headlines

February 8th, 2008 by nazaninm

I think I have milked my last entry as much as possible. You may be wondering why I have not written much in the last couple of weeks. I am not sure. Days merge into nights into days into nights. It’s hard to leave work behind when I live with the women that I work with. There is no beginning or end to it. I have made feeble attempts at writing, but none of them have made it to the web.

I am sure you have been following the news. I have too. Heath Ledger dies of an overdose. Britney will die of an overdose soon unless she gives up the ice. Sarkozy marries a super-model. Ahhh, the news!

Here are some headlines from our clinic…

“No one is spared”
A woman was walking home at midnight after work. She did the right thing; she walked home with her husband and a colleague of hers. But that did not spare her. They were held-up by seven armed men. They apprehended the husband, and took the two women into the bush. She begged the men not to kill her because she has four children to take care of. They told her not to worry; they’d do with her as they pleased and then they would let her go. They did. They let her go.

“Injustice”
A child sees her mother at the market. He runs towards her. But his father stops him. He proceeds to beat the mother. He prohibits her from seeing the child now that he has taken a “second” wife.

“Living in fear”
A woman is gagged and threatened with a bush-knife as a man rapes her.

“Innocence lost”
A nine-year-old girl is raped by her uncle.

“Why??”
A five-year-old girl is fingered by a stranger.

“Blind cruelty”
A blind woman is beaten up by four policemen. The nurse introduces me to her seven-year-old daughter that acts as her eyes. I am briefly grateful for her blindness…I hide my tears behind it.

“Where did your love go?”
There are countless cases of neglect…men that abandon their wives and children and leave them destitute. A woman comes to the clinic asking for help for neglect by her husband. As I wait for the translator to get the story from her, I stare at the abdomen of her child…a balloon tucked under his shirt. I walk over to him, and feel his tummy. He has splenomegaly. I ask the mother if she has taken the child to see the pediatricians. She says her husband does not give her money for it. I ask them to come back the next day, so I can help them out. They did not show up.

“Black eyes”
That speaks for itself. I see countless women in a day that are beaten up by their husbands. Every day. It is so common that it would ordinarily not make it as a headline…

…but let’s make it one.

ghosts

January 15th, 2008 by nazaninm

I am a bit of a local celebrity. I clued in last week. I was suturing a man who had thought it wise to use a bush-knife to swat away some flies…instead he cut his scalp. I had a good laugh. Not very doctor like, I know, but I needed a chuckle. While I was suturing him, and giggling to myself, a man with an arm wound inflicted by a 2 pm knife-fight is talking away in tok pisin. Now, I am no expert in the language, but I can recognize “Canada” and “white mary doctor”. So I bluff, look up at him and say ”You know, you better be careful, I can understand what you are saying” and smile. The smile makes him smile, and that is a relief since I do not want to be his 3 pm victim.
“How do you know where I am from?”
“Word gets around boss.”
There is that word of mouth at work for you. “And we saw you on TV”. Six o’clock news. So much for anonymity.

I have been sick on and off for the last week. Nothing serious. I took a couple of days off. In my post sickness haze, I walk into the emergency department with a feeling of dread, past the putrid smells, the patients lining the halls eternally surprised to see a white doctor, and the filth-covered door.

I start rounds on the patients that had been seen the prior night. I examine a patient in whom I suspect appendicitis. I press her belly and all the signs are there. If I call the only over-worked surgeon in the hospital he will leave her in the “no man’s land” hallway at the back of the emergency department…she will get worse, and then I won’t be able to do anything for her. I ask her if she can afford an ultrasound at a nearby clinic. I hate that question; it separates the haves and the have-nots. Most are have-nots. As I wait for an answer, raspy breathing sounds call for my attention. I look around and trace their origin to a patient one bed over. I scan his body and look at his half-closed eyes. His chest takes in air in a whoosh, and then lets it out with a coarse gurgle, and I know.

I turn back to my first patient, but my eyes betray me…they drag me back to his body. What if I am wrong?

I walk over to him. I grab the chart. Its pages weave the same old story. Twenty-four-year old. Cerebral malaria. Kidney failure. Blackwater fever. Nobody had monitored him overnight. He had received 6 liters of fluid, and a touch of lasix and he had not urinated. Which means that all the extra fluid is pooled in his lungs, drowning him. He must have seized overnight; he has bit his tongue, blood trickling down the side of his face. His breathing is agonal, his most basic reflexes fighting to hold on. I look at his eyes, and…

I wasn’t wrong.

His ghost and I stand there, our backs to him, trying to distract ourselves with other patients. Everyone else seems nonplussed. Everyone except his father, whose quizzical gaze I try to avoid. The three of us are fixated on his breathing. Deep, laboured, instinctual. Deep, laboured, instinctual. Deep…

Then there was silence. Ephemeral life.

His ghost has stayed with me all day. He is still here next to me as I write. He tries to crack some jokes to try to cheer me up. He tells me that my entries are too macabre for anyone to want to read them. I tell him that I can’t help myself. If I don’t write it down, it will fester inside of me. I am irritated, and worn down…my room is filled with the ghosts of those that I cannot do anything about because I am bogged down by bureaucracy, and corruption, and social injustice. There isn’t enough room on my bed for all of us.

A couple of days ago, I heard about an expat young guy in Rabaul that came down with blackwater fever…he got evacuated to Australia, where he will receive dialysis and 24 hour intensive care monitoring, and he will likely pull through.

The haves and the have-nots.

new year

January 2nd, 2008 by nazaninm

Yes, yes, I know…the title is a cliché. But you try coming up with something original in this sweltering heat. That’s it really…the heat is killing my creativity. It keeps me awake at night. At midday I search for a spot on my bed where the ceiling fan creates the eye of the storm while I try to take a 20-minute nap. Sadly as soon as I am invaded by sleep, the sweat builds up and I have to turn around to let it evaporate. Three minute cycles…I have timed myself. Like roasted chicken. Or more likely a roasted pig. I saw a pig slaughtered and skinned by our neighbours a couple of weeks ago. Hmmmm. Strange. I am a city girl, and except for the one time that I milked a cow, the closest I came to a dead animal was, well, in the supermarket. No I didn’t kill the cow, but it must have felt that way to her.

The New Year was brought in not by firecrackers, or bubbly champagne, or 12 grapes. I slept through it. We were greeted by an earthquake though. Not exactly at the strike of midnight, but close enough. 6.3. The first thing I reached for was my laptop. Then my pants. True love.

I have settled in, sort of. In the mornings I wake up to the chirping of birds. I tried counting how many different “tunes” I could hear. At least ten. Idyllic isn’t it, waking up to the chitter chatter of birds instead of traffic moans and ambulance groans? It is. If they could only start later than 4:00 am…it is not when I am at my best! Especially when I have been waking up several times during the night thanks to the khishkhishkhish of our guard’s 2-way radios.

The whole neighbourhood lives in my bedroom. The barbed wire, the guards, Cesar (our killer dog that we have been instructed not to approach within a few feet) cannot keep out George Michael’s voice blasting on the neighbours radio while I meditate. “Last Christmas I gave you my heart…” Sound has no boundaries here.

Nor does word of mouth. It is the fastest form of telecommunication here. “Elsie (our neighbour) is making you mumu on Friday”, a hospital staff echoes a conversation that I had with our neighbour not even ten minutes prior. Faster than the dialup internet service for which you need a dedicated employee to send and receive emails. More reliable that any cell-phone company in PNG.

And more reliable than me! I forgot to mention that our clinic has finally opened. More on that later. I traveled this last weekend. I was on a plane, and the cutest, chubbiest 1 year old would poke me through the crevice between the seats. I’d turn around and poke him back, and walk my fingers up his thigh and then tickle his tummy. He’d respond with a wave of laughter, his two upper teeth peaking through. The third time we went through our new ritual I glanced up at his mother’s eyes, and I was met with two black eyes suspended in a sea of blood, cupped by bruises. Before I left the plane, I gave her my contact information at the clinic. She promised she’d come visit us.

I was grateful for having a place to send her. Hope it will be a new year for her…and her child.

Happy New Year to you all.

witchcraft

December 22nd, 2007 by nazaninm

Written words march along the pages of reports in a procession, adhering to the same drumbeat that all reports do. They may talk about sexual violence against women, or human rights violations, or child prostitution, or war crimes. In most cases the words fail to convey the reality of the situation. But imagine if, as your eyes glance over the pages, the words peel off…first one, then ten, then hundreds of them. The black scribbles swarm around you, and you are about to gasp for air when they swish away and converge into a mass, morphing into the figure of a woman. Her eyes are shut swollen by punches, her lips bleeding, the skin on her back tattered by the gravel road she was dragged on. The words in the reports that I have read in the last few months took that form today. In flesh.

There she was, lying on the stretcher after being beaten up and tortured all night, accused by villagers of being the sorcerer responsible for the death of a child. The child, judging from the daily cases of meningitis and cerebral malaria, probably succumbed to the black magic of those illnesses. The only hex in the room, as my hands trace her bones feeling for fractures, was the animation of the written words that have stared back at me over the last few months.

Witchcraft. It is a dangerous phantom in PNG that conjures violence and kills at the hands of other human beings…not the hands of a witch. There are many taboos here. Misunderstandings. Old traditions mixing with new ones. Witchcraft living side by side with religion. Mostly Christianity.

Remember the woman from my previous entry..the one whose husband forced a stick inside her vagina to terminate an unwanted pregnancy? I’ve been thinking about her…and her husband. It’s hard for me to be angry with him. According to the woman, he had never hurt her before…never beaten her or raped her. Never. So what would drive him to do such a terrible act…what would lead him to hurt the woman he loves? Ignorance? Desperation? Four other children that he cannot afford to clothe, feed, or take to a healthcare provider until they have been devoured by the voodoo of disease? What is going through his mind now? Is he ashamed? Empty? Devastated? Festering with guilt?

Abortion is illegal in PNG. Unwanted pregnancies are rampant here due to rape, ignorance about contraception methods, and lack of education. Unwanted children end up born into poverty, where they enter a cycle of starvation, neglect, disease, or prostitution. A spell cast by lawmakers and religious figures that they will likely never escape.

As in other countries where abortion is illegal, maternal deaths from unsafe abortion practices are high. No one knows the real numbers, but it is thought to be one of the top causes of maternal death. Abortions are carried out at a similar rate in countries where it is legal and illegal. The difference lies in that “illegal” abortions are poison to a woman’s body…the unsafe, unsupervised procedures kill or scar her.

The decision to undergo an abortion is not an easy one for women, and it is never taken lightly. Instead of supporting that difficult decision, and creating a circle of safety, states where abortion is illegal are bogeys in these women’s lives.

It’s taken me a long time to write this entry. I felt compelled to read about the issues surrounding abortion laws and to deliberate every pro and con argument. By doing so, I have come to an important realization: there are no pros and cons. It’s a woman’s choice. You might agree with it or not, but ultimately it is her decision. No one else’s. Simple.

A religious belief imposed on a woman leading to her demise is equivalent to beating a woman in the name of witchcraft. The hand holding that stick was the hand of patriarchal law and religious benightedness.

waiting

December 14th, 2007 by nazaninm

I left the Angau hospital today, and I took the emergency department home with me. It’s been a while since I have done that. When I finished residency, I was at the top of my game, armed with 9 years of training, and an armamentarium of medical knowledge. Then my life shifted…from one day to the next I was not a resident anymore…I was the staff, the attending, the consultant… the one that residents and medical students would turn to if they had any problems. For the first few months, the responsibility and the stress of the ER would filter into my daily life. But one day the feeling was gone, and as I’d leave the ER, the internal dialogue would whoosh away as I walked past the security guard, the paramedics lined up in the hallway waiting to be triaged, and the patients waiting to be seen.

But today was different. Today, I took the ER home with me again.

I was showing the emergency department to Leslie and Rob at the end of my shift, when a man holding a floppy baby walks into the room. He is dazed with panic and looks around in confusion, taking a step first in one direction and then another. No real purpose to his steps except to find someone that would help his baby in the midst of the chaos. I notice him, and direct him to the “resuscitation” room, where there is only one stretcher. It’s occupied. I ask the woman to sit next to the stretcher with her IV pole, and lay the child on the bare metallic surface. There are no blankets.
“How old is she?”
“Three”.

I am not sure what’s different. I am finding it difficult to find my place in the chaos around me. I am trying to wrap my mind around the fact that Angau hospital is a “referral” center and that there are tons of people in the periphery that get no healthcare at all. It also happens to be “the best” hospital in PNG.

Her little body is under the spell of spasms, her eyes closed. Her heart is thumping in her chest, holding on.

What is different is I am trying to erase the image of the 30-something-year-old women’s breast eaten up by her cancer, and knowing that she has no chance in this healthcare system. No chance either for the 30-year-old man with a broken neck whose quadriplegia is a tragedy anywhere, but here it sentences him to isolation from life as he knows it.

We start an IV on her and give her a bolus of fluid while I ask here father a few questions. Fever. Decreased level of consciousness. Vomiting. Spasms. Meningitis? Cerebral malaria? We bolus her with anti-malarials, antibiotics, diazepam and give her more fluids. Then we wait.

What is different is the gush of mixed emotions that rushes from my heart to my head when the medical student, giggling nervously, translates the story of the 30 year old woman that had a stick stuck up her vagina by her husband in order to terminate an unwanted pregnancy.

I went home waiting.

***************

Back in the ED, the morning sun is steaming the nightly rain. Stethoscope around my neck, pen in hand, I turn around and there she is, looking up at the “white mary doctor” with her dark brown eyes, holding a cookie with her 3 year old hands, her curly brown/bleached-by-the-sun hair making her irresistibly cute. We keep looking at each other, and I smile. Shyness tilts her head down but her gaze does not let go of mine. “White mary doctor” is a novelty to her…and she a gust of relief to me.

my first day

December 6th, 2007 by nazaninm

Remember your first day of school? Mine I remember with pristine clarity. Tehran. Warm, sunny day. Hair combed back in pigtails. My mom and I walk through the gates of an all-girl school into the midst of an ocean of blue-uniformed girls, running, playing tag, chatting in groups. I remember my mom letting go of my hand and how I tried so hard to hold back the tears. I did. I held them back.

Here is what I have been doing the last few days…meetings, planning, drug orders, clinical protocols, meeting the national staff, discussing legal issues, medical issues, security issues, political issues, supply issues. And more and more issues related to the set up of our clinic. But that’s not what I want to write about. Not today.

I decided that while our clinic was being set up I’d volunteer my time in the emergency department in the Angau Hospital. First things first. When I say hospital, well, if you consider buildings that are collapsing under the attack of termites, or patients lying on cardboard on the floor, or a place that does not have anesthesiologists, obstetricians, radiologists, surgeons, then you are at the right place.

I was excited about my first day. Excited about diving in, doing some clinical work, about doing what I have come here to do. Also a bit worried…what if I am double-crossed by all these cases I have never seen before…the cases that have been eradicated from our memory in the western world, so much so that after medical school we tend to forget about them. I am talking about the –asis and –osis diseases…leishmaniasis, donovanosis, shigellosis, amoebiasis, borreliosis.

I walk in through the emergency door. The first 10 minutes I see a woman stabbed in the chest by her sister causing a collapsed lung (they fought over a cell phone), a severe pre-eclamptic woman (a condition in pregnant women that, unless treated, can lead to seizures and death), and an overdose in a woman beaten by her husband. That was the first 10 minutes. For the medical people reading this…3 cases of cerebral malaria, 2 cases of meningitis, 1 Ludwigs angina, a woman in shock slouched in a chair, a status asthmaticus sitting in a chair, a severe head injury where there is no neurosurgical backup, a splenic rupture in a man beaten by the police, resistant TB, typhoid fever, a sucking chest wound in a 5 year old. All those on top of the usual gamut of broken bones, lacerations, vaginal bleeding, pneumonias etc…without the usual comforts like an ophthalmoscope, otoscope, ECG machine, blood-work, a glucometer…gauze!

Add an emergency department that I do not know, that has no formal triage system, staff that don’t know me, a hospital system that I cannot figure out, nurses that have to clone themselves to get anything done, a language that I do not speak and….oy!!!!!! The doctor I joined to work with left to his daughter’s graduation and did not return for, let’s see, 5 hours. But who was counting.

That was my first day.

At the end of the day, I am not the child who cannot keep his eyes open because he is using all his energy to breath. I am not the woman whose leg was sliced open and dislocated by her husband in February 2007, who could not get to see a health professional due to the remote area she lives in, and who will walk with crutches for the rest of her life. I am not one of the medical officers that struggle to learn medical skills while staying afloat in the tsunami of under-resourced shifts.

At the end of the day, I get to leave back home to the comfort of my life. Today could be my first day and last day…I could leave tomorrow if I wanted to.

At the end of the day, all I can do is fight back the sheer sadness and insanity of it all and ask the universe for the resolve to do what I have come here to do.

All those back in the western hemiphere, miss you. Internet and time have been a scarcity…but I do get to read your comments…they make me smile.

day and night

December 2nd, 2007 by nazaninm

My watercolor memory of Papua New Guinea, hazy and indistinct, is touched up with new paint-strokes of color and images. PNG is beautiful. We have been in Port Moresby (capital city) for the last few days. It is cradled by an oceanic tapestry of greens and blues, and lush hills lined by palm trees, banana trees, rain trees, and, well, other trees whose names have never been registered into my knowledge-base. The scenery is brought to life by the luminosity of the sun, while I try to shun it out with my newly purchased 19.95 Kina sunglasses after losing mine somewhere along the way. It’s been a long way here.

Port Moresby is where the MSF main office will be based. The team, brimming with enthusiasm, has converged here. Rob, Silvia and I flew in from Amsterdam. Kara flew in from Australia. Karen will fly in later. Lauren has been briefing us on security (including curfews and radio transmission lingo) and health issues (including the procurement of anti-venom for snake bites!).

In the afternoon, I walk around in the market with Billy (our local driver and “fixer”) picking out fresh coconuts, pineapples, and pitpit (a sugar cane-like vegetable that tastes like artichoke). Men, women and children look at me with curiosity; they smile and nod. I bend down to take a photo of the market and the vendors volunteer to have their photos taken. They grin bashfully when I show it to them, though the image on the screen is stolen by the brightness of the sun. Their kindness and friendliness make me at ease. As I take in the scene in snapshots – the multi-colored umbrellas casting shadows over the vegetables, the smiles, the heat of the sun -I am happy.

Yet, words like Koruptem (corruption), settlements, violence and images of barbed wire, guarded compounds and cars, hang in the air. They seem out of place. As if someone put them there by mistake; tacky Christmas decorations that nobody takes down. Maybe someone could pluck them out of the air, and nobody would know the difference. Poof…they’d be gone.

Dusk. We walk to Billy’s friend’s house for a soiree consisting of pitpit barbecued over the fire and local SP beer. The sunset stencils out the trees in the background. No high-rises. The squeals of a pig, protesting the presence of the barbecue fire, break the evening silence. Richard, in his Stopim Koruptem (Stop Corruption) t-shirt, speaks of issues that affect PNG: deforestation due to coffee plantations, poverty, unemployment. His dog MDM (massive democratic movement), nervous for reasons other that the barbecue, pops his head in and out between our legs like a cartoonesque mushroom. A Tribal Freedom banner presides over the evening, as our features are slowly smudged by the darkness.

We are heading to Lae today. We leave Rob (Finco) behind in Port Moresby in our main office for his one-man show. Siliva, Kara, and I head with Lauren to Lae where we will meet Leslie, our logistician. Tomorrow we start the task of coming up with timelines and objectives to set up the clinic.

jamboree!

November 28th, 2007 by nazaninm

Type in www.mapquest.com in your search engine. Search for Lae, Papua New Guinea. Here are your directions:

“Zig-zag from Toronto to Zurich, Zurich to Madrid, head north from Madrid to Amsterdam, train ride to Bonn, car ride Bonn to Berlin, then make a U-y and plane ride Berlin to Sardinia, ferry to Corsica, ferry back to Sardinia, migrate north again to Amsterdam. Stop at the red light until further notice. Not to be confused with the red light district. Loop back to Madrid. Turn on your right turn signal and wait. Wait some more. Some more. Now off you go to Amsterdam. Yes, yes, AGAIN. Five hour stop over. Then make a right and dip down at a 45-degree angle to Singapore. Five hour stop over. Finally glide down to PNG.”

It’s time to pack your bags. After all, as promised, I will take you to PNG. No false advertising. We ARE leaving today!! Thanks for waiting it out with me for the last month and change. The long, long detour was mapquest’s fault…pfffff…what’s with the crazy directions and all.

Next blog entry will be written in 30-degree weather…Celsius!!

disasters

November 23rd, 2007 by nazaninm

Little disasters occur when an immigration officer loses documents that should have been faxed to the Papua New Guinea embassy in Brussels days ago. Now they are finally in Brussels, and our visas are being processed. If all the pieces of this jigsaw fall into place, our team will be leaving some time early next week. Probably next Wednesday. Get going already…you must be thinking! So am I!

Let me explain what has been happening. Aside from the felicitous misplacement of visa papers, a team of two MSF staff, our temporary head of mission (Lauren) and our logistician (Leslie), have been in PNG for the last couple of months trying to climb over walls of paper, while building other walls for our clinic (termites are feasting on the hospital we are affiliated with). The rest of the team is waiting. I managed to get my passport back for enough time to dash to Madrid, while my luggage was sent for a vacation to the coastal city of Valencia. It grudgingly joined me back in Madrid after five days. In the meanwhile I have been taking repose in dance classes. Flamenco. Our Project Coordinator (PC)/ Medical Coordinator (Medco) Silvia and Finco Rob are in Amsterdam, seeing family and hanging with friends. Our mental health officer Karen is completing a course somewhere in Holland. Kara, the nurse, is in Australia.

Now you have met all the members of our team.

While we are waiting for our departure to PNG, the place seems to be falling apart. Floods in the Oro Province have killed, depending on the news source, around 200 people, displacing thousands, and affecting a total of 150,000 inhabitants. Floods are inopportune at any time. But when you take the rough terrain in PNG and the lack of infrastructure such as roads, it creates a real hoopla. Lauren is assessing the situation.

Yesterday, a different part of the island, the part we will be flying to in the next few days, Lae, felt the ripples of a 6.7 magnitude earthquake. I am no expert in seismology, but that seems impressive. Luckily, it seems no human damage has been done.

Little disasters and natural disasters.

dream

November 16th, 2007 by nazaninm

It looks like I will be going to PNG in just over a week. Sigh. Here’s hoping.

I have been using the hours of the day to read about sexual violence. The latest report I am reading is Amnesty International’s report on sexual violence in PNG: “Papua New Guinea: Violence Against Women: Not inevitable, not acceptable!”

The words play out the choreography of sexual violence. Stage right the wives that are “owned” by their husbands, who experience “wife bashing”, who are submitted to sex at the whim of their husbands. Stage left, the gang rape of teenage girls at school. Center stage, the rape of women by policemen, who announce “public toilet” over the radio to let other policemen know that a gang rape is taking place so that they can join in. Backstage the women and girls that trade sex for food and shelter, often pimped out by the same man who raped them into a state of subversion.

Soon, one way or another, I will be part of that choreography. In some ways, I already am.

I place the report down, and gaze at the ceiling. I have read many other such reports, and I can never fully believe what I am reading. Is it possible that such a place exists, where women are denied of their basic human rights, not to mention instinctual love and tenderness from their sons, brothers, fathers, lovers, husbands. Don’t take my question as naiveté. I am simply filled with a mixture of rage, sadness, incredulity. Also gratitude for what I have experienced in my life, thanks to men and women who have fought for our equality, not so long ago.

Night is here, and my mind craves silence. I turn off the light, my sight accommodating to the darkness. I curl under the sheets. Warmth ribbons around my body, and merges with the wavelengths of sleep as I ebb away from consciousness. Safe.

I am in a field, and in front of me there is a tree. It’s a birch. Its bare branches decorated by pink, paper flowers of different shapes and sizes. Women walk towards me from different directions. Their shapes take on nondescript forms, like phantoms. I can’t make out their faces. Without speaking they tell me of their stories of rape and abuse. I climb on and off a ladder, listening to the fog of whispers as I place more pink, paper flowers on the branches.

I wake up and blink into the darkness of the room.