Lauralee in Lankien

Dream #1: I am running in the compound in the rain. I trip and fall. The knees of my khaki pants are covered in mud, so are the shoes I am wearing, a pair of fancy black sandals from home. My husband appears out of nowhere and helps me up out of the mud. My younger brothers, Peter and Robert, are there too, but they look the way they looked when they were 10 years old, just thinner. They are dressed like many of the children in Lankien, in old tattered rags.

Dream #2: I am working in another project in southern Sudan, but it is a cold sterile place that feels frightening. Someone is tied to a chair and is being interrogated under bright lights by the log admin. It is like a gulag and the log admin is talking with a thick Russian accent (I am sorry logistics, that was the dream.)

Dream #3: There is a palette of bright colors in front of my eyes. Gradually all the colors run together in a psychedelic patchwork, the way I would imagine an LSD trip, if I had ever taken one.

Dream #4: It is the middle of the night and the guard is standing inside my tukul, yes inside, not outside where he is supposed to be. "IPD, IPD". I shoo him out of my tukul and slowly prepare to get up and go to work. Oops, this is not a dream, this is real, and I really do have to go to work. Rats.

There is no doubt that my sleep-wake cycle is totally screwed up. I cannot sleep now even when I get the chance. I am not sure if it is the heat, chronic sleep disruption from being woken up so often or my Larium, the drug I take every week for malaria prophylaxis. All I know is that I need to fix it soon.

Another gunshot to the chest.

A 10 year old with a gunshot through her knee.

A 15 year old with a gunshot wound through her ankle.

A frightened woman with a miscarriage who bleeds and bleeds. I finally manage to remove the dead fetus and other tissues. The uterus clamps down immediately. Her hemoglobin is 4.

Another woman with a miscarriage. It is the midnight and the IPD is full of flying insects. They crawl down my back as I hunker over the examining table. I use a camplight on my forehead. My husband bought it for me at Mountain Equipment Co-op in Toronto. It works quite well. I do the D and C and she stops bleeding. There is crap on my shirt and blood on my toes.

I crawl back to my tukul at 2 am.

A 4 year old with tetanus.

A gunshot wound to the chest.

A 10-year old girl raped by a stranger on the road.

An inebriated woman beaten up by her equally inebriated husband.

A woman with a post-partum infection.

A fractured arm.

A steady stream of pneumonia and brucellosis.

The email is down; so is the satellite phone.

The man in Tukul 1 needs his dressings changed. He is missing his right eye and most of the right side of his face. A gunshot wound. A piece of bone from his zygomatic arch is sticking out.

I need to contact the World Health Organization about the girl in Tukul 3 with the leg paralysis. They collected a stool sample for poliovirus last week.

A one year old pees all down my shirt. He looks quite pleased with himself.

Ah well.

Exactly 48 hours ago I returned to the field. We are a skeleton team of four: the project coordinator, the logistician, the lab supervisor and myself. Today we will become five when a new nurse comes in on the plane.

Fiona Gillett helped me ‘find my feet’ in Lankien. I will always owe her a debt of gratitude for her kindness, patience and support in those difficult early months.

Today I fly back to the field. Fiona will board the same plane on which I arrived and then fly out of Lankien for the last time. I will see her at the airstrip for good-byes. She is now at "End of Mission" or EOM.

The composition of the expatriate team is constantly changing as people begin and end their contracts in a staggered fashion. The team you join will not be the same team you leave.

My favorite memories of Fiona:
1) Fiona doing a difficult vacuum delivery of a baby with a severely obstructed labor. Fiona had a fever and was ill herself, but she persisted, saving the baby’s life and probably the mother’s too.
2) Working with Fiona to triage and treat four men with gunshot wounds in the space of an hour.
3) Brainstorming around patient care during morning rounds.
4) Watching Desperate Housewives with Fiona and concocting our own series, Desperate Humanitarians, a satirical comedy about the dark underbelly of an MSF mission.

To Fiona, colleague, friend, nurse midwife extraordinaire, I would love to work with you again, anywhere, anytime. Cheers my friend and thank-you.

Everyone said it would be hard to go back once I got home. They were right. It is tough to leave everyone I love again, tough to leave southern Ontario in the spring with the apple trees and lilacs in bloom, bright pink cherrytrees on every lawn, the days stretching out.

I watch the back of my husband’s head disappear through the airport doors as I wait to go through security. Why am I doing this again? Backpack, coins, keys, shoes, USB key, squirm out of my money-belt, set the metal detector off anyway, a gentle pat down from an apologetic security guard.

I idle away the time in the airport half-heartedly browsing through the bookstore. I have an overnight British Airways flight to London, a short stopover in Heathrow, then an eight-hour flight to Nairobi. I get into Jomo Kenyatta airport at 9 pm, Nairobi time. It’ll be dark then; I hope the MSF driver will be waiting for me. Did I ever program his number into my phone? I meant to. Do I have any minutes left on my phone card?

As I wait at the gate, I hear a snatch of CBC news, ".We all remember her from the SARS crises, for her leadership, dedication." Sheila Basrur has died. Sheila was a classmate, many years ago, at the University of Toronto Medical School, class of 8T2. She was one of my more famous classmates, prominent as the Medical Officer of Health for Toronto during the weird, dark days of the SARS crisis.

I didn’t know Sheila well, just a nodding acquaintance really, but she would be about my age. What would it be like if it was all over now, so soon, with so many things left undone?

I was sad to learn that Chris Curtis died. Chris was an entomologist and professor at the London School of Hygiene and Tropical Medicine. Even after years of teaching, you could tell that he loved his subject matter. He taught us about insect vectors of tropical disease, particularly about mosquitoes and malaria. Professor Curtis made bugs interesting.

My favorite memories of Chris: 1) Chris proudly showing us his insect lab. 2) Chris teaching us how to do indoor residual spraying. 3) Chris’s field trip to catch mosquitoes in an area outside London (Did you know that there used to be malaria in England?)

Regards to his family, friends and colleagues. He will be missed.