Thank you

Hi, Kate here.

I’m a nurse, just returning from seven months in Mattar, Ethiopia, working as the Outreach Nurse Manager.

I worked on a mobile clinic, servicing the Nuer people, a displaced and vulnerable population living and moving along the border of Ethiopia and South Sudan. Our primary targets were under-fives, antenatal care and emergencies.

The people we were treating suffered from a variety of conditions such as malnutrition, malaria, TB, HIV, leprosy, sexually-transmitted infections, pre and post-natal complications, gun shots, stabbings, burns and trauma.

Firstly, I Just wanted to say a big thank you to all our donors and supporters of MSF.

After returning from the field I was blown away by all the messages left on my blog. Having no internet access and only a very expensive satellite phone, news from home was few and far between and obviously checking out the blog was all but impossible.

But, now I’m back, I wanted to tell you that while in the field the Head of Communications, Yann, sent us an email with two pages of blog comments. You have no idea how those little messages brightened our day and gave us the lift we needed to continue our work. Just knowing someone actually cared about what we were doing and appreciated our dedication to our work was a Godsend.

Conditions in Mattar were tough and very basic. I lived in a tukul made of sticks, mud and cow dung with a grass roof. We had long-drop dunnies and cold water showers. Generated power ran from 8 am to 7.30 pm.

Temperatures were in the high 40s when I arrived and after the wet season they were back in the low 40s when I left.

Food wasn’t too crash hot as no vegetables or fruit were available in Mattar and we relied upon food being brought in from Gambella, five hours away. For the last six weeks of my mission we were cut off due to flooding so, apart from the occasional fish caught in the river or very tough goat, it was pasta or rice and tomato sauce for lunch and dinner daily. (Actually, at my medical check-up last week, I was told I have a vitamin deficiency so I now know I’d better pack some multi-vitamins for the next trip!)

Anyway, it really is a privilege to work for MSF, an NGO whose ideals are so close to my heart. I worked very long and very hard to enable myself to be able to work for them, and the work I actually got to do, was everything I’d hoped for and more.

It’s challenging, physically and mentally tough, emotionally draining and at times dangerous, but all in all it really is a great experience that will push you to your boundaries and show you what you’re made of.

For the lucky ones, we saved their lives, for those not so lucky, at least we showed them someone cared. So again, thank you for your support, your donations and your care. Your kindness and generosity means as much to us working in the field as it does to those who benefit from our work. Thanks again and Bless your cotton socks!

Cheers,

Kate

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Coming home

For me, coming home was a bucket filled with mixed emotions. For one, I was sad and sorry to leave the people – the kids especially – not knowing what the future holds for them. The land was still flooded, malaria rife and they’d missed the ‘small harvest’ that comes before the hunger gap. Not a promising outlook with a ‘world food shortage’ looming and still no replacement in sight.

On the other hand I was very relieved to be getting out of Ethiopia, and also Kenya. I got robbed of my few remaining possessions – my cameras, computer with all my work, my money, etc – in Nairobi, just before leaving.

This really left me with a bitter resentment as I felt I’d already given all I possibly could – physically, mentally and emotionally – and had all but managed to escape with my few remaining possessions despite being constantly asked for them by staff in a frenzied attempt at getting everything possible from me before I left.

But in the end, it was just taken anyway.

Heading home via Paris to debrief and handover, I fell into the arms of two of my beautiful friends from my last mission in Sri Lanka. They both eased me back into the normalities of bright lights, traffic, flushing toilets, hot water, fresh food and world affairs.

They allowed me the time to stand and gaze open mouthed like a goldfish in a bowl at the vibrant coloured abundance of fresh fruit and vegies at a local market. They took me home and cooked me my choice of chicken and vegies for my first home-cooked meal in seven months. It was nice to be with friends who understood where I was at. Bless their cotton socks!

I then flew back to Sydney, spent a few days with my son and had my final MSF debriefs, before flying to Melbourne and then taking the five-hour drive back to Strathdownie, a farm near the border of South Australia and Victoria where more of my blessed friends have allowed me to stay in their shearers hut.

While extremely lucky to have a free place to live in between work, mission, or whatever comes next, I found being alone on the tranquilty of the farm was not such a great place to be when I was left alone with my own thoughts. It’s crazy, very difficult to find the right balance between rest and relaxation and the effects that result.

I learnt after my first experience to be prepared for the hyper-stimulation that crowds, supermarkets and shopping centres bring. After returning from Sri Lanka, I was awaiting debrief in Sydney and excited about the prospects of shopping for some of the foods I’d missed such as wine, cheese and chocolate.

I found, however, the bright lights and constant rumbling noise of the shopping centre too overwhelming. I quickly found myself back out in the street, sitting with a drunk aboriginal lady! (This time it was an old fellow living on the street, feeding the birds with stale bread.)

After a good talking to (from myself) I did return and purchased what I wanted, although it was an anxious, rush of a shop. This continued for some six weeks before a sense of normality resumed. (Guess I still have two weeks to go.)

Unfortunately this time my return was in time for the Christmas rush. The hustle and bustle of Christmas shoppers, combined with the voiced concerns of friends discussing what to buy who, who’s making what, and the endless preparation, hype and stress of the ever looming ‘big day’ was quite frustrating.

I found myself wanting to scream: “For god’s sake who cares, just buy them a goat or a chicken through Oxfam, how about the gift of sight from the Fred Hollows Foundation, who cares, they DON’T NEED ANYTHING!” But of course I did no such thing, I just let these thoughts and feelings stew away like acid in a plastic bottle, and then soon after, washed them down with an ice cold glass of the inevitable guilt that followed. Fancy thinking such things of my dear precious ‘normal’ friends.

This time I’ve returned even more anal about wasting food, water, etc. I have literally felt physically sick at the waste. There really is enough of everything to go around. I know it’s the Christmas season and everything is in excess and all, but honestly the wastage is truly disgusting.

I can still see those hollowed-out, little man faces of the malnourished kids, feel the grip on my necklace of the little life clutching to life itself, feel the feather weight limpness of the emaciated child left too long, the urgent tugging and tapping of the mother looking for hope. It’s haunting, and revisits me, welling in ebs and rises, accentuated when I witness the needless waste.

After all it really all just comes down to where you are born, the opportunities and availabilities afforded to you, by the place you are born in.

And yes, I know it was “my choice to go there, to live and work with those people.” Honestly, I don’t need to be told that, I know, but it really is difficult watching the dogs or chooks here getting fed enough to feed a family of seven for a week in oneday’s waste, when you’ve seen the other end of the spectrum.

Coming home after mission can also be a time of trepidation, worry and insecurity. For some of us, while relieved and happy to be getting out of a difficult situation that has been your life for the past six or seven months, returning home can be just as stressful, if not more than actually staying on mission. Unsure of what the future holds between now and the next call-up and dealing with alien thoughts and feelings that make you feel guilty and make you question yourself to who you really are; and to where in this world you actually fit.

Also, the stress and guilt resulting from having to rely on friends or family to share their home and possessions, because you gave up all your belongings and security in order to work for a humanitarian organisation such as MSF, is not uncommon. And has been reiterated in many expats I’ve talked to.

How you feel about coming home also depends on how you left your mission. If the population you were caring for are safe, if your work will continue, if you made a difference and if you can rest assured that the people you have grown to care for will continue to receive the assistance they need, it balances out. If you left in unsettled circumstances, unsure of the security of the population, tasks unfinished and without a replacement to see them through, it’s tough. It leaves you to wonder ‘what was the point?’ and ‘why did I bother?’. Have we done more damage by giving hope and then taking it away, than by not offering hope in the first place?

So here I am, a month has gone by after returning home. I’m still stuck between not wanting to be left alone too long and being with the people I love. Yes it’s a fine line, I’m working through it one day at a time. And by past experience I know I will soon mould back into this land of abundance, of wealth and security. I’ll stop thinking badly of the actions of those closest to me and the guilt that follows.

If I only knew what was next for me – work somewhere here in Australia (I sure could use some money) or another MSF mission – it would help. I am still totally committed and passionate about the cause and what we do, but can’t live off my friends for much longer. Anyway, that’s the way the cookie crumbles, I’ll just have to wait and see what the New Year brings.

Thanks for listening, I hope to blog again sometime in the future,

I hope 2013 is a good one for you.

Cheers,

Kate

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The final Sunday

Well it’s Sunday again, the last Sunday of my mission in Mattar. I’m leaving directly after the Pul-deng clinic tomorrow. The road is nearly fixed and we should be just about able to do a kiss movement.

I have mixed feelings about leaving. I’m concerned what will happen to the people out in the Never Never. In the last two weeks we have only been able to attend two clinics due to flooding, and of course the continued saga of the boat motor.

I’m concerned about the security issues and leaving the team alone. I’m concerned there is no handover and the clinics won’t ever get back to what they were. I feel sad to be leaving with so much unfinished business, when we were once running so well. I’m concerned the people who trusted and benefited from us, will now be forgotten.

I’m concerned that the selling off of land to foreign investors will force these people to seek other land to feed their precious cattle, that they will in turn be forced to fight for territorries, as they are pushed from their known pastures onto an ever-shrinking landscape.

For those of the Ethiopian/South Sudan Border, the sick, injured and displaced, those, the most vulnerable, those who have been abandoned, to you I am truly sorry.

On the other hand, I am totally spent. Sitting around the compound waiting to work, waiting for the boat motor to arrive, waiting for the floods to subside, waiting for the road to be passable, waiting for word about my replacement, waiting, just waiting, like a bear in a den awaiting the thawing of spring, has taken its toll on my spirit.

As my time here draws to a close, the staff have begun with “I need your hat, I need your watch, I need your shoes”, I feel like I’m on the ground dying, with the vultures circling over head, waiting, just waiting for my final breath before they swoop down to pick my bones clean.

The moral is at an all-time low, the silence around the dinner table is deafening.

Malaria is still rife, children are dying and all I can think of is those we have left, unreachable, without word, without help, without hope.

So it is with a heavy heart, that I farewell the people of Mattar, Moun, South Sudan, Ninenyang, Nib Nib, Jikow, Nyawech, Itang and Pul-deng.

The people of the crocodile, python and animal ancestors. The people who live for their cattle. The place where the sunrises in the same vibrant orange, pink and purple, as the sunset; where the beautiful children work from the time they can walk; where life is hard and death comes easy; where the river rises or falls by feet in a single day; where fish are so plentiful they are literally jumping out of the water; where crops can go from planting to harvest in a mere two months. But also a land where the ground turns from vibrant richness to nothing but dust in a matter of weeks.

I say goodbye to the people and the place that I’ve called home for the past six months. In reality I feel like I’ve been here at least three years.

I’m unsure of what awaits me, of where I’m going or what I’ll do, but I do know you can tell where I’ve been. I can see it in the gleaming eyes of the people, the exaggerated, shoulder pumping hugs, the extended hand-holds, the waves and vibrant smiling faces of the kids.

In every site, in every clinic, people refer to me as “my mother”, even the elders. They call for me by my Nuer name, Nyabouy, and in the last few days, this has broken my heart. My tears shocking them into shoulder pumping frenzies of “sorry sorry sorry”.

I know the time here has changed me, hardened me, numbed me, taught me to say NO. No I can’t give you, no I can’t help you, no I can’t take you, no, there’s nothing more I can do.

I have seen many many things, and learnt so much. I’ve worked as a logistician, precariously maneuvering my team through the ever changing landscape in order to reach the unreachable. I have worked as a doctor, consulted, assessed, tested, treated and prescribed for TB, Tetanus, HIV, leprosy, malaria, malnutrition, leishmaniasis, Kala-azar and a variety of tropical diseases. I have sutured, expelled, packed, realigned, cleaned and dressed, injuries resulting from gun shots, spearing’s, stick blows and the continuous wounds caused by clan fighting.

I have delivered and I have buried. I’ve seen life and death from Darwin’s perspective, had my spirit broken and my dreams crushed.

But despite all the trials and tribulations, I have seen great beauty, in the landscape, in the people and in the precious children.

I have been blessed, to be allowed this opportunity, to learn, to teach and to share my life with these people. The ones the world’s forgotten. For them my passion remains strong. I only wish for them, the peace, justice, and equality, that we all as one deserve.

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Natural hazards

Well it’s Sunday again and another week has passed. We are still cut off but the water is reducing fairly rapidly. We are able to do a kiss to Gambella but have to walk an hour or so through the water so we can’t send any patients or kids.

I had to give up Latte this week as the pressure and threats from Woreda have been so intense we can’t give them any reason to pick on us. It was really sad as like I said previously, he wouldn’t eat for anyone and followed me around like a dog. He was a good friend, but he’s gone to one of our nurses, and has the company of goats. Apparently he’s OK and eating, but they wouldn’t tell me if he wasn’t anyway. Funny how a little thing like him could make such a big difference to life but he did.

Yesterday I was sitting outside talking to our American nurse as she got her hair platted when she gasped “snake”. About six foot away was a (small ?) three-foot-long greenish viper heading for the pharmacy. Without much thought I picked up a big rock, threw it and got it! Crushed him in half! Quite exhilarating actually, I felt like a true Nuer woman. The people here are deadly with a rock at 20 paces! Even the kids use pebbles and sticks to herd their cattle, goats and sheep in the direction they want them to travel in. So yes, even the guards were impressed!

One of the nurses had found two snakes under her mattresses early in the morning, and was so shaken she couldn’t work. She just kept crying, poor girl. That was in the staff compound across the way from us, but they are averaging two to five a week with plenty in the health center too. We also average five snake bites a week out in the clinics. Mostly vipers as the mambas, puff adders and cobras don’t make it that far.

The day before yesterday, “snake” was yelled just at our back door in the washing-up area. There was a five-foot black, shiny snake. It had its head up, tongue flicking as it smelt the air for prey or whatever. It had bright yellow bands on its throat and when the guard came running, stick in hand, he took one look, cried “ah very dangerous” and backed off. Anyway after a time it slithered around our pots and pans and finally disappeared into the pipe that catches the water from the sink (very basic plumbing) so I poured some boiling water down there, with the help of the kettle on the end of a broom stick! So I don’t actually know if we got it or what as the pipe goes out to the river.

Since then the logistician has sealed the pipe with netting so it won’t be coming back in that way at least. If I had the internet I’d Google it, maybe it was a mamba, but won’t know till I reach the other world. All the locals say it’s “fatal” but they would only have a Nuer name for it.

The local authorities came and asked us for help the other day. Apparently there is a “huge snake” that is living in a hole by the cattle selling tree. They say at night it climbs up the tree and makes a noise like a goat! We asked what they want us to do with it, we are medical not pest control!  Don’t know why they don’t just shoot it, but anyway I’d like to see it. Must be a buffalo eating python, to be that big and make a bleating noise of a goat! Guess it’s calling out its prey! But as it’s near their precious cattle, it is a problem!

The river is still only 15cm from the top of the bank but I think it’s peaked. It’s practically clear now and you can see at least a few feet down. The fish are prolific! Last night I was sitting in the boat watching thousands of tiger fish swarming in the water like piranhas on a picnic. I think they may also have the same result of piranhas if you fell in, judging by their teeth, but these were only baby’s between 10- 30 cm long, red tails flashing, water literally bubbling in their frenzy.

Last Monday when we went to Pul-deng, we were driving in the middle of nowhere and there right in the middle of the road was a fish, maybe 10 pound! We stopped and picked it up. One of the health education workers had to throw it on the ground to stop its powerful flapping before bring it along for a midday meal at the clinic! It was in a very small puddle so I don’t know if it was dropped by an eagle or just flapped its way from the flooded side of the road??? Amazing, the staff took it as a gift from God. I said I hope he throws down some spuds and carrots too!

Speaking of which, we finally got some supplies from Gambella, not much but there were tomatoes and LETTUCE! Woohhhhoooo, it was so good. We’ve been back on the rice and pasta with tomato sauce for a while now as no supplies could get through.

The weather has been gradually heating back up and is in the 40s most days, cools down a little as the sun goes down and then for some crazy unexplained reason, heats back up about 7-8pm and that makes for a difficult night’s sleep!  With the heat or at least the lack of rain, comes the bugs! Furious, frenzied, stupendously-swarming bugs: locusts, crickets, cockroaches, flying lice and tick-like bugs. Biting, stinging, sucking, making the daily activities such as eating a meal, taking a shower or going to the loo a hazard!

We have removed a light bulb in the dining room but still all retreat to our rooms within an hour or so of meeting for dinner as the dreaded bugs creep into your clothes, hair, drink and food, making it impossible to stay sane and remove them from within your clothes with any sense of decorum! Very inappropriate for the dinner table!

In the morning there is literally a carpet of bugs, several centimeters thick, covering the table, the ground, everything, especially around a light source. They smell like rotting fish! The birds and frogs in their thousands however are having a ball! But even they can’t make a dent in the numbers!

The spiders are growing at an alarming rate and I’m not sure how but we all seem to be getting bites while in bed under the mosquito net. Before going to bed, I strip off, rub myself with a towel to get the bugs off, brush my hair and then dive in under the net, but still a few manage to get in! I have a new hole in my tukul, looks like a snake hole but it’s pretty big. It’s got a piece of wood jammed in there to block it so I hope it’s a good deterrent!

 

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Sweet Latte

Amongst all my recent frustrations I do have one shining light that comes in the form of a baby antelope called Latte. He came to us a couple of weeks ago. A lady turned up at the compound with him saying the mother ran off leaving him. I’d had a very bad night the night before and had not slept. I’d been up since 4am and was in desperate need of coffee. So in the middle of the night I battled the bugs zooming into my headlamp while I searched the store room for the blessed black beans, alas, to no avail. By 8am I finally asked the logistician and discovered we were out! Not surprising!

Anyway, this little fellow arrived and lifting our spirits was named Latte. We discussed it, and thinking I could let him go in Gambella national park in a day or two, bought him for 200 birr ($10). As it was he really must have been only a day or two old as he had no teeth and so is still with us today.

He is truly beautiful and brings a lot of joy to everyone who sees him. He’s about two-foot-high, a red brown body with black and cream legs and ears. I started by feeding him some powdered milk three times a day, which he took to, drinking from a bowl immediately.

Latte the antelope

Latte the antelope © Kate Chapman

 

He sleeps in the old chook house safely locked away from the genet and wild dogs. During the day he is often found sleeping in my tukul! When I go to the toilet, he waits at the step, when I have a shower he sits at the door. He really is attached only to me which is a problem as when I’m out on the clinic, he won’t drink from anyone else! When I got back from Ninenyang at 6pm, he greeted me bleating madly, flanks sunken and dry as a chip. The team told me they had tried to feed him but he refused!

Yesterday when I was seeking some solitude, I climbed in the boat, which is my favorite spot. Latte was running back and forth on the dock, next thing he leapt into the boat, back legs getting caught on the side, dangling precariously half in, half out! Crazy!

Each day I walk over to the Health Centre and he follows closely, no lead, just the clip-clop of his two pronged hoofs following closely. All the kids come running, adults too, for a quick pat and glimpse of the white lady and her antelope. The patients, caretakers and staff all love him and are happy to see him and he brightens their day too. So I’ve been looking for someone to take him for over a week as we have no grass in the compound and he really needs to be with other animals, although the goats are afraid of him. The problem is that both domestic and wild dogs will kill him. Nearly everyone who has goats has a dog to protect them. But he is eating grass now and has a few little teeth coming so I hope to find him a new home soon. Not that I want him to go but MSF can’t be seen to be keeping wild animals!

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Frustrations

Well it’s Sunday again, another long week without much progress. We are still stuck, flooded in, unable to move via car or boat. Logistics has been unable to organize a cargo boat for supplies so we are running very low or are out altogether of many things like oxygen, therapeutic food, blood glucose test…. with no idea when we will get anything.

I think the river has peaked. It’s about 15cm from the top of the bank, that’s 15 cm away from flooding the compound so I hope that’s as high as it goes. Apparently the water on the road is reducing and tomorrow our field coordinator will attempt to get to Gambella to meet the Head of Mission. There’s a section of road that the car can’t get to so they will attempt a “kiss”: our car goes as far as it can and a car from Gambella does the same, and then you walk the difference – takes about an hour – to meet on the other side. Apart from this attempt, there’s not much else to do as we are forbidden to go on a cargo boat and any motor that would allow us to use our boat still hasn’t been fixed, replaced or hired. The mobile clinic is most likely finished in Jikow and Moun as we can’t get there without a boat. We will try to reach Pul-deng again tomorrow.

On Thursday we held a sort of clinic in the Ninenyang Health Centre as they are out of drugs and have a malaria crisis. It was a really hard day. The weather’s been heating up again and it was over 40 C in the shade. When people heard we were there they literally came running, babies in arms! I spent the day triaging, it was tough. We said we would only see urgent antenatal cases and malnourished kids, but over 1200 people came. As with any new clinic the people rush you, pull, tug and tap you, trying to get your attention for assessment. I constantly made them line up and only gave out a registration slip for the sickest. In the end roughly 1 in 8 people got through. To triage I just walked the line feeling foreheads, looking at eye lids and respiratory rates, purely visually assessing. We saw 176 patients. 97% were malaria positive, 10% of the kids were suffering from SAM (Severe Acute Malnutrition) and 32% from MAM (Moderate Acute Malnutrition).

One of my youngest patients

One of my youngest patients ©Kate Chapman

 

It is pretty shocking considering it is the only other functioning health center between here and Gambella, and has a large population, and although it’s still malaria season, the hunger season finished two months ago.

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Car chatting

Well it’s Sunday again here in sunny Mattar! It’s been a pretty hot week both in weather and mood. The realization of not being able to get out or in has finally dawned and the mood is somber. I only did two clinics last week and after doing the monthly stats yesterday I found we had a record low attendance for the month. After the past two months with consecutive highs it’s pretty disappointing.

But I’m calm and over it. I gave up a week or so ago and have come to terms with this crappy situation. So here’s some funny stuff, well I think it’s funny.

On Friday I went to Moun with the new head of health authorities – a very large Nuer man with the definitive six cut scars on his forehead and a crazy left eye that leaves you wondering just where he’s looking exactly. He started the conversation:

“Your Nuer name is Nyabuoy, do you know what that means?”

“Yes: bright light”

“That’s correct but it also means light of heart and caring”

“Oh, that’s nice”

“Well if you were light of heart and caring you would give me some gum boots!”

I gently explained how the boots we have had taken three months to receive and were for those who had to mobilize for “patient care”. He went on to ask why I brought a bottle of water for myself and not anyone else. I explained it was my bottle I’d filled from the tap and that if he wanted water he could have brought some himself. He continued:

“You see my eye?”

“Yes, you have a cataract”

“Yes, I need an operation; you can send me to Addis for the operation”

“MSF only do “emergency surgery” that’s not an emergency, half the population have a cataract, I actually have one myself. And I will get it fixed when I get home”

“How much does it cost in Australia for the surgery?”

“About $2000, but there is a long waiting list, that’s why I’m here, I have to wait 6 months”.

“I could come to Australia and have the surgery, you could sponsor me”

At Moun he asked me if I was in the military

“No, definitely not”

“Are you sure, in this country someone as big as you cannot walk so far or carry so much unless they are in the military”

“Really? No I’ve never been in the military”

“Have you ever shot some one? Killed them?”

“NO! I’d never sleep again if I did”

“Oh, I have. I was in the military and I have been trained how to hunt down a man and kill him. You never shot a person? What about if someone came in your home?”

“If I killed someone in Australia, even if they were breaking into my house, I would go to jail, that’s the law”

“Mmm that’s a stupid law, would you hit them with a stick?”

“Yes, if they broke into my house, I’d hit them with a stick, but if I killed them I would go to jail”

“Are you sure you never been in the military? I think you have”

“No, I don’t want to hurt anyone, that’s why I’m in MSF, to help people”

Back in the car on the way back he decided to sit up front with me. Squashed in, him 6 foot 4 and solid and big  and fat, me, plus the driver in the front of the land cruiser. The conversation goes on:

“You like children?” Some were running out waving as they do each time we pass on the way to the clinic.

“Yes they are beautiful kids”

“Do you have children?”

“Yes I have a son. He’s as big as you”

“How old is he?”

“25”

“What? You lie!”

“No really, he’s 25!”

“How old are you then?”

“45”

“You LIE, you are lying to me! You are like Bush the American president”

“WHAT??? What do you mean?”

By this time I was totally exasperated and had no idea what the hell was going on. Besides the driver was giggling like a school boy!

“You are a very political person”

“No, no I’m not. Why are you saying that? And anyway Bush is in his 60s”

“You are very political! Can I have your pen? I need that pen”

“What? NO!”

My head was swimming and the driver was now in tears of laughter. By the time I left my new friend, he had asked for fish from our freezer, beer we have in our fridge, some books we use for registration and a mosquito net!

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Road rages

It’s been a few weeks since I’ve written anything. A lot has happened and had a huge impact on my work and life here. A couple of weeks ago, my translator, my right hand man, my most reliable staff member, my best friend here, did the stupidest thing.

We were on our way to Pul-deng and one of the health workers was on a motor bike checking with army guys on an explosion that happened the night before. My translator asked if he could ride the bike. I of course said no way but to cut a long story short he did it anyway.

So I was fuming and thinking I was going to kill the idiot, but alas coming round a bend there he was in a ditch, broken, bleeding and in shock! He had apparently swerved to miss a leopard and crashed, being flung into the swollen drain on the side of the road. He was so lucky he got out as he could have drowned if he was knocked out. Anyway we now had an emergency patient to be transferred to the hospital, the other car soon arrived and we packed him up and sent him to Gambella.

When I went to meet with the local authorities about the incident I was informed that it was actually their bike and that as it’s MSF who crashed it they needed compensation immediately! It was their only means of transport for the whole region and they use it to deliver medications, therapeutic food and all other types of medical activities. The bike is now totally destroyed, with hole in the motor, forks twisted, wheels bent etc… The meeting was rather hostile, so apart from the shock of the accident, working all day without a health officer or a translator and blatantly ignoring my instruction, now I had to go back and tell the project coordinator that we have a problem!

Apart from this, it’s been weeks since the 75hp boat motor died and I started harping on a replacement to no avail. We haven’t gone to Jikow for the last 3 weeks, which means that all the HIV/TB patients will need reassessment, the leprosy patients will relapse, the nutrition kids won’t received their food supply after walking for hours through swamps. Well as previous experience tells me, they won’t come back. Not to mention that the most critical patients we get are from Jikow as it’s right on the border of South Sudan.

Apart from this, the last driver that was sent from Addis had a problem with his contract and was sent back two weeks ago, leaving us with only one car.  As we don’t have a backup, we can’t go to any clinics that may see us bogged as we can’t get help. It also means that if there is an emergency where we have to evacuate, there won’t be a car if we are out on a clinic. And as I said we don’t have a working boat that we can go further than town with.

Apart from this, the road to Gambella is rapidly being eaten away by the rising flood waters. Last Friday it was blocked in two places by trucks that had fallen in holes. This resulted in us walking and carrying all the gear and patients through the floods, including a fully dilated pregnant woman with hand/face presentation. On Monday when we came back, the car was actually driving in water up to the bumper. When we stopped behind a stuck truck, the air filter was full of water although it sits about four to five feet high! The staff in the back was calling our driver the “boat driver”. This is in a land cruiser, so you can imagine.

So we are officially cut off now. No more supplies, no more visits in or out, but worst of all, no more emergency transfers. That means all our emergency obstetric and surgical patients will have no option other than to die slowly before our eyes.

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Lilies

Well it’s Sunday again. It’s been another long, frustrating and concerning week.

On Wednesday, the river had risen so much that the area where we land the boat in town had broken its banks and flooded half the town. This left our only landing point around 800 meters from the road on the main dock, wedged between the many huge open top, steel cargo boats being loaded with contraband destined for South Sudan.

The clinic in Adura had been busy with over 150 patients. On the way back we had one patient for transfer in the car, an old lady with TB. We came across some men carrying a very unwell looking man. We stopped, found him to be critical, packed him in the car and made our way back to Mattar.

I called ahead to our base and asked them to send the boat with a stretcher and to meet us on the road. Of course no one was there when we arrived so leaving the patients by the car we carried the heavy boxes of drugs and equipment to town, meandering through the heavily bogged path leading to the river. This is very difficult as just walking without carrying anything is a challenge in itself on the treacherously slippery Mattar mud. I am twice as good at not falling over compared to how I was at the beginning of the mission, but compared to the sure footed team, I’m still a joke!

Mud © Kate Chapman

Our boat was wedged between two huge cargo boats and the river was chock-a-block full of lilies slowly creeping from upstream Adura, headed for the big Baro River where the current will take them to Sudan. We literally had to pull our boat along by hand using the cargos to get out. I sent the team back with the gear asking them to drop it off then come back with a stretcher for the patients. I went back to the patients and waited. Half an hour went by before the log turned up with the stretcher, but he said the motor was playing up on the boat and he couldn’t get in near town so he was going back alone and the other boat would pick us up. I, together with some locals and caretakers brought the patients down from the road to town under the shade of a tree. Another hour went by with no one turning up so I called base again, to be told they had left ages ago.

The town river front was boxed in by cargo boats being loaded. The river was so full of lilly plants that it looked like an iridescent green field you could walk across. After pacing up and down the bank for some time I spotted our boat. It was slowly making its way through the jungle of plants. There was nowhere to dock and after trying in vain with an army guy to push the cargos to make enough room, our driver finally pulled up at the end of the dock behind the cargos.

We carried the patient on the stretcher, the old lady and her belongings, and some other bits through the bustling hive of dock side activity, climbed into one laden cargo boat, walked across the supplies packed beneath the tarpaulin, climbed into a second cargo boat, and walked the length of it atop their cargo to the end where the owners and packers helped us lift and pass both the stretcher and the old woman and supplies to our boat. I then found out why it took so long to come back and get us. The river was literally choked with lilies and clumps of grass as far as the eyes could see. We had to break our way through, separating the lilies with a stick. It took around half an hour to travel the 1km back to the compound. This river is a truly amazing endless source of change.

After getting back and taking the patients to the health centre, I did my computer work, unpacked the metal boxes and repacked the plastic ones in preparation of Jikow on Thursday. I then went to bed as a sore throat, runny nose and ear ache had been plaguing me since Monday. About half an hour later, our program coordinator called me with some bad news! Our second boat with the 40hp motor was stuffed! Kaput! Finito! Totally knackered! So that meant no Jikow, no Nasir, no boat travel other than from base to town.

I wasn’t too upset about not spending six to eight hours in the boat while I was feeling like shit, but more importantly the nutrition kids would be without their therapeutic food and the leprosy, TB and HIV patients would be without their medication, which means they will need reassessment and blood levels taken in Gambella before restarting treatment. This is a nightmare as anything to do with movements takes weeks of frustration to organize, especially for non-urgent patients, so many – like our previous leprosy man – will relapse before recommencing treatment.

The atmosphere at home has changed with the reduction of people and now it’s a bit more relaxed. The bugs are horrific and have plagued our everything for the last few weeks. If you pour a coffee you will get earwigs from both the kettle and the sugar. Small lice-like bugs the size of a thumb nail have invaded with force and are constantly crawling biting and getting into places better left undescribed! Whenever you walk through a doorway the small tick-like bugs fly straight into your face, up your nose and any other orifice they can enter. The trick is to close your eyes and exhale as you enter or leave. The stink bugs, small, black, crispy, biting bugs that stink like rotten meat are constantly in our hair (lucky Matthieu) or crawling on us. When you brush them off or touch them they dispel their odor tenfold. Not to mention they taste just like they smell! Last night when I was cooking dinner, they were so thick in the kitchen that Petra stood behind me flapping a towel, trying to create enough air to keep them out of the pan!

With the bugs also comes the swallows. A fantastic frenzy of flying acrobats that swoop and soar in spasmodic, unpredictable waves of excitement. I think they are chasing bugs, but I honestly can’t see. Anyway it’s a spectacle to see.

With the rising river, the huge Schelle (Nile perch) 20-100 kilos in weight have arrived, not to mention the 20-30 kg tiger fish with teeth so sharp and long they could take a finger off in a single snap, probably an arm with one bite and a quick shake!

Yesterday arvo I sat in the boat by our dock having a little R&R, smoking, soothing my burning throat with a cold coke and dangling a line just by the side of our cargo boat. I got a bite straight away, lost my line with the weight of it, caught a small one (2 foot) then lost my line again. I can wind them in to the edge of the boat but one shake of the head snaps my light 15 lb. line so I actually get to see what I’m losing! Anyway I caught a few small ones but without a heavy line and steal trace I won’t be landing any of these monsters! Imagine catching a fish as big as me!!! I think I’ll try and make a gaff of some description today! Anyway our freezer is full of some of the nicest fish I’ve ever eaten. Gone are the days of pasta and tomato sauce! Its fried fish, baked fish, fish soup, fish stew and with my new soup supply, fish morney! :D

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Local food

A woman prepares food © Kate Chapman

 

I’ve learnt some new things. Firstly, I was invited to a “traditional Nuer lunch” by a health education worker in Pul-deng. As we were really busy and only half way through the patients I told them we would have to be quick as the patients were waiting. Everyone was sitting cross legged on the floor of a tukul waiting for me, a large pot of maize porridge cooked in goat butter sat in the centre of the room and a chair carved from a single piece of wood was set to the side for the guest of honour! A large scooped silver spoon was handed to me and I was told to start.

Each handpicked pod of maize had been dried on a mat in the sun for a week and then crushed in a huge mortar and pestle with an eight-foot-long pole. It was then stewed with water from the stagnant pond until soft and then handmade butter, churned from goat milk, was added. To be honest it tasted like clag glue mixed with dirty oil and I had quite a challenge to actually swallow without gagging, and keep a surprised ‘mmmmm’ expression on my face.

I was being watched with baited breath for my reaction of (feigned) pleasure, before the others ate from the pot, laughing, smiling and chatting happily. I made my spoonful last the equivalent of 10 of theirs and then tried the next dish, mashed pumpkin and the same crushed maize stew. It was much better as I could taste the pumpkin which helped to push the oily residue down. While asking about my son and family, they also shared some of their intimacies, such as how many wives and how many concubines they each had, which ones they liked and why!

Local food © Kate Chapman

“Mmmm, well I really better get back to the patients,” I voiced

“But wait there’s more, you haven’t had the milk yet!”

With that a litre of very chunky curdled milk was poured straight out of the gourd and into the remainders of the first dish, given a quick stir and then they all waited again for me to sample their gift!. Now it’s certainly not as hot as it was when I got here but it’s still in the high 30s. In a tukul, literally in a jungle of vines and palms, surrounded by stifling, mosquito-infested swamps it was perhaps in the mid-40s and humid as hell, not to mention the four big, burley men all well over 6 foot, sitting in a 3m x 3m tukul, half filled with plastic bags of belongings. I braced myself, smiled, looked each of them the eyes and then plunged in with my ‘special’ silver spoon the size of a small shovel, with another big smile at my special honor. Before it reached my lips I could smell it, like unwashed person or clothes that have been lived in, sweated in, slept, peed and pooped in, for at least two weeks!

I exhaled as I put it in my mouth so as not to smell it, took a mouthful off my heaped spoon and swallowed. They were beaming:

“Good ha? Ha? you like Ha? special, traditional Nuer food!”

“Wow it’s great, thank you so much!”

I was thinking that I’d get sick all the way home, that I might not even get through the consults, but they were so proud and happy that I was sharing with them. So they went on to explain that they would take the remainder out for the rest of the team, who could never enter a Nuer tukul as they were “habbasha”, which is a local word to describe Ethiopian highlanders from Addis Ababa. That if “one of them” ever came in their tukul, a cow from the owners heard would die, which is sacrilege.

“Really?” I asked,

“Yes, yes it is certain.”

This is very fascinating and sad too as I really are noticing the gap between cultures, between clans and sub-clans. Wars are fought and people killed over what I think are trifles. You can take another man’s wife or his daughter and have a retribution/compensation set by a leopard skin priest, without much shame or trouble, but say or do anything against a man’s cows and you may be killed for it!

Another interesting thing is that you cannot be killed in your tukul. That is the rules, the law! If men are chasing you with a gun and you get in your tukul they can’t shoot you until you come out. Even the army can’t go in and get you, despite it being made of mud and cow poop, and with one swift kick you could make a big hole. But that’s the rules across all the clans!

Another thing I learned was that Nyaliep, a common girl’s name, means ‘father has gone to Sudan and the child was born before he returned’

“Really? You’re kidding? All that is in Nyaliep? even going to Sudan, not just going away?” “No it means ‘father has gone to Sudan and child was born before he returned’”

Amazing!

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