Aid Work

Shingara, Betel Nut, Diptheria and a Whole Lotta Love /  by Sarah Rawlins

28 Jan 2018

It is hard to believe that I arrived in Bangladesh almost 2 weeks ago. I’m back in that crazy time warp where it feels like I have been here for months and like I just arrived. It’s hard to explain the phenomenon unless you have experienced it yourself. I am already mourning my departure, as I know it will come all too soon. My days here are long but it is a good kind of long. I am reminded almost immediately how much I love this type of work.

I wake around 6 am to prepare for the day, load into a van around 7:30 and head out to Kutupalong camp (6 days a week). It takes 1hr plus to drive to our drop off point and another 30-45min to walk in to our clinic. The walks in and out of the camp are actually one of my favorite times of the day. Another colleague described the walks as an exhale. I would have to agree. The camp is constantly in motion, an anthill of activity where everyone has a job to do. Yesterday as we walked out of the camp for the evening we were constantly having to give way to children and adults hauling 20-30 foot long bundles of bamboo. The kids that were too small to carry the bamboo instead opted to drag it through the dirt, leaving snake like patterns in their wake. If you looked away or got distracted for five seconds it could mean getting impaled by a shoot of oncoming bamboo.

Kutupalong Refugee Camp-for as far as the eye can see.....

They Things They Carry.

Every day a new market, enterprise or home has sprung up; a new ditch dug, a road improved. I have been told that the winds are coming early and this means an early rain. The awareness of which sits like the smog of the Los Angeles basin, trapped by the heat and with no winds to move it. Unfortunately, the reality will be a perfect storm of disaster and disease. It will be an absolute nightmare with homes and latrines slip-sliding down cliffs and hillsides. Homes and bridges will be buried and swept away with sewage and garbage-filled water. I honestly don’t even want to think about it. It is almost too much to bear. I cannot imagine this being my reality. It is no wonder that people are using every possible minute of the day to prepare as best as they can for the oncoming storm.

'local business'

Stagnant water during the dry season--a taste of what is to come with the rains

This beautiful new road sprang up overnight!

As we enter the camp, the children greet us and wave. As we walk out they say ‘bye bye’, ‘ta ta’ and ‘thank you’ with different cheering sections for each. The ‘bye bye’ kids are the first to greet us as we depart the clinic. They are followed by the ‘ta ta’s and then the ‘thank you’ kids come near the end. We pass barber shops, pirata and shingara vendors (delicious, fried, samosa-like dough snacks), tea stands that sell pineapple cream cookies, hands down the best cookies in the camp, fish vendors selling baskets of both dried and fresh fish, abnormally large cucumbers and squashes, curry-color dusted peanuts and of course the local favorite, the betel nut leaf. The betel is a central nervous system stimulant and is chewed until your teeth become rust-red and then begin to fall out. It is not uncommon to hear people expectorating huge betel nut loogies. I have almost been bathed in the acidic juices on several occasions. Walking through the camp, one has to laugh at all of the saliva 'nut' trails, which cover the path.

Betel Nut preparation.

In order to arrive at the clinic we have to traverse up and down several sets of mud-carved steps and have to cross several bamboo bridges, all of which will be impassible once the rains arrive. The primary health care center is small, however rapid expansion efforts are underway. Currently we are treating minor burns and wounds, upper and lower respiratory tract infections, diarrheal diseases, malaria, diphtheria, measles and mumps. Diphtheria cases, severely ill patients, severely malnourished kids, mental health and patients requiring surgery or obstetrical interventions are all referred to other local actors. We probably transport 3-15 patients to nearby hospitals or specialized clinics daily. The acutely ill are carried in either on chairs and or in blankets tied to two bamboo poles. It is truly incredible to behold. The other day we had a patient with late stage leprosy, which proved to be a good teaching opportunity for the local, Bengali nurses. Diphtheria is fortunately decreasing, however we continue to see many mumps patients, both diseases I had never before seen. We probably see 200-260 patients a day at our primary health care clinic and satellite clinics combined.

I have the privilege of working with six Bengali nurses who are truly running the show. They are amazing and it will be up to them and the national Bangla physicians to run the clinic once everything is handed over. I’m trying to support them as best as I can, looking for any available opportunity to teach and to mentor. In the upcoming months, we hope to hire 30-40 more national nurses who will then staff our new primary health care centers along with the Bangla physicians. While each new day brings its own challenges and gifts, I have begun to find my routine. It is a routine that is both simple and complex, devoid of the distractions and often misguided priorities of life back home. You almost have to ask yourself which is real life….my life back home or the life here? A colleague of mine recently commented upon returning home, 'well, it's back to reality'. For myself however, I find that I need to ask, 'what really is reality'? Is it being able to eat a fresh salad and choose between 200 micro brew options, or is it the here and now? For the Rohingya, the daily reality of life is a reality that few back home can comprehend nor will ever experience. So then, how do we allow ourselves to become immersed in another's reality, a reality that sits in stark contrast to our own? For many, the answer is to ignore these parallel realities because for one, it is much easier and let's be honest, we are inundated daily with news that goes from bad to worse. It's the boy who cried wolf playing out in the form of school shootings, racial violence, terrorist attacks, earthquakes, landslides and flooding. Soon, one tragedy blends into another. We become blind and dare I say apathetic. But this is how we cope, because what is the alternative? How do we hold the tension of the weight of the world and not become so weighted down ourselves that we are unable to move; paralyzed by sadness and overwhelmed by the magnitude of an incredibly broken world? As hard as it is, I challenge us to not grow apathetic. Start by choosing one topic that gets your heart pumping and place your efforts and your voice here. Learn all that you can about this topic, engage your community, call your legislators, speak out and while you do this, don't forget to seek out the stories of hope, joy and restoration, which can be found embedded within the layers of injustice and pain. Without this reminder of goodness, the weight will become too much. And in everything, always remember to love. 

Reflections from Tumultuous Times. /  by Sarah Rawlins

*The views expressed in this blog do not represent the views of MSF*

It is amazing how quickly and also how slowly 9 months can pass. Working with MSF (Médecins sans Frontières/Doctors without Borders) can feel like living in a time warp. By the time that I left South Sudan, it felt like I had been there for years. At the time of my departure, there was only one other colleague who I knew since the first day I arrived and this was because he had extended his contract. By the end of my 9-month assignment, I had both introduced myself and said my goodbyes to more people than I could remember and yet still I remained. On the other hand, where did the 9 months go? Wasn't it just yesterday that I arrived on that dusty landing strip with all of the children frantically darting off of the runway so as to not be swept away in the overpowering cloud of dust as the power of the plane's engine made contact with the parched earth? It is amazing what can transpire in 9 months. 

During the past 9 months I had the privilege of meeting and working with some of the most incredible people. I ran what I would like to think of as a 'successful' training program for the national staff at a large field hospital and more importantly, I had a lot of fun doing it.  I had no idea that I would LOVE teaching! I contracted Typhoid or maybe its ugly cousin and thought I was going to die. Being jet lagged and sleep deprived, I  tripped and fell at a hot spring in Tanzania and managed to tear my meniscus and three ligaments...and then I proceeded to go on a safari where my friend and I were ambushed by baboons and where I had a close encounter with a hyena. I spent a month in Kenya trying to navigate physical therapy at Nairobi Hospital. I learned some pretty great Dinka dance moves and also picked up some useful Dinka, Arabic and Swahili. I went swimming in a water drum, provided training for over 800 people, almost got attacked by a swarm of locusts and lived in a tukul (typical South Sudanese hut) that was also visited by frogs, goats, cats, hedgehogs and scorpions. I missed 3 flights, traveled to 9 countries, spent an afternoon at a local Italian police station and did I mention that my car was stolen (I could have done without that one).

I would be lying if I said that few tears had been shed this past year. I would also be lying if I said that there were never times of great loneliness and despair. However, I would also be lying if I said that it wasn’t all worth it.

My story of the past year is a bit uncharacteristic. Unlike normal people, my holidays, which were meant to be times of refilling and rest proved to be times of deep pain; filled with unrelenting troubles and trials. On the contrary, my time in the field, although incredibly difficult, was a beautiful gift that filled me with great joy. I do not know why I had to experience such pain during the times which were set aside to be times of rest, but I do know that a piece of my heart has been left in South Sudan.

Leaving South Sudan was an incredibly emotional experience. As the wheels lifted off of the Sudanese soil, I looked out of my window over the community of Agok. My eyes said goodbye to the hospital, to the market, to the tukuls and to the airstrip. It was with a deep sadness in my heart that I left, knowing that out of all of the times that I had left Agok in the past 9 months, this time was different.

My goodbye party. 

My goodbye party. 

I began my time in Agok with feelings of trepidation, unsure of what to expect, especially after receiving some not so encouraging information…. What I found however, was a community full of incredible people with arms and hearts wide open, and minds so hungry to learn that I couldn’t keep up with the training requests. I was continually overwhelmed by the support and encouragement I received, from nursing supervisors who would come in on their days off for training or to help me administer tests, to the anaesthetist who offered to translate 50+ exams from Arabic into English during his free time. I remember offering a training for the Watsan (water sanitation) team on the basics of Tuberculosis after reports surfaced that the team were neglecting to clean the wards as they feared that they would contract TB. I will never forget teaching this group of 30+ as they sat rapt in their seats, completely attentive-hanging onto every word I said and offering up questions at every opportunity. Mid-way through my teaching, and elderly man stood up and began to cry, thanking me for seeing them as people worthy to receive training. He said, “we are the very least, we clean the latrines, people see us as nothing. Never before has anyone taken the time to give us education. We will forever be grateful”. I wanted to melt right there and what I really wanted to say was that according to Jesus, the ‘least of these’ are in fact the greatest. As a few tears dripped down my face, I took his hand in mine, looked him in the eyes and did my very best to tell him that he was valued.

My friend Nyandeng, one of the  water & sanitation crew members.

My friend Nyandeng, one of the  water & sanitation crew members.

Life was not easy. On the day that I left, temperatures had reached almost 48 degrees Celsius (118 Fahrenheit). With the heat came the sandstorms. The wind was constantly stirring up sheets of dust, which clogged every pore and covered every surface. It was impossible to keep anything clean. I was always dirty. My mattress had become a hole in which I slept. It was no wonder that more than half of us suffered from back problems. At night I would cover myself with a wet sheet, then position my fan so that it blew directly on me. Even this did little to help reduce the suffocating temperatures. During this time, we were also visited by hundreds of birds of prey. They descended upon our compound overnight. If you decided to carry your food outside of the dining tukul chances were that you would be attacked by a massive hawk nose-diving straight for your plate. During the rainy season the insects descended in overwhelming numbers and with them come the flash floods. Several of our tukuls were prone to flooding, bringing in snakes and frogs and sometimes black rainwater would collect in the thatched roofs and pour down on us while we were sleeping. When it rained, I had very little time to grab my rain boots and jacket and run to the training room to try to move all of the supplies to the center of the room so that they wouldn’t get rained on and destroyed. I especially loved exiting the shower at night where you had no option but to step directly into the floodlight and be instantly covered in bugs as they slithered down your wet body. The humidity was at times so high that my clothes would mold in my room in a matter of hours. From June-August the bees were relentless. It was almost impossible to eat as you had to continuously spoon them out of your food. At night, the hedgehogs would come out and if you were lucky they might come visit you in your tukul. The food could have been so much worse, but it was not great, especially if you are a vegetarian and many days I would get to the kitchen too late and would find absolutely nothing when I lifted the heavy metal lids. If we had received a fresh food delivery, then I could grab an apple or an orange but if it was the end of the week, my lunch or dinner would be whatever I could find in the pantry (wheatabix, instant noodles, bread with peanut butter). Everyone worked long hours. The work was exhausting and we saw far too many children die. Despite all of this, Agok was a beautiful place. It is also a place where lives are saved, where Dinka and Nuer come together in peace, as patients and as staff. It is full of passionate, intelligent and caring expats who also know how to be creative in order to make compound life enjoyable. And of course it is home to all of the incredible staff who are there before and after all of the expats arrive and depart. The hospital is staffed not only by National staff but also by many people who have either been relocated from other parts of the country or from neighbouring countries. These people make the hospital run. They are the heartbeat.

Sandstorm. 

Sandstorm. 

Maybe you’re reading this and thinking, ‘why the heck would anyone willingly choose this way of life?' I’ve even had people go so far as to insinuate that I must be slightly ‘off’, not quite mentally right.

But what about the millions of people who have no choice? For them, this is the reality every day and at the end they cannot go back home to a life of luxury and ease full of supermarkets with endless aisles of cereal options.  The least that I can do is offer up what little I have to learn from and to serve these incredible people.

Goofing around in Triage with one of our nurses. 

It’s not hard to understand why so many struggle with ‘re-entering ‘normal life and returning to their normal jobs. When you are out in the field, you experience these crazy low-lows but you also experience these incredibly high-highs, which are only made possible by the low-lows. After teaching people who are so eager to learn anything you can give to them because they have lived their entire lives in a country with no education system how can I possibly teach people back in the U.S who sit in class more interested in their smart phones than in what I am saying, because after all, they are the entitled ones, they are the customer, the consumer. How can one go from resuscitating babies every day to a hospital back home where if one baby dies, the parents file a lawsuit, even though you and your team did everything you could to save that child’s life?....to go from a country where death is unfortunately an accepted fact of life, to a country that cannot accept death in any of its forms. How can you return to a system where medical supplies worth thousands of dollars are thrown in the garbage after being touched, even if they remain enclosed in their original packing, meanwhile, in the country from where you just came, you are cutting maternity gloves down to use them for wound care, are rationing out isolation masks and cleaning supplies and praying that the next shipment of supplies comes in soon? What about going from working in a country where pain medications are a rare gift and where people accept their pain with an astonishing stoicism to a country where you are screamed at if you are 3 minutes late delivering a dose of oxycodone; a country that gives out narcotics like they are candy. These are just a few examples, so yes, I can completely understand why it is so difficult for aid workers to cease being aid workers. Normal life can be unbearable in comparison.

As I re-enter ‘normal’ life, or whatever ‘normal’ life is supposed to be, I reflect on this past year and see it for the amazing gift that it was. Returning to work in the U.S health care system, especially given the current political climate, will not be easy but it is my hope that the experiences of this past year can serve to fortify my work back in my home community of Seattle rather than to weaken it.

The 1st International Agok Dance Competition! /  by Sarah Rawlins

*The views expressed in this blog do not represent the views of MSF*

They say that burn out is high here. They say that you must really take care to ensure that you don’t become another ‘casualty ‘of the environment. One thing that has made Agok special, at least during my time in the field, are the events and activities my teammates have conjured up specifically to combat this emotional, mental and physical lethargy that so many experience during their time here. To be honest however, when I first heard word about the ‘dance competition’, my initial reaction was to feel even more exhaustion. I could not remember the last time that I had a free weekend, let alone even one free evening to myself. Planning for the competition was underway; posters were hung, draped and plastered onto every surface, announcing when the first round of auditions would be held, when the second round of auditions would be held and then finally when the actual competition would be held. I heard murmurs of costumes, of props of music selection and my response was… “when will I possibly have the time to partake in this!?” ‘And costumes!??’ I think if I hadn’t felt so exhausted, my response would have been one of pure elation as I LOVE to dance. So normally, this would be MY event.

As things started to come together however, I realized that this was actually therapeutic and beautiful.  As the sun began to set, crowds started to gather into a large circle. Before we knew it, the competition was well underway. Together we watched in awe and amusement as first the maternity department ‘took the stage’. Dancers dressed in tennis shoes with knee-high socks, dyed red layered skirts, white T-shirts and red and black poker style top hats flew into the arena shouting, singing and dancing. The leader entered first, weaving in and out of the crowds carrying a huge shield and a leopard print loin cloth.

When the log team was announced, probably forty, shirtless, 7-foot-tall midnight sky black South Sudanese men came running into the center of the circle. Some had MSF masking tape-bracelets around their arms, others sported belts, from which hung empty Dettol bottles, keys, water bottles and other ‘log paraphernalia’. They danced, ran, jumped, kicked up an excessive amount of dust and discharged waves of testosterone into the heavy South Sudanese night air.

Then there was the ‘Western Dance Group’, a mixture of hip hop and modern dance to raise the energy even further.

Being on the expat team, our dances and costumes were of course thrown together and improvised and paled in comparison to what the others presented, however the entertainment factor was high. The air was filled with laughter as probably over a hundred people watched us dance la Bomba to a G-string wearing sumo wrestling hippopotamus who was projected onto a screen in front of us. We all had leopard printed bandanas around our heads, except for our fearless leader, who had also made himself a leopard print G-string (over his pants of course). We saved our ‘performance for the end’, so as to not set any precedence and so as to merely end the evening with some lighthearted entertainment. We knew that we had no chance of winning the competition.

'La Bomba'crew. 

The real stars of the night however, were the Acholi group. They danced their way into the open, the women coming first and then the men. They had fashioned headpieces out of feathers, wire coiling and metal washers. The women all wore, full pleated skirts which served to accentuate even the slightest hip or buttock shake. The dance was beautiful. It was a song. A story. Ultimately, it was a dance of Peace.

Acholi Peace Dancers.

The men of the Acholi. 

Acholi in Action. 

The Acholi head-piece making its rounds. 

Here, in the middle of war-ravaged South Sudan, we were dancing for peace, choosing to celebrate one another’s differences rather than let them divide us. For a moment, I contemplated how to bottle this spirit of peace and spread it freely outside Agok, until it had permeated all 28 states with its sweet aroma. If only it were that simple. For now, we will continue to dance, to celebrate what it means to be alive, to love one another, to honor and respect one another and to cherish our differences, because our differences are beautiful.

May We Continue to Pursue Peace. /  by Sarah Rawlins

Together, we celebrate what it means to be alive, to be living and working together; one team made up of many nations. Although our backgrounds are very different, we are-brought together by our shared experience of living in Agok and of caring for and serving our patients. Together, we celebrate the newest country in the world. It is an atmosphere pregnant with hopes, longings and anticipation; all finely balanced upon a fragility, which speaks of defeat, loss and the exhaustion that comes with being resigned to a life of war.

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Everyone has Stories /  by Sarah Rawlins

Even when we live together, we segregate ourselves. We form our little groups, find our place of comfort and all too often forget that there is much to be learned from the very people who we find ourselves judging. We miss out on this deep well of great beauty when we fail to take the time to hear people’s stories. I don’t say this as an admonishment. These words are for me as much as they are for you.

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