Final Blog Entry

July 23rd, 2008 by kevinb

A special thanks to Ken Tong, and Inma Vazquez who supported my controversial blog activity about a very sensitive environment.

As the last view days of my Darfur stint approached, I became equally discouraged as I was excited to get back to Canadian life. The situation in Darfur seemed to have fallen several steps backward from when I arrived in October, especially as the rainy season was approaching. I was not expecting to leave the country with a feeling of victory or contribution – but I was not even able to draw conclusions.

I presented my debriefings and meetings in a ridiculously pragmatic manner: Providing suggestions on staffing and material ordering – and even those issues were politically charged and ethically challenged. The office in Khartoum was very busy dealing with the Abeyie Crisis, so I felt obligated to make a subtle exit- which matches with my social skills anyway.

I disembarked the Air Canada Flight in Toronto and collected the slim remains of my travel belongings… a school bag, and a few plastic grocery bags. I rode the subway back to my apartment in Toronto and started my Canadian life as if I had never left.

I am back working at St. Michael’s hospital on the front lines of nursing: working in nephrology/urology – kidneys and penises – A small but vital role in our matrix of a healthcare system. I really miss my co workers in Sudan, but the staffs on 8CS are kind and so much fun, it makes adjusting much easier. I’m also back to drinking too much expensive coffee – I could probably feed a whole community in Sudan with the money I spend on coffee. Patients complain about different things here: "my jello is the wrong colour". Sometimes I am temped to parallel a typical African healthcare problem with them – but then I think of my coffee habits and conclude I am set in my Canadian ways too.

This is my 5th attempt at making a profound final blog entry in hope to leave people in tears with motivation and inspiration – ha ha! But I’ll refer you to more skilled people for that: Currently I am reading James Orbinski’s "An Imperfect Offering". It is a good book, making my introduction to humanitarian-aid appear puny. I’ve also been reading "28: Stories of AIDS in Africa" by Stephanie Nolan – a very realistic perception of AIDS in Africa. I have plans for volunteering with an MSF touring exhibit called "A Refugee Camp in the Heart of the City" where we set up a model of a refugee camp as it would appear in a developing country and give various groups an experiential tour. In the fall I will take a nutrition course, with hopes to be off on another MSF humanitarian project in the winter of 2009.

My Favorite Sudan Moment:
When visiting Seleia weeks after the attack, we celebrated David’s (the field co-ordinator) end-of-mission with food that was available in the renewed beginnings of a basic market. Dr. Senop wrote and sang a song about being in Seleia. Adriene the logistician used a stick, string, and a tub to make a base musical instrument to accompany the song. Then Mr. A. started to play some remarkably groovy Sudanese music on this very simple device. Mr. Y. continued speaking in a conversation completely unrelated to the music but stood up and started dancing as if it were an involuntary action. Then Mrs. H and some other women from the community moved away from the group and re-approached spirited and singing as they marched and danced toward the group. I tried to immitate Mr. Y.s dance trying to prove that not all foreigners are lame. Olivier, a specialist from the Geneva office grinned wide-eyed at the action. He must have appeared arrogant because Mr. T. put his food down and fell into a crazy- rhythmic-intimidating dance toward Olivier which caused him to run away laughing. I had previously declared this burnt village one of the most miserable places on earth. But that night we were able to put politics aside, celebrate and have fun. Other community members jointed into the fun- we were no longer just aid-providers and them beneficiaries, we were all people with the same basic human needs.

Kevin Barlow

Experiential learning

May 23rd, 2008 by kevinb

Patients have asked me a few times “do you know what it feels like to be a patient?” I usually answer “no” and focused back onto my academic knowledge of health. In some instances victims of a problem are the least appropriate to empathize with the variety of patient needs. But at the same time lacking the experience can dismiss seemingly insignificant issues – I’d be an awful hospital patient.

I have just returned from a 2 night in Seleia – the first sleep over since December. Though I was very excited to return to my humanitarian home, I had to keep in mined that I was returning to a very different Seleia. We hiked into town on foot with material for a clinic, some material for cooking, and other basic requirements. Our previous living compound did not offer any living support. Broken glass, needles, and other biohazards requested vigilance with every footstep. The buildings remained, but were polluted with the same hazards of the outside. The gate to the compound was missing and the doors of the tukuls and were nonexistent. The residents who returned to Seleia were still gravitated around the military base for safety leaving the town vacant. The location and condition of the compound made it feel like a death trap.

The health center was in a similar state as the living compound, but we gave it some good points because some doors could close, and there was a gate that surrounded it. Resembling an IDP family the MSF team set up their living area on the porch of the health center. We cleaned out one room, then I.C. and Eric immediately started to see patients. David the field coordinator and the liaison officer set off to rekindle the community relationships and get an update on the security situation. Aaahhh, we are back in Seleia again but this time living, working, cooking and sleeping in the same room.

As the medical consultations commenced I set off into the community. People were still living huddled around the military base. It seemed impossible to count families because life seemed so chaotic. The community was almost all made up of women and small children. Groups of 5 to 10 women lived together with their children in temporary grass dwellings. I was surprised to see one group with chickens, goats and donkeys brought to and from Chad. I found a group of kids and I chatted with them for a little bit. They did not have any complaints, a few of them made some toys from medical material left behind from the looting. Some of the kids later came to the clinic complaining of “Wadga Botton” – belly pain. Perhaps their diet was not diverse enough, or maybe they were upset. I hope they can return to a time of their old life of going to school, playing football, living in a complete family unit and wandering around with their friends in safety.

Later I went to fetch water. I was the only man at the well; the other 10 people were woman and children. I think it was strange for them seeing me the foreigner-male pumping water. I exhausted myself caring the 10 litres back to the clinic, it’s hard to believe that the women do the same several times a day while carrying children. Actually I have to confess that some charitable local women helped with the work.

When I returned to the clinic I found a very pleasant surprise: A friendly dog looking at my team members without the usual growling and barking expected from a typical Seleia dog. David stated that is was Clemens our puppy whom we adopted before the evacuation three months ago. “Clemens?!” I could not believe it. He acted the same way, but I could not believe he survived, let a lone was able to grow into a healthy dog! I then confirmed his identity with his unique tail markings and then we played for a little bit.

At dinnertime we were out of sugar. So my Sudanese friend and I set off to look for some sugar in the chaotic settlement with no market. I know, buying food from people in their most vulnerable state is ethically questionable. But I think the food supplied from the World Food Program was one of the few safely marketable items. Was I taking food from the poor, or contributing to their economy? You decide.

I slept very well that night knowing my animal friend (Clemens) was protecting or at least to warn me of any danger. Lying on the ground, I learnt to appreciate suffering the IDP population experienced. The nights do get very cold in Sudan, there are huge bugs all over the place, and without a bed there are no boundaries for people to sleep undisturbed.

I slept next to a patient who had suffered a gun shot wound entering in the chest and exiting in the back next to the spine. He also had a broken collarbone making his sleep very interrupted. I hooked him up to an oxygen monitor to ensure he was getting enough oxygen despite his pneumothorax (sucking-chest-wound). Mind up I gave him enough pain control to affect his breathing in hope he would get some sleep so I could get some sleep. As I laid awake listening for snakes I was debating calling Clemens over for protection – but that would threaten my clean patient care – /sleep/cooking/office environment; so I left Clemens in charge of possible bandit attacks. Then I heard some hissing…was it a snake? No, it sounded more like my brother’s whistle nose that earned him his own room. But it wasn’t the patient’s nose it was air being exchanged through his lung cavity and the environment! He was breathing through his wound- but it was nothing a 3-sided dressing couldn’t fix.

The patient was sent to El Genena with a military convoy and we headed back by helicopter. The “camping trip” was fun but exhausting, but I don’t think I could have taken another day in the insecure environment with scanty food and missing infrastructure. I image the Seleia population wonders what the next day holds every night they sleep – It is hard to believe that my 2 night pretend taste of IDP life is an eternal reality for many people… and even then I was lucky when it came to resources and status.

Poetic Justice

April 30th, 2008 by kevinb

What’s in the wadi?

I think the dust is settling a little bit here in Darfur for the time being. MSF is able to access the displaced populations and attacked communities to determine a strategic way to address the needs of the population. Almost everyday I go to and from work on a helicopter… it beats the office any day. It is very difficult to assess a community in 4-5 hours — but we are getting better at it with every Rapid Assessment.

My role is to systematically visit families and assess their demographics, living structure, and general health condition using rapid assessment techniques. The problem is my rapid assessments are neither rapid nor quick enough. As a nurse I am in the habit of focusing on holism rather then numerical data. Plus, I am always concerned that I am going to miss something by being too direct. A few days ago I was assessing an internally displaced persons (IDP) community and I came across a family who were making Alcohol! I think one of the grandmothers was offering me some but my translator would not participate in the situation and kept me focused on health status — maybe she was teaching me how to make it.

Being my translator is a difficult job, I ask too many abstract questions, I try to speak Arabic, and sometimes I get into trouble. One of the questions on the questionnaire involves the availability and use of a latrine. My translator initially answered for the IDP family, instead of asking. When I insisted that he ask, I learnt that all the families were using the riverbed (wadi) as a latrine that is the same place where they get their drinking water. Typically health education should be participatory, community driven, and non-punitive. Health teaching programs are also implemented after the assessment, but in this case I could not wait. I told every family: “Don’t use the wadi as a latrine or you’ll end up drinking each others pooh!” — That phrase had to be translated by someone through my walky-talky radio. The kids thought it was hilarious hearing such vulgar language come out of the small speaker in my hand. Was I condescending? Could I have treated people the way I would have liked to be treated given the situation? Perhaps I did not know what it was like being an IDP without a place to go to the toilet.

It wasn’t until I arrived at the next house that I learnt my lesson. During the interview my stomach started to cramp, I was notably in distress. Sitting with the 10-person family, with a crowd of on-lookers I was starting to make a scene. I confided in my translator telling him that I needed to use a latrine. He brought me to a small exposed ditch assuming I had to have a “short-call”. Dancing on the spot and moaning I told him I ate poorly prepared food from the market – he then pointed me in the direction of the wadi. I shook my head in disagreement but it was the only place where I could attain some degree of privacy. Looking at the tears in my eyes my translator instructed me to run! “hurry!”

The on-looking crowd: the military, children, cattle etc. watched me off in the distance being the ultimate hypocrite as I received my dose of poetic justices. I returned to the family I was previously interviewing – embarrassment is not an exclusion criteria. The very next question was: “Do you use a latrine?”

There are plenty of factors that cause a population to behave in a way that is contrary to their usual health habits. There is nothing more discouraging then being relocated from a “prosperous” community to a dusty desert strip of land – the security situation can make it a prison. With family members missing or dead, building such things as latrines may be too far on the list of survival activities. During this visit, I came across some situations where people’s most basic survival activities could not be performed because of grief alone. In three particular cases the head of the household could not answer the questions of the rapid assessment – they were too consumed with the tragic events of the last week. They would describe the events with their faces swamped with tears. I think I was the first person removed from the situation whom they were able to tell their stories to, and had the time to listen. Their children and other family members would stand around and watch the explosion of grief and frustration. The systematic rapid health assessment did not have an area where I could document this crucial requirement – mental wellness. To perform the activities of daily living when life seems impossible, mental wellness is essential.

A dodgy Internet connection allowed me to catch a glimpse of psychiatrist Steve’s blog about MSF mental health treatment programs on the Sudan-Chad boarder. Please take advantage of your technology and read it thoroughly since I only got a minute or two of viewing.

Seleia’s Ashes

April 1st, 2008 by kevinb

The helicopter approached the burnt and abandoned town of Seleia. The MSF team exited the fuselage on the rocky pad and watched the helicopter take off. It was a strange feeling landing in this community without curious greeters, no vehicle to load equipment into, no animals, no local colleagues… just the wind as the sound of the helicopter fading away. I think it was especially strange for those of us who had spent a significant amount of time in the community. Three months ago when we were evacuated, I expected to return to a more stable community still full of life, happiness, “industry” and fun. In stead we carried our medical equipment through evidence of dwellings, and yards looted and burnt to the ground.

As we approached the town center we found two local women who had returned from being refugees in Chad. Each of them had a baby on their back. The MSF medical assistant spoke to them and learnt that everyone was staying around the military base for safety. On the way to the confined Seleia camp I noticed some holes in the ashes where people likely retrieved the food which they buried- for most this was not the first time they have been attacked and forced to leave everything valuable behind.

The returnee sample of Seleia resettled with only woven grass walls for shelter, a few items for cooking and something to collecting water- some of which I recognized as our medical equipment. I’m glad some medical items ended up in worthy hands. The small grass walls were huddled together for protection, exposed to the open desert, nestled next to the military base. Knowing what this population had been through, I was too impressed with their resiliency and innovation to pity them. I don’t think anyone from a western lifestyle can comprehend what it is like to start again in this way.

Approaching the living area people seemed too busy or perhaps tired to yell out the usual comments that every foreigner to Sudan hears. The population was mostly women and small children; apparently it was too unsafe for many men to return. As we started to settle a clinic area around a tree people approached, then crowded around. It was so great to see some familiar faces again. A few of our staff had returned: One of our guards, the woman who used to clean the operating theater, her infant who would ride on her back while she cleaning, and our translator. As expected they were not themselves. There was not enough time, and too much going on to catch up with them as we set up a table under a tree for medical consultations. Dr. Eric typically works in the emergency department of a teaching hospital in Iowa – this old school desk under a tree in the desert could not have been a bigger contrast. I left Issag and Eric to see the patients and I made my way back into town to inspect the medical facility and the MSF living area.

The only items left in the inpatient area were 2 intravenous poles with the solution bags, and tubing. No beds, no tables, and no one really knows what happened to the patients. The tent part of the operating theatre was missing- medical equipment and waste was spread all over the place- there was no point in collecting an inventory. I could not find a single item to contribute the makeshift clinic in progress. Items I didn’t know were valuable were taken such as: light sockets, hinges, and doors, screening… everything. Jean the logistician was able to find a biohazard container that we were able to use. Jean stayed in the compound and burnt all the medical records and hazards, then later joined me at the clinic set up.

Beside the consultation table I sat on a plastic mat, cleansed and dressed some of the physical wounds of the population. As time went on people acted out their story to me and explained what happened in their local dialect. I was able to pick up a few grim details of what they told me, I wish I had a translator. Though there were some serious wounds, I think a lot of people just wanted recognition, to be listened to, and maybe reassured. One elderly lady was listening in as I was trying to teach the patients about wound care such as what to do with the dressing material, cleaning, etc. Later she declared that it would be her role to teaching people (in a way they could actually understand) how to care for their wounds so that I could continue with the dressings. This woman also went through the crowd and brought a few people to me who needed attention.

I wanted to stay, I felt obligated to become part of this welcoming community again but it was too unsafe at night. The afternoon was coming to an end and we soon had to close our clinic table to return to the landing area. I went through the crowd to determine if there was anyone who was too ill to wait for our next visit. I thought I found everyone such as the women laying on the ground, the baby with the fever, but other sick people still presented themselves to the clinic table, as we had to leave. I hope we were able to attend to all the serious needs.

I watched the burnt town of ashes get smaller out of the helicopter window. Strangely, I felt a sense of reassurance that people were still functioning, being progressive, and doing everything they could to regain themselves. Again, people like me should not mistake the optimism and resiliency of a community with the reality of their troubled state.

I used to be a little baffled by the psychosocial interventions MSF would initiate. I thought that psychological interventions were more of a developmental, rehabilitation project. It was comforting to read the blog of the Canadian psychiatrist Steve who is working on the Sudanese/Chad boarder (sorry I don’t have the specifics, my internet access is few and far between). My Seleia friends who are still refugees need all the motivation and clarity they can get- it is easy to loose faith in outside parties. The more displaced populations I visit, and burnt villages I assess, it becomes clear that it is not so much the NGOs that get a community functioning again- it is more the human spirit.

Talking and tea

March 4th, 2008 by kevinb

Yesterday one of the midwives who worked in Seleia appeared at the office in El Genena. I sat with her and drank tea. It was difficult to have a sensitive conversation with her through translation considering the circumstances. Also, she did not want to talk very much. She briefly explained her story of suddenly becoming an IDP (an “IDP” or “internally displaced person” is someone who has had to leave their home, but is still within their country of origin. In comparison, a “refugee” is a displaced person who has crossed a political/national border into another country). Her story confirmed some of the rumors I have heard: Having to travel for days at a time on foot, having to retrieve buried food and the danger she faced in Seleia. She also spoke of the other staff members coming to El Genena. I hope I get a chance to see my co-workers again – we can get together, buy a sheep, eat it, and try to forget about misery for a little while.

Putting faces to the people

February 26th, 2008 by kevinb

After a lot of effort our Sudanese MSF co worker was returned to us. He is safe and he appears to be functional. The staffs here were able to sleep soundly for the first time since he was missing. During the last several days my MSF – El Genena co-workers and I tried to respect the balance of being functional and being sensitive to the atrocities that have occurred in the communities north of us. Being angry, grieving, or attached to the situation is not always useful when planning an effective approach. As a nurse, I am able to begin every hospital shift as new, “forgetting” all the patients who have died in shifts past. In Sudan, people have taken the same approach to communities burnt and people killed by the hundreds. If people in Sudan functioned any differently there may be a vigil every day of the year- the memorials would take up more space then any piece of infrastructure. Unfortunately, what I have witnessed in the last week is just another awful memory for people in Darfur; life goes on.

In the case of Seleia, it is more then just another burnt community in the North. Although all my friends and coworkers arrived safely in Chad, they do not have a single item of material. They and their families exhausted themselves by walking through the night and day without water or food to seek refuge in Chad- where they really are not welcome at all. We are able to have contact with them by satellite phone and communication provided by MSF-CH operating in Chad. They received their paycheck there, and will start to build their lives with such fundamental needs as attaining water, warmth and food.

Though my empathy goes out to my co workers and their children, there are so many other victims who are worse off. The UN / AMIS hybrid force (UNAMID) have been doing assessments in the Northern communities. Their team consisted of protection officers, human rights officers, child protection staff and a few other sectors. They reported the presents of elderly living in the burnt communities who were unable to seek refugee in the surrounding areas. Some women made their way back to help support their parents or grandparents. For these people their burnt houses are the least of their worries. Apparently, they hide in the outer area of the town to avoid the sustained violence and harassment of their attackers. Everyday there is shooting. At night they may be able to access their food which they buried underground before they escaped.

On February 14, 2008 the UN team assessed Seleia. I went to their debriefing and heard that Seleia had sustained the worst damage and attack than any other community in the northern corridor of West Darfur during the last few months. The community of over 15,000 was reduced to a small group with almost half of the village burnt. During the assessment the attackers continued to loot and harass the people who were still in the area. To my surprise, the Women’s Group in Seleia was still functioning and networking. Once again, women in Seleia have demonstrated their secrete strength which is incomprehensible to men and others in developed countries. The assessment team was able to leave food for about 500 people in hope to get access to the community again shortly. The 30 children left in the community received Plumpy Nut for therapeutic feeding. Although I abided to a functional-pragmatic philosophy in analyzing the situation I still get a knot in my stomach putting faces to the people living in misery.

One face that comes to mind is Hadja. She is the grandmother of Abu Romand, the health educator, and is the next-door neighbour to the MSF compound in Seleia. I do not know how old Hadja is, but she looks well over 80. She hobbles around with a stick, collecting firewood and herding all her grand children. Everyday she stands next to her donkey, does a few movements beyond the nature of physics, and then lands on the donkey to ride away. When she sees me laughing at the surprise gymnast move- she laughs too… a hardy old lady laugh. She is someone who has tonnes of life left in her – I hope people are making her as comfortable as she has made others feel.

As for the medical approach to the situation, it is very complicated. In Canada free medical care is a way of life. In Sudan, it may be reason enough to move back into a horrifically threatening environment. In addition, MSF may also provide a false sense of security by our presences alone if we were to return to Seleia soon. There are usually few clear answers when it comes to humanitarian aid interventions. In this case, the only clear fact is that both the population and the community structure are difficult to access.

A Community to access

February 20th, 2008 by kevinb

Two months ago, in mid-December, I had to leave Seleia because of bomb attacks. Since the evacuation the MSF team has been monitoring the situation to see if it is safe for return. My original impression was that the attacks will finish in the course of a few days. However, the northern corridor of west Darfur is inaccessible. In between then and today there have been many other atrocities in the area: Civilians killed, villages burnt, and other insults from various attackers.

Yesterday Seleia suffered another bomb attack this time accompanied by uncontrolled militias. Apparently families crowded in the MSF compound in hope that the attackers would respect humanitarian law and space. The compound was looted, the driver was high jacked with the car, and a Sudanese employee at the ICRC in Seleia was shot dead. The entire town of Seleia (15 000 people) left for Chad to start a life as internally displaced persons again. We had since lost radio contact with our staff, but the latest news was that they had to leave for their safety. At current time access to the area is becoming more possible but not because of stability, but because of increased humanitarian need. Sadly I don’t think there will be a community to access.

The Sea of Sticks and Plastic

February 14th, 2008 by kevinb

I have developed a bad habit of downplaying shocking situations. We all do it- think of the homeless people you step over in your home cities. Remember when murder or gang related crime was a big enough deal to make headlines? Healthcare professionals also become desensitized to illness, suffering and neglect. But every once in a while, something triggers reminders that some situations should not be acceptable.

In the town of Seleia, the internally displaced people (IDP) are set in a “rural” manner – the families appear to have the space, some resources, and usually a few relatives who are happy to support them. In El Genena, the IDP population has a much more urban feeling: Less land, more formalized assistance, and politics. Regardless of my anticipated pity, I rather enjoyed visiting the camps around El Genena.

The first camp I visited was in an old school compound. Small dwellings resembling the forts I would build when I was a small boy. These huts were lined side-by-side, it was difficult to tell where one living space ended and the other began. It seemed impossible to guess how many people lived in each area… It was just a sea of sticks, plastic, grass and other modest building material. Hidden in between some areas were livestock such as cows, horses, donkeys, goats and dogs. Then I got a little lost in the maze, so I tried to look like I had a plan of direction. There were a group of about 10 children following me, making it more and more difficult for me to fade into the environment – I was embarrassed. One little boy held my hand and told me a very exciting story in Arabic (I have no idea what he said, but he spoke with a lot of expression). The adults would look at my scenario and laugh. With every dead end I encountered, I was greeted with a family who would say: “Fautall” (Sit and be welcome). The community I had originally thought of having nothing was hosting me as a guest- offering me tea, beans and bread. The corky yet innovative layout and material, reminded me of the children’s summer camps I worked for. Perhaps stripping away the materialism of life gives people a sense of belonging and “self”. There were programs for elders, schools for children and even a market crowed into the camp with the 700 families. It was little city in a city.

A few MSF employees live in the camps surrounding El Genena. One of the guards is fluent in English. He arrives to work in a slick suit, full of energy and enthusiasm. It is difficult to believe that he lives in a hut made of sticks and grass. I think I mentioned him in my last entry his IDP story. It is complicated for people in the western world to understand the resiliency of people who still function after traveling for days as their community members drop dead in transit. It is even more surprising that his story is not unique, but is one variation of the many people who have been displaced. IDP camps are not as cheerful as they appear. Perhaps people like me prematurely dismiss situations as being miserable, just because people appear to be making the best of a bad situation.

The day after my introduction to the El Genena IDP camps, MSF received information that there had been a fire in the very camp I visited. The fire killed 2 children and one adult. Six people were sent to the hospital injured, and 150 families who had “nothing”, now had less. We spent the early morning loading up the MSF truck with non-food items (NFI) for the residents. MSF hired some extra help for the intervention. One of the workers was also one of residents at the camp, he was crying but still worked just as hard.

The site at the camp was sick. Women stood with their children on their mat size lot with tears in their eyes staring in shock. Everything was flattened and reduced to ashes; Cattle were charred solid like iron sculptures. People were digging through the ashes of their food rations attempting to get a meal. Before the fire, people were already at the end of their line when it comes to attaining resources- the fire could not have chosen a more vulnerable group. Perhaps only the members of the camp can appreciate the difficulty in collecting the items they require to survive. To a westerner these belongings have little significance and would be garbage waiting beside the Nissan to be delivered to the curbside for disposal. It was apparent that the grief went far beyond the lost of material items.

MSF networked with a few other organizations in a meeting in the center of the disaster. We stood in the center of the field of ashes and discussed planning, roles, and resources. We were all distracted by the despair around us. MSF was proud to report at the meeting that we already had a truck packed and ready for NFI distribution. MSF’s independence can be quite effective when it comes to avoiding politics and just focusing on the issue at hand.

Later in the afternoon we distributed: Mats, blankets, water cans, plastic sheeting, soap, cooking material, and BP5 nutritional supplement. During the distribution some community members walked in with trays of food for people in side the walls of the camp. The El Genena officials had a dedicated presence to this population – they were concerned about food and shelter were delivered in a timely manner. The distribution continued through the afternoon: a man called the families one by one, yelling though a megaphone labeled food along the side. Some families received the bulky rations with lots of carrying hands, but some women had no one but toddlers and/or newborns to help them out. I helped a few women carry the material to the lot of ashes where they had been living. Though grateful, there was not much interaction.

As the distribution finished, I commented on the worker who had been crying at the beginning of the day: “he looks like he’s feeling better”. It was then; one of my co-workers told me that it was his 2 children who had died in the fire. Putting a face to the story reminded me that the few deaths reported were too many.

The day ended a little more optimistic. When the plastic fence was put away the children shifted around the empty boxes. It took one crafty little boy to pull at a box, for a swarm of little ones to start grabbing and running. Some adults tried to gain some control over the situation but that just started quicker movements and giggling. When the dust settled there were some disappointed kids left with nothing but the pile of paper product monographs. My already exhausted heart went out to them… so I lead them in a paper air plain making seminar as my coworkers cleaned up. Yes, I got out of work and had fun. The IDP kids were approaching me from all directions with paper asking advice on their paper air plane technique. I was a camp counselor of a different kind. The kids I usually work with in Canada consider themselves poor if they do not have an up to date entertainment/video game system, these kids considered themselves rich for getting 2 cardboard boxes.

Since my first visit to the IDP camps, I have made semi regular visits to the camps around El Genena. It is difficult to leave the camps without seeing, hearing or being involved in a situation that begs the answers for lists of questions.

More Information : 13 February 2008 – Darfur : Aerial bombings and attacks lead thousands of civilians to flee to Chad

It’s Christmas in Darfur!

January 4th, 2008 by kevinb

The wind blows the winter dust in a desert storm.
Through the dusty blizzard people are bundled in their best garments.
Covered from head to toe in white robes and vivid dresses.
The kids pull their livestock as they usually do,
But this time excited, for the feast and days of celebrations to come.
Everyone seems to be working away preparing and sharing.
It is a time to forget about differences, and appreciate similarities.
The earth shakes with “excitement” (and a little artillery).
Slaughter the fattened cow! Put on your white jalabia!
It’s Christmas in Darfur… Actually Eid.
Eid S’Eid and Peace on earth… Well, not quite.

The Muslim holiday Season is Eid, which celebrates the end of Ramadan- the months of fasting and sacrifice. Sadly, many families will have fasting and sacrifice before the next Ramadan because of the challenges faced in Sudan. One challenge takes place in a little community near Habilla, where MSF has been operating a hospital. For this community, their village was burnt to the ground after a fire used for cooking got out of control. The fire left 40 families without a village for Eid celebrations on December 24th.

Though Santa Clause does not celebrate Eid, Santa-Serge does. Serge is an MSF field co coordinator, logicistician, and now Santa. He and his team in Habilla loaded up the red and white MSF semi-rig and bumbled around the desert land delivering emergency supplies to all the boys and girls. Some of the displaced families were welcomed into the homes of the Habilla residents- Santa-Serge delivered supplies to them as well. The image of the this humanitarian sled grinding through the dried riverbeds providing basic living supplies to people in need is the true holiday spirit.

Eid is also celebrated by preparing huge amounts of food: For family, friends, and the poor. People seemed to have established a sense of normalcy though living in insecurity and chaos. I have a strong appreciation for the Sudanese culture of people who can step out of a situation seen as pitiful by the rest of the world, and celebrate who they really are. Laughing, sharing stories and news with family, then sitting and eating very tasty food.

I spent Eid with a Sudanese co-worker and friend named Tiger. This Eid celebration resembled how I am used to spending my holidays: People together, good food, and tones of kids running around, climbing on what ever they could find. These kids played games- seeing them run around with plastic Kalashnikovs acting out life in Darfur was cute…I know, in Canada such behavior would be unacceptable and sad. I guess it’s debatable what should be considered normalcy vs. maladaptive… I’ll let someone more academic figure that one out.

I was not able spend Christmas in Seleia because of security reasons. Since being evacuated a few weeks ago, the only interaction I have had with my Seleia friends is translated and transmiteed through a fuzzy hi-frequency radio. Though leaving Seleia is the only acceptable option, I feel I have abandoned my friends in their time of most need. Apparently they are doing okay. I hope to return soon. I left a puppy named Clemens behind who I recruited to kill snakes and rodents. I was not able to leave instructions on taking care of him: It felt wrong leaving instructions for care of a dog taking into consideration the resources of food, and security situation for humans. I am now down to 2 pairs of underwear from another rushed packing job. Problems in Darfur are all relative.

Adris, One of the MSF guards here in El Genena speaks excellent English. He told me about being displaced from his community three years ago. It took his community 3 days to get to El Genena- 75 people died. Again, it’s all relative.

The power of encouragement

December 14th, 2007 by kevinb

When working in an environment that requires humanitarian aid, it is easy to get cynical and judgmental. Sometimes you can convince yourself that no one knows enough, no one works hard enough, and nobody cares. But in these environments acts of kindness and strength are even more exemplified. These acts often involve people putting their political views, pride, and self needs aside.

A few weeks ago the other nurse (Halima) introduced me to a little 3 year old boy visiting the clinic for nutritional follow-up. I’ll give him the fake name of Howie for the sake of the story. This little guy was jolly and chubby as can be. I pressed on his skin to see if he had any signs of protein deficiency, but he seems as healthy and playful. Halima, told me that Howie came the hospital a month ago looking like a skeleton with every bone visible. I didn’t believe her.

A week later I was called into the nutrition office to find two children wasted away. Their mothers would not make eye contact with anyone and appeared full of shame as they tried to feed their sickly children breast milk. The one girl, perhaps a year old, looked like a shriveled up old man, and the 2 year old boy was hypothermic, not having enough fat to stay warm even though it was 28 degree Celsius. Typically there are groups of relatives supping those in the hospital by camping out side the ward. These two women and their babies appeared to have no one to share their situation – again I think it was shame. Then I saw Howie accompanied with his mother in the background, both of them were full of hope and support.

I learned that Howie lives in a village, which is isolated from medical care and very difficult to enter or travel from because of security issues. People are reluctant to access medical care in fear that they will not be able to afford it, be threatened or be unable to support their other children and family. Traveling to Seliea is not always worth the risk – even to save the life of children. Howie and his mother identified these two mothers’ malnourished children. Having “walked the walk” they convinced the troubled mothers that the trip to Seliea is worth a try. I was moved that Howie and his mother came to Seliea for no other reason to support their little malnourished friends.

So the therapeutic feeding began, with antibiotic treatment, vitamins, treatment for stomach worms, and re feeding with F75 therapeutic milk. Every morning the children were weighted, from a scale hanging from the sealing. The mothers would seem to hide from the staff crowed around to see the weight of their children. It is frustrating re-feeding a malnourished child… they do not have an appetite, and are always miserable. I can only image the guilt these parents felt for the status of their children – but malnourishment is not always just the lack of food, there are usually underlying pathologies such as diarrhea and infection.

Atom, one of the local staff makes the milk for babies three times a day. When he arrives at the door of the ward, Howie, the super toddler greets him. Howie would take each bottle of F75 and deliver it to his malnourished friends one by one. He would then go between each baby to make sure with great intensity that they were drinking it. As the week finished the two patients advanced to F100 and BP100 bisques. Howie would hand feed his little friends and of course ate some himself. Strangely he seemed to have the patience and faith in this situation when most others could not. When I would visit the ward I would get a serious handshake from Howie – I think he was trying to show me the good work he was doing.

In Darfur, people are expected to arrive the hospital with their own food, bedding, and money for material that the hospital does not have. MSF provides free healthcare, but the need for more support became evident. These parents did not bring anything with them but perhaps desperation. Because the malnourished children were still breast feed, we started to give the parents some BP100 bisques to ensure they maintaining nourishment. We also gave them some food rations to ensure the breast milk had enough protein in it.

Three weeks later, these two babies were completely different. They were fat, full of life, and playful – just like Howie. Howie and his mother, were packing up to head home. Though there was much more required to support the nutrition status of these patients, we all knew that these once severely malnourish children were in the clear.

Now a days the well nourished baby friends come for check up appoints. Their mothers present themselves as brave women with laughing and interaction with other mothers. When there is a poor healthcare system, it is difficult to encourage health-seeking behavior. All the health promotion and education sessions occurring have been put to shame by the magic that Howie the super toddler worked. Yet it is sad to think about the other possible babies out there whom are malnourished who have not had the lifesaving motivation and spirit of a heroic toddler.