The dusty Yellow Brick Road

It turns out the Yellow Brick Road is just Dust. Hot. Hot. Dust everywhere and in everything. I do wish I had Dorothy's red shoes sometimes. Just for a moment, a respite from the dust and the heat and the sweat.

It turns out the Yellow Brick Road is just Dust. Hot. Hot. Dust everywhere and in everything. I do wish I had Dorothy's red shoes sometimes. Just for a moment, a respite from the dust and the heat and the sweat. Especially the sweat, that runs in your eyes and down your chest and gives you a terrible rash.

Tap my red shoes, and I have 10 minutes on the top of a ski hill in Canada, looking out over a white winter wonderland, crisp, cold air that tickles your nostrils, and the thrill of the wind going by as you fly down the mountain..... Yes. Back to South Sudan.

My new room in my new tukul has a cover over the shelving unit. It takes me a couple of days to figure out that that it is there to keep the dust off of everything you own. Sometimes I am not too swift; it can take me a while to sort simple things out and I have to shake my head at myself. My kids rag me about that; make fun of me and ask me how I ever made it through medical school if I can't figure out how to program the TV remote. I don't have an answer to this question.

I have been at my new job for a while now. I am settling in. It is a new team. It is a very different place. It is an entirely different job. I finally have my own room, and I have put up my photos, and have a sense of ownership of my small little tukul, a sense of place that has been missing in the past few months, as I travelled here and there and it seems everywhere.

It has been a good experience to see so much of South Sudan, but I am so happy to have a place of my own. I feel settled. The job is not what I originally signed up for, it is much more challenging, it is a bit overwhelming at first, but it is good.

I am in Leer. MSF runs a full hospital here. It is huge. There is no other medical care of this calibre anywhere near here. We have a huge IPD (In Patient Department).We have an ICU (Intensive Care Unit), although this means a much different thing here than it does at home. We do OB (Obstetrics) and we have a delivery room.

There is an OT (Operating Theatre), an HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) program, providing ART (Anti-Retroviral Therapy), a TB (Tuberculosis)program, a KA (Kala Azar) ward, an ITFC (Inpatient Therapeutic Feeding Center), where the severely malnourished children are cared for an OTFC (Outpatient Therapeutic Feeding Center) where the less malnourished children are given nutritional supplements, and we run an OPD (Out Patient Department) (like a medical clinic) and an ED (Emergency Department) and an Outreach Program, consisting of MSF staff that travel far and wide, supporting the local clinics so far away that they are run by our National Staff.

I think that is all. It is a huge undertaking, and it takes a big team. We have a good team here There is not as much dancing, but there is just as much camaraderie. It is now officially 39 degrees in the shade, and getting hotter every day. It is too hot for dancing anyway.

And I have gone back to worrying, again, that I don't know enough. It really is hard to know something about everything that walks in the door. I am responsible for the full medical and emergency departments, and there is no way to prepare for the incredible variety and severity of the illness that I am now seeing. The national staff, nurses and Clinical Officers, are incredibly helpful and always point me in the right direction when I am not sure what to do next.

And, I am so lucky to have a really experienced MD, who is running the HIV/TB program, to help me. I can just slide over to her side of the compound, ask for her advice on a patient, and head back to my area, comfortable with her pleasant guidance and willingness to lend me a hand, no matter how incredibly busy she is. I know how fast I will learn, and how I will soon be really enjoying the new challenge. I better learn fast. She is leaving for vacation soon, and I will be very busy.

But, tomorrow is my birthday, and no-one here knows it. I am new, and I really don't want to draw attention to myself. But, it has been a tough day; I am missing home. Another day I should be celebrating with my family, and I am on my own, with the team, but it is different.

I was called tonight to the IPD (In Patient Ward) to see a very sick newborn, only 2 days old. The baby was hypothermic (very low body temperature) and not breathing well. After a quick assessment, trying to get a temperature, pulse and oxygen saturation, none of which were able to be registered, I went to the maternity ward to get our makeshift cardboard box incubator (made by our awesome TechLog (Technical Logistician) with the tin foil walls and 100 watt bulb inside I found another baby already in it, born yesterday, prematurely.

As I tried to sort out if that babe was well enough to give up the box for the evening, I went back to my patient, and found that she had 'passed' (as they say here in South Sudan). Attempts at resuscitation were not successful. I looked at the mother, said how very sorry I was, and sadly walked to the nursing station to do the necessary paperwork.

After about four minutes, the incredibly amazing nurse in charge of the ward came to ask me to see another seriously ill child. As she led me to the child's bed, I realized that it was the bed of the child who had just died, having been already vacated, and filled with the next critically ill infant. I felt such a sense of utter hopelessness, for just a minute, and then I looked around our 'ICU' (Intensive Care Unit) and tried to accept that there were six children who were still alive because MSF is here, and moved on to my new patient.

It is not easy, this work.