NormalisationI have been here in Darfur for almost two months now and continue to experience a crazy mix of exhaustion, exhilaration, frustration, anticipation, despair and hope. But things have also become very ‘normalised’ (a psychological coping strategy that I am sure all humanitarian workers experience). So, when does normal become extraordinary?
-Malnourished child with sepsis and severe dehydration = Normal (give fluids, antibiotics, supportive care – next patient).
-Four such children, one dies = Crap week (review case, look for improvements, keep trying).
-Eating dinner and then hearing gunshots = Normal (pass the pizza please).
-Machine gun fire continuing after the pizza is finished = Hmm, unusual (keep radio and satellite phone handy, call UNAMID, inform HQ).
-Pregnant lady dying from Hepatitis = Normal.
-Three deaths from liver failure (including one child) = Bad week (wish we had more investigations, could have done more, stay alert for epidemic).
-Two doctors for the whole hospital and outpatient referrals = Normal.
-One doctor for the hospital, feeding centre and >200 outpatients = Damn, not again (work overtime, take shortcuts, turn patients away, coerce a medical assistant to work their day off).
-Government officials delay arrival of staff by weeks = Normal (cover job by other staff, be patient).
-Our only nurse, midwife, lab technician and other doctor denied entry = only in Sudan (stretch staffing, trim activities, keep sweet-talking authorities).
Working here is a huge balancing act just trying to do the best within our limitations. I am frequently reminded that we can only do so much, we cannot save the world, and that without us there would be no access to health services at all. It is very true! But it can also be used as an excuse for the rich world neglecting their moral obligations to the less fortunate - a way of making ‘universal human rights’ selective and relative.
A Day in the Life (Part II)Last letter I began to describe the nuts-and-bolts of daily life as a medical humanitarian aid worker. I left the story at the end of the hospital ward round, so will pick it up from there now.
…By the time the ward round is finished it is early afternoon. Usually I take a lunch break, but it is the fasting month of Ramadan now so I convince my translator to skip his break and promise we will finish up early. By now there is a line of patients waiting outside the doctor’s consultation room who have been referred by the medical assistants in the outpatient department for review. I admit a child with pneumonia, a man with hepatitis, and a woman with pyelonephritis. Another child comes with suspected appendicitis, so I arrange for him to be transferred by taxi to Zalengei hospital, 2 hours to the west. I lance a big boil on a boys leg, review a couple of nasty wounds, and find the other referred patients can be treated without needing admission.
After reviewing a few of the sick patients from the ward round I handover to the other doctor and collect together all the patient files to collate for the statistics. Today I am pleased to handover by 3:30pm (usually it is closer to 5pm) and get back to the office to start on the stats. As the expat doctor (the other 4 doctors are all Sudanese) it is my job to do the stats and medical reports (as well as organise medical education, look after staff health and supervise the hospital, nutrition program, outpatient department and mobile clinics). This is a time-consuming and mundane job, but I do get a geeky thrill out of seeing all the morbidity trends and looking out for epidemic trends. Maybe one day I will bore you with some of the results (-:
I try to get all this finished by 6, though today we have the end-of-week team meeting that stretches a bit later. This last week has been particularly busy as we are short-staffed and my big reports were all due. So I have been burning the midnight oil to push out a 75+ hour week (finishing each night in the dark as the generator switches itself off at midnight). This is certainly not something I plan to make a habit of! I promise myself no paperwork tonight and a full day of rest on Friday (our one-day weekend).
I return to the living quarters throw down my gear, have a wash and do some cooking (we have cook who prepares our evening meals, but I usually like to cook something extra myself). Sunset is around 7:30pm, and during Ramadan I have made a habit of joining the other non-local Sudanese staff (who live in the same compound as me) for the evening breaking of fast. We kick back, eat, drink tea and chat - I hear all about upcoming marriages, how life is away from family, which villages they are from, and what their plans in life are. It is always intriguing to hear common human aspirations and life experiences presented with their unique cultural and individual expressions.
By the time we finish chatting it is after 9pm and I am ready to wind down and go to bed. So after my evening exercises, reading and meditation I duck under my mosquito net and drift to sleep.
Profile: “Ali”In response to my last email, a friend has asked me to tell the story of one person “so we can juxtapose their situation with our own”. He commented that many Americans/Australians/westerners want to “hide behind the notion that they are ‘middle-class’, not really wealthy, forgetting that they are fantastically wealthy in comparison with the majority of the people in the world”. Very true! So, in an attempt to personalise the experiences of Darfuris I offer the stories of some of the extraordinary ordinary people I have had the privilege to meet.
Ali Abdullah Musa, 35-year-old father of 6, husband, and my extremely talented translator (English/Arabic/Fur).
Ali grew up in a small village in west Darfur – a self-sufficient agricultural community who lived in simple mud huts without piped water, electricity or any other ‘modern’ amenities. After finishing school he worked as a teacher, got married, started a family and was planning to go on to university. In 2003 his village was pillaged by a group of armed militia he (and other IDPs) calls ‘Janjaweed’. While he and his family got away safely, many of his neighbours have never been seen again. They made their way to Niertiti as part of the first big influx of IDPs (internally displaced persons).
Ali is one of the most motivated, positive people I have met and tells me passionately of his future plans “when there is peace in Darfur”. Like the thousands of other IDPs he has had to put the past behind him to create a new life for his family here. However, unlike most of the other IDPs, he does not seek to forget this past and has written down his own story and recorded the stories of dozens of other IDPs (a growing manuscript that would make an absolutely fascinating book!).
In the 6 years since arriving here Ali has done so much for himself, his family and the community. His self-constructed ‘house’ now has three rooms, a separate cooking area, and a small courtyard that is full of pot-plants and a steady flow of visiting neighbours. This small, mud-brick, thatched roof hut is one of the most homey, welcoming houses I have ever been in. Water is collected from a hand-pump around 100 metres away, and they share a toilet facility with three neighbouring households. His salary goes to support both his household (wife, 6 children, mother-in-law) and assist his extended family and neighbours.Ali started work with MSF (Medecins sans Frontieres) as a ‘Home Visitor’ when MSF first set up in Niertiti in 2004. [HV’s are the key link between the community and MSF, providing communication on security, health, environmental, logistical and cultural issues back and forth.] After doing this job for a few years he began acting as a translator and is undoubtedly the most fun and talented translator I have ever worked with. Employment with MSF has ensured Ali a secure income and given him a relatively comfortable life compared with most of the other IDPs. [Most IDPs depend on UN food handouts and self-employment (doing such things as collecting wood, making baskets) with most of the more profitable and skilled occupations dominated by the original Niertiti townspeople.]
Ali is a daily reminder for me of the human capacity to find hope and direction in the worst of circumstances. In many ways he is a poster-boy for what an intelligent and educated person can do in tough circumstances with motivation and a bit of luck (and yes he has been much luckier than many of the other IDPs here). It is also a good reminder of the capacity of the ‘poor’ to create a future for themselves - and how the ‘rich’ can play their part in helping them realise it.
Rich Africa
A friend reminded me by email of the richness of life in Africa – “a richness not defined in dollars, cents and possessions…”. It is a blessing to be working in such an environment (and without the unnecessary necessities of my car, house, mobile phone, career, shares, technology etc.). And perhaps it can also be a reminder to all of us about what is truly important and necessary in life.
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