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.