Shauna in DRC

Dear wonderful people who read my blog and the blogs of my colleagues,

Thank you for all of your support and encouragement and interest in MSF and what we are doing, or trying to do, in any case. You helped me to get through a difficult day.v

Thank you to everyone who donates their time to volunteer with MSF, at home or in the field, especially my team here in Kilwa. You are an amazing group of people and the very best kind of people to live and work with.

Thank you to everyone who donates money so that MSF can exist and do the work that we do. You saved many lives today. You may not realize it, but today you paid for children in Mukupa who are sick with measles to be treated for free because their parents cannot afford to pay the 75 cents it costs for the medication they need.

Thank you to the national staff that work with MSF, who sacrifice their time, who put their lives at risk, so that we can reach the people who need our help. Especially Jean-Bosco, who came back from his vacation early because we have an emergency in Kilwa.

Thank you to the people who we are trying to reach, “the beneficiaries”, as you are officially called, even if you don’t know it. Thank you in particular to the people of Congo. You have suffered so much, and in some places and in many ways you continue to do so… And yet you still greet me with a smile, you still sing and you still dance, you laugh easily, you love your family and your friends without reservation.

You are an amazing group of people. Thank you for your courage, your spirit, your perseverance, your resilience, in the face of so many obstacles. You are a constant inspiration and I am grateful for the opportunity to know some of you, even a little bit, and to share your stories with the people who read this blog.

Any seasoned ER nurse will tell you to never schedule yourself to work on a night where there is a full moon if you can help it… Tonight the sky is full of the big round moon, and the generator broke down which means radio contact is precarious, the plane landed and couldn’t take off again, leaving four extra houseguests which we scrambled (literally we made extra eggs for dinner!) to accommodate, and I got the news of 12 measles cases one hour from Kilwa, did I mention there was a mass vaccination campaign one month ago? And all of that happened in the span of 20 minutes on the day of the full moon… coincidence? Perhaps…but I have worked a few shifts in the ER during the full moon and I can honestly say, strange things do tend to happen on these nights. Did I mention we hit a chicken with the car and that there are soldiers on the move in one of our sister projects in search of rebels?

I started thinking about the moon, not because of all these strange and coincidental happenings, but because last week we were sitting around the brazier in Kasongomwana and Augustin, one of my drivers, asked me why sometimes the moon is there, and sometimes not, why sometimes it is big and sometimes it is small, and after I got over the initial amazement and understood it to be a serious question, I realized that there are probably a lot of other things I know and take for granted or assume that everybody knows, especially here. I tried to think of other things to tell him about, but it is hard to put yourself in the frame of mind to un-know things, to be in a position of such innocence, it has been a long time since I felt like that…about anything really. I had to rack my brain from my third-grade astrology lesson to try to come up with an intelligent answer. I think I managed ok but I am not sure he was totally convinced, especially the part where the moon itself doesn’t actually light up…and of course that I apparently can’t differentiate between astronomy and astrology…

I think that what I have appreciated most, or what I do appreciate most about being here, is that every now and then, I manage to see things through fresh eyes, like I have never seen whatever it is I am looking at before. I am somehow transformed by this feeling, sometimes into someone a little bit less cynical, a little bit more like Augustin (although I’ll never have his way with the ladies), a little bit less jaded and a little more in love with the world around me… And for that I count my very lucky stars, and the very full moon, no matter the craziness that comes along with it…just to be able to feel like some part of this world is still new and beautiful and wondrous and good and waiting to be discovered.

After a lot of travelling and a lot of jet lag I am home. I am at home in Kilwa…in the MSF ambulance on the road to Kasongomwana, in the house where I live with my team, asleep in my bed – well except for the night before last where I slept in the toilet because of the raging gastroenteritis I mysteriously contracted and yet nobody else got – no worries though it wasn’t cholera, which was Christine’s main concern, and I am feeling much better now. It was nice of the loggy though to offer to put a mattress in the toilet for me. There is some great collaboration here in Kilwa between the loggies and the medics…

For those of you who may have heard about the Ebola outbreak in South DRC and now see the irony of the incredibly inappropriate medevac jokes I was making, it is in fact nowhere near here, and will likely not arrive here, very fortunately for the people of Kilwa and everyone in between. MSF is working in Kasai however to try to minimize the impact of the outbreak and to provide care for the patients who have already been infected.

Instead we are continuing to find active measles cases here in Kilwa, thankfully not ebola, despite the vaccination campaign that finally took place. It actually went very well and we were able to assist the ministry of health but unfortunately only children under five were vaccinated and the last campaign was in 2004 so there are still lots of kids uncovered. But then some children vaccinated are better than no children vaccinated,you know, glass half-full.

I can’t write much at the moment because I am still not at 100%… which was confirmed by Brigitte-the lovely girl who cooks for us- this morning, who took one look at me and said I should not go to work because I would fall down… although I did not fall down I do feel like I should lie down and so I will write more soon, but not now, perhaps after I have rested in my Kilwa bed, which is thankfully not in the toilet.

There we were, cruising along in our speedboat, MSF flag flying high, when we were once again flagged-down by a boat full of Zambian fisherman… Only this time there was no pregnant woman in labour (thank goodness!); they were rowing towards us at an alarming pace and yelling something in kibemba… which in fact turned out to be “Give us condoms…” Apparently condom is synonymous with the MSF flag… The Nchelenge project should be very proud of all their hard work!! (Nchelenge is the MSF HIV project just across the lake in Zambia) Apparently it is the common reaction at the sight of the MSF flag… Condoms!!

Jean-Bosco explaining the ABCs of HIV prevention

We were on our way home from Kashobwe where we have been supporting a hospital during the measles epidemic… Did I mention that there is a measles epidemic in Katanga? The national vaccination campaign has been postponed repeatedly since January, and is now scheduled for the end of August… The plan is to vaccinate the entire province in 5 days… I don’t want to be a pessimist but I have to say I am not convinced, seeing as Katanga is… well you’ve seen the roads… Logistically speaking, the DRC is one of the most difficult places to run a mission, and a mass vaccination campaign is just that, an enormous logistical operation… you need people…you need transportation…and most importantly you need a cold chain for the vaccines, and of course the vaccines themselves, which of course have been on the way since January… and well based on the hundreds of cases we have already seen, we are quite late in the game…

You may be thinking “Why doesn’t MSF just vaccinate everyone?” I thought that too, but unfortunately it is a lot more complex than that and the resources needed are enormous, and well we are not enormous enough to vaccinate the entire province and certainly not in 5 days… Also we are not the only game in town and the responsibility has been given to somebody else, somebody enormous and with infinite resources and so instead we have to wait… instead we have the responsibility to try to control the damage done by a vaccination campaign come-too-late for some, but hopefully just in time for a lot of other people, sometime at the end of August…

Hopefully…

The other funny thing that happened is that our driver was accused of running over a chicken… well I guess not so funny, kind of serious, but not as serious as running over a duck, they put you in jail for that, because apparently a duck can’t defend himself…

There are so many things I could write about.

I could write about the woman we transferred from Kasongomwana, who is twenty years old and only 1meter 36cm and very, very pregnant for the first time, thus at very high risk for obstructed labour. The health centre midwife referred her so that she could have a safe delivery here in Kilwa, but she decided not to go to Kilwa. By chance, she went into labour (obstructed of course) when we were there and so we raced along the “road” for three hours and forty-five minutes and despite a foetal heart rate of 80 on our arrival, she delivered a bouncing (after a little resuscitation of course) baby boy.

I could write about our guard in Kasongomwana who, when I retold the story of the young woman, responded with a “if only she had eaten a white chicken”…to which I responded “maybe you are onto something there…white chicken and all… however I think that she should have maybe eaten the chicken on her way to the hospital when we asked her to go.”

I could write about the trip to Lukonzolwa where I had a three-hour meeting with the Comité de Santé (the volunteer community group responsible for overseeing the health centres, part of the MOH.) The discussion points were mainly around how the muzungu managed to say hello to everyone in Bemba…why not every person that comes to the health centre gets a laboratory exam in the new lab (people are apparently very angry about this) and why we will not start a circumcision program in the MSF Health Centre. I have to say that the last point left me a little speechless.

I could write about the trip back from Lukonzolwa when we were flagged dow by a rowboat which of course, contained a pregnant woman in labour, and how we transferred her into our boat in the middle of the lake and then into the car and then raced to the hospital only to discover that we were too late because the umbilical cord decided to arrive before the baby.

I could write about how for a long time I wanted to be a midwife but decided to become a nurse instead…and yet here I am in the Congo with all these women having babies everywhere I go, and I am kind of wishing that I sure knew a lot more about delivering babies. It’s ok though, I have started to spend my Sundays with the midwife in the maternity to catch up on a few things. It’s not so bad, to spend your Sundays welcoming new people into the world.

Speaking of new people, I could write about the incredible shrinking baby I came across in Kabangu yesterday…who when I first asked the midwife, weighed 2.6kg, and when I had serious doubts about this and asked her to re-weigh him, the baby was a whopping 1.8kg. In fact, when we transferred the little shrimp to the hospital and reweighed him again, the scale here being slightly more reliable, we discovered that in fact the little guy weighed 1.5kg.

I could write about the garde-malade who was accompanying the mother of the tiny shrimp to Kilwa, who without warning threw up all over Bosco, my Mobilisateur Social, only a few minutes after I had asked him if he wanted to change places with me in the car and he refused….

I could write about the wedding we are all invited to this afternoon and the long conversation in the car with Bosco and Papa Shamba (who seems to have forgiven me about the flour) on wedding etiquette in which I learned that the biggest possible insult is to give someone a duck as a gift, or to prepare duck as a meal for the guests. It is also unacceptable to give a sheep or a rat. But a good gift is a goat or a chicken, or a pagne or an oil lamp. Normally you do have to wrap the gifts, but not apparently if it is a live chicken or a goat. Jean-Seb, my loggy, was very disappointed about this, and I agree, it might be fun to try to wrap the goat we are giving, but on the other hand, maybe the goat doesn’t want to spend his last day wrapped up in fancy paper.

Cultural differences… Sometimes making their presence known in brightly coloured, loud and noisy fashion, sometimes invisibly dividing us into strangers who seem unable, or who have simply forgotten how to understand each other…If only in these moments when the difference between us seems impossible, we could remember that if you turn us all inside out, we are all, in fact, the same…

Sometimes these differences are so subtle, that you do not notice them. Sometimes you stumble across them when it is too late to avert disaster and the small crack that has divided your sameness develops into an abyss and it is nearly impossible to close the distance between you and the otherness of the person in front of you.This difference of Culture can push the possibility of a simple exchange of thoughts and ideas beyond your reach, beyond your understanding, beyond the ability to understand and tolerate each other.

Take humour, for example…This week one of the drivers on my team, Papa Shamba, a wise and widely respected man, asked me if he could put a bag of flour in the car that someone had given him. And I, in mock-horror responded with a “Non!” and then I laughed and then he laughed and it was clear to me that he understood that I was joking…it was of course very good fun…it remained fun and clear until the moment when we were driving away and something possessed me to ask him if he had in fact put the flour in the car and he said no, he hadn’t because I said he couldn’t. I was mortified and of course we turned the car around and I apologized a million times and tried to explain my ridiculous sarcasm to no avail…and that of course he didn’t even need to ask me to put it in the car in the first place. But it felt too little, too late.

Another good example is clothing….In Kinshasa people were demonstrating in protest of women wearing pants. In Kilwa I often hear men and women, and even children in broken Bemba saying something accompanied with a sneer of distaste about my “pantalons” in reference to the fact that I wear pants, which here is quite scandalous for a woman, even if I am a muzungu. In fact one day a young man started a discussion about this issue with our logistician, in complete and utter disgust at our flagrant disrespect of the cultural norm. But it is not that I have a lack of respect for anyone’s culture, but in all honesty it is ridiculous to me that wearing pants is scandalous, that a simple piece of cloth can put a wall between us, and I also just like wearing pants.

The thing about culture is that I think that there is room for exchange. It helps to close the gaps between us. Culture is one of the most fascinating things about the human animal and it is what separates us from the apes….ok…maybe that along with a little conversation and a few neurons… But in my culture women wear pants. And I am sure, that at the end of the day, I will continue to wear pants, even if it is mildly offensive. Maybe some of the women of Kilwa have wanted to wear pants for a while, and if they see us doing it they might find the courage to put on a pair, one leg at a time. I will however definitely make the effort to leave the sarcasm behind.