just grow it

October 28th, 2008 by juliap

when i first arrived in png, i was eating dinner with the capital team and we were discussing the living conditions of people in the country. i was asking about the settlements i’d heard of, and wanted to know what they were like.

i think someone remembered that i was so recently out of bangladesh, and that i was probably picturing very crowded ‘shanty’esque situations. so i was quickly corrected. (it’s hard sometimes to switch mindsets so quickly when you are sooooo embedded in a country or region and the issues that exist there… bangladesh has very little land, and a lot of people, here it is a bit different).

land is of huge importance in this country. you must have land. enough land to have a garden. that was the clarification.

so the settlements that grow around the big cities are actually small villages. as one staff member explained to me last week, ‘if you live there, you run cords to the one house for electricity, and you tap into their waterline’. and the landlord? ‘makes a tidy profit for selling you the power and water’. are there gardens? ‘of course!!!’ (how could i be so silly to insinuate there may not be.. again, my bangladeshi experience nails me).

to ask if there were gardens was beyond redundant. of course there were gardens. gardens are everything here. our clinic has gardens around the border where the guard has planted taro and flowers and i think i may have seen a watermelon starting to form. even the dirt patches edging the walkways inside are full of clipped vines, some so small they must be protected by coconut husks as they gain height and strength.

‘what plants are grown here? what fruits?’ i had to ask. (i love fruit, and love to discover the most popular ones in each new location so that i can look forward to massive consumption of them while i live there.)

‘everything’ is the response. the geographical diversity in png means that the highlands grow different fruits than our area, and we grow different fruits than the capital region. ‘they have the best strawberries in the highlands…’i was advised. ‘don’t let someone go there without bringing them back’.

at this point in the conversation, i was getting excited, but still barely matching the excitement of my colleagues.
at one point, the doctor turned to me and said, ‘everytime i go somewhere, and if i see something i want, a plant i don’t have, i have to get it! i just have to get it… and then i just have to stick it in the ground and grow it.’ [i've seen this first hand while waiting for someone - our driver spied some pretty flowers, and saw that some had gone to seed. open invitation to harvest a few to take home for both our garden and his.]

while chatting with some of the staff, i asked about mangosteens… one of my favourite fruits in the world. everyone looked at me strangely as i tried to describe a fruit that tastes like a cross of mandarin oranges and lychees, and looks like a small round eggplant. obviously i must be nuts… nothing like that grows here.

but mere weeks later, i walked into the clinic and what did the doctor have?? mangosteens!! ‘i think i found them! i saw them in the market and bought them!’ everyone was curious about how to approach them, so i started peeling them, staining my hands the telltale shade of purple in the process, and we divvied up the sections. i was hoping it wasn’t an acquired taste, or perhaps one not suitable to the palate of my team. i realised i’d ‘done good’ though when the doctor declared she was going to start growing these in her backyard.

so yes, land is important here, but so much because of what you can grow on it. and when you receive a gift from that harvest, the honour is clear. the services at the clinic are all free, but there are a few cases where women wanted to express their thanks. one woman presented a bouquet of home grown flowers to her counsellor the day after she had been to the clinic. another woman dropped off a bag of vegetables with a note that said ‘thank you’. the gifts could not be rejected, no matter how dodgy an outsider may judge the act of acceptance. it would have been incredibly insulting. so the vegetables became lunch, and the flowers prettied up the staff room. the added beauty and the hearty meal were very nice to have, but the acts… the acts of taking something from their garden, something they had grown, and coming back with them to give us, it was a sign that we had ‘done good’. and we were humbled and honoured and touched by the acts.

this did not escape my thoughts as i sat down to dinner with my colleagues in the capital. we were having management meetings over thanksgiving weekend, and within the team we had a few canadians. somehow we three persistent canadian women convinced the male british logistics coordinator to cook us up a dinner of roasted chicken (almost a turkey) with all the fixins. while stuffing ourselves with the food, questions came up from the non-canadians about this strange holiday we kept referring to, and we did our best to explain. to me thanksgiving is dinner with my family, a table full of vegetables from my grandparent’s farm, a trip to their basement to gather harvested squashes, jars of tomatoes, a cold chain of freezer-bagged corn kernels; food for the winter that’s been grown to share. [not to forget that thanksgiving also means lots of pumpkin pie and the birthday cake for my dad.] it is a changing of the season, a moment with loved ones, and an appreciation of everything that sustains us.

this year, the third thanksgiving i’ve spent far from home, i thought a lot of the things that sustain us. the land the grows the food. the doctors that give us the medicine. the people who are there just to listen, and let us speak the traumas that haunt us, thereby lessening their power over us just a little. i thought about the act of giving thanks, of letting someone know that they did somehow help… giving thanks is in itself a gift of strength, and in the hardest moments it is a gift that somehow holds back the looming threat of feeling overwhelmed and defeated. perhaps what we do, however simple and small in the face of this violence can make some sort of difference. this is what sustains us.

xmas psycho

October 7th, 2008 by juliap

i was having dinner with some friends the other night, and i think i was ranting about my christmas airline ticket (see, i told you i like to hyper focus on the trivial details) and one friend turned and said:

‘ahhhhh christmas. the best way to shop for presents is on christmas eve, as late as possible, all in one go’.

i nearly spit out the well chilled red wine i was drinking (in png, they believe in chilling the red, it even comes in an ice bucket).

anyway, my friend, my dear friend, had just described a recurring nightmare that i have every year. the nightmare that i’m expecting any day (night) now that turkey dinner I is nearly upon us, which means the countdown to turkey dinner II has begun. usually in the dream, i am frantically shopping at 11pm in the local 7-11 trying to decide how much beef jerky would be enough for a gift, and whether or not the hot nacho cheese will still be hot when my dad opens the plastic take-out container. last years nightmare actually included being on a plane on christmas morning and trying to buy duty free for presents. yes, i do have a problem.

my obsession with christmas and with presents was one i thought would perhaps, let’s say, wane with my career choice. but well, nope! the year in sudan… still got the nightmare and was frantically shopping the moment my plane hit the tarmac in vancouver (and i should mention the last minute souk trip in khartoum to buy jallabeyas for the men in my life). midway through working in bangladesh, one of the poorest countries out there where we worked with a population who literally lived in mud… lost neither the present enthusiasm nor the running out of time nightmare! still completely obsessed with presents (although to be fair, all shopping was done the night before we left bangladesh because there was this little thing called cyclone sidr that kept us a bit busy in the pre-christmas shopping season – i would like to point out that year was the closest i’ve ever gotten to a living christmas shopping nightmare. it culminated in me standing in the middle of a handicraft shop 15 minutes after they were supposed to close, staring up at the shelves and mumbling the names of friends i hadn’t seen in 10 years as i pondered what scarf would suit them best… luckily, jason dragged me out of there).

and now, here i am, another year wiser, another year more obsessed. but since the airline ticket just may well bankrupt me, i’ve openly pondered the option of just wrapping myself in a giant gift bag and sticking a bow on my head.

but lets get serious, that is not gonna happen. the credit card companies have been silly enough to issue me with plastic, and if i have to have my own sub-prime crisis, so be it. prezzies are not optional.

which brings me back to png. which is possible the only place to have people who actually seem to be more obsessed than i am. we’ve had traffic jams in lae for the past week, which is apparently caused by the entire province of morobe travelling to the capital for… yes… you guessed it… christmas shopping! and the wonderful pharmacy i dropped by today is already decked out with santa hats nailed along the top of the walls and a large plastic santa motive smiling benevelantly down at us.

definitely my kind of people. let’s see if i can get them all into repetedly playing the boney m christmas album too. then i will be in paradise.


October 6th, 2008 by juliap

i’m frustrated tonight.

and i’d like to say it’s for all the right reasons. but the thing about the human brain – when the right reasons are too much, the little (wrong) reasons take over.

i’m frustrated because i can’t find a cheap flight home for christmas. and because christmas means the world to me, so there is no option to not go. i have to see my family. i have to hold on to that one single tradition. so i will pay an extraordinary amount to do it.

i’m frustrated because a good friend of mine is no longer a good friend. time and space wrecked a good thing. i love human connections, and when i find out it’s been trashed, it hurts.

i’m frustrated because i have a pile of paperwork facing me right now. and it’s all got a purpose, but i’m counting the hours of the days and the hours to do the work… and there’s a wee discrepancy that may cause some problems. unless i can finally leap over that barrier of space/time relations.

but yeah, the real reasons. the things that i finally had a good cry over the phone to my husband about. the reasons that occasionally make me engage in the type of vocalisation an ex-yoga teacher (dave are you still out there?) would be proud of (luckily it’s loud enough in the ‘hood that i can yell in the backyard without anyone getting worried).

the real reasons. ok. so perhaps it was the 3 hours i spent the other day keeping an eye on the men beating on each other in the street. all so drunk they could barely walk, and yet, they’d have the strength to stomp on the other one who had fallen. frustrated at watching the kids peering from behind the large tree. frustrated that i couldn’t do anything.

or maybe, it’s the woman who came into our clinic, who wasn’t actually a patient of ours (she was at the wrong place), who was so thin from tb that i was careful not to nudge her as i walked by because she looked ready to break. and she wasn’t our patient.

maybe it was knowing, that for all we do, and for all the people here who work so hard, i heard reports of a woman pulled out of a police station by her abusive husband after she’d gone there for protection. the police did not follow.

maybe it was the past week of struggling to find a way to refer patients to services, and have those services work. knowing that we could simply spend our days personally advocating for each and every woman who walks through our door. knowing we could pound our heads against overworked and underfunded services who don’t know what to do either.

maybe it was dealing with a case where a woman had decided to leave her abusive husband, but literally had no where to go.

or maybe it was the young woman who had been brought to our clinic by a stranger after she was gang raped in the middle of the day.


so now to appreciate the other little things. the family next door is shrieking and shouting right now… with happiness. they are laughing. it is alright.

and we cannot do everything, but i know we do something.

and the women here, for all they go through, they are strong. they are incredibly strong. and it’s been some time since i’ve seen women who are so assertive and opinionated and loud. and yes, that makes me happy.

and again, go back to the people who bring in their friends, who bring in their family. go back to what is, not just what isn’t.

the paperwork will get done. the ticket will be purchased. and we will treat the survivors who come with respect and give them back some choices and let them take back a tiny part of what violence takes away.

we will go to bed and try to get a good sleep.

indy day

September 16th, 2008 by juliap

today is independence day in PNG, and i got to go to my first sing sing!!!

sing sing is when people dance and sing and drum and it’s excellent. first we had to sit through speeches, and all the students marching off the field in formation… but then the dancers came out. and really, there’s not much i can add to the photos, besides pointing out as i should have many times before in this blog, but don’t think i have, people here can be soooo kind. everytime i went up to a crowd around a dance, they would usher me to the front so that i could take see better. so i’d crouch down on the ground, next to the kids, pretty much with my butt in the mud (and oh how much mud there was), and snap shots of the dancers and drummers, while the children chose to stare at me instead. i’m not sure how i could be more interesting than the dancers, but life is funny that way.

enough talk, here are my favorite pics.

ground rules

September 15th, 2008 by juliap

i struggle a lot sometimes with these blogs… trying to figure out the best way to talk about what is going on, give an accurate picture, represent somehow the reality of where we work. i want to be honest and say what i know of the people we are serving, but still avoid the pitfalls and traps of speaking ‘for’ people. so really, all i can do is say what i see.

but even then, there are some things i will never talk about explicitly in this blog. the survivors that come to the clinic have stories that are not mine to tell, and would never be appropriate for this forum. but i could give you glimpses perhaps from what i read in the papers, stories that are printed every day of young women assaulted by people they know, or women attacked as they walk home in the night, in the day… really it doesn’t appear to matter when they are walking…

and there will never be photos of our beneficiaries. i will show pictures of the clinic when empty, and from that, you will have to imagine a monday, when every bench is occupied by women and their family, women and their friends, women and those who support them/ depend on them.

i want to tell you all a story about people working so hard to fight back against the injustice of violence. i’ve met so many people who, whether survivors or allies, are committed to ending sexual and domestic violence in png. i could introduce you to high level politicians, to women i meet on the street, to volunteers i talk to in meetings… and i want you to hear that story while i explain the reality of violence here, the scope of it.

and i can tell you our little story, as msf. our story of medical support. of a small act in the midst of this struggle. while it rages on, we say very simply, we are here, you deserve medical treatment, you deserve your health, it is not negated by someone else’s violence.

that is what i can tell you.

cultural relativity

September 9th, 2008 by juliap

i think there are two things to point out before this post makes sense.

the first is that i spent a lot of my undergrad reading, debating and flat out arguing about the role of ‘western’ women in the struggles of women abroad. a lot of words like privilege, oppression, colonialism, and values would get thrown around. this didn’t just happen in the classroom but also in community groups i was working with, and political debates with friends.

the second is that, what i always appreciate about msf, is that we look at suffering and medical needs first. then our actions are based on addressing medical needs, and when warranted, speaking out about the situations that cause those needs. it’s not about coming in and thinking we know all the answers, but providing services to people who aren’t receiving them. and the simple act of providing medical care to someone who has been denied, is an act of solidarity in itself. my old boss said once ‘we may not be able to do much, but just being there, saying ‘i think you are worth it’ can be a huge act of solidarity all on its own’.

when i decided to come to png, i wondered what a lot of people would think about this program. amazing to say, but i know people who will look at this program and see it as ‘interference’ and ‘importing western beliefs about gender’. gender based violence is normal there, they’d tell me. it’s a violent culture so why go in with your namby-pamby western ‘feminist’ beliefs and mess about.

and i knew this was wrong before i came… but it became that much more obvious the moment i got to the centre and started talking to my colleagues who are from png. it usually started with, yes, there’s a lot of violence, this is reality, this is normal. but then it also became ‘i can’t believe the case i heard about today, i can’t believe someone would actually do this, it is horrible. it is wrong. this is not what i believe in. when she told me her story, it broke my heart.’ (to paraphrase).

just because something is normalised, or frequent or common, does not mean that people want or accept it. just because the newspaper has an article every day about a rape that occurred in Lae, does not mean that survivors come in and say ‘yup, give me medical treatment but i’m cool with this and don’t mind it happened’. just because many women and girls (and young boys) grow up with the constant threat of violence, doesn’t mean that it doesn’t affect them on a psychological level. just because our staff have also grown up in these situations, doesn’t mean their stomach won’t drop when they listen to a woman’s story.

normalised violence does not equal desired violence. not having the tools to medically treat rape does not mean people think it is acceptable to acquire an sti after an assault. this is not about importing western values or humanitarian colonialism, it’s about sharing the skills, knowledge and resources of an emergency medical organisation. it’s doing what we can.

to the newbie

September 3rd, 2008 by juliap

i received an email over facebook from a soon to be expat. what’s your advice for a new guy he said? something akin to’waaa?’ was my initial reply. but, heh, with the arrival of our new mental health officer, it’s something that’s been on my mind anyway these days… so after getting over the shock of being asked for advice, i thought about the things i’ve heard from other people in the field – and the advice that made a big difference for me. i came up with my top three tips for a first timer:

1/ ‘be prepared for anything.’ before arriving in the project,
chances you received reports from the field.  this could include
the project proposal with objectives and strategies.  it could
be the handover document.  you may even get to read a blog or
some communications docs.  if you are like me, you’ll use these
documents to try to somehow peice together a picture of what you
are about to walk into, looking for clues to complete the images
in your head, and perhaps you will think you know what you’re
getting into.   and if you are really like me, you will still
end up gobsmacked when you arrive and are confronted with
everything, promptly forgeting all that you’ve read, and end up
still spending your first few days in a haze as you try to make
sense of the world again.  this is normal.

2/ ‘don’t make any big changes your first month in the field.’
really really take your time getting to know the program and
your own department.  if you listened at the door of the new
expat training, this is one thing you would hear repeated often
- and there’s good reason.

when you arrive in a project full of ideas and energy and
passion, it is so easy to pinpoint all the things you think are
wrong, or inefficient or not logical.  this is  a good thing, it
promotes improvements and progress in the project… but it’s
best not to push through right away.  it’s so useful to take
lots of notes, ask lots of questions, keep your energy high, and
allow some time to find out why things are they way they are.
there could be good reasons, or perhaps outdated reasons… but
usually there is a reason that is not immediately obvious. part
of working for msf is finding new ways of solving problems and
dealing with issues (ways that can best suit the context,
population, resources etc etc).  you’re not in kansas anymore
and if you don’t know the context, you may repeat old mistakes.
so listen, ask questions and give it time before plowing ahead
with your brave new program.  you’re going to have to be
creative and flexibe in your approach, and this time allows you
to be best prepared.  you don’t want to reinvent the wheel only
to find out your beautifully streamlined program can’t hold up
to the potholes and wadis.

3/ as hinted at, the last big advice is ‘be prepared to suspend
disbelief’.  there have been so many times i said to myself,
there is no logical way this can work… my canada brain was
like ‘what the hell are you trying to pull off?? this is not
gonna happen!!!’ but here’s the catch, it did work.  somehow, we
all make it work.  and it may even make sense eventually… as
long as you don’t think too hard about it.

refugees with supply stock ruptures

September 2nd, 2008 by juliap

translation is never easy – i took languages in university… but i realised it more when i started working for msf.

last year while in bangladesh, we had a fairly lengthy document that needed translation into bangla. it’s a tricky process, even for the translators we had on staff (they focus on verbal translation) because of a different alphabet, and it’s hard to even find a program to allow you to type it in the computer (even after you memorise the new key assignments). so i sent it off to the translating service and asked them to do it.

a few days after i sent the completed translation to the project i got a phone call from a very amused project coordinator.

‘did any of you read this?’ she asked.

obviously i hadn’t (not too good at reading bangla at this point – continues to this day).

‘no…. i just took the package and sent it to you guys… is there a problem?’

‘yeah, actually, not the body of the document, more the translation of our name’

in our docs, it’s always ‘medecins sans frontieres’ so i’m thinking the classic, medicine without borders" or "medicine without limits" or "doctors gone wild" or something wierd… but this was the best…

they’d translated us to ‘border dwellers without medicine’. best. translation. ever.


so yes, the translators changed it, slight modification, and a very amused project team.

then i got here… and tok pisin is a tricky language. there are words that have a number of meanings, and get used in all different contexts. every english word can be replaced by 4 or 5 pisin words, which in turn could all mean 4 or 5 english words each…

so for our tok pisin translation we got the equivilant of doctors without fences (pisin word closest to border really). the word for fences is ‘banis’ and is akin to ‘border’ or ‘boundary’. so conveys closest to the idea that we want. we are "doktors i nogat banis."

and then after finally deciding, everyone agreeing, signs made, stationary used, months into program, we find out that ‘banis’ is also used for some other terms. so in addition to doctors without borders, we are also calling ourselves:

doctors without condoms
doctors without vaccines.

ha! basically the word ‘banis’ is now being used to indicate a whole bunch of barriers, barriers that are really good!

sometimes you just have to stop trying to fit in, because it ain’t gonna work. from now on, we’ll be known by the french or english name… that’s it. although if i manage to translate "border dwellers without medicine" into pisin, i may try to convince the management team to adopt it as our in country title.

and on that note, anyone who can work out what the title of this blog is in english, then you win my praise and respect. and the people i already told aren’t allowed to answer.


August 25th, 2008 by juliap

25th August

goodbyes are never easy – i think it’s even harder for our staff when we are new in a country. in sudan and bangladesh, the expats had been coming and going for eons… people were ready for it. here, we are still new and young and the staff are still a bit shocked i think by the departures. our mental health officer recently left, and she was the only one left from the ‘opening’ expat team. so in proper tradition, a feast was cooked (taro, coconut rice in banana leaf baskets, watermelon, pork skewers… soooooo good) and bilums were presented (bilums are traditional bags here). to give you perspective, she had to pack an extra box to get all the presents home!


entry point

August 13th, 2008 by juliap

so, judging by my inbox, most of you are wondering just what i’m doing here. and now that it’s been a while, i think i can answer. with the help of previous reports, i’ve tried to summarise our program in lae below…

last year an msf team came to png to assess the current situation. we’re used to populations dealing with conflict, post-conflict, isolated and vulnerable communities, and we’re used to medical needs related to a lack of health care access, neglected diseases, natural disasters, traditional wars… but what we found here was a bit different.

we found out that in png, women and girls were suffering from an extremely high level of gender based violence. there was awareness going on, and a clinic at the hospital in lae doing it’s best to support, but despite all of this, appropriate medical and psycho-social care for survivors was almost completely absent. our target population was spread out across households, and our neglected medical conditions were those caused by sexual and domestic violence.

the need was there, so in december last year we started providing services from the clinic at the hospital in lae (the second biggest city in PNG). and that’s where i am now. the msf clinic is focused on medical and pyscho social care for survivors of domestic and sexual violence. there are now 5 counsellors, 4 medical, plus international and support staff.

the physical location of the centre has moved from the original space (we needed more room :) , and when we built it, they came. it has grown from 1 medical/counseling/admin room to 4 counselling rooms, 2 medical rooms, 1 triage and an office. in june, before i arrived, we had already reached our 1000th case. by august we were at ~1300 new cases. sexual violence cases represent about 300, with the other 1000 split between physical and non-physical domestic violence.

it’s been a busy 9 months for the msf team. we did some work with the emergency department, and also supported their triage system. as well, our medical team has provided training to the emergency department staff and awareness to health care workers across the city. our outreach staff have been to settlements, schools, churches and markets to talk about gender based violence, and how survivors of rape deserve treatment, and that treatment is most effective in the first three days.

nearly the best things about this project is that there is major support for this initiative and at a national level we are working with government and ngo’s to help establish the national guidelines for treatment of sexual violence. there is a real desire to provide services and as we learn the nuances of providing medical care in this context, we hope to support a model of care that can be used by the other centres across the country that should be started soon. we have an incredibly dedicated team at the clinic, and support from a lot of really cool people.

for more offical like talk about our programs in png, you can check out the activity report on msf.org which is linked here. otherwise… that is my attempt to summarise really quickly!