and support for the people who are committed to providing resettlement services to refugess skyrocketed.

(and the title is a reference to a program going on right now, a refugee camp in the heart of the city, go to http://www.refugeecamp.org/home/ for more info).

to poke or not to poke:

my nephew and i have something in common right now… needles. vaccinations are a fun part of the expat (and newborn) life. well, not just fun, but important. last week, i was lucky enough to get jabbed with a booster that i needed. and yes, i did feel like warmed over crud for a day or two (which just means its working… sigh), but, i’m quite happy to be protected. and while i joke that i’m now vaccinated enough to be able to juggle raccons with rusty chainsaws while licking a park bench, i’m really careful to make sure my doctor checks my records every year. so imagine my shock when my sister told me that there were people in north america, parents specifically, who were seriously campaigning against vaccines for their children. i had read an aritcle in a science magazine about this, so i knew the history (and i know what the science says!), but to learn it continues… stunner. this is one of those things that i would be embarassed to talk about in the field. i would be ashamed to tell a mother who walked for hours to get her children vaccinated, that some people in my country don’t want it, even though it’s available. i would be horrified to say this to a woman who had witnessed what outbreaks looked like, had lost family members. i just wouldn’t know what to say.

and let’s get this straight, i am fully in favour of people taking an active part of their health plan. asking the doctors lots of questions, finding out what they can… and ye old second opinion. but what i find scary is that there is so much misinformation out there and that people read it like they would read scientific research. and on a basic level, that people seem to have forgotten what these diseases are, and what they can do.

we are so lucky to have the access to healthcare that we have. after seeing people who are literally dying for healthcare, i find it hard to understand why people would ignore it. ok. off the soapbox now.

oh my mountains:

i love this land. i love the mountains. i love the lakes. i was lucky enough to wrap up the amazing times with family and friends with a drive over the mountains, and i just couldn’t stop loving it. i think this photo will say it all.

ch ch ch ch changes…

May 31st, 2008 by juliap

(don’t tell me to grow out of it)

well, everything seems to have worked out, and it is becoming quite clear that i will leave bangladesh in one week. finally end of mission… over 14 months will be completed (really, the longest i have been in one job for a while – i’m the type to get bored easily and 12 months is usually as long as i want to stay in one place).

my replacement has been found and confirmed and will be here this week. my handover report (currently 20 pages!!) is definitely on its way to being complete. my ‘unique’ form of filing is being simplified to something that may make sense to someone who doesn’t live in my brain. my evals for my team are all mostly written, and meetings will be held next week. my boss and i have done my eval. my end of mission schedule is worked out (just need to confirm flights).

and i’ve said good-bye to a lot of folk already. i found myself in teknaf in early may for the ‘farewell/closure’ party for the project. many of the staff had already started working for a handover partner (we have handed over the IPDs and are co-managing the outpatient clinic right now). there were a lot of goodbyes going on at that party. but there was also dancing, which is something i haven’t been able to enjoy a lot in bangladesh. but we did dance at this farewell. a combination of hindi superhits, and aqua.

i haven’t talked a lot about leaving. but i knew that it was likely my last time in teknaf. and i was definitely sad. and yes, of course, i cried a little as we drove out that last day. but that’s to be expected yes?

further confirmation that it was my last visit was that i finally (!!) saw elephants!! finally after i don’t know how many times i have driven the highway outside teknaf… i saw the elephants!

and it’s strange… my expat ‘team’ here hasn’t really changed much for a long time. i’ve had the same head of mission, log coordinator and medical coordinator since june. i said goodbye to the head of mission last weekend before he left for meetings, to the medical coordinator last night before she headed to holidays… even most of our teknaf expat team has been the same since last summer. so it’s been the first of really big goodbyes of people who i’ve been through so much with in this mission (floods, cyclones, closures, openings…).

and while the management team i’ve worked with this past year will likely never exist as itself again, there is a chance i will see the expats again. but my co-workers who are national staff, my own team, my own department – this is a pretty solid goodbye. i can hope we will keep in touch, and thanks to the miracle of social networking sites, perhaps we will. but in reality, there’s little chance i’ll ever come back to bangladesh. and just like my colleagues in sudan who i’ll likely never see again, the same is true for my colleagues here.

and finally, it’s saying goodbye to the people here. saying goodbye to tal camp and everyone living there. saying goodbye to the beneficiaries in the hill tracts and in the old cyclone project sites, and the dhaka project. and it’s more abstract than the people i know by name and have worked alongside. it’s more abstract, but it’s a bit harder. after a year of learning about, and trying to provide services to people, i’ve come to care a great deal about what happens to them. and while i’m confidant in our handovers, and our project teams, and my replacement, it’s difficult to let go. specifically, i have seen the struggles and hardships of the rohingyas living in tal camp, and very soon, i will no longer be part of trying to provide them the stuff that basic human rights are made of. i will no longer be a witness who can speak out. it’s hard to let go of that.

i have a lot to look forward to. my baby nephew, the rest of my fabulous family, and friends i love dearly who are all waiting for me to come home. so while i’m thrilled beyond belief to go home and see them all, it doesn’t come without the sadness.

but as the wise dr. seuss once said (and as the staff in teknaf wrote on the invitation for the farewell party)… don’t cry because it’s over, smile because it happened.


May 15th, 2008 by juliap

…another project!!!

(ok, i’ll admit that is rather cynical sounding, but it’s becoming a standard joke that every three months we open a new project in bangladesh – the emergencies have kept us on our toes!)

quick update:  i went on leave in april, and came back to another project opening!  we carried out a food assessment in the chittagong hill tracts back in march/april, and the results came in – there was definitely a need to intervene.  so we have started up a short term nutritional intervention in the region that appears for now, to be the hardest hit by the flowering bamboo/ rat infestation (for more information, click here).

so the past month has been another flurry of activity.  6 new expats so far, with some on the way.  plumpy nut arriving on planes (a form of ‘ready to use’ food which we currently use in our feeding program in teknaf as well – sachets of a paste made with peanuts, milk, sugar and vitamins – kids love it!.  more info on ready to use foods here).  the area we are working in is not unfamiliar to us – you may recall the post from over a year ago when i was in khagrachari for the final phase of our malaria health program.  the hill tracts are a very unique region of bangladesh.   it’s very hilly, and there’s a lot of jungle (as opposed to the rest of bangladesh which is river delta/ flood plains).  malaria is a huge problem up there, which is why we had a program for so long.  until a few years back, it was a conflict region as well.

the access is difficult, not tonnes of roads, and during the rainy season the streams become rivers.  lots of hills, and jungle combine to make a lot of locations ‘walk-in’ only.  the assessment took 4 weeks simply because of the amount of time it took to reach each location!

our logistical teams are currently trying to get to set up outposts in different areas so that the medical staff can set up feeding programs.  as i mentioned, the terrain is not easy, and there’s lots of hiking involved… everyone lives in pretty small villages, and they’re pretty far apart, so we have to find a way to make sure we reach the malnourished kids.

next challenge is a food distribution (!)

to my dear sister, and the baby she will soon have:

May 8th, 2008 by juliap

i know it can get rough, and your writing makes sense.  it’s understandable to have some panic that the baby will arrive before you are ready (similar to the dream i had the other night where i had to get on a plane in 2 hours and pack for a nine month mission and i didn’t know what to take!  i just threw all the dirty clothes off my floor into a plastic bag and called that ‘packed’)

i know you worry you won’t be prepared enough, won’t have the right stuff, will drop the baby… and any other creepy crawly worry that can get into your head.  but, i’m here to play the ‘aid worker’ card and tell you about what i see in my work. (so aged and wise i have become)

there are mommies that just love their babies.  mommies that have nothing at all, unregistered refugees living in mud.

i see them when they bring them to our clinics, they hold them, they feed them anything they can.  they are held in slings and scraps of cloth.  when the babies get better, they start laughing and gurgling and they are happy.  then the mom is happy.  and so are the sisters and brothers there with them…

seriously, love is all it takes.  i have watched a child grow from 1 kilo to 3, born premature to an ill mother.  father was gone, but child siblings all present.  i watched the mother, frightenly malnourised herself, feed that child throughout the day with theraputic milk via an eye dropper.  everytime someone arrived, she eagerly showed off her growing child.  her son and older daughter would skip around the bed, gleeful.

but yes, it’s misleading to say love is all it takes, because this child could have died despite her mother’s love – the world is incredibly unfair that way.  but my point is simple, and it’s something i know you know, but may be hard to hold on to sometimes… all the baby needs is for you and his father to love and protect him.  i have watched mother’s with nothing to offer their babies but love and the willingness to take them to a doctor, save their babies lives.

i can’t wait to meet your baby this summer.  i never knew how much i could appreciate the sight of a fat baby, but it makes me so happy now.  i’m happy to know that your baby is fat already, and loved already.

post script… my nephew was born but one week later.  1 month early, but still a healthy 6lbs and 10 ounces.  i guess my sister’s dreams about the baby showing up early were actually warnings :)   i am such a proud auntie right now!

cyclone photo blog (very tardy)

April 14th, 2008 by juliap

finally, a proper cyclone entry.  only 3 months late!  way to go me!  to make up for the tardiness, i’m gonna make this super long.  so i’ll understand if you only want to look at pictures. i can be very verbose.

so this is going to be about the trip to galachipa, a town in southern bangladesh located in a region heavily populated with chors – which are small island like patches of land that suffer quite a bit of flooding at the best of times, and were quite badly hit by the cyclone.around the chors, we distributed thousands of NFI kits. NFI stands for non-food items, and as the name suggests, the items can refer to a number of goods that aren’t food.  one common nfi is a blanket.  cyclone sidr hit right before bangladesh gets cold.  and our mothers have all been correct telling us to button up when it’s cold.  blankets are important for keeping warm in the winter, otherwise it’s easier to get ill.

what you can see in the photo below is 3000 blankets.  what you can’t see in this photo are the other goods that went into the household kids – candles and matches, cooking pots, soap and some other necessities that were meant to keep a family warm, clean and able to cook food – all important ways to stay healthy.


next up is a photo of the supply logistician that got flown in for the emergency.  it’s funny, because when you work for msf you work in these teams and become so close to people and you wonder if you’ll see them again.  and so when they show up in your next mission, it’s so awesome!  case in point, lori and i worked together in sudan, and we got to do it again in bangladesh.  huzzah!  here we have just finished a nutritious dinner of fried bread stuffed with lentils.  mmmmm.  we’re doing our evening decompression on the patio before it’s off to bed.

as november flew into december, the capital office was in full swing trying to support three projects instead of our usual one, and working like mad (see earlier reference to dinner being fried food).  but i realised one day that i was needed in galachipa to give the administrator a hand, and make sure our finances/admin etc was all in order.  so away i went to the southern coast, where there are even more boats then i’m used to seeing.

i was travelling in a pickup, but the most common method of travel down there appears to be motorcycles – which after a cyclone is handy because they can manuever around trees and other debris on the road.  i would feel beter if the women riding behind the driver would wear helmets though.  sigh. (hmm.. you can barely see her in this photo)
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this type of thing is why i want them to wear helmets.  and in the cars, seatbelts.  and maybe knee and elbow pads and a neck brace or something.  perhaps people should only travel coccooned in duvets and bubblewrap.  yes.  that’s it.


ah yes, the ferries.  seriously good stuff here.  anyone know the needles ferry?  it’s like that but somehow more trucks.  somewhat claustaphobic inside the car – but outside was all exhaust.  best place to be was the front of the ferry, standing by the ledge.

or perhaps running around the ferry taking pictures of people’s bicycles as i seem to have preferred.

and here we have a gaggle of children that hung out with me while i waited for one of the ferries (there were many – many ferries, many children).  they ended up taking the ferry ride with me too.  they seemed totally entertained by me, and they looooooved getting their pictures taken.  love the age of digital cameras.  nothing creates a fit of laughter in the kids like seeing themselves on the screen.
on the big ferry i was invited to the steering place (anyone nautical enough to tell me what the room is called with the big wheel thing?)  i didn’t understand why i was invited, and kind of ignored the invitation, until i realised that everywhere i went on this ferry, there were men folk wanting to take my picture.  um.  it was strange like, really unnerving and specific to this ferry (hadn’t happened on the previous 18 or so…) eventually, i decided to cancel the media scrum and stop clogging up the balconies and i went to sit on one of the seats in the steering room place.  there was a guy in there taking my picture too, but i decided one guy was easier than 30.  and now i got to take some pictures. i like this one.

finally, we got as close to galachipa as we would with the pickup.  the final leg of the journey would be by boat.  teensy little boats with loooots of people and only one silly foreigner with a heavy pack on her shoulders.  oh yes, and the foreigner was wearing sandles.  slippery sandles.  her more practical shoes were in the bottom of the backpack.

very happy to report i did not fall in,and only looked slightly ridiculous going from pier to boat.


yup, i’m standing at the front of the boat.  can you see galachipa on the other side?


now i’m in galachipa.  and i’m not going to show a picture of the office, because apparently i didn’t feel it was very exciting (as i didn’t take any pictures).  the admin there was doing a good job getting it set up, and we spent 2 days solid in that room getting all the systems up to spec and worked out.  we worked from dawn until a few hours before the next dawn, surviving off instant coffee and sweet biscuits.  when i did take the occasional walk around the hotel i could appreciate the view.  it was a motel-style set up, and we had a ‘kitchen’ all worked out on the roof – complete with tables and chairs to eat.  the view was pretty awesome, as you can see below

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but yes, exciting two days of reciepts, spreadsheets, office supplies and the occasional strech of legs.  the day i left i awoke at dawn again to catch the boat back across the river.

and it was a beautiful morning.


so there you go, a nice little photo blog about my trip to the south.  and now, the obligatory photo for mom… sorry it’s such a giant picture of my forehead.  spots and all.

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March 28th, 2008 by juliap

i wrote this post 2 months ago, after 3 of our staff were killed in kismayo, somalia.  this post is about my own feelings, and i didn’t want to post it, because i didn’t feel that it was fair for me to comment, when there are so many people for whom this loss is so much more personal.  for the teams in the field, for the people of kismayo, and for the entire worlds of family and friends who loved these 3 men, and whose grief is uncalculable to me.  i didn’t feel it was fair for me to speak, and to have such a platform, when there were people who had so recently lost of peice of themselves and their hearts with this attack.

but maybe now i will post.  and i’ll apologise ahead of time if the writing is totally stupid and wrong.  something like this post, i don’t even know how to make it appropriate, how to edit it.


dhaka, 1st of Feb, 2008

this is the post i don’t know how to write.  this is something i’m not sure i can put into words properly.  i don’t know if i can put into words that will make sense, but worse, i don’t know how to put in words that will honour those people, and those families affected by what’s happened.

i was on the phone monday night, talking to the project coordinator in teknaf, a question about contracts and staff and we were working something out.  and as the conversation wrapped up, i did what i often do, i glanced at the news webpage that is up on my computer screen.  aid workers killed in somalia it read.  and i clicked automatically.  as i read that it was msf, that it was my section of msf, i started swearing. out loud. repeatedly. trying to say what i was reading, trying to make sense of it.  there were no details, there was only witness statements.  aid workers killed in somalia.  when i managed to regain any sense of my brain, and return to the conversation, it took me a few seconds to remember what we were trying to talk about.

and somehow we managed to conclude the conversation.   i knew i should just sleep and by morning, there would be something from amsterdam, something that wasn’t conflicting and different, and vague.  i should sleep.

but instead i spent hours refreshing news webpages, and waiting and running through names in my head.  who.  why.  and sobbing.  and it’s threatening to start again right now.

but in the morning i got up, and went out to the office.  i was the only management team member there, as the rest were in the field.  there was official notice, three msf workers had been killed.  and so i went to each office, and sat down with the teams, and told them what we knew so far.  told them the name of the logistician, damien, the surgeon, victor and the driver, bidhaan, who were killed.  i didn’t know what to expect, or what people would bring up.  but we talked.

not knowing how the incident occured, and not knowing if it was on purpose, the recurring question was ‘why would someone do this to them? why would they do this to msf?  to us?’

and it’s never been more evident to me that we are a family.  it’s a different country, a different continent, and while we could not know the great pain of those across the world, it was still grief, and shock, and confusion.  and it was us.

as i sat outside talking with the drivers, i had one of the worst moments when i spoke the name ‘bidhaan’.  as i did, one staff member quickly asked ‘the driver?’.  a driver, a person who no matter how limited out access, or how dangerous it may be, if there is a program, if there is a team, there is always a driver.  and the staff member who asked, a driver, knew that.  so many media outlets didn’t seem to realise though, that a driver is an aid worker.  so many media outlets spoke of 2 aid workers, and a driver.  how can i explain such a simple concept, that our drivers are aid workers.  our drivers go everywhere msf goes.  our drivers act as translators, liaisons, negotiaters.  our drivers are essential.  please honour that our drivers are aid workers.  please don’t only name those of us who work in countries that are not our own.

and what do you do with all of this?  talking with the staff was hard, but it was concrete.  it was something i knew i had to do, something i knew how to do. so really, it was easy.

but this is hard.  i don’t know how to say to the team in somalia, i’m so sorry.  i don’t know how to say to the families of the people killed, my heart is breaking for you.  i don’t know how to say to the people of kismayo, you live with this, you endure this, and i don’t know how you do it.

but i will say again to the media please realise our local staff are aid workers.  please respect this, and report their profession and commitment, especially when they have lost their lives while working to benefit others.  and while i’m pretending that reporters will read this, i will ask that you do not mistake our work, you do not mistake us for heroes.  we are trying to provide services to people in crisis, people who are marginalised, and we do so while trying to keep our staff as safe as we can.  there is always risk, but we are not careless cowboys.  we are simply trying to do the best we can.

many staff told me that their prayers would be with the families of those killed.  while i don’t presume they will read this, i will write it here just in case.

my thoughts are with you too.

international women’s day

March 18th, 2008 by juliap

so how did everyone celebrate international women’s day?  i really did not do much more than work.  but i did think about the whole ‘what does international women’s day mean to me here in bangladesh?’ and mostly, international women’s day made me think of the moms in the hospital in the refugee camp.  moms holding tiny malnourished babies.  moms who are barely past childhood.  moms that as malnourised as their babies.  when we did our nutritional survey in november, we gathered data that revealed 1/3 of households in tal camp are female headed.  as well, 1/3 of children between the ages of 6 months and 2 years are malnourished. and one more ‘IWD-appropriate’ statistic; 1/4 of pregnant and lactating women are malnourished or are at risk of malnutrition.

while i was in teknaf last month, i saw a baby that was only 1 kilo when it was born.  the baby was doing remarkably well, and had fattened up to 1.6 kilos by this point.  mom had gained some weight too, as she was 24 kilos when she came to the hospital.  she was smiling a lot and showing off her baby to the doctor who had come back from vacation, asking how soon they could leave.

some moms held babies that did nothing more than look.  they just looked up at the ceiling, up at their mom, or just out to whatever was holding their gaze in midair.  they weren’t crying to gurgling or laughing.  just looking.  the babies that just stared made me scared.  it sounds wimpy to say, but they looked so fragile, serious, and just so ‘not like babies should’.  later on, one of our staff members showed me her new baby, and it was fat and reassuring, and i realised that they sight of a malnourised baby is still so unreal to me, so very sunday morning fundraising 30 minute infomercial on tv.  instead of babies, they look like frail old men, lying there staring at you, asking for some sort of explanation.

i would talk to the moms a bit (ie. say hello and smile and use some universal sign language since we had no common spoken language).  i was thrilled at one of our hospitals, when a 13 month old girl, 1 day from being discharged and feeling goooooood, smiled up at me when i walked around.  she had big eyes naturally, not just the kind left hollow from a wasting face.  big eyes, and the start of some chubby cheeks underneath.  and she gave me a grin that revealed the new teeth arriving.  all that baby wanted to do was giggle and shove her fist in her mouth to soothe her aching gums.  but our nurses, who are constantly trying to reinforce hygiene, kept reminding mama to pull out the hand.  baby was a bit disgruntled with this, but i tried to distract her by playing peek-a-boo with my scarf.  she was SO into it!  she started using mama’s scarf to hide behind.  woot!  what a party.

then she wanted down, and showed off her hesitant steps.  i was kneeling on the ground and she toddled over to me and then collapsed onto my legs, grinning again.

so i took a seat on the floor, perched the little one on my leg, and we had a fine 10 minutes of hanging out time.  mom thought it was funny, the nurse tried to get me to not sit on the floor (the staff hate it when i sit on the floor, or on a step or anything that isn’t a chair), and this little girl just had a field day trying to climb up my hair.

so i will try to do with this story, what i do with so many others in an attempt to keep myself sane.  i will look for the silver lining, the lessons learned.  i will be proud that we are doing what we can, and treating those people who we can treat. i will forgive myself for the shock i felt when i saw the 1 kilo baby.  although to be honest, i hope the sight of a malnourished child never fails to shock me.  i hope i never normalise this.  i hope i can respond to the nightmare with compassion and action, and not shutting down, or bailing out.  It’s so easy to avert your eyes, i hope i don’t.


March 15th, 2008 by juliap

it’s funny just how quickly time can go by.

my silence has not been deliberate, but rather a side effect of 2008 flying by much too quickly.  i am trying to come to grips with it being march already, constantly catching myself referring to something being ’6 months ago’ that actually happened in july, which is i guess 9 months ago now?

so apologies.  i now finish up and start posting to all of you the entries i have started and abandonned over the past few months.

finger’s crossed!

quiet time

December 23rd, 2007 by juliap

hello all,

i’m on holidays right now and won’t be posting until january.  so happy holidays, eid mubarak, and will post as soon as i can.