“When you’re on assignment, it’s important to maintain a number of personal routines.”
That's what they told us during our intitial training. And it's true. Keeping up a regular routine is key to maintaing smooth sailing while in the field.
So, each morning I squeeze a green lemon into my glass before filling it with lukewarm water. I look out from the kitchen to the mountains which turn greener and greener each day, following the arrival of the first rains. As beautiful as that maybe, it is also the annual signal of the potential cholera epidemic that can come with the rains, prompting the medical teams to intensify their surveillance.
At 7:30 in the morning, silence seems to fill the emptiness of the valley.
You can almost hear the sound of the birds of prey circling over us at dizzying heights—a contrast with the situation at the hospital a few hours later.
I think about my day and I wonder what type of unforeseen event, the kind that happens every day, will greet me.
After downing a banana and a couple of biscuits, it’s time for me to get moving. I’m responsible for opening up the office each morning before the teams arrive, and this is not a minor responsibility, if you know anything about my tumultuous relationship with punctuality.
I load up my bag and sling it over my shoulder, on top of my MSF jacket that clearly identifies me. This type of jacket is something of a symbol that I used to associate with the field workers before I became one of them myself—a permanent reminder of the weight that we carry on our shoulders.
Life in the hospital
In the morning, I often look out the window of my office and see patients lying on stretchers where the low wall runs along the main street. Some of them are in bad shape, while others seem to be enjoying the sun with a smile on their face, their legs in plaster from their toes up to the top of their thighs.
Aida interrupts my gaze.
"Ya Thomas! Today, let's go for a walk through the hospital."
It is true that since the quick look I had with Ekaterine (our medical team leader) during my medical briefing, I haven't had the opportunity to go back there. More than a month later, it's high time: I had promised myself not to fall into the trap of staying in my office permanently.
"Good idea. Tamam, let's go!"
We start in triage, the gateway for incoming patients, who are then referred to the various departments, based on the seriousness of their case.
A small waiting room at the entrance then opens onto a much larger space, where a number of beds are set up, separated by simple curtains of varying colours, depending on the symptoms.
Patients are being examined by doctors in white coats. When they see me, they greet me and I explain the purpose of my visit, which is to better understand how the hospital works so that I can do my job more efficiently. Aida translates what I say when necessary, as not everyone speaks English as well as she does.
I then discover the offices of my hospital's management colleagues—the heads of HR and Finance. These are my primary contacts for my field of work and it's all about maintaining positive relationships, even though we often have the opportunity to disagree on various issues. I'll come back to that.
The inpatient department is strictly separated into two departments—one for men and one for women. We only visit the men's department, where I am allowed to enter.
There are several rooms, but none of them are single rooms. There are rows of simple beds, each with a small chest of drawers acting as a separation from the next person. In this type of situation, I notice that it is better to cultivate the art of mutual respect when there are numerous roommates, even though the occupants do not seem to be bothered by the communal sharing of their condition.
My attention then turns to this cute little cat, adorable in its grey coat with black stripes. There would be nothing wrong if this were not in a hospital, and it wasn’t under that bed in the hallway! There is certainly a lot more to be done in terms anti-infection measures... I'll put in a word with Ekaterina.
"Ya! Doctor," I hear these words being shouted in an aggressive tone a few yards away. We continue on our way, because loud intonations are commonplace, and calm is not really a part of the scenery. "Ya! Doctor!" There's no doubt this time the voice is directed at me. I had forgotten about the MSF emblazoned on my jacket. "Ana mach Doctor!" ("I'm not a doctor!") I reply, proud to be able to use some of the rudimentary Arabic our teacher taught us in our weekly classes. This was far from being the only time I've been shouted out to this way, usually in the hallways, and in the city on one of our rare outings. I find it amusing to think that it's just a simple jacket that replaces ten years of university studies to allow a person to have a Dr. in front of your name.
Nevertheless, I try to discern what the man wants. Aida explains that the man is here with his brother who had been involved in a road accident the previous day, and he is not happy with how the MSF doctors have reacted and have been treating his brother. During the conversation, I try to explain to him that the doctors make rounds regularly and that if there is no emergency, a bit of patience would be appreciated. Even though I repeat that I am not part of the medical staff, he is insistent that we go to see his brother, who shares a room with about a dozen other patients. We agree. As we enter the room, all eyes are directed at Aida and me. Now at the patient’s bedside, we see the accident victim. I’m not a doctor, but I can see that the accident victim, who is strikingly thin, is not in very good shape. We talk for a few moments and I get the feeling that the patient's brother is less upset now, and is smiling more now, when I inform him that we have to continue our rounds. A moment spent just listening to him may have eased the man's mind temporarily. It is really not much, but I am nevertheless relieved and pleased about it.
Rounding the bend in a corridor, a nurse stops us to point out the condition of the ceiling. A large number of black stains caused by the humidity have appeared in this part of the building, and buckets have been positioned under them to catch water from the torrential rains that often fall on the city at this time of year. She tells me that it would be really great if something could be done about it. I can only offer sympathy, of course. These are not optimal working conditions. Powerless at the time, I inform her that I will talk to my manager to see if there are any renovations in the offing.
We now enter a corridor, and at the entrance there is a television set spitting out images of military personnel accompanied by lively music, being viewed by a large number of patients. We have just entered the part used for trauma victims, including war wounded who have returned from the front injured. We don't go into the rooms but I can see the patients. I am struck by how young some of them are, probably around eighteen, if not younger.
Before entering the next department, Aida asks me if I want to go in. This is the ICU (Intensive Care Unit) department. I remember that I had declined on my first visit, because I was afraid I wouldn't be ready to deal with the challenging situations of the patients there. But from fear comes courage... It's time to take the plunge, but not without trepidation. The time has come to test my mettle. We cover ourselves from head to toe with protective equipment, following the standards for protection against infection. The nurse in charge informs me that there are only eight beds available, all filled. At each one, she explains the reasons for the admissions in a calm reassuring voice. The vast majority are comatose. I am deeply affected by this little 6-year-old girl, with a deformed, swollen and purple face for the most part. She fell from a significant height while playing... I shudder when the nurse tries, unsuccessfully, to rouse her. I jump when a 90-year-old woman screams into her breathing mask in what looks like pain. I take half a step back at the sight of a man sweating profusely, and convulsing, with a tube in his mouth, and whose life will surely not be the same after his car accident.
A bit like a sailor going to sea for the first time, I'm surprised and relieved to find that I don't get seasick. The armour is holding, for now.
We next visit the lab, where they perform the various tests (X-rays, blood tests, radiology, etc.). The doctor there takes the time to explain ultrasounds to me as he probes a patient's belly, pointing me to a screen that reminds me of the images you see on a sonogram. I am especially interested in the lab for a different reason: because I receive the monthly bills for all these tests, which are quite high, I have a mandate to monitor and ensure that we are funding them appropriately, since more than 7,500 tests are performed each month. That's why it's important to understand how the operation works. It is absolutely critical in my role to ensure that the money spent is spent directly on the patients. There would be no question of funding a surplus to serve any cause, other than the health of Yemenis.
Aida points out the maternity ward in the distance, which we also funded until last January.
My attention then turns to the cries of the men who, with one hand in the air and the other carrying a coffin covered with photos, head for the exit in a ritual that seems well-oiled. They're coming back from the morgue and honouring one of their own who gave his life in battle. For me, it's still a life torn apart by the drama of war... I call Bea immediately to let her know. It is important that the Fieldco know what is happening in the hospital, especially in order to ensure that no weapons are allowed in.
Back in the office, I was dismayed to learn that one of our employees had had to leave work after learning that his brother had passed away as a result of the fighting further east. Two weeks after his cousin. I was even more shocked when I learned that he will not even be able to go and have one final goodbye, as movement is impossible in this dangerous part of the country. One more life swept away by the drama of war...
Later, shortly before 5 pm, we gather all the staff together to deliver some delicate news. Due to the possible lack of arrival of expats in the country because of the Corona virus, we have to temporarily suspend activities of the project that was supposed to start up a few weeks earlier, in Al-Qanawis. This is a difficult decision, after so much preparatory work by the teams on the ground for more than a year and a half. All employees are being reassigned to other projects and we are pleased to welcome Faiz back, after he had been sent in the opposite direction two months earlier.
After the announcement to a confused audience, Bea suddenly yields the floor to Aida, just as a large cake appears in the middle of the room. "Happy Birthday, Thomas! I know it's five days before the official date but Ramadan starts in two days and we wouldn't have been able to celebrate then!" Got it. A surprise is beautiful, and even more so when you really don't expect it. The singing starts, in English, and then in Arabic. Certainly I feel touched when I thank the entire team for their extraordinary kindness and hospitality, and it's only a month after my arrival. Smiles fill their faces—symbolic of the mix of emotions that occurs every day in the life of a field worker.
After the work day
After the office closed, I'm talking to Anwar on the doorstep and he reminds me that he'll meet us at the house in a few hours. Wednesday, which is a bit like Friday night in Canada (the official weekend in Yemen being Thursday and Friday), has been named "K-night", in honour of the Khat and Karaoke duo.
As a practice that is deeply rooted in Yemeni culture, khat is a plant leaf that is chewed by more than 90% of the population, both men and women, generally from the first hours right after lunch until late at night. The size of the ball in the hollow of your cheek is proportional to the hour of the day, and it is proudly displayed in the street. It is not uncommon for government officials to chew khat during work meetings. It is said to help with the decision-making process. The production of khat, some of which is exported to neighbouring Saudi Arabia, is key in the country's economy and represents a huge cost in terms of irrigation. Its price, far from being cheap when one is looking for a minimum level of quality, is not always friendly to the family budget, which is often a problem. The use of khat is prohibited in most European countries and is illegal because it is considered a natural stimulant. Depending on the individual, it can have an impact on attention and sleep. For this reason it is banned during working hours for MSF staff.
During my first "khat session" in Sanaa with Roger in response to an invitation from a colleague from Doctors of the World, we initiated a ritual every Wednesday with several members of the team, based on the principle of "whoever wants to, can come." Beyond the practice itself, which is not necessarily pleasant and whose effects on me are very limited, what I like is the social aspect of the event. Time seems to stand still whenever we get together, seated comfortably on sofas, for hours on end, just talking about life. No matter how hard I look, I can think of no equivalent in my Canadian life, where the suffocating rhythm of the hands of time makes us forget the importance of taking time out. These sessions provide the perfect opportunity to learn more about the team and about the culture of the country.
So that evening, Anwar, our logistics manager, was there as always. He again prevented me from contributing to the cost of the khat used, in keeping with the tradition of not charging a guest for his first sessions. With his slicked-back black hair, round face and tiny glasses, he can't help but keep a broad, mischievous smile on his face. Open-minded, he is never stingy in sharing his experience or his vision of the world with a burst of pleasure. I am learning more about his incredible story. Originally from Hajjah, Anwar took the bold step of leaving there in 2002 to move to Haradh in the northern part of the country to set up a training institute with classes in computer science, language and human development. Under his masterful leadership, it quickly became a major player in the local economy. Meanwhile, he also married and he and his wife raised three children. But in April 2015, everything collapsed. As fate would have it, his world was turned upside down. For no real apparent reason, because the city was not a strategic military base, bombs suddenly began to rain from the sky on the city's civilian population and infrastructure. Anwar's family home was literally sliced in half. With no real alternative, the family hurriedly packed up their remaining possessions and left their lives behind, never to return. The jar of red ink was spilled on the page of his life's story in Haradh, erasing everything with sudden and unprecedented violence. And so then the time came to turn the page. Back in Hajjah, the urgent task becomes one of putting food on the table. "God's gift" as he puts it. He finds an opportunity with MSF, first on our project in Abs, then in Hajjah. After rising over the years to the position of logistics manager, Anwar is now finding fulfilment in his work, which he says is rewarding. With the organization tattooed on his heart, and with an abiding dedication, his relationship with MSF is much more than a simple union based on an employment contract. "I work for God, he protects me," he explains.
I am amazed, listening to his story in the form of an ode to resilience, fascinated by the nonchalance with which he tells it, admiring his ability to bring out the pen when the page in the book of life so suddenly turns back to white again.
Some time later, in bed, I turn out the light, ready to become one with sleep, after another intense week. But the images of the day come flooding through my mind. I turn the light back on. I take a moment or two to jot down a few notes that summarize what I had experienced. Some days are more special than others. This is one of them.