Dear Darfur…

My day started with the sight of a neonate’s head stuck inside his mother. The functionality of a head first delivery is that the head dilates the way for the shoulders, hips and everything else that comes out. If it were not for the midwife (Caroline) and the MD (Mike), the newborn would have certainly died. After a few minutes of watching the struggle to get the head out, I was expecting a sad out come. With a few nifty maneuvers the baby was delivered. To my surprise the newborn was breathing, breathing infrequently, but breathing.

I started the generator, then the oxygen concentrator, and found the manual suction. It was pretty surreal to resuscitate a newborn in a tent. With in 20 minutes the baby was breathing normally and started to show signs of consciousness. Soon after he opened his eyes, after jumping feet first into the world

This baby was enormous, 4 kg plus, which would explain part of the difficult delivery. Though healthy looking, large newborns can be a symptom of pregnancy induced diabetes Mellitus – one of many reasons to support prenatal programs. Pregnancy induced diabetes one of many issues that can be detected and often controlled by lifestyle adjustment or medication.

Later the newborn and his mother were admitted into the impatient ward. Caroline the midwife carried the newborn with a huge smile on her face. The mother picked up three rolled up mats, a jerry-can of oil and marched her self 100 metres to the IPD, full of energy and stamina. This child was the ninth delivery from this rather young looking mother. Women in the Sudan never seem to stop working.

Once settled, the mother asked everyone on the 5-bed ward his or her name. She asked me last through translation of a Sudanese nurse named Halima. She decided to name her ninth child “Kevin”. I was very surprised. I did not know what to make of this honor but smelled a bit of trouble. Halima explained that it was a tradition for the person to buy a gift if the child was named after them – typically a sheep. A sheep is 100 pounds, which I could easily afford, and willing to purchase. I was concerned that naming children “Kevin” would be a phenomenon, creating a new industry at the cost of my foreign name and presence. So I took the opportunity to explain to the mother that it was Dr. Mike who actually delivered the baby… I just set up the equipment. After a discussion with her mother she decided that “Kevin” sounds better. So “Kevin” it was.

The following day, I asked the baby “Is-much-minook?” (What is your name?). The mother perhaps forgetting my name, asked me to name the child. I decided on a nice Sudanese name: “Seif” after my translator. Seif shaking his head at the declaration stated that should still be my responsibility to purchase the sheep. I have left a message with Caroline to ask: “is-much-minook” at the follow-up appointment to see if Seif and I are out of trouble.

Post Delivery Day 3: The baby’s name is still Seif, and I will purchase the sheep.

IN THE MORNING.

At 5 am the day begins with dogs barking, roosters crowing, pigeons, goats, sheep, and donkeys all stating their opinions on the situation in Darfur. The shower is always too cold in the morning, so I wait till after work giving the sun time to warm the show tank.

Then Jabbinna (coffee), and more jabbinna. The coffee here tastes great but does not have nearly enough caffeine as I’m used to. Apparently in some parts of Africa coffee is a tradition as tea is with Japan. Every culture should have coffee as a part if its cultural fabric… just for me.

Sometimes chickens wander into the eating area trying to get my bread. I give them some when no one is looking. David (the field coordinator) and Michael (the doctor) found a snake in the eating area last week.
The snake finding made it to the weekly security report. Although I was not in on this snake exile, I have walk with caution ever since. My tukul has a hole in it just perfect for the large head of a venomous snake to poke through. Will snakes chew through a bug net?

A WALK THROUGH TOWN.

After work I have a routine to take a walk through the community. My outsider ways creates quite the ruckus. Did any of you spend your childhood car travels trying to get truck drivers to honk their horn by pulling an imaginary horn with your arm? It can be so amusing what one’s manipulation can cause people to do. The kids in Seliea play a similar game: Any obvious outsider is called “howajy”. To make a howajy talk is apparently hilarious for kids here. Every where I walk there is a little voice poking through the fence: Hey howajy!!! howajy!!!. howajy!!!

Me: Salam elecome/hello

kids: ahhh hahahaha.ahahah. Howajy!

They likely make bets on who can get the closest or shake my hand. One of the kids convince me to eat a disgusting seed or nut. I bet she got some sort of howajy-manipulation award. If howajy is a derogatory term I am truly sorry for others who have been victimized by howajy tricks.

THE HORSE.

Friday is my only day off. David suggested that we go horse back riding. I agreed if I was still up for it at the end of the day. So Abdulla set off to get the horses at 4pm. As he was leaving I requested a donkey since I have never interacted with a horse. Abdulla said he would be ashamed to ride with me on a donkey… it is not an animal that represents me. So the horses arrived with their owners who were very proud to allow us to ride them. I watch David and Abdulla “mount” their horses and I did similar. My feet
would not fit in the peddles so I kicked off my shoes. As soon as I started to look for my rope-thing the horse started to walk away. My dog sled commands were not working with this horse, nor the few phrases from western movies I knew. Then David’s horse started running… then mine started to race his at full speed! All the town saw a howagy charging at full speed on a horse yelling the most profane language. Under a thorny
tree… “howagy, howagy howagy,” through the market…. “howagy!”, shit, howagy, f-….. then out to the “not so safe” edge of town. Luckily this randy animal found himself a female horse to flirt with and settled down a bit. I put my feet in the foot peddles and he started to wander toward David and Abdulla’s horses where I received some instructions and requested a donkey again.

I ended up enjoying my horse. Working in Seleia challenges my confidence, but horses require someone who is sure of them self. I can see where ride is therapeutic. I traveled through an IDP (internally displaced person) camp which went further then eye could see, then relaxed at the house of one of my co worker’s. We ate, danced, had tea, and then it was time to return the horses. The horses must have known that their fun with howagy was over because they started running out of control again. Through a herd of goats!, Leaping over stumps, to the hospital, passed my tukul and out to the edge of town… thank goodness for another female horse. The owner of the horse found me having a long conversation with the horse and walked me back.

With my adrenaline still pumping I will willing to pay him any amount for bringing me back safely. But he kindly told me through Abdulla’s translation that he did not want any money, but would appreciate if we drop by with some food for the horse. I was very moved, there are some very good people here in Darfur whom you may not have seen on the news.

I slept well that night, having wild dreams of wild horses. Then I woke up the following day with a very sore ass.

After about 3 weeks of traveling with delays at every possible stop I have arrived in my new home for the next 6 months… Seleia! It is a beautiful clean country town with not too much in, and not too much out.

Approaching the town by helicopter I saw herds of sheep, goats and cows being kept by their herds on horse or donkey. A helicopter passing is big news in Seleia… this time good news. It is rare to see a vehicle, most people travel by horse, donkey or simply by foot.

I live in compound with several Tukuls (mud huts). I love my Tukul, it has a grass roof that makes up most of the structure except for the mud brick wall. I have to crawl into it since the door is only as high as my waist. I have this tukul all to myself, no animal friends this time.

My co workers are very fun. A large gazebo is the dinning room, office, meeting room etc. The compound is powered by generator for short periods of the day… the rest of the time I am without electricity. There are no phones, no TV, no internet. I am only able to access email sent to an address I share with everyone. In fact I am writing this blog via satellite during my beloved generator hours!

Life is very simple here. I was only allowed to travel with 15 kg of luggage which included some field equipment. So my clothes last for 3 days before I need to wash them.

The hospital/clinic is right next to the compound. It is managed by the Sudanese ministry of health. It consists of 4 buildings: a ward, outpatient clinic, a nutritional office, and a latrine. It is very tiny at the edge of town. The ward is two small rooms with six beds in each. One room for women and children, and the other for men. It is the role of MSF to support this hospital since referrals are no longer possible and because of the number of internally displaced people (IDP) camps in the area. MSF also has an operating room right in the compound (we call it an operating theater here, and it is very theatrical). This “theater” is also in a brick building with the examining area in a tent. I do most procedures in the tent since they don’t require sterility.

So far no real surgery, just a few sutures, cast application, and a few other sick situations. Working with malnourished children is very new and complex to me. In this situation it is not always because of food shortage, but the lack of primary health care to treat pathology. Here breast feeding is the only way. But if the mother get pregnant while breast feeding… both children become at risk. I saw a women bring a herd of cattle back into town while carrying two children on a donkey, and breast feeding one. It is my impression that she may not have enough calories to breastfeed 2 children hurt goats and complete all the other responsibilities a women must do. Other children get worms in their gut who seem to eat more food then they do. Worms cause cause diarrhea and a calorie nutrient absorption issue. Even non GI issues such as pneumonia will burn up too many calories to sustain. It really is an issue that is not as simple as food shortage.

But right now someone needs the computer and the generator needs to go off. I’ll write again soon.

My my, finding a computer and email, and time is next to
impossible… sorry.  I have been in El Geneina (big city in Darfur)
for well over a week.  The only way I am able to travel is with the
world food program.  My flight has been delayed for over a week because
of Eid (a festive holiday) and various other logicistical
difficulties.  So I have been keeping people at the local hospital
company.  In sumary I am safe, comfortable, and keeping myself busy. 
Surprisingly there are somethings about the hospital I like. It is in a
huge compound, like a court yard.  Famillies of sick people live in the
court yard when their sick family members are admitted and support them
with food, prayer, blood, and adovacy.  Some of the food wonders around
the yard… a true circle of life.  Each ward is a different little
house in the court yard, perhaps about ten of them.  Like St. Mikes
hosp. there is plenty of movement and smells.  The nurses and doctors
are very kind but do not have time to do even the most necessary things
like finding blood donors etc. I would have given mine, but I should
safe it for my real job in Seliea.  Because of the lack of diagnostic
tests, their assessment skills are quite impressive.  In regards to
developing this hospital I would not know where to begin.

As for El geniena I feel like I am back in time.  Every thing is the
same colour- brown… my favourite- really!  Cammels, donkies, goats,
and hourses all over the place…  not much seems to leave or come
in… amazing how one can live off the land in the desert.  

I am very tired at the end of the day, and sleep very well.  I have
several lizards and a cute little hedge hog that live with me in my
hut.  The cook Uma teaches me an Arabic greeting Everyday.  We laugh at my pondering of very simple phrases.  An Arabic
greeting is a long processes…  I spend half my morning saying hello. 
Similar to the hospital all rooms are a different building.  It reminds
me of working qt camp Trillium.  My co workers are amazing but are
anxious to get me started with my real job in the town of Seliea.

I wish I could say more.  This french key board, weak internet, and
limited comp time mqkes it difficult.    I will write something more
meaningful later, I promise.  I do not want to comment on poverty yet,
I do not think el geniena needs pitty, they just need your support. 
MSF would never beable to work without the leadership, support, wisdom,
and knowlege of the local people.   The problems here are too
complicated for any one group to be sufficent at keeping the basics
needs of life intact.   If your learn nothing else from my flacky
blog… please remind yourself that people in developing countries can
teach more then they can recieve.  Poverty is not about the lack of
resources or lack of knowlege of those who suffer…   So what is it
about?  Tell me.

Kevin

I left Geneva at 0430 hrs. I was surprised to meet up with other MSF folk at the airport- Milena, Serge and Maia. They are wonderful people, some of whom had been to Sudan before and are back for another dose. I’m not sure if the details I heard from them are reassuring or concerning but their presents was certainly comforting. Like many other developing countries the Sudan is a wonderland of NGO (non-government organizations). I am greatful and proud to be working with MSF.

At first I thought I was just feeling the exhaust from the jet- but it was indeed one of the cooler temperatures I will being feeling for the next 7 months of 40 degree celcius (over 100 F). My flease jack will not be necessary.

The people of Khartoum are friendly and calm. I guess any intense emotion or movement will make the heat even more difficult. The country (or the capital anyway) has a surprising about of imported material in my opinion. Walls are made of dry wall, air conditioners are sticking out of a few windows, professional looking hydrolines, and coffee!!! thank goodness. I was expecting a more decilate environment but to my surprise there are tropical trees, and some nice gardens. I ate a delicious lemon this am. straight from the tree; my craving must have been indicative of my vitamin C deficiency. I was very timid in my lemon mission… How common are snakes in the tree and the grass. I am more senstive to the heat based on Al Gores award… regardless of the accurance of his inconvient truths, global warming is a political and a peace issue. Movement of people are often based on resources due to climate change. You may have to verify my points for me, because this internet is too slow.

I’m typing from a tiny internet cafe, very slow internet, and the stickiest key board ever. By the time I finish the sentense I forget what I was writing about.

I spoke to a few administrators from the MSF Khartoum office to get the vibe of the project I will be working on. I am more excited then ever to get started. I wish I could explain the political and security information in this blog but I need permission, plus thats not why I’m writing this blog. In addition, the situation is so complex it would be impossible to explain it in a way that is accurate and fair.

I will do my best to put pictures in my next blog. I’m not sure how this population takes to having their picture taken. In addition, I do not want to appear like I am here for the tourism.

Well, I’m going to suck on some more lemons and do some more reading. I hope all is well in Canada, miss you all ready.

…a very lovely city. I am here in Geneva for my briefing at the Swiss MSF office. This city is cute compared to Toronto… I think I am in Whooville from “how the Grinch stole Christmas”. Speaking of WHO, I had dinner with a Canadian friend from the Would Health Organization (Amy). I was also found by a Human Rights NGO – Human Rights Watch (I was locked out of my building). So my briefing ended up being somewhat self-directed and intersectoral out side of the office. MSF has a dual mandate in advocacy/humanitarian rights issues based on medical or health findings.

In the MSF office, I learned plenty about my project. I will be working with a team of five expatriate staff – an MD, a field co coordinator, a midwife, and a logistician (engineer type of person). I will also be working with about 24 people from the community – nurses, guards, translators, etc. I finally made contact with the team via email… they sound like a reasonable friendly bunch.

WHY MSF?

A good nurse looks at illness outside of the medical context. As mentioned above, MSF captures what nursing by including the social and political context of people in need.

I love excitement. As much as I feel it is important to help those in need… my interest goes beyond helping. I consider myself very lucky, and I think we all have a lot to learn from those living in developing countries. Everyone likes to rescue, but rescuing is temporary and patronizing. All those involved from the patients receiving care, to the national MSF staff and those in political positions need to be included with provision of health.

WHERE AM I WORKING?

I will be working in Seleia. A community 100 km north of El Geneina consisting of about 5000 residents and 15000 internally displaced people. This community is only accessible by helicopter because of security implications. Thus, MSF is supporting the existing health clinic by addressing patient care needs related to population increase and lack of access to El Geniena.

Politically, the situation is very difficult to describe in a public blog. The MSF Charter includes statements of both neutrality and impartiality. Therefore I will not be differentiating between the supposed criminals and the victims. Anyone in need of medical aid is to be perceived as a human being before being regarding as any particular party.

WHY AM I BLOGGING?

From speaking to various communication officers, blogs like mine can create a significant security risk.In the passed humanitarian workers have been arrested in there attempts to speak out about various acts of violence and political controversy.In addition, I am also concerned about exploiting the population I work with by using their troubled lives for gross pictures, emotional reactions, and my hobby. The purpose of this blog is to put meaning to a challenging experience, to put a face to the MSF experience, provide an anecdotal perspective on living in troubled areas of the Sudan, and to communicate with people where only satellite communication exists.I want to speak about the small things in my daily life: the food, the bugs, daily if of community members.Furthermore, we all need reminders that the people of Sudan are people too… not just pictures on the news.Although it is disclaimed that this blog is an individual opinion; it still needs to represent the collective MSF image and vision.

So tomorrow I am off to Khartoum, Sudan. I hope to provide more contextual information from Khartoum, after I explore what is safe to share. Right now I a very sleepy and quite frankly “spun out”. I better do some reading.

Dear Darfur,

I am looking forward to learning about your region, the people, and the conflict. I will be heading to Geneva, Switzerland, for a briefing, then to Khartoum, then to a town called Selea (aka Seleia, or Seleya). Selea is in the North West area of Darfur in the Sudan. I will be working at a health centre servicing anyone that needs help, but I am placed there based on the large numbers of internally displaced people in the area. Apparently, this primary health care clinic has some surgical capacity – I can’t picture it.

I am completing my last few shifts at St. Michael’s hospital in Toronto before I depart next week. Working as a nurse can be difficult even in a developed tertiary center like St. Mikes. Patients, families, and staff can take refuge when people are sick knowing that: Everything is being done, that could be done- such as consults, surgery, procedures etc. Working in a state of the art facility, in a developed country makes sickness and even death a little easier to accept. I do not think I will feel this way when I’m treating people whose thoughts are consumed with where they will get their food and water from. I wonder if people who live in developing countries know how difficult there lives are… or do they just get used it.I wonder what factors allow Canada to be ranged number 11 on the life expectancy list – leaving the Sudan ranked at 156.

When preparing for my last MSF project my biggest concern was trying to get all my music to fit onto my ipod. This time I am concerned about my competency, endurance, and feelings about poverty. (Though I do need to make sure there is coffee in the Sudan).

Position: General Registered Nurse — Selea, Sudan
School: Graduate of McMaster University BScN
Previous MSF Project: Bangladesh 2005 — Malaria/primary health program
Previous Nursing experience: Canadian North — Moosonee, Attawapiskat
Currently working: St. Michael’s Hospital, Toronto
Super Powers (with coffee): Endurance, creativity, teamwork, wise cracks, BS-ing
Weaknesses: Spelling, cooking, romance, organization, tidiness, tactfulness
Side Kick: TBA
Nemesis: none — I don’t believe in evil people, just bad behaviour.