Lauralee in Lankien

When the plane arrives, the children of Lankien flock to the airstrip. They come running from all directions, alerted by the sound of the overhead engines. The children from the TB village, which is right beside to the airstrip, are the first to arrive. Adults, young and old, follow. When the MSF staff arrive, the children run towards us with outstretched hands shouting "Male, male." (Pronounced ‘malae’ and meaning Greetings in the Nuer language.) They all want to shake the Kwai’s (foreigner’s) hands.

The plane is important, both symbolically and practically, in the life of an MSF volunteer. In addition to bringing all of our food and supplies, it is the plane that takes us on our much-cherished R and R and it is from the plane, that we get our first and last glimpses of Lankien.

The pilot does a quick "fly by" to make sure the runway is clear of people and livestock. He comes around a second time and lines the plane up for the runway. People yell at the children to move back. A goat meanders onto the airstrip at the last moment. Someone runs out, shouting and waving his arms around; the goat shuffles off. The plane lands nicely and taxis to a stop.

Today, I am leaving for my first R and R. I am going to the island of Zanzibar, off the coast of Tanzania. I found a dusty old guidebook here at the compound. It was buried under an eclectic mix of old magazines, steamy paperbacks and newspapers from Kenya. I imagine myself exploring the "architectural treasures" of Zanzibar Stone Town, getting lost in the "narrow streets of beautiful buildings" and relaxing on Zanzibar’s "stunning white beaches". Today I fly Lokichoggio, tomorrow to Nairobi, and then Zanzibar tomorrow night.

The plane is late, crowded and full of cargo. The heat and humidity is unbearable. Sweat drips down the back of the pilot’s neck. I say a little prayer as we roar down the runway. And then finally we are airborne and flying away from Lankien. I look out the window as the people and tukuls grow smaller and smaller, and I wonder what it will be like to leave this place for the last time. An unexpected lump rises in my throat. Now what is that all about?

Every year, the College of Physicians and Surgeons of Ontario randomly audits the practices of a sampling of its members. This year, my name was pulled out of the proverbial hat. The letter, announcing my audit, arrived at my home in Brampton. When my husband phoned the College to remind them that this year my "practice" was in southern Sudan, he was informed that an audit would no longer be necessary and that my name would be "thrown back into the pool". Well, I am a bit hurt, as I would welcome a visit from someone from home, almost anyone, even a medical auditor. He/she could join me on rounds, squatting on the floor the ICU tukul, sweating in the 50-degree heat and swatting the flies away. He/she would have to adjust their expectations when inspecting my "practice" for cleanliness and make allowances for the state of "my charts". A sense of humor and proportion would be an asset.

Gatwich (not his real name) is 1 ½ years old. He has been sick for 2 weeks with fever, cough and weight loss. His mother carried him for 3 hours to the MSF hospital in Lankien. Gatwich tips the scales at only 7.3 kg; he should weigh almost 12 kg. He is weak and wasted with an enlarged spleen and lymph nodes. Gatwich is diagnosed with Kala Azar, Because of his age and malnourished state, he is particularly at risk of dying. We admit him into the Kala Azar treatment program where he receives vitamins, nutritional support and specific anti-parasitic treatment.

Gatwich’s treatment course is not smooth. He develops bloody diarrhea from a bowel infection. Kala Azar suppresses the immune system and makes him more susceptible to all kinds of infectious agents. These infections are often the final cause of death.

At the end of 2 weeks Gatwich is finished his medication for Kala Azar and he has improved, but he is far from healthy. Although his fevers and diarrhea have stopped he is still severely malnourished. He is transferred to MSF’s Therapeutic Feeding Program, where he continues to receive nutritional support and is monitored for weight gain.

Gatwich starts to gain weight slowly. His mother, who originally looked tired and hopeless, is starting to smile.

"Flexible, adaptable, stress resistant, tolerant of changes of plan, and ready for a challenge."

This was one of the specifications in my Job Description. If only I truly were this stress resistant person.

Stress in the field is a hot topic for MSF. How it is managed probably makes the difference between a successful mission and something else. Many of the volunteers I have met experience exceptionally high levels of stress; it comes from a variety of sources and is dealt with in a variety of ways.

Sometimes the coping mechanism becomes the problem.

So how am I doing? Well I am 4 days away from my first ‘R and R’ and counting. For southern Sudan missions, Rest and Recreation is a 10-day break that volunteers must take after they have been in the field for approximately 60 days. It is sobering to note that I have been out of the field twice already for sickness but still feel the overwhelming need for my R and R.

My stress management strategies thus far:

1. Music – Before I left for Sudan, I downloaded every CD my husband and I own onto my new ipod; 80 gigabytes accommodates a lot of songs. Every day I try to listen to something new and surprising. This morning it was blues legend Robert Johnson singing a song called Dead Shrimp Blues. I like the words. "I woke up this morning, all my shrimp were dead and gone, I woke up this morning, all my shrimp were dead and gone, I was thinking about you baby, someone fishing in my pond".

2. Photos – I downloaded all my digital photos onto my ipod. I can look at pictures of my family and friends anytime I feel like it. I have pictures of my parents, Eda and Regis, on their 50th wedding anniversary and pictures of my husband and I on our wedding day. We looked quite nice in retrospect.

3. Audio Books – I have several audio books that I am listening to: The Classic 100 Poems, The Kite Runner, Ovid’s Metamorphosis, Empire on the Nile and What is the What.

4. Support from family and friends – having a strong base at home is more important than I thought. Knowing that people at home are thinking of me and interested in my MSF adventure is very comforting. Support from my husband is probably the most important. Erik holds the fort at home, deals with the administrative loose ends of my life and gives me an immense amount of practical and psychological support. He is my emotional home base.