We are leaving for South Sudan today. Me and MSF. Me and my things. 18 hours and counting. Many of my things are not actually leaving. They would like to come, and I would really like to have them with me, but they are way over the awesomely light weight limit (20 kg including carry-on) suggested by MSF, and they have been set aside, like a long ago lover. There are many things you so wish you could take on a journey such as this, but as you sort and resort and sort again, you start to realize how much you don't really. need.
The reason for this weight limit is because once you are off regular commercial airlines, and flying about in very small planes and helicopters, there's not much leeway in the amount of extra weight that can be carried. The guidelines tell you that you don't need to bring 6 months of supplies; that you will be able to buy things like shampoo and tampons, but really, my mission is in the middle of nowhere, living in a tent in a village only accessible by plane, where there is not even a market. How much shampoo should I bring? How much does a bottle of shampoo weigh anyway? And how long does it take for me to use one bottle? These are things I never really thought about before. It is strange that this is what I am fretting about.
I think it is much easier to worry about the inconsequential things, the things that will turn out to be totally irrelevant, than to focus on the worrisome things running through your mind before you leave on your first mission. Will I have the skills, the fortitude, the interest, the stamina and the desire to do this after the first couple of months? Am I really capable of going and treating a disease, Kala Azar, that I had really never even heard of before?
It has another name. Visceral Leishmaniasis. That registered in my brain from long ago in medical school, but just a distant memory. Have I done enough reading and studying to not look like an absolute idiot on my first attempt to be the responsible MD? What should I bring for looking up the diseases that I will see that are not Kala Azar, diseases that I may have never seen before? And the snakes they warned me about. We don't really have deadly snakes in Canada. Perhaps I can look that up on the plane. I know nothing about so much. The medical books are heavy, and most of the ones I want are not available on the internet. Oh dear, what to do? I will start with tearfully saying goodbye and getting on the plane and hopefully, leave all the worry behind.
It has taken me 21 days to feel that I can write anything at all here in this brand new country. The Republic of South Sudan has taken me in, twirled me around like a tornado, and spit me out. I am trying to land on my feet. What a 3 weeks. I know, from previous experience working in Africa, that it is necessary not to make any big decisions, judgements, or formulate any definite opinions until you have been 'in country' for a while, and have had a chance to get your sea legs, as (I think) they say in the boating world.
It's called culture shock, and it does lessen with each trip, but for me, it is still there each time I return. So, there has been some 2nd guessing, some wondering what in the world I was thinking, but mostly I am trying to accept that things are often not what were expected when you are working in a volatile situation. This is a new country, that has been at war for 20 years, that is struggling to make it work, but it is going to be a rough and rocky ride for the country, and for me, I think.
The flight, Toronto, London, Nairobi was long and exhausting. There was no briefing in Amsterdam, and I flew straight to Juba, the new capital. First impression is hot and wet and dusty at the same time. It is the end of the rainy season. In Juba, I was finally briefed, and told that, due to unforeseen circumstances concerning security issues, I would not, right now, be going to the place I am contracted to work. As a matter of fact, they had just pulled out the team members that were already there, in an emergency helicopter evacuation. It seems the airstrip was too wet to land our plane.
So, despite the preparation course in Amsterdam and the knowledge that you have, indeed, signed up to work in a potential area of conflict, it is disconcerting to be told on your very first day that you can't go somewhere because they are worried for your safety. But, turn this around, and it is comforting to know that MSF will monitor security and spare no effort in evacuation by whatever means possible if a situation becomes potentially dangerous. I was clearly advised (by both my HOM (Head of Mission) and PC (Project Coordinator) before I accepted this placement that it could be unpredictable, and I am just right now taking things day by day.
So, after a fitful night of unsleep under my mosquito net, I finally get on the plane the next day to go to the north of South Sudan, near the new border with Sudan, to a wet and rainy town to await the next decisions about where I will be going and what I will now be doing. Flying over the land that will be my new home for the next 6 months is daunting. There is nothing below me but miles and miles of scrub land, few trees and water, which by the time I leave, will be nothing but bone dry arid tundra. There are many mud homes, with thatched roofs, and cows, the currency of the people. I am told the houses are called tukals, and if I am not living in a tent, I will be living in one of these. For now, I join the team already in Malakal, who are very crowded because we, who are supposed to be elsewhere, will be living with them. Introductions are made, names are forgotten and once again, I collapse into my bed in my crowded room. They seem an eclectic group, and what a surprise, there is cold beer here. This is a good sign.
And so, after much anticipation and with significant trepidation, I start the work of treating this deadly disease. For now, I am working on the Kala Azar Ward in the Malakal Teaching Hospital. The hospital is run by the Republic of South Sudan Ministry of Health, and MSF supports the Kala Azar ward with funding and staff and support to help treat the victims of this epidemic. I am learning from the current MD who is stationed here, and the South Sudanese nurses and Clinical Officers. The learning curve is steep and I often feel overwhelmed with my lack of knowledge, but having worked in Africa before, I know this feeling of total incompetence will be replaced with some confidence and relief as my skills and my knowledge base increases. The current MD will be leaving on vacation soon, and I will suddenly and soon have a brand new job as the senior medical staff person.
And so now, finally, I am caring for patients. My patients. The people who look at me and hope that I have the skills and the medicine and the ability to do what needs to be done in a desperate situation. The mothers that can only hope that I will have the knowledge needed to do the right thing for their sick baby. But, and so importantly, this job is obviously about the medical work, but a critical part of the MSF mandate is 'temoignage', witnessing the events you are involved in, and letting the world know. So, I will try to let you know, and you can bear witness with me.
Please, wish me and my many patients well.