One of the things that has come up unexpectedly for me as a result of a few conversations here is being feminine (being womanly, being girly however you want to phrase it) while you are out with MSF is a surprising challenge.

And although it may not be the be all and end all, there is no denying the fact that from the moment you are born, whatever your take on gender equality, what sex you are will subtly determine and direct much of the rest of your life and behaviours. Even and especially when you don’t want to. And it has to be said it leaves something of a void when it suddenly no longer seems to be much of a factor in your existence.

One thing is certain, I have learnt from ten years working in the highly female-dominated profession of nursing that it is surprisingly hard to feel feminine amongst a group that is exclusively female. Something oddly counterintuitive about that… you can feel bonded with, bitched at and anyone of a dozen things in between including a fantastic sense of sisterhood and nurturing community, but you don’t feel feminine. I suppose the thing about femininity is that it stands as a counterpart to masculinity. To have a sense of one, you must somewhere have the other by definition.

Anyway, what these musings are heading towards is how on earth do you do that here? “Here” being just about anywhere with MSF I should imagine. One of the common denominators in developing world context is the comparatively low status of women relative to men – especially in a working environment, which is almost exclusively male. An interesting upshot of this is that in order to reconcile the gender/power reversal amongst the male national and local staff that I am loosely “in charge of” is that I seem to be regarded as curiously asexual. I am not treated like a woman of their culture and community – but nor do they treat me as men of my culture and community would treat me. As an “Expat” I am accorded a similar/same level of respect as a male elder of their own community – respect is given to my education, experience and the organisation that I represent. And the issue of my gender is quietly shuffled off to one side and ignored. I feel that if I were writing this blog in German, I would be using the third gender, or neuter, to describe myself in my day to day work. Which now that I’m aware of it I’m can’t honestly say I’m 100% comfortable with!

Like many western women not a small portion of my sense of identity as a female is wedded to my own perception of my attractiveness. How comfortable I feel in my own skin and the level of acceptance I have of my own reflection in the mirror. (I’m not saying this is necessarily a good thing, just a true one!)

Well feeling attractive is a certainly challenging here. My pride and joy – normally fairly blemish free skin- is covered in a gritty permafilm of sun-cream, sweat, insect repellent and dirt, overlaying the polkadot effect of insect bites. The daily dress code is baggy MSF t-shirt and combat trousers, with a stethoscope sticking out of one pocket and a VHF radio sticking out of the other (by day and more of the same but add in a fetching socks and sandals combo by night). My normally decent posture is wilting in the 35-40 degree heat and my hair… actually, probably best not to get me started on the state of my poor hair. I can’t cook sumptuous meals for my friends like I did in my home – and I do love being a hostess. I’m not a parent – so my maternal drive is as of yet somewhat latent. And there’s scant chance for salsa dancing out here which always made me feel wonderful and gorgeous at home!

In a small bid for frivolity I have bought my favourite nail varnish out here with me and am foolishly pleased with the daily effect of shiny red toenails peeking out from my grubby hiking sandals – but that is about as girlie as I’m able to get. And frivolous it may be, but it puts me a little in mind of a story that I’ve heard from the second world war when the Bergen-Belsen concentration camp was liberated in 1945. This story is taken and paraphrased from the diary of of Lieutenant Colonel Mervin Willett Gonin who was part of the army medical relief crew first on scene. There he relates how in the midst of an overwhelmingly desperate need for food and medical supplies for the Jewish inmates who were dying in droves from starvation, neglect and a multitude of diseases, an unexpected and unordered crate of red lipstick arrived. This lipstick transformed the wretched lives of the internees in an unprecedented way – emaciated women still lay clad in rags lay on the floor the same as before, but with bright scarlet lips; the corpse of one woman was even found with a lipstick still clutched in her hands. After years of being treated worse than animals the lipstick gave them back their interest in their humanity – their femininity – and thus in their lives in a way that no amount of food or medical care ever could have.

It’s an extraordinary story, but one that in some small way is played out all around if you look close enough. The Nuer women here may be poor, desperately so by our standards, but their hair is gorgeously and meticulously braided and styled, no matter how simple or threadbare their clothing may be. Here though, femininity rests on far more than attractiveness – it also rests on your fertility. I’ve said in a previous posting that child bearing here begins young , often at 17 or before.

There is one particularly heart-breaking case on my mind at present – that of a very young woman in our ICU who came some days ago in severely obstructed labour – we’re talking days and days of failure to deliver here. Eventually her uterus ruptured necessitating in an emergency hysterectomy during the Cesarean. The baby sadly, was long dead. The girl – and she is barely more than a girl – has stormy recovery ahead of her following major surgery and sepsis resulting from the dead child inside her, but if she recovers then in her culture her value is near nil as a barren woman. I was sat by her for a while during my on call this week, prescribing fluids and trying to bring her raging fever down with cold compresses on her beautifully braided head. At the moment she is blessedly unconscious. She doesn’t yet know the outcome of her surgery and the profound and irreversible impact this will have on her future if she survives. But it somewhat put my struggles with maintaining a sense of femininity into perspective.

So maybe part of my femininity is going to diminish for a time here. But I think that is something I can live with – just as long as I have red toenails.