Everywhere I look, women and men alike wear something covering their head. It appears to be a long accepted cultural norm. Children start to flip a scarf loosely around their shoulders, and from an early age learn how to make it drape with grace. Whilst leaning forward and working with your hands, my local staff do not falter. Despite being elbows deep in body fluids, they even have the ability to wear white without getting a single visible spec of blood on the edge of a scarf.
So why cannot I get mine to stay on my head?! I have tried mutli-layer wrapping, pinning, asking each and everyone what is the trick. I have tried wrapping my head the walking like I am wearing a neck brace. Surely by not rotating my head left or right it may stay on for just a little bit longer? In the end, while I try to perform a vacuum delivery, one of the midwives comes up from behind and whips it off me. I had trailed most of the end in a puddle anyway. Half my head was showing. There are only women in the room. It was better off anyway. I must remember to apologise to our cleaner who will later fight to remove the blood-stains from the beautiful material. Logically, wearing a black burqa would work better - it would stay on my head easier. I would not ruin my beautiful scarves with stains. And I would not have to constantly worry that it would fall of, showing an inappropriate amount of hair, neck or skin.
But before I truly start to contemplate the investment in earnest, it starts to makes sense. I study the other girls, how they apply the veil in the tea room after the occasional one falls off. It's all about the length of the first drape over the head, a double wrap, and a tight tuck. Suddenly, it fixes in place for a reasonable amount of time! The tail end does not constantly trail in places I would never want it to! I relax, and I realise the more I relax, the more naturally I move, and the longer it stays on. I can suddenly forget what I am wearing and practise medicine like normal. I do a whole morning clinic without having to re-wrap. This is brilliant. I don't have ultrasound gel all up my arms either. I feel I've achieved a minor miracle.
Other things start to fall into place. I cannot work out where the light switch is for the main overhead light in my bedroom. Suddenly I have a light-bulb moment. Those random flickers of light from my overhead light were not the power going on-and-off, out of sync with the rest of town. It was when the boss was trying to turn off all his bedroom lights for bed. After days of wondering how and why a light switch in Peshawar (my bedroom) controls a light bulb in Karachi (the boss' bedroom), the is cause explained. The electricians have been re-wiring the hospital and our expat quarters. When re-wiring Peshawar they mixed up the wires for Karachi. At least I now know why I do not have light.
As people have previously warned me, after a few weeks in your new strange environment, ever the grossly abnormal becomes normal. When I awake in the middle of the night to the sound of a cow moo-ing, I simply roll over and go back to sleep. Only the next morning do I remember and re-think it over. Yes, sure, I hear roosters, dog and cats all the time, but a cow? This isn't the grassy, green countryside that I grew up in. I'm in the middle of a concrete hospital compound, in the middle of a town, in the middle of the desert. Was that really a cow? I make coffee that same morning, I rinse the old beans out of the filter and repack it full of new. Outside the kitchen window, brought in on the breeze, I hear little put-put-puts in the distance. I fill the coffee pot with water and set it on the stove. A few more put-put-puts. I light the stove. I realise I am listening to celebratory gunshots in the distance. Something I had ever heard in my previous 27 years until moving here. Have I already acclimatised?
During the day we have a lady who presents following an incomplete miscarriage. She has bled profusely, according to the translation I receive. I prepare for a blood level through the floor, as most patients that I see are profoundly anaemic to begin with. I am yet to see a normal level since I have been here. I ask the laboratory to cross match blood in preparation. I give her fluids to help bolster her low-ish blood pressure. I guess in my head - how low will it be? A new record low? I have not yet seen a 3. Or will all this be overkill? Will it be closer normal? She is not bleeding now and I have not seen how much she lost. A midwife notifies me of the result.
"Dr Jessica, it is twelve."
"Twelve!" I exclaim.
A normal level is 11 - 14. I start to think of all this possible things that could have gone wrong. Is her blood thick for some reason, making the level falsely elevated? Was the blood not mixed with the additive correctly making the cells clump together? Could the machine be broken? We check the hand-held ward machine - one tenth the technology of the lab machine but still very accurate. We get a similar result. I have only been in the field for a few weeks yet I am already starting to question if a normal result could be true!
That afternoon I am called to the ER to review a patient. I don't bother with details on the phone, the day has settled into calm and I welcome the change of scenery in a different department. I review a gunshot victim. He has an in-out bullet wound just above his right collarbone. Clean, tidy, simple, if a gunshot could ever be described so. The staff have already patched him up and sorted him out. He will be fine, and I am happy that despite the potential horrors of gunshot wounds, this man should make a full recovery.
But later I see a patient who has been the victim of an improvised explosive device (IED). He has flash burns up the front of both legs and his right inner-upper arm. Shrapnel make a black and pink polka-dot pattern across his shins and torso. Some sensation is absent on the front of his left foot. But he is incredibly lucky. He still has both feet.
It is a time like this that I take stock. I close my eyes for a nanosecond. I make the smallest flicker of my head to shake the images away. I think of crashing waves as they break, white foam flying into the air, the tide coming in to moisten the dried sand. The sky behind is a dark grey, thunderous clouds threaten storms on the horizon. I see the ocean from the ten-second view you get as you drive past a disused railway bridge on the sand-dunes through Kilcunda. It is a ten-second memory of home, one that I love, one that puts me back at ease with the world. I can smell the salty air and the fresh green grass. It doesn't make me homesick, just remember who I am. I remember the sanctity of life and hope that all the death I see does not desensitise me.
I now have seen just how safe we are at home; I have never felt true danger until I have now seen it here. My freedom is limited for my safety. I have a new perspective on all persons who have left their war-torn home for the alluring borders of a country living in peace. After narrowed options for food here, I hope that I never again take for granted having a variety of vegetables. I realise that back home we use water that is safe for drinking to clean our cars. Diarrhoeal disease are incredibly common here due to unsafe running water, or no running water at all. And after only a few short weeks here in a managerial role, I realise the enormous work that is required to keep the hospital cupboards stocked with a variety of essential equipment.
It is the silly things that make my day though. A broad earnest smile and a vigorous hand shake from the cleaner after I show her that I have now learnt how to say hello: Assalam o-alekum. She responds with the expected alekum o-assalam.
Later in the day I also have a conversation with our new emergency nurse. We are discussing the foods that we miss and we make a pact to make ice-cream. Somehow. We may need to beat it by hand or use the reincarnated blender that has some suspicious electrical wiring. Should it be a traditional fruit flavour, or something silly like curry? Should it be dust flavour as a tribute to the fine sand that covers every surface minutes after cleaning it? Instead we settle on peach flavour as they are currently in season.