Who's that lady?

It started as something to do in the market near the hospital (yeah things in Sudan were THAT exciting) and then it became a new hobby which I carried on to Kenya.

King Richard, driver extraordinaire by day, beautiful woman by night

William, I mean will men be able to resist those locks?

TJ Balding, wanna be Guns-N-Roses guitarist, but settling as a back up RuPaul dancer

Phillip, field coordinator expert, who has Jermack, bounce back, beautiful hair

Kuku, I mean who doesn't want to rustle those feathers?

Nairobian

I have been in Nairobi now for almost a month, trying to settle into a new routine. We have been still working to provide support to the hospital in Nuba in our absence via organizing the procurement of medical supplies, medications, and staples. It's been challenging since there are not many airplanes willing to travel into a war zone. All of the updates I have received have assured me that all of the hospital staff are safe at this point in time. Please continue to do what you do: pray, meditate, or chant for all of them.

I have begun to train as an anesthetist at a hospital here in Nairobi.  So far it has been going really well and I've been learning a lot. I successfully intubated a patient the other day and have been doing a lot of spinals. I hope I will be able to translate these new skills back in Sudan, but I'm not sure I will be able to return.

Learning the city of Nairobi has been interesting to say the least. I have gotten lost in town several times as I have been attempting to learn the matatu system. The matatu rides are an adventure in their own right...crammed seats and loud reggae blarring, all complimented by bumps on your head from hitting the ceiling along a fast and bumpy ride. It reminds me of traveling in Guatemala. I've been learning Swahili, which has been much easier than learning the local Arabic dialect in Sudan. I forget how much of a visual learning I am and having an actual book has been invaluable.

Overall everything is going well. I still have guilty thoughts of abandoning the people of Nuba and Dr. Tom, but I have come to realize that it was the best decision given the circumstances. I am doing my best to support the hospital remotely and to rise up to all the new challenges presented to me.

Diani Beach, Kenya

Whirlwind

If you haven't picked up a newspaper or clicked on an online article about Sudan by this point, I highly suggest you expand your knowledge of what is going on there. The last few weeks for me have been an absolute whirlwind of emotion and activity; I am still trying to wrap my head around what I have seen and experienced.  Looking back, it seems that these changes happened gradually, but the situation now is so absurd that it's like a runaway train off its track. It all started with Bashir's threats of taking back the border states and then he started to "make good" on his statements. The fighting broke out in Kadugli and various other villages in that area. The fighting eventually spread to areas closer to where I was in Gidel. About a week before I was evacuated we started to hear the sounds of Antonovs and MIGs flying above us. At the time I didn't even know what an Antonov was, but I was taught to just lie down if I heard them come closer.  Apparently, they are very inaccurate when it comes to bombing and used mostly as a scare tactic. It became a daily occurrence to hear bombing and gunfire in the distance. When wounded soldiers and civilians from various areas began trickling into the hospital it started to feel a lot more real.  I over heard one soldier saying to another that these injuries were caused by "freedom bullets;" the people of Nuba Mountains will do anything to solidify their freedom from the North, including sacrificing their own lives. Many articles refer to people in South Kordofan as "rebels" which is completely inaccurate. These people never had an opportunity to vote like the individuals in South Sudan; they never got the popular consultation they were guaranteed.

The number of patients treated over the last 2 weeks is well over 100 now. We just learned that one of our employee's neighbors was killed by a bomb and she was 9 months pregnant. The stories I continue to receive from the field are horrific and having seen some of the wounded first handedly will forever stay in my mind.  I did not want to leave the field, but evacuation became inevitable and at the same time extremely problematic.

When some of our builders and the remaining teachers were waiting on the airstrip to leave, Antonovs and MIGs showed up and began bombing them. The plane was unable to land and evacuate them and they hid under trees as bombs were landing 5 meters away from them. After the bombing of the airstrip, no planes wanted to land. Two days later all of the ex-pat staff was packed and ready to be evacuated after a pilot actually agreed to land on the same airstrip. None of the staff knew we were leaving because we were afraid  of a security breach leading to a repeat airstrip bombing. We got up at 5am hoping to be on the plane before the Antonovs showed up for their morning scare. We traveled in two trucks, whose white paint was smeared with mud to be more discrete. Once we were close to the airstrip, we hid under trees awaiting the arrival of the plane. The first sounds of a plane brought about slight panic- was it an Antonov or our plane? Did somehow the North get information that another evacuation plane was coming? When it was confirmed to be our plane we sped as fast as possible to the airstrip.  We ran with our bags to the plane while SPLA soldiers looked over us with their guns. Once we made it to the plane our bags were thrown on while the propellers were still moving. The real moment of truth was waiting for the pilot to take off while we were all strapped in. If a plane came then we would have no place in which to run. I glanced at my watch as we began to take off; it was 8:20AM.  The national staff was by then all at the hospital ready to work, discovering for the first time that all of the ex-pats had left.  

Dr. Tom is currently alone with only a handful of qualified help. When surgical cases come in he is now both the anesthetist and the surgeon. So now I am in Nairobi trying to find a mission hospital willing to train me as an anesthetist so I can return to the field to help him.  At the same time, we are helping to organize emergency aid for the hospital.

The last few weeks have been nothing that I could have ever imagined experiencing and I obviously have very mixed emotions about leaving.  At least being out of the field I have saved my family and close friends a lot of money from paxil co-payments.

Please keep the people of Nuba Mountains in your thoughts. They are the strongest people that I have ever met and do not deserve any of the atrocities which they are currently forced to face. I hope for peace and stability so that I am able to go back and continue with the work I set off to do.

Middle School Nurses

Pharmacy 

One of the huge problems in this area is lack of education. In the entire hospital staff of over 100 nationals (from the cleaners to the nurse assistants) there are about 5 people who have finished high school. The first graduating high school class in this area was 2009. The statistics are staggering, but unfortunately not surprising considering the history of this area. A huge amount of fighting between North and South Sudan took place in South Kordorfan in the Nuba Mountains. There simply were no schools to attend during that period.  Some children were sent elsewhere for education, but times of war render financial instability and the funds were not available to the vast majority.  The other problem with the Nuba Mountains is that they are not part of South Sudan, so they are not eligible for many scholarships set up for the Sudanese. When I talk to some of my colleagues, 99% of them are desperate for an opportunity to continue studying. Some are trying to save up money for school fees by working at the hospital, many are using their salaries to send their younger brothers and sisters to school instead of finishing more school themselves.  For example, my translator Kodiki only finished half of high school and his salary (~$100/month) goes towards feeding, clothing, and schooling his younger siblings since his father lost his life during the war.

Right now there are several former hospital employees who began nursing school through sponsorships in South Sudan.  The program is 4 years long and they are the first group to be sent from our hospital.  The hope is that in the future these trained nurses will eventually be the ward in charges.  The other opportunity for medical education is a basic nursing course at a local NGO.  They just graduated their first class this past year, and although they have some book knowledge, they lack hands on experience.  In the mean time, the hospital staff continues to run with nurse aids that cannot tell you where Japan is on a map but can start an IV line and assist in the operating room.  These individuals are extremely dedicated to the hospital and their drive to learning clearly outweighs any formal education they have received.

Miriam, who after I learned was my translator's Aunt, I now call Auntie in Arabic. She calls me "Betu" and hooks me up with tea.

 

Lojo and Mandi (you might know him better as the "rat slapper")

Some of the lab staff

Rhiala: one of the few high school grads seeking further education

 Joseph: my buddy seeking to be in every picture I took

If you know anyone who would like to sponsor an employee or one of their family members for educational opportunities get in touch with me! 

Photo Montage #3

Best Quotes of 2011

I find myself extremely amused by the many of the staff members lingo. I'm sure they are equally entertained by my own English slang. Here is a small sample of some of my favorites:

1. "Let Kuku get his admission fee. He (the patient) is likely to escape."

One of our staff members Kuku is the accountant. He collects all the payments for the patients (admission fees, surgical fees etc). Many patients can be stubborn and try to leave before they are medically or post-
operatively stable. In this instance we had a young guy in his 20s who had a broken leg, who kept walking around on his cast and never listened to any of our advice.

2. "You don't eat dove?"

Dove season just came and went. I was unfamiliar with the trapping and roasting dove procedure. Two of the  ex-pats (Julius & Francis) from Uganda made some contraptions with string to catch multiple doves in our garden. At first all I could equate eating a dove to was munching on a city pigeon, but I overcame these notions and I did partake in the dove eating . It was actually quite tasty meat.

3. "Laura, are you married? Good...I want a white one."

No explanation needed.

4. "Having a wife is not like drinking water...it's like putting yourself in prison."

My translator was explaining to me the difficulties of marriage and why he was not married yet. I guess he
may never be.

5. "We are going for communication."

In order to get cell phone service in this area you have to climb a mountain which is a good 20-30 minute walk or go to the "city" of Kauda which is 40 minutes by car.

6. "Mandi kills rats with his hands...he slaps them to death."

Mandi is the theater assistant that has now left to complete high school. I have witnessed the
catching and killing technique that he uses. It is quite impressive.

7. "They say that when a child pees on you that you will have a child very soon."

This was explained to me when I was urinated on twice by two different little boys. I tried to counteroffer this belief by pointing out that when children don't utilize diapers the chance of getting tinkled on exponentially increases.  But in their defense there are a lot of pregnant women in the Nuba Mountains.

8. "So that's what you do when you're in a hurry...you walk fast?"

 Definitely had an attack of laughter when this was stated by one of my Kenyan friends when we saw a staff member power walking to the hospital.

Photo Montage #2

Some of my co-workers Alamean, Musa, and Joseph. 

You say "Po-ta-to", I say "Pa-tah-to"

One of the biggest challenges I have encountered working at the hospital is deciphering the patient's medical complaints. Let's just say that obtaining an accurate history is next to impossible because the people here have a totally different concept of disease. For example, I would say that 95% of the people I see state that they have "burning in the urine." At first I thought it was a glitch in communication with my translator, but after hearing the complaint on average 50 times a day, I started to get suspicious. In addition, when I have had patients that speak English they say distinctively in English "I have burning in my urine."  Even the mothers of 9-month old children look me straight in the eye and state that their babies have "burning in his/her urine." This lead me to have two large concerns: is there a urinary tract infection epidemic here and why hasn't my nephew of the same age gained as vast of a vocabulary yet? Dr. Tom has assured me that UTIs are not running rampant in the Nuba Mountains and confessed that even he is unsure what to make of the compliant. I will have to discuss the latter concern with my brother and sister-in-law via skype or perhaps directly call child services because they clearly are not taking this parenting role very seriously. It doesn't help that the follow-up complaint is usually "I have hotness in my body." One might conclude that all the patients have hemorrhoids, ulcers, and horrible sunburns, but being the astute clinician that I am, I have discovered that they are not all suffering from such inflictions simultaneously.

Another barrier to getting to the bottom of a patient's problem is their warped sense of time and convoluted  stories.  I have learned that one can not trust a patient's concept of time when they honestly have no idea how old they are. This is probably every American women's dream, to just pick a ball park age, but it makes getting a history that much more difficult  Allow me to reenact:

Patient (who appears to be in her late forties but claims to be 31 years old): "I have burning in my urine, headache, joint pain, and back pain"

Me: "Okay. For how long?" (in perfect Arabic)

Patient: "I have hotness in my stomach, hotness on the bottom of my feet, and my left eye waters during the night when the hotness reaches my head."

Me: "For how long?" (again, using impeccable Arabic)

Patient: "A long time."

Me: "How many weeks, months, years?"

Patient: "15 years."

In my training as a PA I have yet to come across a disease entity that fits that description and has no findings on physical exam.  

Another problem is that the patients tend to be rather tricky and slip in the legitimate compliant at the end of all the temperature sensitive ailments. A patient whose hotness throughout the body is "so strong" will casually reply that they have had vaginal bleeding for 2 months or say they have some swelling on their thigh which turns out to be an abscess with over a liter of pus inside.  I guess all that heat fully encompasses the patient's body and consequently consumes all of their other physical problems. 

Having been here now for 3 months, I have gotten a better handle on interpreting their medical complaints and making a proper diagnosis, but it has not been an easy path.  I must say that it is quite fitting that here in Gidel the sun is amazingly strong, beating down on your entire body, and that the "roads" around here are twisting paths of rocky dirt.

Third Time's A Charm

Fasten your seat belts, hold on to your hats, and secure your wigs because the following is a doozy of a ride. 

In the videos below you will witness first hand the entire gamut of human emotions associated with  SUCCESSFULLY killing a chicken.

WARNING: if you are a chicken lover please refrain from watching the videos but if you like chicken soup please cut and paste the following links.

http://www.facebook.com/video/video.php?v=555961072945

              

  http://www.facebook.com/video/video.php?v=555984256485

I will have to admit that one of my previous entries may have insinuated that killing a chicken was a slightly less fear inducing activity, but there is no hiding the raw emotion of terror via video.

Burger Night

Unfortunately, with limited supplies and limited access to obtain new supplies, it can start to feel like you are living in the movie Groundhog Day when you walk into the kitchen for meals. Therefore, among the ex-pat staff, we try to think of new ways to prepare the food that is available to us. I came up with the idea of hamburgers, since I walk past a baker's dozen of cows pretty much everyday. I did not anticipate the idea to be all that unique considering they eat beef all the time here; I was gravely mistaken. Not only had no one actually tasted a juicy burger, but they did not even know what a hamburger was.  Hence, project burger night was put into effect.  We got some fresh  meat at the Saturday market down the street and began our preparations. To obtain the proper consistency, we used a grinder attached to the foundation of the kitchen table.  This means that you have to bend over like a hunchback or squat on the floor rotating a metal handle using sheer muscle power.  I assure you there was not a dry armpit in site. Next, I chopped up garlic and onions for seasoning and mixed it in with the meat.  Dora was on fry duty and cut up all the potatoes and cooked them in oil.  To top off the American burger feast we had tomato salad.  Dr. Tom contributed with a bottle of mustard he had received from a friend at another NGO in the area.

Warning: cover your keyboards before continuing on...heavy salivation is likely to be induced.

         Francis's first hamburger bite. He is clearly mesmerized by the flavors.

Phillip ready to sink his teeth into some meat.

Josephine says, "washing hair takes the back seat when amidst the air is a burger treat."

We helped Darius dress his burger right.

Julius proves to be another satisfied customer.

Yusef has now perfected the two hand "i'm lovin' it" burger pose.

Dr. Tom saluting gluten-free burgers

the full crew with their bellies filled

With the drastic success of burger night among the ex-pat crew, I have decided to plan another burger night for the locals who have also been deprived of hunks of cow hugged by two buns.  I definitely got burger fever because I also decided that I should open up my own hamburger hut at the top of the street.  If this dream because a reality I will try to follow the FDA serving size guidelines.  After all, I don't want to single handedly be responsible for an obesity epidemic in the middle of central Sudan.

Photo Montage #1

Uploading pictures takes forever because the internet connection is rather slow. It has also been difficult to take a lot of photos because my luggage was lost that contained the charger for my camera, which is now powerless.  To top it all off, my computer was stolen several weeks ago.  Against all odds and to satisfy the cries of my 23 followers, here is the first installment of a purely photo blog....

welcome to Gidel from Tyler & I

the full theater team ready for some serious cutting action

new home sweet new home

the driveway and parking spots out front

people beginning to line up for outpatient clinic

my outpatient office to see patients

sudanese sandwich

So what do you do in the middle of nowhere?

It's not exactly an exaggeration to say that working at the hospital consumes the vast majority of my time and energy. Nor is it a far fetched statement to say that this area is slightly lacking in the realm of live entertainment. But, I am a firm believer of making your own fun. So here is a list of some of my new favorite hobbies while living in Gidel.

1. Slaughtering animals

Do not be alarmed, I have not developed a sadistic personality disorder; I am simply embracing the inner Nebraskan farm girl in me. (Although I've never been to that state and I am pretty sure sledding in a cow pasture as a child does not constitute being a farm girl) In any event, killing chickens, goats, and cows is a normal occurrence here and I have become intrigued by it. I was taught step-by-step how to kill a chicken and when it was my turn I failed to complete the task. I had perfect form: my right foot on the wings, my left holding down the legs, its' head in my left hand and I de-plucked neck for optimum slicing, but then the chicken got squirmy. Apparently she was not too happy about having a knife to her jugular. The chicken's movements made me nervous and I lost my cool. So, I ended up handing over the task to a true professional (my ex-pat friend Dora). As of now I am 0-1 for making chicken dinner from scratch.


2. Learning a new language

The primary languages spoken in this area are Arabic and various tribal languages. I am trying to learn Arabic which is by no means an easy task. For example, the word "where" is pronounced exactly like "when." I mean, really? One of the biggest handicaps is not being able to visualize properly what you are trying to say.  My usual plan of attack is trying to write the words phonetically in English characters as an aid in memorization.  All of the national staff has been really helpful and I have made some progress, but I have a long way to go! So far I have mastered essential sayings such as, "I am going to pee" and "dance party today."

Most of the national staff are from the Tira tribe and they try to teach me that language as well. My American brain cannot learn both Tira and Arabic at once.  The only word I confidently use in Tira is diarrhea. I cannot even say "I have diarrhea." Simply just the word diarrhea.  I use it in many expected scenarios. If, for example, I have felt sick I will grab my stomach and say "gaucha." or if something smells horrible on the wards I will plug my nose while saying "gaucha.". There are other times, I will admit, I just say it completely out of context; it does roll off the tongue quite nicely.  I believe knowing one word instills a belief in my colleagues that I am still trying to learn their tribal language and it is important for them to hear me say it.  There is a chance they might catch on a few months from now when my Tira vocabulary has not grown.  I am confident my brother would be proud of the word I have chosen to utilize, considering that instead of saying "eeny, meeny, miny, moe" as children to determine the dreaded "it" we recited "ink, stink, poop, fart, out."

3. Food preparation

Let me start off by saying that Sudan is the mecca of sorghum, which means living here is a glutard's paradise. They prepare medida often, which is a sorghum based porridge. (Yes, think Goldielocks)  They even make marisa, which is a gluten-free beer. Overall, the food here has been really good. The cooks' staples are beans, rice, and kale.  Eggplant pops in sometimes, as well as homemade salsa.  Cassava is a popular treat, which is prepared similar to a potato. I have started to become an iron chef myself with the small kerosene burner and help often in preparation of various dishes; although I have had my share of trouble.  Often, or perhaps always is a more accurate term, I have been forced to call in reinforcements for the extinguishing of the fire. I spent one afternoon sitting in front of a roaring kerosene torch waiting for a fellow hungry ex-pat to stumble in. They walked in, long after what I had prepared was eaten, to a solitary kerosene burner strategically moved away from all flammable items in the kitchen.  They say the wicks were too long; I say we should get an NYFD volunteer for the year.  In any event, I was quite grateful (again) to stop inhaling the fumes and now secretly only use the kerosene burner when I know someone is around to put it out.

Celebrating Nuba Style

It was a first to spend the holiday season in a warm climate and be away from my family. Not having to wear a winter coat while opening Christmas presents on 1 Thomas Drive was a plus, not seeing my family and friends was a big minus. Christmas here in the Nuba Mountains was about as action packed as I've seen it get in these parts. People started walking to Christmas mass at the wee hours of the morning. I woke up at 6am not because I was anxious to open presents underneath a nearby baobob tree, but because of the sounds of chanting and drumming.  There were hundreds of people from various tribes walking to mass. I would like to compare this to the Macy's Thanksgiving Day Parade in New York with the Snoopy balloon omitted. The mass commenced with the bishop at 10AM and the sounds of praise continued well past that two hour celebration.

The highlight of the day was the tribal dance competitions. Representatives from various tribes put together a routine which they performed in front of the Bishop and about a thousand bystanders. Because we were considered part of the Bishop's entourage, we got front row seats to the event.

Not everyone was as lucky and they had to get creative in order to sneak a peek at the action.

The performances were extremely entertaining and we were also graced with the presence of many local village characters who liked to blow the instruments right in your face.

After watching the dancing and singing for many hours we retreated back to our compound, only a 5 minute walk away. We then enjoyed some goat and karadae wine that we had prepared the week prior. Some enjoyed a larger quantity than others...