msf’d

i am, and that’s the way it is.

last saturday night, we stood in a puddle around stacked soda crates, a goat sizzling over coals beside us, when the three, buzzed-out speakers in the canteen started to play this song and the same dozen cast of characters that i share my hospital days and compound nights with drifted to the tent, and danced, grinning, mud between their bare toes.

soon, it was only me and one of the departing three for whom the party was held leaning on the red cubes of coca-cola, and we agreed that there was no club in new york city that was better than this one, none where you could dance so sincerely, freed completely from the fear that there might be another, better way to spend your time.

this afternoon, i tried to walk from my outpatient clinic to the ward, and was stopped every three yards by a somali woman who pointed at the baby on her hip before detailing an illness in a language i could’t understand. one of the nurses smiled as he walked by. you’re going to miss being so famous when you leave, he said. i will.

so i nodded my head to the beat of a mother’s wagging finger, and over her shoulder saw the familiar eyes of a woman from the TFC’s (therapeutic feeding center) perilous first bed. i looked into them each morning as she asked me, wordlessly, to do something more, anything. he’s dying, she would say. i know, i know. patience. he’ll make it, i said, only half believing.

now she was moving through the gate’s swinging door, a box with a month’s worth of cups and shawls and mats and plates under her arm. behind, an older daughter carried her happy young brother, newly discharged. his mother and i looked at each other, as we had each day for a month. this time she raised her hand in the air, shook it as she walked past. though i will never be on the field for a goal that 60 000 fans will cheer, there’s no way it could sound any sweeter than the beads did clacking on her wrist.

the credit, of course, was hers and the trip she made back and forth to the jug of ORS so she could pour water in as fast as it poured out, the nurses who took over when she was too tired, the people who gave us money for the tin cup she used. but it is these moments that are so remarkable, that they keep us coming back, are worth all the sleeplessness and latrine running, daydreams of drooping faces, the awkwardness of a home that fits you less well than it did before you left because we get to be witness to the concentrated effect of the human spirit’s brightest part; intention manifested.

i remember once, months and a lifetime ago i watched a lizard track a moth up a wall. as she fluttered from one face to another, the lizard leaped, flew, narrowly missed, and the bug bumped back to the burning light. in that instant, i saw how lizards became birds. not by trying to grow feathers, and not by imagining what it would be like to fly, but by wanting that moth in their mouth so sincerely. the wings come later, but they fit perfectly.

you become what you pay attention to. and what that is, there are no rules, only possibilities. we’re all making it up what a human being is as we go along, moment to moment, and if you’re not deciding, someone is. in that understanding is a scary freedom and the world’s real magic, that as the universe manifests perpetual change, it does it, at least in part, through our imaginations.

intention made manifest. for me, some of it is self evident. msf is the world’s largest medical NGO and despite a teetering financial system around the world where even the most confident economist admits she doesn’t know what’s going on, its budget is the largest in its history, made up almost entirely by contributions of individuals around the world who give a few dollars each towards the idea that reducing suffering, even by a little bit, lightens the weight on us all.

with that money, we mark on maps military movements, to decide if we can get close enough to strike, not with weapons, but with a hospital large enough to accommodate the wounded from both sides, the hundreds of civilians who are drawn screaming into today’s modern version of war. with it, we sit like i did the other day, with a group of new arrivals who walked for kilometres through the desert heat to give up their freedom in dagahaley because it was better here, in this place where camels drop, than where they came from. among them, was a young mother who had delivered just the day before, on the road, a tiny baby, invisible under scarf. it wasn’t until she pulled it aside that i saw him, fragile and new, clinging to her breast. we said to her, we’ll take you to the hospital to rest, and we’ll find room for your husband too, and tomorrow we’ll help you work on tents and food, don’t fear, we’re here, you’re safe. it’s not near as sweet as kissing away the tears of someone you love, but it’s about as close as strangers can get, and if there’s any hope to be had in the world, it is in this direction.

like any optimist would, i deny the aspersion, citing realism. either way, i think we’re slowly winning, and if you’re not convinced, talk to your grandpa who lost two brothers to measles and one in the war, then take a walk down your quiet city street. but as you do, and the thousand dollar computer in your pocket shuffles songs, remember that there are still places where tin cups matter. it starts outside this door, the one with the curtain billowing in the sandy wind, and it reaches to the curb you’re stepping off of.

the work is never perfect, only better. but we try, sincerely, and one day, maybe, wings that fit. should you want to be msf’d, or its equivalent, i’ll write more about how you can make happen in another post. if you want to know why, it’s because we’re gonna win and we have the best parties. so if you’ve got the fire, and the tools, we’ll take you lost, we’ll take you found, we’ll take you running as long as that is how you hit the ground, and it’s in the direction we seem to be going, because there’s still so so many more miles.

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rain

early last week, our logistician returned to the mission. he said that on his drive to dagahaley, he passed a truck, stuck, sunk, people pushing to and fro, while its wheels spit sand. he and the driver stopped to help, and as they were, a herd of camels passed. from it, one slumped to the ground, its hump sagging, starved for water. the owner beat it with a branch, but it wouldn’t get up.

most times, people arrive here from somalia with nothing. either it is what they started with, or all that is left when they get to this place where camels can die. with time, they get a tent, and some food, a plastic jug. in the new arrivals area, yellow and red plastic canisters snake in a cue a hundred long as people wait for water. tonight, though, there’s no waiting. it’s everywhere.

the sky is dark, and it hammers so hard on the tin that it drowns the sound from my small speakers. i’ve tethered my curtains to my window’s iron bars, but still, as they billow, drops fly in to\ speckle my screen. i’ve moved closer to the door.

this is the second rain this week and the second this year. the other evening was like this one. from a near clear sky, a sandstorm, dust in your eyes, your mouth, then a sweet smell, like fog, and a cloud crashed down. still, the next day, there were no puddles as proof, just dime sized dimples in the dust.

tomorrow i think there will be, though. the rain lashes. before i ran here, to my concrete room to check on my electric things, a nurse and i stood in the mess, marvelling at the sheets of water and bright flashes of lightning. as we did, a metal sink, sunk in the middle of our yard, wobbled, its edge trembled, lifted, then caught by the wind, creaked over at the faucet. i’m sure we shared the same thought of tents turning end over end, children huddled in the mud.

i’ve raised the hospital on the radio. we’re checking on the feeding centre tents. could be my fault if it’s full of water. today i lifted the flaps so that the breeze would flow through, and fewer families would scatter through the hot yard. from drought to flood. so little middle ground.

the feeding centre is packed. yesterday i discharged three, admitted thirteen. in today’s morning meeting, a nurse confessed he was having trouble keeping track of how many patients there were, packed in the ward, the tents, in the old radio room, underneath trees. we guessed fifty, then walked through them all, counting children, marking their foot with a pen. fifty two. maybe sixty by tomorrow.

the rain’s stopped. it’s just like that, isn’t it?

outside my door, puddles shine. i wonder if tomorrow the water truck will be spinning, up to its axles in mud and the people who were, just minutes ago, watching the edges of their tent tremble and lift, will be under a tree, hands on their brow, until they can’t leave their kids alone anymore at home and decide instead to gather some of whats on the ground like anyone would and if that happens, and their children fall sick and fatten further our feeding centre, how tricky it’s going to be to keep track of so many. this time with water, the world answers: be careful what you wish for because you might just get it.

it is just past dusk. the bugs are out, already partying. they’re fast that way. people are splashing their way towards the mess. i’m going to join them. blessblessbless. more soon.

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the great battle

hey.  tomorrow night?  movie night?” someone asked.

”why not,” the surgeon answered, reclined on a mattress we’ve leaned up against a wall below the razor wire. “i’ve got nothing else on.”

”i can’t.  i’ve got tickets to a concert,” our nurse said. “i’ll try to come after.”

we laughed, then more at the laughter.

”yeah, tomorrow i can’t either.  i’m having a dinner party.”

”i’m playing someone above me on the squash ladder.”

“swimming lessons.”

”ice capades.”

we faded to smiles, our shadows cast perfectly on the cement behind us by the harsh security light.

it is not easy to write about this place.  it is not for a lack of opportunity, for after the work is done, hours of curfew yawn.  it’s not a matter of material; so many stories bear repeating. i struggle because of the sudden, severe beauty that passes so quickly in front of me, words won’t do it. you’d have to follow me through the hot yard where people perch under trees, their children beside them on mats, and we’d pass a boy, his striped shirt stretched over an abdomen so swollen by his liver that he looks like a bumblebee, his mother dabbing blood from his nose as he patiently tries on a rubber glove we gave him, and then he sees us, and with a wide smile, he claps, begging for us to blow more bubbles. Next to him, an older sister and we start at her, feint a grab, and she screams and runs behind the tree where she peeks out smiling fist from one side, then the other.  A cleaner comes over, takes off his hat, extends a long arm, wishes us a good morning in the only English he knows, and we’re not even halfway to the lab.

a tough morning report today.  An infant who I saw before I left last night, seizing and febrile, coughing for days before the mother had the courage to come to hospital, died this morning gasping in twitches.  On his heels, a 3 year old girl arrived  after a week of diarrhea to have her heart stop on the hard wooden bench outside the emergency.

In Europe, is it the same as it is here, the nurse asked? Some things, yes, i said.  Fevers, coughing.  But a child dying of diarrhea, he said? No, no. Never.

I wonder what seeps into our subconscious as we move throughout our days, what dramas work there as we look for something certain in a world that can seem careless.  does it play out in our dreams, or how we live our days? is it what makes home fit so poorly once i get there?  I listened once to a psychologist who supported the notion that we live trying to answer questions we asked ourselves when we were infants, before we could form them into words.   as someone once said, be kind to everyone you meet, for he too is fighting a great battle.  even if its deep underneath.

no word on the girl who i gave my rhinoceros to, and hers.  i was in nairobi last weekend, and tried to find her.  i called the national hospital.  who?  they asked.  a girl.   from dadaab.  she came on wednesday.  i gave her name.  i stayed on hold for almost half an hour, and finally hung up, visions of teeming wards and a weary nurse reading through stacks of paper charts that dropped from the desk.  i’ll find out.  she has my rhino, after all.

though i could do it more, i find that in medicine, like in life, its usually best to let yourself go, to hope deeply, even if it means the pain of it being dashed.  to release, as much as you can, the tiny elastics those pains have placed around your heart because if you don’t, you can forget what its there for, and with that, what we’re here for, this short time on a rock spinning wild and green around one of a trillion trillion stars.

this work is good exercise. you’re asked to give as much to the 35th patient as the first, pull out the elephant (i bought another in nairobi) with the same shock of amazement as the bed before, counsel the mother as gently, so that she can spread the word, and next time she passes a child feverish on another woman’s back, she might give directions to this place.

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news

i’ve been away.  it was a place much like dagahaley.  the difference was, when i tired of the heat, or the sand, i would wade into water near as clear as air, and swim between schools of skipping fish that pattered its surface like rain.

no rain here. before i left, i would ask the old men when.  “soon,  soon,” they would say. now, they shrug. perhaps another two years.

and still they come.

i returned yesterday, after two days of driving.  as we drew closer, i saw green fade to brown, women’s faces framed behind bright beautiful scarves and soon, we were swerving on sloping sand, fishtailing in the dust.  camels loped behind burnt trees, and between these, miles from each other, houses of rounded sticks. an impala stepped from the brush, sleek as glass. a young boy, six, waved an empty plastic bottle at us, and we stopped to give him all the full ones he could carry.  they fell from underneath his arms as he tried to juggle more, and landed in the dust at his feet.  he grinned, his tongue bright between missing front teeth.

and then i was home.  here.  and when i saw people, they were glad to see me.  glad!  and me to see them.  perhaps that is what makes a home, a place in which you can find your love reflected back.

this morning, i did my daily march down rows of the sick and stick thin, and then to the tents which we’ve pitched to house them because still they come, and i wonder whether this is news anymore, if news needs to be new, or at least heard for it to qualify.  i went back after lunch, and the nurse said to me, quietly, “that boy passed”, the one i spent the morning with convincing his mother to stay, that his best chance was here under our careful watch.

on the day before i left, i took my prized dagahaley possession, a plastic rhinoceros, one that i use to buy the favor of suspicious three year olds, one that replaced the toy elephant that marched off when i left it on the desk and turned my back, the one that children look at, spellbound, having seen neither a rhinoceros nor a plastic toy and which their parents hold up and examine in equal amazement, i gave my remaining rhino to a 12 year old girl who, when i left, was dying of sepsis, and told her about the real animal, how big it was, and strong, and that this one would reminder her of that, and asked her if she would hold it for me until i returned.  she would.

she did. well, her father gave it to me this morning.  she lived, though barely.  she is unconscious now, hasn’t eaten for days.  i arranged for her to travel to nairobi, should there be a chance for better care or x-rays or blood tests or one thing that might be everything, as they pulled away from the hospital this afternoon, i handed it back through the window. i feel foolish now, she’s a bit old for toys, but i could think of nothing more to give, and i wanted to give everything and sometimes its like that.

so that’s the news.  there’s so much more, but i don’t know where to start, or if i did, how i would ever finish.

it’s the end of the day now.  9 pm, the dagahaley midnight.  i’ve poured water on my cement floor, so that it might cool.  an evening wind, like clockwork, has picked up, and is picking up the grass from my roof.  i’ll read some, and go to bed soon.  i’ll lie there, until the day unclenches itself, and i fall into the dust of the next one.

see you there.

this song just shuffled on.  lullabye.

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All along the water tower

so little water.  it hasn’t rained here for two years.  we get ours from boreholes dug deep in the dirt, metres down where hidden lakes hover between layers of clay.  we bring them to the top, hold them in tanks, high in the air and let them fall, chlorinated, into our cups, onto our hot backs.  one of the tanks is down so that its platform might be rustproofed, and last evening, at dusk, i climbed it and  watched wind whip dust into tight swirling dervishes until there were ten at one time, scattered and spinning across the horizon.

i sat there, smoking, and thinking about smoking, watching my breath trail away with the wind. i had started by having a cigarette only on saturdays. wednesdays and saturdays. and since fridays were pretty much little saturday, those too. now, at the end of each day, i buy one “sportsman” cigarette from the canteen, climb the steel ladder, dangle my legs through the aluminum bars, and gape at the wide outside beyond our barbed walls.

children play football, their kicking scrum disappears in a cloud of sand until the ball emerges with a pock, and the players race after it, their footstrikes smoking on the flat ground. in the trees, their bright clothes hang on branches, swatches of color caught in a sharp needled net.

beyond, camels amble through the barren trees, bend their long knees to take a single leaf that the other may have missed. goats move past, sweeping the ground for the same mistake, moving in mass past our gate, a bleating army, the cloud of dust settling with their trailing yells.

a car in the distance bumps between trees and past donkey carts, filled to bursting with lucky passengers, destination unknown. above, a sliver of a moon, and near it, a glinting planet, hundreds of thousand kilometers distant. the wind reaches me, finally, and the red of my cigarette glares harshly.

pling…..pling…..pling.  someone on the steel ladder.

a hand, then a head, then a hope-you-weren’t-looking-for-some-quiet-time, look. of course not, come on up. the more the merrier.

the thing about the deep desert heat is the true pleasure you take from the laziest breeze, a tingle of delight spreading from the hairs on your arm to the nape of your neck. such full experience of things that might otherwise be ignored when your familiar register is taken away. the slightest wind, a piece of orange, or 30 seconds of quiet, watching the world.

soon, there are seven of us, starfished on our backs, watching the stars blink into black patches of sky. someone brings up a tray of cheese left behind by some journalists, another some chocolate. we talk, and smoke, and wonder what to say next that is not about work when here, that is all there is.

I wrote this for my parents who said that I should spend some time describing for young doctors what life is like here. it is like that. you find ways to get through, and even though they might not seem particularly special at the time, they are, and they keep you coming back.

the rest are details (room four metres by four metres on whose walls I’ve drawn pictures of birds, more than a hundred people in similar rooms, some sharing, it’s never quiet, food’s made for you, camel every dinner, breakfast always thin pancakes and fried dough, your clothes are washed and dry in the sun, squat latrines, shared showers, radios crackle all over the compound, and you live for your work, and outside of your room, you never get a moment of privacy except, sometimes for those 30 seconds, watching the wind whip the earth into spiral shapes all along the water tower).

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