Turning the Page

It has taken me a while to start writing this post because I wasn’t sure how to start it. There obviously needs to be one more, a completion of this account of my experience. But I was stumped on what to title it, how it should begin. The end of the chapter? The end of the journey? The end of the beginning? Nothing seemed to describe things accurately because it doesn’t necessarily feel like an end. Yes, my time in Agok is over, and I have clearly ended that part of the journey. But, as all things with this experience, I continue to learn how much this time will stay with me forever. So, “Turning the Page” seems like the perfect way to start this- I’m turning the page. But first, saying good bye.

The last 2 weeks in Agok flew by. My work continued to surprise, amaze and humble me, usually all in the same day. While just a normal day had any number of adventures, one particular day stood out in a big way. I was working day shift and had a woman there who was in her 4th pregnancy (one pregnancy was a set of twins) and having mild contractions. I was fairly certain she had twins again as I could feel a head presenting and another under her ribcage, but that second baby was a bit harder to completely feel the position of. She was 7 centimeters dilated (for those not familiar, 10 centimeters is considered “fully dilated” and when a woman usually starts pushing. Sometimes, especially when it’s not her first baby or if the baby is premature, she can deliver at 9 centimeters). Normally this would be an no-brainer case; the patient would be admitted and we would just monitor her for progress. However, this woman was determined to go home. She told me, “Today’s not the day. The babies aren’t coming for another month”, and was quite insistent. Because she was so far dilated, her contractions were regular, and she was having twins, I felt uncomfortable having her leave. But of course, the decision was completely hers. I explained my concerns with her leaving, and asked if she would be willing to wait 3 hours and then I would recheck her. If, at that time, she was still 7 centimeters,  I wouldn’t put up a huge fight about her leaving (even though I would still be hesitant); she agreed. Things got busy and I lost track of time. Four hours later I rechecked her and she was 9 centimeters but still insistent that the babies weren’t coming. I had to tell her, ready or not, the babies were coming. We talked a bit more and she finally conceded that today would be baby day, though this was likely due more to the fact that she had started involuntarily pushing than my powers of persuasion. I alerted the staff so we could have enough people in the delivery room. It also came to mind that we had an ultrasound machine now, and perhaps it would be helpful to do a quick scan. Why this did not come to me sooner I have no idea. We had just recently gotten the ultrasound machine so I was still adjusting to the fact that it was even an option. I asked the supervisor to do a scan and, much to our surprise, she noted that there appeared to be a 3rd ribcage. She wasn’t positive so we just made sure we had enough equipment ready for 3 babies. I felt horrible for not getting the ultrasound sooner, but she said we wouldn’t have done anything differently. The first baby was head down, and given her 5 previous vaginal deliveries, she wouldn’t have gotten a cesarean section this time around just because there were triplets. Looking back, the fact that I didn’t even think to do an ultrasound right when she got there, and that we just put our gloves on and coached her in her pushing efforts after discovering she might have triplets, both are shining examples of how much I had gotten used to practicing midwifery there, without all the bells and whistles of modern technology. Here I was, practicing the art of midwifery at its core, doing exactly what I wanted to do. How amazing! Along with the midwife assistant, we coached the mom through pushing. She, however, still seemed to be clinging to the “not today” idea and did not move the baby too much. Then, an older woman came into the delivery room. We couldn’t make out if she was the patient’s mother, a town elder, a traditional birth attendant or a care giver for another patient who just happened to be hearing what was going on. I could not understand the words she was saying, but I sure understood exactly what she was telling the women just by her body language- she was telling her to push! And man did she listen; the next contraction the first baby came out. She started crying right away, and I could tell by her size and the size of the mom’s abdomen that she was one of three. We did another ultrasound and sure enough, there were 2 babies head to head still hanging out inside. The woman started laughing when we told her she had 2 more to push out (we had warned her there might be a third so it wasn’t a complete shock). She had clearly gotten the pushing down and delivered two boys within 5 minutes of their sister. Both were breech, came out healthy and required minimal resuscitation. It was a pretty amazing site, and a day I will never forget.

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My replacement was able to come earlier than originally planned which was awesome as her original start date wasn’t until after I left. While her position is much different than mine due to changes that were made during my last month, I was able to give her a general overview of how things run. And we had time to just socially chat; turns out she’s a midwife from Madison who went to school in a very small town in “nowhere” Wisconsin- Rhinelander!!! She couldn’t believe I knew where that was! It was so great to pass the baton to a fellow Wisconsinite (though, sadly, ANOTHER person from the States who doesn’t follow football!! Unbelievable!). I was so glad to have the time with her; I cannot imagine showing up for my first mission and not getting any handover from the person before me. It also provided an opportunity for me to really see how much I had become a part of life of Agok, or rather, how life in Agok had become part of me. Going through policies, explaining the day-to-day flow of things and reviewing paperwork were all so easy, and I couldn’t help but think back to how I had felt at the beginning, feeling like it was so new and foreign. The flow of the days and all the little nuances of everyday life had become second nature. As she asked questions and I explained things, it started to become clear all the ways life was so different in Agok from what I had been used to, and how drastically it was about change again for me. Before I knew it, my last few days had arrived.  I had my last pizza night, during which I had to pass along the secrets of making the cinnamon rolls.

 

I had my last night of playing the Monopoly card game that had become a nightly tradition. And then I had to start the goodbyes. It was hard to say goodbye to all the people I was used to seeing everyday. Few times in life are there circumstances where you not only work but also live with the same people day in and day out. For better and for worse, these people had been my family, and it was hard to part ways. Some I knew I would be keeping in touch with for a long time, and many I knew I was saying goodbye to forever. Each left an imprint on my heart that I will carry with me forever.

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This was the very strong US contingency I left behind (plus one Brit, though you’d never guess by her shirt).

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Some of the cooks on our compound

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The midwife assistants in the Antenatal Clinic

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One of my translators

 

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Some of the maternity crew

The next few days were filled with travel, debriefing and rest. Debriefing is a time to talk with people in positions in the mission offices in Juba and Geneva about my particular mission: what worked, what didn’t, areas that need improvement, high points, low points. It was a lot of talking and for me, it was a time to start processing. A lot of emotion came out as certain things became clear that were hard to see in the middle of the mission. It also was very surreal to be on the other side of the last 6 months. It seemed to go so fast and so slow at the same time, like so much of life. I was so fortunate that after all that my brother was able to meet me in Italy to help me start to reacclimatize to the developed world. We planned some of the time out, but also left a lot open to see where the day took us. It was a wonderful time, and it is a trip I will remember forever. But it was not my usual relaxing vacation. It was 3 days before I was able to get through a day without hyperventilating about something, and those episodes usually involved large crowds. I noticed I was on edge a lot more than I usually am, and got stressed out a lot quicker over things that normally aren’t a big deal for me (like deciding what to eat when given more than 4 options on a menu). Luckily the cuisine choice was easy, but which restaurant to go to was just always a “woah!” moment. In the talks with my brother it also gave me my first taste of realizing life had gone on without me. No matter how much contact I had with people while I was away, it’s not the same as being there in person, or being able to talk on the phone regularly with a good connection. Life went on for everyone while I was in Agok, and i would have to catch up on all that. So I tried as best I could with him, and soaked in beauty and slow pace of Italy as best I could.

After one last bear hug from my brother, I headed to Geneva for a night before heading to New York City. This is when it started to really feel like I was going home. My entertainment system didn’t work on the 9 hour flight. Luckily, I’m now a pro at entertaining myself. After I got over the initial devastation at not being able to catch up on current movies (to which I reassured myself it would only be on the other side of the flight that I could catch up for sure), I just pulled out my books and hard drive filled with movies, podcasts and shows and went through ones I hadn’t yet seen. Something that previously would’ve really put a damper on a very long flight just caused me to shrug my shoulders and warn the crew for the next flyer. I got quite emotional going through customs when the agent asked how long I had been gone. And I was beyond thrilled to finally not have to think about what language I was supposed to be speaking. After 3 countries in 4 days 1 week, and 2 in 2 days the next, it was nice to finally be speaking English (yet still said “Graci” a few times. Thanks to the recent close to record breaking snow storm, New York City was a disaster. It was 4 hours to get from JFK airport to my friends’ house in New Jersey. By the time I got there I was exhausted and, as usual now, emotional. But I got huge hugs and lots of love which made it all worth it. The next morning I got even more love from “my boys”, the awesome 11 year old twins to whom I am Auntie Katherine, and who I witnessed coming into the work as their labor and delivery nurse. They showed me where the Oreo stash was, showed me all the snacks, covered me with blankets when I sat on the couch, brought me drinks, made me chocolate covered strawberries, were my sous chef when I made dinner, and hugged me first thing in the morning and cuddled with me at night when we watched TV. I couldn’t have asked for more. While not being spoiled, I went into New York City for more debriefing. At this point I was really done talking with people. And because my mission was through MSF-Geneva, those in the New York office don’t have much direct say in things related to my particular mission. This was mostly general HR, communication, organizational stuff. My first meeting of the day though was with the therapist, which was likely the best way for me to get started. It was a safe place to vent my emotions and get some feedback. And, after having a little time since my last briefings, I had been able to get ideas focused a little more and articulate them a bit more coherently, though the tears flowed just as freely. After talking with her I was told I wasn’t alone in feeling the way I did, which was somewhat reassuring, but also made it more frustrating because knowing that doesn’t exactly help me personally get through it. But it is what it is. After this, I was finally done with debriefing and could finally go home. So, 4 days ago, I came home. Seeing my mom for the first time since I left was so wonderful. She and my dad had an embarrassingly large banner and flowers for me. My big sister had a priceless sign as well. It was great to see them right when I got there and get the bear hugs I so desperately missed. Because, no matter how much I try to organize my thoughts and feelings, I just can’t get it done eloquently, mostly because they themselves are all jumbled up. So, in an effort to get this post completed before May, I’m going to resort to bullet points. I haven’t gotten to a place where I am able to talk about this experience yet with everyone. I’m still trying to process, and remember, and just give myself some time. This is where I’m at right now (and it’s pretty disorganized so beware).

I’m relieved to be home, surrounded by familiar things and people. I’m incredible grateful to my family for allowing me time and space to do what I need to do, but being available in case I do want to talk. And for allowing me to just start randomly crying because I found more socks. That’s right, socks are a BIG deal!

Simple things like deciding what to do for dinner, when given any option, can be too much for me to decide. I’m making a lot of quick, pointed decisions rather than considering all possibilities. I miss only having a couple options. Yes, they were the same options over and over again, but they were simple. Here there’s just too many.

It’s hard seeing how much life happened while I was gone. Talking to friends and finding out things that I wasn’t here for, things that I absolutely would’ve wanted to help them through, is so hard. It is also hard to now be seeing the aftermath of my grandmother’s passing. I am not able to start getting to that yet, but I know it’s there in so many ways.

Breakfast sandwiches, oh how I have missed thee! I had 3 in New York, each one as blissful as the next. The 6 month buildup did not disappoint!

Frozen custard- ditto!

I missed an entire Packer season. The whole thing! This fact is a tough one to swallow. Yes, Super Bowl Sunday is a family holiday in my house, and we will have massive amounts of food. But still, no Packers for me this year. That hurts. My only consolation is that it was not one of their most shining years. At least it wasn’t an undefeated season; they can do that next season when I’m stateside.

I am experiencing exhaustion unlike anything I’ve ever had, even after my most grueling race. I’m tired to my bones. And I can’t sleep through the night most nights. So this becomes a constant struggle.

I’m slowly trying to find me again. I laugh, I cry and I get glimpses of myself. But I cannot get myself to feel strong emotions. It just feels like I’m numb.

I find it’s easy to go through a day and forget the last 6 months happened. And then some small thing will happen and it all comes rushing back. A diaper commercial comes on TV. Someone will use 2 paper towels for something that would only take 1. Water comes out hot, and then cold, a big range of temperatures instead of just “on”. It’s all so new again.

I got to do some pretty amazing stuff, meet some pretty amazing people, and be witness to some pretty amazing things in the last 6 months. I’m so fortunate to have had this experience.

I miss random things about Agok. I miss it taking at the absolutely longest 2 minutes to get from the door of my tukul to the door of work. I miss being able to throw a load of laundry in a lunchtime (and by throw a load in I mean soak the clothes so they’re ready for a scrub and rinse after work). I miss having conversations with colleagues in our towels outside the showers. I miss the joy of a Coke in a 100 degree day, and of wine in a mug after a long day at work. I miss how much joy a slice of cheese or pastrami or a piece of chocolate can bring. Not surprisingly, I miss the sound of the fan at night. I miss the slow pace of life, of not being in a rush to get everywhere. I miss being able to walk across the “street” of my tukul to have a chat with a friend. I miss the beauty of the sky.

I’ve rediscovered the joy of a run. As hard as I tried, I never got into a good exercise routine in Agok and am now down to the smallest amount of muscle mass I’ve ever had. My skinny jeans now are more relaxed fit than skinny. So thanks to my incredibly smart foresight to have my winter running clothes here (go me go!), I’ve been pounding the pavement and it feels amazing. Not only do the endorphins help my energy, but I am getting back to my favorite stress reliever and problem solving method. While I do miss the kids yelling “How are you?” and waving as we ran down the road, and even coming up to run barefoot with us for a while, I do have my running companion here in the form of a furry 4 legged creature who is all in for my February boot camp.

I was so lucky to have so many people write, text, and send me things while I was away. Every single message, whether on the blog, on Facebook, in an email or sent snail mail meant so much and helped me get through a little easier so THANK YOU!!!!

I’m grateful for the people who have touched base since I’ve been back but have kept their distance and allowed me time to reach out to them further, hopefully without being slighted when it hasn’t happened immediately. I’m a work in progress everyday. And if you get tired of waiting, just tell me. Of all the things I got while I was in Agok, a Poker face is not one of them so my emotions are still written all over my face. You’ll know quickly if it’s too much.

There is a lot to figure out for the next chapter in my life. This adventure has changed my perspective on my place in health care and what I want to be doing. I know I don’t want to be away from home for 6 months at a time anymore. But I also know I have a passion for international health. How this will fit into my practice in the future I don’t know yet. But I will be working hard to figure that out. I’m excited to be at a place of change, to know that how I practice will forever be different, and for the better. But for the immediate future, I’m going to sleep. And stay in my pajamas as much as I can. And continue to work through processing the last 6 months. And sleep. And find a new place to live in Chicago. And run. And sleep. And reconnect with friends and family. And sleep. And…..

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One of my last sunrises in Agok

Thank you for taking the time to read this blog. My hope as I started this was to keep people updated at home about what was happening in Agok. I wanted to give people a little feel of what life was like, with all the good and bad. It became a place for me to work through things as well as I tried to organize events into coherent statements. It’s ofter not easy to articulate all that has happened, which is why it’s hard to start talking to people. Where to even begin? But this spot has helped me start and for that I’m grateful, even if no one reads it. So if you do, thank you for being on this journey with me. Again, all your messages meant so much. Thank you!!! And I hope that, by reading this blog, you have a little broader view of the world you live in and the work you do. Much peace and love to you all.

Katherine

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Merry Christmas!

Season greetings from Agok! In staying consistent with the rest of this journey, the last month has been a roller coaster of events, emotions and growth for me. And as I’ve moved through this time, it has become more and more clear how difficult it is to convey properly what this journey is like. No words or pictures will capture it. But as always, I’m going to try.

After Thanksgiving we started having a pretty rapid turnover in staff. Many people ended their missions and new people joined our group. It was hard saying goodbye to people I had become close to, but also wonderful and exciting to meet new people and have new energy around (The fact that some of the new people are English speakers was another bonus. But sadly, I still haven’t found another football fan; it is so disappointing). One of the positions that changed over was the neonatal nurse. I was sad to see the other half of “K and K2” leave (her name was Katrin); she was a great nurse and even more entertaining as she tried to increase her English vocabulary regularly by asking me, “How do you say…?”. She is missed. But another wonderful nurse has come to take over and we bonded rather quickly. Unfortunately, that bonding came in the form of the most depressing week of my career, let alone here, and it happened to coincide with her first week here. We had a baby die every day for 4 days in a row, and in one day I had 3 moms lose their babies. One of those moms had lost 3 of the 5 full term babies she had birthed; it was heartbreaking. That is something that just isn’t seen often in the United States. Another had delivered a premature baby, then journeyed 3 hours to get to us. Unfortunately the baby passed away in the ER, never even reaching our unit. And the last was such a fighter, but finally couldn’t hang on anymore and passed away as I held his hand. The nurse and I walked out together that day, arm in arm and crying. Trying to process all that,  especially all in one day, at the tail end of an exhausting mission, was a challenge. Someone asked me, “Weren’t you expecting this?”. In short, yes, I was. I knew death and suffering would be a part of this experience, more so than I ever witness back home. But knowing that and experiencing it are 2 very different things. Anyone can imagine how hard it will be to lose a loved one; actually experiencing that loss is such much more visceral. Knowing there will be very limited resources to help save lives, and knowing there will be a subsequent increase in the amount of loss and death is one thing. Seeing it first hand is a whole other realit. As I worked through the emotions of that week, I realized that one of the most difficult parts for me was the barriers for me in giving comfort to the families. I have never so acutely felt the language and cultural differences as in this time. Having to say “I’m so sorry for your loss” through an interpreter, and not being sure what physical contact was acceptable and appropriate for each mother made me ache with sadness. These are situations where I normally talk with patients about their feelings, cry with them, hug them, and just listen to whatever they need to say or ask. Here, loss is so much a part of their lives they don’t talk about it, and very rarely offer up how they are doing. But that does not mean they do not feel thatnloss. That is evident in the faces of the families as they watch us try to save their little baby, or in the quiet tears they shed after they realize we weren’t able to do enough.  And I have to believe they can feel my sympathy, and I do my best to convey it in anyway I can. So I just sit on their bed, place a hand on their hand or arm, say I am so sorry for their loss, and frequently shed a tear with them. Most days it doesn’t feel like enough, but it’s all I can do so I do it.

On these days I have to remember to keep looking for the bright spots, and they’re always there. There is a patient who’s been here for a month now from our project in Mayom (about a 2-3 hour drive in dry season, upwards of 6-7 hours in rainy season) who’s pregnant with twins. She’s staying with us until she has the babies because we are better equipped to handle any complications during her delivery. I admitted her, and I smile and shake her hand everyday I’m on, which usually makes her laugh. I figured I was just the crazy white lady who shook her hand in the morning, but I was okay with that. Few days go by that I don’t get laughed at about something I do. Then one morning I ran into her outside the ward on my way into work; she smiled huge and reached out her hand to shake mine. It made my day!

There’s a little boy about 3 years old who has been here at the hospital for a while with what appears to be burn injuries. He wears a men’s shirt that reaches his ankles, and with it a huge smile every time I see him. He always waves and smiles at me when he sees me. He came around the corner of the ward one day with some other kids who were patients/children of a friend of one of our patients. I saw sitting at the desk at our entrance and as soon as he saw me, he lit up and started waving like crazy. It melted my heart and was definitely my bright spot of that day.

What has become one of my favorite scenes occurs every morning outside the maternity ward. It has been very cold here at night now, getting close to 60 on the really cold nights (yes, I know that sounds crazy. But when you’re used to 100, 60 is downright frigid!). But our mornings always bring a bright sun by 8am. And there is always a lineup of women standing outside maternity against the wall, soaking in the morning warm. It reminds me to take a moment, breath in the brightness, and remember it’s a new day. I love it!!

One big boost came in the form of the newest addition to our Agok zoo. He have a puppy! He was found out side our latrines and quickly burrowed into our hearts.

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I call him Noel (I think it could be a boy’s name and he joined us at Christmastime), others call him Latrine (hence, Noel). He’s snugly, feisty, and just downright adorable! He is a nice reprieve at the end of a day. He joins, among others, Brandon the sheep. I enjoy nice in depth conversations with him daily.

The biggest boosts though has been Christmas. The season for me started with the arrival of 2 packages from home stuffed with Christmas love. I had cards and presents from family and friends that just warmed my heart to the top. I opened a couple cards a day so as to spread out the joy, just like getting mail at home. I again was on the receiving end of some hostility from others who were jealous I got more packages. But as I’ve said, I can’t help that I have awesome family and friends! They are he best!

I was asked several times if they have Christmas here; the answer is yes! I talked with the assistants one night about their traditions, and they have Christmas in it’s most basic and true form. They go to church, gather with family and eat. There are not a lot of decorations (one of the girls said “Katherine, my country is new. We don’t have decorations yet”); I took that as a challenge. I had such fun figuring out decorations, gifts and food with the resources at hand. I used things from the garbage (a puzzle and a book), things that got sent to me (fake snow, battery operated lights, ribbon, fabric and, shockingly, orange netting- thank you Mom!), and things laying around or bought here (tape, string and paint from the market), and turned them into what I thought were awesomeness.

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My wreath from puzzle pieces

We decided to do Christmas Eve night as our celebration with all the staff in the compound. There were a few of us that spent most of the day preparing food. I made the stuffing from Thanksgiving and cookies. It was a recipe from my dad’s mom, and my mom sent the powdered sugar and crushed nuts needed with my dad on holiday. They were a huge hit, especially with the cooks; I promised the head cook I would show her how to make me before I left. I had an emotional moment as I tried the first one out of the oven. With Bing Crosby playing on my iPad, I closed my eyes and was in my parents’ kitchen. imageBut I quickly became happy again as my friend Tamara urged me to be happy to share the love with my holiday family here. And that I did for the rest of the day. I had claimed decorating as my thing to do. I was surprised that the excitement I feel back home came right away as I started hanging decorations in the dining tukul. It all came together great; it’s amazing what you can do with so little.

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Not the greatest picture, but this was the dining tukul all set up

My favorite moment of the day came as I returned to the dining tukul after showering and wrapping my Secret Santa gift. Everyone was gathered around the entrance, and as I got up to the front I realized they were all looking at and taking pictures of the decorations and food. For me, that made the holiday and filled me with such happiness. I was so glad to be able to give all of us who were away from our loved ones some Christmas spirit. The gifts were very creative, and we discovered the rather random things that can be found at the market. I made sure to take a moment to look around and soak it in throughout the night. It was a great group of people, and a Christmas I know I will never forget.

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The cooks and some of the feast

So, as I said, a roller coaster of emotions. It’s amazing to me that I only have 2 weeks left here. I won’t lie and say I’m not very much looking forward to coming home. Or, rather, meeting my brother in Italy for a week before coming home. But I am also sad to see this experience come to an end. As emotionally and physically drained as I am, I still try to embrace each moment for the gift it is. As the year comes to an end, I know I will be able to look at this year with such joy. I leave you one last image- the sunset tonight. Happiest of New Years to you all!!

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Happy holidays!

Seasons greetings! I’m having a hard time believing it’s already going into the second week of December. As usual, the time continues to go fast and slow. Today there are no pictures as I realized as I sat to write this that I haven’t taken any here in a while. So, today I just reflect.

I wasn’t in the happiest of places going into Thanksgivng. The reality of not being home for the holidays took hold and made it rather depressing for me. But I had 2 options- wallow in my sorrow or try to find some way to celebrate however I could here. While I was tempted to just wallow, celebration won over. I  found a recipe for vegetarian stuffing which was to only Thanksgiving dish I had most of the ingredients to make. It turned out surprisingly well, and it was a hit with all the international team here. They were incredibly kind, wished me a Happy Thanksgiving, and amused me by going around to say something they were thankful for. And being movie Thursday, we kicked off the holiday season by watching Love Actually that night. It was great! The calls home to talk with family were tough, but I’m grateful I had the opportunity to see them even if it was over a computer screen. And I felt the love from home as people emailed and texted my good wishes.

The weeks since have mainly been spent trying to calm down my GI tract, work, and finish up the orientation program I was working on for new midwives. That project is pretty much finished. It was a great review for me of things I do everyday, as all things are that involve training staff anywhere. Hopefully it will help make the transition a bit more organized and comfortbable for the new hires coming in. And it’s something I can leave behind when I go.

As I look back on the last few weeks, it’s easy to think it was the same old, same old. But I’ve come to have a very different “same old”. I continue to have rather busy shifts (my colleagues back home will be amused to hear the black cloud of busyness has continued for me here. I even had a midwife assistant tell me when she walked in and saw I was the midwife on for the night that she wanted to switch shifts because “your shifts are always busy!”I had to laugh, and told her that was nothing new). I continue have moments that make me smile and appreciate the little things (like a mom kissing her baby as the baby cries while I brutally take his temperature. Because the thermometer under the arm is torture!). I missed one of the highlights of last week, but got to hear all about it. We had a mom who had just delivered twins, and she was found breastfeeding one of the babies while her mother was breastfeeding the other!  And the grandmother apparently was crushed when she was told she probably didn’t have enough milk to feed the baby (though it is quite possible she had had a baby in the last few years). Not something one sees everyday. I have also been struck yet again by how universal my job is. I had a conversation with one of the assistants last week about the fertile time in her cycle. She is very frustrated by the fact she isn’t pregnant yet, and her husband is asking her why it hasn’t happened (she has 2 other children). After explaining when she is able to get pregnant, she let it out that her husband is frequently gone for a few weeks of the month. I smiled as we finished, thinking I’m thousands of miles away but still having the same conversations with women. And I continue to have moments when I am reminded of the reality of where I am, like when a women came in with a laceration she said she got by sitting on something sharp but was clearly from an assault, and from which she bled so much she required 2 blood transfusions.

My goal for the coming weeks is to make it Christmas in whatever way I can. Thanks to my family I have Christmas lights, decorations and food. I took in candy canes this morning for the staff for St Nick’s day. They had never had them before and loved them! It is definitely something I will remember- being able to share a staple Christmas treat from my home with people who had never had it before. We have plans for a decoration-making night in the compound. And I am playing Christmas music in my tukul. Little things to make it feel festive. That being said, I’m not on Facebook anymore unless someone messages me; seeing the fun back home is hard. So if something big’s happening email me! 😀

So that’s what is going on here. It’s hard to believe I have just over 5 weeks left here. I wish for all of you moments this holiday season for you to reflect on the blessings in your life, and time to spend with the people you love. Sending holiday cheer and love your way!

Changing Seasons

Happy November from dry season in Agok! Hope this finds you not already knee deep in Christmas decorations.

Well, what can I say about holiday except that it was such an adventure? The 5 hour delay getting into Zanzibar was not at all fun, but once I got there I was greeted by 2 big bear hugs. And a bag full of love/food from friends and family back home. And a swimming pool. And fluffy pillows. It was heavenly! We spent the next 2 days doing some exploring the island including Stonetown, a spice farm tour and a visit to a forest full of red monkeys, the only place in the world to find them. It was interesting to watch my dad and sister experience Africa for the first time. The food, people, atmosphere, and history were all fascinating. And it was nice for me to see another area of Africa; so many similarities and differences at the same time. The spice farm was quite educational in a very fun way. I never knew red, white and black peppercorns were all the same peppercorn, just picked or processed differently. We got to try ginger root directly out of the ground- so delicious! We all agreed that many of the spices smelled and tasted differently than we are used to because they were so fresh. And the red monkeys (Theresa’s find) were so cool! They are used to people roaming around their habitat and know we won’t harm them, so they got up close and personal. I even got the amazing experience of capturing one of them breastfeeding. They both just looked at me as I took their picture without seeming to care.

imageAfter that I was good for the day!

After exploring the island we headed to the mainland for a safari. I could go on for pages about the safari, but I’ll keep the long rendition for those when I get home. But what I will say is… WOW!! I am so glad we did this! The first part was in the Ngorongoro Crater. We arrived to the area just before sunset and were able to look down into the crater. I must say,I was a bit nervous looking down into it about what we would see down there; it was very barren-looking. I could see some black dots which I figured were some sort of animal, but that was about it.

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So as we started driving down into it the next morning, it was a mesmerizing surprise to come across a line of zebras just, you know, out for a morning stroll.Over the next 6 hours we saw more zebras in addition to hyenas, warthogs, lions, water buffalo, wildebeests (cool the first few times, not so much a couple thousand later) a black rhino, gazelles, baboons, hippos, ostriches, and, my favorite and the highlight for me, elephants! We knew we were having a very good and unusual Monday when we felt we had seen enough zebras; can’t say I’d ever said that before! It was neat to stop and look back down on the crater from the top on the way out, knowing everything that was in there. Definitely a different perspective on the way out from on the way in.

The next day we headed to Tarangire National Park. On our way there we passed an elephant just walking down the side of the road, kind of like I see deer on the side of the road back home. It was the “We’re not in Kansas anymore” moment of the morning. It was also a beautiful testament to the Maasai people who inhabit the area around the park. They live in harmony with the animals, letting them migrate through the land as they desire. Inside the park we saw many of the same animals as the day before, but much closer and with the very important (for Theresa) addition of giraffes.

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And I was even more in awe than the day before as not only the number of elephants in general was beyond imaginable, but, even more spectacular was the number of baby elephants! They were everywhere!

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I could’ve watched them all day. Even caught one breastfeeding!! Theresa and I were sad that the elephants were not playing with the giraffes, and talked about starting an outreach program to try to get our favorite animals on more friendly terms. Then, at lunch we saw a giraffe forging across the water to get closer to the elephants! It was like they heard us!! It’s hard to see the giraffe, but he’s there in the water, checking out the elephants on the right. We will forever remember the olive branch being put out there.

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It was amazing to see so many different animals all in the same space.

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The highlight I think for all of us was when we came across a lioness on the prowl for lunch. Our guide was very experienced, realized what was happening, and led us around the park to follow her. We patiently waited for her to make her move, during which time I was sweating because I was so nervous she was going to attack the baby elephants. As we watched, we noticed all the other animals in the area become quite aware of her presence. The elephants all formed groups to have every angle watched, with the the babies protected in the mix. I know this picture is hard to make out, but on the left is a group of elephants, all facing different directions, with a baby next to one of them. Under the tree on the right is the lioness.

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These are things you don’t get to observe at the zoo! We lost the lioness at one point, but we quickly found her again when animals started a mass stampede as she attacked. She didn’t catch anything, but seeing her run after the animals was breathtaking. She moved so quickly and so stealthily, though sadly, not quickly enough. That time at least; I’m confident she got some food eventually. After that, we felt we had had a good and satisfying safari experience.

The next day we headed back to Zanzibar to finish out or holiday relaxing on the beach. My thoughtful dad treated Theresa and I to massages, I was able to indulge in bacon every morning, try my hand at the make-your-own Bloody Mary section (can’t say I was super successful), swim in the ocean, swim in the pool, finally learn the basics of chess, read, and do a bit of snorkeling before playing pass-the-bucket with Theresa when the waves got the best of us. So all in all, a successful holiday! It was so nice to talk face to face with them, get some big hugs, and just hang out. I also learned that there is a high possibility my food standards have changed a bit. This was discovered after I ate half a plate of some rather questionable (aka horrible smelling and inedible) shrimp before deciding maybe I shouldn’t continue. The best part- I didn’t feel amazing but I didn’t get sick! Woohoo!! I also further appreciated how truly kind the Tanzanian people were. They were very accommodating, got whatever we even hinted we may want, and smiled all the time. Yes, the people trying to sell us things on the beach did get tiring very quickly, but they usually backed off immediately when we said no. It was a beautiful country, and I am so glad I was able to experience it with some family.

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So, now I’m back in Agok. The 2 weeks I was gone brought a lot of changes. I could tell the landscape was less green as we flew in. Most of the frogs are gone, replaced by incredibly annoying and intrusive grasshoppers (seriously, one jumped down my shirt while I was face timing a friend is weekend! So inappropriate!!) and bees. The days are hotter, the nights cooler. I even put on a sweatshirt at work last week. The locals say they know it’s getting cooler when the American and Europeans start putting on long sleeves; I guess we’ve arrived. The stars are not as plentiful, and I haven’t been able to see the Milky Way since I got back. The sunsets have changed too, now more hazy and hide the sun way before the noisome. But I still make a point to look up and appreciate the view every chance I get.

Work has been very busy since I got back, and I have been quickly thrust back to the reality here. I had a mom lose a baby due to something that could’ve been detected and managed appropriately had she had access to an ultrasound or been able to get to the hospital quicker. I also had a mom who was able to take her healthy baby home because she got herself to the hospital in labor, but likely would’ve lost him if she had delivered at home. That’s life here- celebrating the victories, and trying not to be too down about things we cannot do, the ones we cannot save. For me, it’s a constant and on going journey. One minor (I’m kidding, it was major!!!) happening at work was being able to catch my first set of twins! It was beautiful! Luckily both the boys and their mom made it through perfectly (she was a rock star!) and it will be something I will never forget.

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For the last part of my mission here I am now working on getting the orientation program for new midwives together. This is going to be my little stamp to leave here when I go, and I’m excited to get it organized.

So, that’s life here these days. I’ll admit I’ve had mixed emotions about seeing holiday things online. I sometimes want to ignore the fact that Thanksgiving and Christmas are coming, and then remember who I am and admit there’s no way Christmas will go unnoticed or uncelebrated in whatever way I can. It would also help me immensely if the Packers could go back to winning. I have been waiting for it to get a bit cooler to wear my Packer socks, but they might have to come out either way next weekend. I’ll be rocking the knee socks with shorts but hey, whatever I can do from here!

I have 8 weeks left here. I’m trying not to wish myself back home too quickly and really soak in every minute and every moment of this experience. But for those interested, I’ll be in Milwaukee the last weekend of January😀

Halftime Report

Hello hello!

I’m a bit shocked I’m already writing this, but I am now halfway through my mission and officially on holiday! I will say, it could be because I knew this break was coming, but this could not have been better timed. The general feeling of exhaustion and a desire to walk around freely had become quite overwhelming. This seems to be the perfect time to sit back, take a break, reflect, and regroup for the second half.

The three weeks since I’ve returned from Denmark have been ones of change in Agok. My department is under a bit of transition right now. The supervisor who has been there for the last 2 years left at the beginning of October. One of the regional midwives is acting supervisor right now, but most of the administrative responsibilities have been split up between the 7 of us midwives. This has been an adventure in itself; it’s nice to get a different perspective on things as they are run on the unit. I was tasked with supply and logistics. Basically this entails ordering supplies for the unit every Monday and making lists of things that need fixing (luckily I do not actually have to fix things myself, though I have been pulling out my Leatherman a bit more frequently, much to the surprise of most of the male staff!). I have discovered that we have a Pen Monster on the unit who sneaks in and takes our pens. The speed with which we go through the box of 50 I order is remarkable and can only be explained by the Monster. I did tell the staff before I left that, if the pens did not stop disappearing, I would be starting a sign-up sheet, and they would only be allocated a certain number of pens. The laughing I got in response makes me feel they did not think I was serious. But it has been interesting to see how and what things get ordered on a weekly basis, and has me thinking about ways to help conserve resources. I think everyone is getting a better appreciation for all that it takes administratively to keep the unit running, which I don’t think is ever a bad thing.

I have heard that the end of malaria season is coming; the hospital even threw a party for the staff last weekend to thank them for their hard work during the peak time. I am not completely convinced yet as our unit is still full of women with malaria, but I will keep watching. I was a bit confused one night at dinner when we were talking that people from the communities were saying malaria was over because they were starting to have more people with diarrhea. I did not quite understand the connection. But then it was explained that during wet season, malaria is rampant. During dry season, water levels go down, water quality goes down, and cases of infection, diarrhea and malnutrition go up. The wet season was very short this year; last year the peak of malaria was well into January. So, I’ve been reading up so I can properly treat these new (for me) illnesses as they start coming in. Always something new to learn. The temperatures seem to have gone up during the day, making us look for new ways to try to cool off. As we are in the “be creative and take what you can get” mode, a couple of us enjoyed a reprieve when going to get restocked on vaccinations from the pharmacy cooler. image

That’s is about all of the news. I’m looking forward to taking some time now to reflect on the mission so far, and on things going forward. I am feeling and thinking a lot of what I expected to at this point. I’m amazed at the things I have learned and those that I continue to read up on. I’m humbled by things that still remain uncertain to me, and by things I miss or mistakes I make. I’ve had extraordinarily sad cases in these last 3 months, and also many amazingly beautiful moments. I’ve been reminded of the frailty of life, and the resilience of the human spirit. I’ve learned to try to better appreciate the little things everyday instead of letting the culmination of everything bad get to me (though I admit this is a constant, daily challenge). And I’ve come to appreciate things that I knew were important, but have come to mean even more now. I’m incredibly grateful for my colleagues back home who have done text and FaceTime consults with me. Not having a doctor to consult with here, I have been at a loss a few times and needed someone to bounce things off of. I’m so happy anytime I can Skype it FaceTime with someone from back home, or when I get a text or email. It’s hard being away from everyone, but it’s great to get updates or even just a “hello, I’m thinking about you”. I’m grateful for the websites that give me play-by-play updates during Packer games, and my friend Binni for the morning-after run down (though I didn’t get one this week lady!). More importantly, I’m grateful the Packers keep winning; thank you Pack! it gives me a little extra boost on Monday or Tuesday morning, even if I am tired from being up during the middle of the night catching updates.

I’m planning to take the next couple of weeks to just breath, and think of what I want to do in the next 3 months. One thing I know for sure is that I will remind myself daily that this opportunity will be over before I know it, so I better soak it all in while I can. The good, the bad, the frustrating and the invigorating. It is all part of this great lesson I continue to learn. More immediately, I’m looking forward to the huge bear hugs I will be giving and getting tomorrow afternoon from  my dad and sister! And the bag full of goodies that they are bringing me😀 On that note, a huge THANK YOU to everyone who has sent me something!!!!! You will really never know how much it means to know you took the time to send something. It doesn’t matter what you sent- I love it, appreciate it, and can guarantee it will make me smile! You rock my world! That being said, I have to ask that nothing more get sent to the NY office. There are currently 5 packages that have been sitting there for over a month waiting for someone to take them to Geneva (have no fear- they are being rescued by my friend Bill who will help get them to me). I’m afraid anything sent after this won’t get to me until right before I leave, if then. You can just send me an email if you feel the need to send something; that really is enough. If you feel you absolutely have to send something, it should go to the Geneva office (which will get it to me much quicker). The address is:

Medecins Sans Frontiers

Katherine Erbe, Agok mission

78 rue de Lausanne

Case Postale 116

1211 Geneva 21

Switzerland

But really emails are fine:)

And now I must sleep. I wish you all a wonderful evening, and hope your corner of the world is bringing you peace and love. I leave you with a recent sunset (I still haven’t gotten used to them). image

It’s October!!!

How is it already October?!?! Crazy!

Well, this post is a bit of a change. About 3 weeks ago I was approached by the Medical Team leader here and asked if I wanted to go to Copenhagen for a training course. I will admit that that was all the information I got out of that first conversation- training and Copenhagen. My feeling was that when someone offers to send you to another country for free training, there’s only 1 correct answer. I said yes immediately! A few days later I asked for a little more information on the course (much to her amusement when she realized I said agreed without knowing what I was saying yes to) and then got even more excited. The course was Advanced Life Saving Skills in Obstetrics, aka ALSO. It was designed by the American Academy of Family Physicians and then tailored for providers working in low resource environments. The course itself was for 3 days, but there was a 400 page manual to read beforehand so those of us that we’re coming from the field were given 3 days in Copenhagen beforehand to read and study (there was a 2 part exam at the end of the course). Coming from Agok, that came to a grand total of 2 weeks from start to finish with all the travel time factored in. So, I packed up again (I have that down to a science at this point), said my good byes and headed on out.

I will admit, leaving the compound was very strange. It was interesting to see the airstrip, fly in the plane, and land in Juba 2 months after first making the journey here; my perspective on it all has changed so much. Walking into the office in Juba was so cool; there were people that I knew right away. It was great to reunite with friends and get big bear hugs. It doesn’t take long before this family starts becoming familiar. I enjoyed eating in a restaurant, actually flushing a toilet, and relaxing in the air conditioning for the first time in months. After 2 nights there, I flew to Nairobi where I met up with one of the regional midwives from Agok who was also going to the training. We then flew to Qatar for 1 “night” which ended up being a very short 7 hour layover. But it was a critical point in the journey as it marked my first hot shower since leaving Geneva in July. I almost missed the shuttle in the morning because I took so long enjoying the luxury of that hot water! But then we finally got to Copenhagen! The next 3 days were spent exploring, eating, and a little bit of reading mixed in there (the up side of taking so long to get there was that I was able to do a lot of reading en route so I could have more time to enjoy Copenhagen). I always love exploring new places and Copenhagen was no exception. I toured a castle, saw one of the most beautiful art museums I’ve ever been to (and the art inside wasn’t too shabby either), visited the botanical gardens, and saw a really neat stork fountain which I of course had to get a picture with.

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And there was there was the food- ice cream, bacon, salads, lattes, and pastries which I ate at least once a day. I was in heaven! Just walking around aimlessly or sitting in a coffee shop, it was nice to be taking it all in. The course started on Tuesday and rather than bore you with details I’ll just say I’m very glad I got to go. It was a great review of things I don’t do on a regular basis, information on some that I’ve never dealt with, and great hands-on practice for a lot (most of the 3 days was spent in groups doing mock drills of different emergencies). It was well run by a great group of people. The best part for me though was meeting all the other participants; they were midwives and OB/GYNs from all over the world who have been with MSF for varying amounts of time, many for several years. It was so refreshing to swap stories about experiences, patients, and life in general. My roommate was a doctor from the Netherlands who had just finished her mission in Myanmar. We had such a good time sitting in the room at night talking about anything and everything. I realized within about 5 minutes of meeting her that after being on mission for a while, small talk goes right out the window; we dug right into the “no really, how are you REALLY doing” and “what are you doing in life” pretty quick. Luckily, come Thursday everyone passed both the tests and we got to go out for celebratory drinks. We had a nice time enjoying one last night in the city.

Friday afternoon I started the 5 day journey back to Agok. This included a 2 night stay in the MSF guesthouse in Nairobi. The first day one of the girls there invited me to go with her and some friends the next day to see elephants and giraffes. Again, not a hard decision for me- YES please! We went to the David Sheldrick Wildlife Trust elephant habitat. They adopt baby elephants orphaned because their mothers died from poaching, accidents (such as falling into wells which apparently happens quite often) or natural causes. The elephants ranged in ages, but all were under 5 years. They stay at the nursery for up to 5 years, then go to another site where they stay for 5-10 years while being reintegrated into the wild. Visiting hours are only for 1 hour a day, and it’s during a feeding. As elephants are my favorite animals, I was in heaven! The elephants know they are coming out to get fed so there was more than 1 that made a beeline for the wagon with all the milk in it. The wagon got knocked over twice by over excited hungry elephants. It was also quite educational (I never knew elephants breastfed for 2 years!). A worker talked about the project and the elephants while they were being fed. He also talked about each one individually; we got their names, how and where they were found, how old they were and a little about their personalities. It was a tie for my favorite ones. 1 was the one born premature who was still small but growing quickly who, while being talked about, was attempting to tackle another elephant significantly bigger than him. The other was the “trouble maker” of the group who, ironically, was at that particular moment taking muddy water and squirting it on himself and everyone around him. I could’ve watched them forever. That will likely be a highlight of my entire trip; they wet SO cute to watch! The elephants can be “adopted”; for $50 a year you can pick your elephant and get monthly updates on how he or she is doing. I will likely be donating some money soon. The pictures don’t do it justice, but they are stil, adorable!

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The giraffes were also really neat. We got to feed them and get up close and personal. And just the environment around them was breathtaking; Kenya is a beautiful country! imageimage

It was it was a nice stop in Nairobi, and a good introduction back to Africa. As I got back into Agok on Wednesday, there were some things about the trip that stuck out:

I thoroughly enjoyed the little bit of fall in Copenhagen. I was feeling quite sad about missing an entire season back home. Walking around in a jacket, looking at trees start it to change, and enjoying the little crispness in the air, I felt like I was getting my time in fall and I am so grateful for that.

I’m very grateful to be in an organization that allows for the opportunity to go to something like ALSO training; what a perk!

There are a lot of incredible people doing amazing work all over the world everyday. I knew this, but it was reinforced.

There are very few problems in life that cannot be solved with ice cream, bacon, a fluffy pillow and a hot shower. And it can, in fact, be too quiet when trying to sleep. I could not believe it when I discovered I couldn’t fall asleep in Copenhagen because there were no frogs, crickets or fans to be heard! What’s happened to me?!?!

African skies are unlike anywhere else.

The freedom to be able to go outside and explore past your front door farther than 100 yards is a gift. I noted each increase in what I could do as I made my way to Copenhagen and each step back as I returned to Agok. Perhaps the long travel time was a good thing so I could slowly get used to the changes.

I’ve only been here 2 months, but I’ve already been here 2 months. I had friends here emailing me while I was away and I was greeted by hugs and smiles when I came back. I’ve said it before and I will continue to say it; I’m blessed with the group of people I am with here.

I have 3 weeks back here before I get my half-way-through holiday (yes, this is a rough month for me😄). I’ll be traveling to Zanzibar where my dad and sister Theresa will be joining me. I cannot wait!!! But for now, I must head on back to work; those 6am meds will not give themselves. For now, please be sure to take a minute and enjoy the beauty of a tree changing color. Happy Fall!

Sisterhood of The Traveling Skirt

imageGood evening! Well, it will be morning by the time I get this posted, but still night in your part of the world, so you win!
Here I am, in front of home #4 here. Do not be deceived, I am not kneeling in this picture. The windows were about mid-door height, and I felt like I was in a treehouse the whole week I stayed in this tukul (I have since moved into tukul #5). I’m proud to report though that I only hit my shoulder on the roof 3 times, and never hit my head- a great accomplishment I felt!

So, last week was a challenging one for me, and since I’ve been trying to explain how things are here, I will try now. I will start by saying I know how lucky I am to be here. It is a privilege and an honor to be able to do this work. I’m so fortunate to have fallen in love with a profession, been able to find good, rewarding work in said profession, had that passion grow and evolve over the years, and that journey have brought me here, to work that I continue to feel fulfilled by. I cannot say how many times I have heard people say how jealous they were that I was able to come and do this. Many cannot due to their particular life situations, be that family, work, finances, or any other number of personal circumstances. This is an amazing experience and I know I am blessed.

That being said, I think last week a lot of things came together in grand fashion for me. I had been thinking about how well I had been handling things; I hadn’t really felt too affected by the situation. Yes, I saw things that made me sad, but overall I was feeling pretty good. And then I saw a mom kiss her baby and got choked up. I sat down to write in my journal and got choked up. I laid in my bed all day before a night shift, then had to drag myself out of bed to go to work. I got into bed the next day after the shift and felt totally and utterly lonely. Not alone, just lonely. And sad. And overwhelmed. And it became very clear I needed to face things and find a way to cope with them. To do so, I had to process them. So here’s what I have to process, this is the reality here.

I’ve seen more women have to deal with losing their children here than any other time in my life. I have seen for the first time women losing their babies while in labor. Not going into labor after knowing their baby has died, but actually having he baby die while they are in labor. We had a mom we could not convince that her baby had died because she swore she was feeling the baby move. No matter how many times we put the Doppler on her to listen and were unable to hear a heartbeat, she did not believe her baby was gone. It took her actually delivering her baby for her to believe and accept it. I have never missed an ultrasound machine so much before in my life. It made me see how much the actual picture of the baby without a heartbeat can begin the grieving process for a family; I will never take an ultrasound for granted again.

There are extraordinarily limited resources here, it’s a known fact, that’s why I’m here. But the personal, real-life reality of that fact is a tough pill to swallow: Hearing that a 5 year old had no idea what to do with a piece of paper, scissors or a marker, having never seen either of them before. Taking a mom out of a truck that has traveled 8 hours through very rough conditions for a c-section to deliver a baby that has already died because he is laying across her uterus instead of down and won’t come out. Sitting with a family at the bedside of a woman who is having seizures and trying to figure out if they are from her malaria or eclampsia, and debating the risks of a c-section versus waiting it out for her, the baby and any future babies she may want to have. And then, after she gets the c-section and continues to seize, realizing that there is absolutely nothing else I can do for her. Being able to see 55 patients in a day in clinic because, well, here’s not a lot to do. There are no ultrasound reports to review. There’s no blood work besides the ones we do in the clinic (which are checking her iron level, syphilis, HIV, and malaria). There’s no genetic testing. I can talk about diet recommendations, but it’s not as if she has many choices on what she can eat. There is no birth plan to discuss. I can do some education, but there’s not much to it. Rescucitating a week-old baby for 20 minutes, only being able to give epinephrine, use an ambu bag and do chest compressions, and watching him pass away when that is not enough. And having to do it all over again for another baby literally 5 minutes later. I have not had to do CPR on anyone before, and 2 babies in 45 minutes was just horrible. I debated what was harder- telling a patient she had miscarried or unsuccessfully resucitating a baby in front of his parents. I decided the latter. No words can describe what it was like to glance up while giving compressions on an infant to see the looks on the parents’ faces. I know I will never forget that. Ever. It’s amazing to see the acceptance of death as a part of life. Katrin (the expat nurse who runs the Neonatal ward) told me parents don’t name the babies in her unit until they are going home; the families do not want to get too attached. This has all given me such a greater appreciation for what Katrin does on a  regular basis.

And that’s just work. I’ve been doing a lot of night shifts because of a little staffing shortage (quite a few of the midwives were gone due to taking holidays or working at another site). Don’t get me wrong, I came here to work. But the night shifts are long, and also isolating. I eat dinner while people are still at work, finish and have breakfast after most have gone to work. I sleep when most people are up, and am wide awake when they are sleeping (like right now). I’ve also had to work during all of the few parties they have had here (completely by random luck). It makes me miss a lot of the socializing time when everyone is getting to know each other, let alone let off some steam. The options for daily activities is also very limited, and when I have a lot of daytime hours free due to the night shifts, it presents a challenge. I miss the freedom of getting into a car and driving somewhere, going for a run, having a taco or macaroni and cheese, picking up the phone to talk to someone, anyone, looking up the  weather forecast and having it being in the ballpark of right (I’m in he middle of nowhere that apparently isn’t recognized by any major weather predictor).

So, that’s just a bit of what I tried to reflect on, process, and learn from. How did I do that? Well, a few ways. The first was just to cry; I just let it all out. And it felt pretty good. I also journaled. I have a few journals here. One is just for a daily quick 4 liner. Another is a blank book to just ramble on and on in. And the least is a gratitude journal I got as a Christmas present from my sister 2 years ago. Before coming here I had written in it twice. I now try to write in it regularly to help me keep perspective and watch for the little things that are good. (It’s sad how little I wrote in it before, but I really am a horrible journal writer!). Each in its own way helps me focus my thoughts. I’ve also gotten into a more regular exercise regimen- hello endorphins!! I’ve also talked with people here. Each person is going through their own experience here, and everyone has their own challenges and struggles. And they are all incredibly supportive and encouraging. It helps me remember I’m one of many going through this journey. One of the biggest helps has been my family and friends. They have allowed me to ramble on about things and given me encouragement and support. Just getting an email with a simple hello is so special to me. And have mementos I use constantly. Before I left, I was talking with my cousin Lisa’s 3 daughters (who I call my cousins even though they claim I’m more of an aunt. Cousins once removed. Second cousins. Second aunt. Whatever. You’re family!). One of them, Meredith, had recently completed a study abroad South America, one of I suspect many trips abroad as she seems to have a passion similar to mine? We somehow got on the topic of my wardrobe here, and I said I was packing a lot of long skirts as, in general, legs should be covered here. Meredith just happened to be wearing a long skirt at that moment. Well, it shortly thereafter came off (don’t worry, she had shorts on under) and got handed to me and we proclaimed it the Sisterhood of the Traveling skirt; we decided to get it on all the continents between the 4 of us (we demanded Madi send actual pictorial proof of Antarctica after she said she’d take that one). That’s the skirt I’m wearing in the picture above; I put it on and it’s like they’re hugging me. I have 2 necklaces, one from my parents and another from my siblings. I combined them into 1 so they are all with me everyday. I have a bracelet a coworker and friend Tina gave me. Not to be forgotten is the Olaf keychain (you know, Olaf, the snowman from Frozen) from my friend Barb who always makes me smile, as well as the tape measure she gave me to measure those bellies. I have cards that my friend Laura gave me before I left to open at times throughout my assignment; 1 has been opened. Each of these has helped me remember why I’m here. I know the road ahead will continue to have ups and downs, and I will have to accept the good with the bad. I’ve said many times that when the tough times at work don’t affect me anymore it’s time for me to find a new profession. That rings true here more than ever, and I will continue to grow as this journey unfolds.

I would be remiss if I didn’t throw out a big acknowledgment to Theresa for getting the first package out, with honorable mention going to mom for the 2nd, and a “You ROCK!!!!” to my friend Lizzie who sent a card for my mom to include in her package. Even though Theresa’s 2nd package was officially the 2nd to get to me, Mom gets the award because hers was sent to another site here in South Sudan and just got into my hands today. These packages were full of awesomeness- thank you!!!! And mom, the miniOreos were another casualty tonight. There was a hole in the bag, and the humidity would’ve killed them so it was really for their own good I ate them.

This week saw me bedridden with what was determined to be tonsillitis. It was looking like malaria on Monday but luckily my test came back negative twice and I’m on the mend. I had to deal with the mean and bullying doctors here, one of them threatening to give me a very strong sedative if I attempted to go to work tonight (and by mean and bullying I mean making-my-parents-very-happy-taking-good-care-of-my-stubborn-self and being very cautious). One of the other midwives actually does have malaria so I’m happily back to work tomorrow to cover her shift. Through the rough times last week, I felt my best when I was at work which helped me recognize and remember that I’m where I’m meant to be, for good and bad. So onward I go!

All in a day’s (or night’s) work

Hello hello!

Thank you for all the messages in the last couple of weeks; they were all so appreciated and helped me get through. I continue to feel very blessed by the people in my life both back home and here; I’m a very lucky gal.

Now, I figured it was about time to share a little bit about the work here. It is in some ways what I thought I would be doing, and in others not so much. But it is always interesting and usually challenging.

To start with, my areas of work include an outpatient clinic and then the inpatient hospital which for me includes the maternity ward and the neonatal unit. Those are the only units in my building, and the clinic is a separate structure (building would be a very loose term for it, which you will see later). There are buildings for lab, surgery, emergency room,  inpatient beds, intensive care, and infectious disease (TB which is really a tent).

A little on staffing…For my area (as I’m still trying to figure out the rest of the hospital’s staffing situation), shifts are day shift (8am-6:30) and night shift (6pm-8:30am). The staff includes midwives, midwife assistants, and a nurse in neonate). The staff includes national staff (from South Sudan, mostly in the Agok region right around he hospital), regional staff (mostly from Kenya) and expats (we are 2- representing the U.S. and Germany). The national staff includes midwife assistants and, very recently midwives. The assistants have no formal training except what they get once they are hired here. They are hired from the community, and get 5 days of training on the unit. Most, if not all, have no medical or nursing background at all. Some speak some English, but most learn a lot as they are on the unit working for a while. These assistants triage patients, give medications, do vital signs, perform vaginal exams, attend vaginal deliveries and do simple perineal and vaginal repairs (sorry for those not in the medical field. I know that’s graphic. But this is what I do). The assistants in the clinic do the patient intake, vital signs, basic testing, fundal heights, listen to fetal heart tones, and sometimes speculum exams as well. The national midwives attend a 3 year school, and this is a very new program. We have 2 national midwives here, 1 woman and 1 man. The man said there were 12 men in his class of 26, very different from the U.S.! The regional staff is all midwives working with 6 month contracts. They have no specific maternity training, just general nursing education. The expats are myself and a nurse (Katrin, which makes it easy for the staff when we are working on the same day) who runs Neonate. Maternity is staffed with 1-2 midwives Monday through Saturday (one of them usually the supervisor) and 3-4 assistants during day shift. Neonate is Katrin and 2-3 assistants 6 days a week. On Sunday, there are 2 midwives, 1 for neonate and 1 for maternity. And night shifts are 1 midwife and the same number of assistants. Hope that all made sense.

In the hospital, there are Clinic Officers. They get 3 years of training, and the best analogy I can think of for their role is a chief resident, but they are not doctors. They get called with complicated cases, but on maternity, they often defer to us midwives because they don’t have a ton of maternity training. But they round on every neonate every morning and are very involved in the care for them. They only round on the complicated cases we call them for on maternity. So far those have included recurrent fevers in post-operative patients and sever malaria with accompanying severe anemia (in the 4-5 hemoglobin range). There is also an expat MD on call if we really have someone critical. For example, they get called called for every rescusitation that is done on anyone. I have only done 1 consult with the MD so far and, much to my amusement, we sat together reading the protocols together to decide what to do.

So that’s the staff. It has taken a lot of time for me to figure out who’s who and how I fight into the group. It’s a very interesting dynamic having assistants with no formal training, yet know so much about many things I know nothing about (like the tropical rashes and diseases, breech and twin deliveries). Having them coach me through my first breech (butt first instead of head first) delivery his week was awesome! There are also areas I’m gently trying to show a different approach (deliveries honestly are very difficult to watch. There is no patience in allowing moms to slowly push their babies out; a lot of yelling and manual stretching and pushing legs apart roughly. Because of this, I’m showing a lot of excitement when someone is close to delivery and making it clear I would like to be the one to catch the baby. I’m hope to lead by example). But I think I’ll save the actual work for later. For now, I’ll just do the basics.

Pictures are difficult to get because I cannot have any patients in them. This is because the patients here cannot really give true informed consent. While I can ask permission, being that they are getting much needed health care from our organization for free, they would likely not say no if they felt uncomfortable about it. So, I’d rather not put them in that position. But here’s what I could get so far…

Here’s the maternity ward from the outside-

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The patients bring their own sheets and blankets for the babies, so there’s a laundry area out back for them to do laundry (frequently done by a family member of care giver who’s there with them). There are 20 beds on maternity, 5 in the labor area, and 15 for others (after delivery, malaria, preterm labor, etc).

This is the labor area –image

the string hanging from the ceiling are for hanging IVs and tying the mosquito nets to (everyone gets one when they get admitted, and they take it when they go home). At the end of the room is the delivery room with 2 beds-

 

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The light on the bed is actually the sun. If I need a light, there’s a flashlight or actually torches. I keep forgetting my headlight in my tukul at night. One night we had serious electricity issues and I almost caught a baby in the dark. I’m hoping to get to do at least one by flashlight before I go:) We frequently have a hedgehog in here at night, and on my last night shift here was a frog about the size of a quarter who hopped all the way across the room, stood right by my foot, and stayed there until the baby was out. It was adorable! even the patient laughed. I so wanted a picture but he was gone when I looked for him later, clearly tired from the excitement.

Here’s my clinic-

 

The clinic

The patients wait in the front area. There are benches, but they frequently overflow onto mats on the floor. They are seen on a first come first serve basis, and frequently not everyone can be seen. If there are too many, we try to see those who traveled the farthest or are the most critical. The back has 2 rooms, the exam room-

The exam table

And the office-

My desk

This is where we (the midwife or assistant) talk with the patients and do charting.

So that’s he basics of work here. My role right now is being in the pool with the midwives for staffing the units. So, as such, it rotates around. Right now there are I think 8 midwives on staff, but only 4 are here due to holidays, trainings, and 1 in another village staffing a project there. Because of the rotating needs, each week is a different schedule. I usually do 2-3 night shifts a week, and then 2-3 day or clinic shifts. The night shifts can be very exhausting, usually lasting 15 hours after sign out. But all the shifts, day, night or clinic, usually  go pretty fast; there’s always work to do. Much like Chicago can be quieter in the middle of a snow storm, rain keeps people home as getting here is challenging on the muddy road. I love being able to walk to work; if I take a very leisurely stroll in, it takes me 2 minutes door to door. And that’s stopping to check out the sky as I go. And oh, I almost forgot one of my absolute favorite things here! Right outside the hospital, between the hospital entrance and the living compound entrance is this tent-

 

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This is a breastfeeding tent. It’s there for the children of staff members so they can go out and breastfeed while they are at work. It’s amazing! There are older kids who stay with the babies, and they are usually singing and saying hi and waving to staff as they come and go. They always make me smile, even just hearing them sing when I’m in the compound.

So there are the basics. Hope it made some sense. I am now headed to bed as I work tonight, so I shall say…good night:)

 

 

These Irish eyes are smiling down

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For those that are not aware, my beautiful grandmother passed peacefully away on Friday morning. I have thought a lot about whether or not I should write this post, and have concluded it’s something I need to do. I had to make the extremely difficult decision to not go home to be with my family. I would not be able to get home in time for the funeral, and after talking with my mom, we decided I should stay here, knowing my grandma would want me to keep doing the work I committed to doing here. I think the hardest thing has been not being around everyone to talk about the wonderful person that she was. I remember sitting with my aunts, cousins, mom and sisters after my uncle passed away a few years ago going through pictures and sharing stories about him (and I was pleasantly surprised to learn things I never knew about him!). It was such a healing time. As I am currently not on the same continent as anyone who has known me more than 3 weeks, this is being sent out to the universe of my loved ones so I have a way to share. So, here some of my favorite things about my grandmother, things that are very much a part of me.

She was so proud of her Irish heritage. The picture above was taken the last time I saw her before I left to come here. I purposely wore my “Run fast. Live Irish” t-shirt, and she loved it, as I knew she would. Her house was filled with Irish memorabilia, and no one got more dressed up on St. Patrick’s day than she did.

She loved to laugh, and she had a great laugh. She also loved to whistle. I remember so many mornings after a sleepover at her house waking up to the sound of her whistling.  I remember the whistling and the hot chocolate from the sleep overs. And  the record-playing; nothing sounds as good as Bing Crosby on a record.

She was very independent. She never wasted anything, knew how to manage finances, lived in her own house on her own well into her 80s, and knew how to pick out something of value. She taught me how to pick out a good piece of crystal instead of cut glass. And everything she had had a story to go with it. One of my favorite times of year at her house was when the Christmas decorations were out; I loved hearing where they all came from or when she got them.

She was also increibly stubborn (a trait I didn’t get, but others in my family did😊). She started saying “This will likely be my last birthday” before blowing out her candles every year. She did that for at least 15 years. It became a joke as we reminded her she kept saying it.

She loved to travel and see new places. And she loved being outside. We had so many meals and game nights outside on her veranda, and she had lovely gardens.

She was nothing if not a lady. She had proper manners, always had lipstick on, and had her hair done, especially for holidays. And she loved fancy shoes; she loved anytime someone Wore heels or had bows, flowers, or any decoration on their shoes. And her jewelry! She had the first flooring-standing jewelry chest I had ever seen, and she used to let me spend hours just going through it and trying things on. I love hearing where and why she got pieces and seeing how she wore them. My dad often sees me in a casual outfit like running or painting clothes and will comment that I’m the only person he knows that would wear jewelry with it. And I always think, probably not.

When I had my first nursing job in labor and delivery, I was over visiting her shortly after I had my first patient with a stillbirth. She let me talk about it for a while, and then she offered some friendly advice. She told me to never forget about the mom, that frequently in those situations the staff can be so busy with the baby that they forget to talk to the mom, explain things to her and support her. I reassured her that I had been sure to support the mom. Throughout the years, I have seen so many times when the mom can seem like a bystander to what is happening, and I always try to make sure the mom understands what is happening every step of the way.

She was so proud of her family, even if she sometimes made you work to figure that out (something us cousins laughed about; we all heard about the amazing things the other ones were doing). Her walls were filled with pictures of her family, and she was so happy when her house was filled with us. There were countless nights of card games with multiple tables going- living room, dining room, kitchen and veranda. Just walking through the house, you could feel the love and see her happiness. And when we were out and ran into friends, they all knew what I was up to because she had told them all at it.

She loved to do silk flower arrangements. She had boxes of flowers in the basement, all sorted by color.  She made baskets, vases hats, wall hangings. I remember her bead crafts too (strawberries made out of  red plastic beads; cannot beat them!)

She believed in hard work, reaching for your goals and dreams, and enjoying your successes without being too boastful.

I could go for days, but I’m leaving it at that. I smile when I think of how I thought the sunset on Thursday night was the most beautiful I had seen here yet, not knowing what was happening back home. I felt her with me at work last night when I was able to witness 3 beautiful births and successfully place my first 2 IV lines in babies. I questioned that presence this morning when I realized I had been attacked by bugs in my bed (not to be confused with bedbugs), but I chose to take that as a “get out of bed” message from her. I am grateful I was able to say my goodbyes the last time I saw her, as I was nervous she would pass while I was away. And while I am not with family and close friends, I am very lucky to be with the people I am with. I got a hug immediately after hearing the news Friday that quickly turned into a group hug, and I have had amazing support since; if I can’t be home, this isn’t too bad of a runner-up.

It’s an incredibly popular Irish blessing, but the first time I saw it it was on my grandmother’s wall and I never hear or see it without thinking of her so I’m going to close with it….

May the road rise up to meet you. May the wind always be at your back. May the sun shine warm upon your face, and rains fall soft upon your fields. And until me meet again, may God hold you in the palm  of His hand.

I love you grandmother! Xoxo

My sunset Thursday night

My sunset Thursday night

 

 

 

 

Home Sweet Home-Away-From-Home

Happy Monday!!

I’d like to start by saying I tried to change the theme of the webpage, but after it took 5 minutes to load 5 of the 200 options, I gave up. So boring black and white it still is. Perhaps one of these weekends….

Moving on. It’s August! And more than a week in already!! Crazy! it’s about time I give you a little tour of my (very) humble abode. So, here’s a better shot of our little tukul “village”. imageThere are around 40 of these housing the 50ish people living here on the compound. Some have 2 beds. Some have 2 units under the same roof. They all have some variation of the same furniture- bed with mosquito net, plastic chair and table (think patio furniture), and, really most importantly, a fan. For the last week and a half, this has been my bed.  imageBuying a pillow in NYC before I left was some of the best $5 I spent on supplies so far! The white drapes (which a are heavy plastic) do their best to keep the rain out, but when it gets crazy windy, as it tends to do when the downpour happens, not much can keep the wetness out. I need to work on tossing and turning in my sleep less. I barely fit in the bed as it is, and the 1 night I mistook the light outside for morning and left my foot out of the mosquito net, well, I was attacked and have about 20 bites on my foot. It was a mistake that only needs to be made once! (On a very random side note- several years ago when he was still in college, my brother donated money in my name to an organization that bought mosquito nets for women and children in Africa. I frequently think of that as I lay here, years later, under my own net, working with a group that gives out nets to all pregnant women who walk in the door. Funny where life takes you. Another item on the “my brother knows me well” list). Anyways, tomorrow I move to a new tukul. I’m told it will be about 2 months before I get my permanent one; I’m excited to not live out of my suitcase.

Here’s where the magic of cooking happens…image And why yes, that is a chicken! It was walking around the cooking area for a few days supervising the activities. And then he was gone. And there was chicken served for lunch. Couldn’t bring myself to eat any. There is rice and/or potatoes at every lunch and dinner. Lunch usually has a tomato and cucumber salad. And then there’s a variety of stews, soups, lentils, cabbage salad and sometimes a pasta, all of which is prepared over the Bunsen burner-type things on the ground. The cooks fill them with coal, put a pot over them,  and cook away. Everyday except Sunday there is fresh bread for breakfast made in our awesome wood burning oven….image This is also where the pizza is made on Friday nights by us residents after work. I incorrectly loaded the pizza my first week- rookie mistake that lead to some well done pizza. Still was edible, but I kept myself on the prep side last week and left the baking to others. There’s also sometimes pancakes, boiled eggs or scrambled eggs with veggies mixed in I get VERY excited on the egg days!  We get a weekly shipment of fresh fruit and usually avocados from Juba, and are kindly asked to eat only 1 per day to make the shipment last until the next week. It’s not the biggest variety of food, but it’s edible and has fruits and vegetables so I’m good, though the lack of texture does sometimes get to me. I have used a few of the spices my sister Theresa got me before I left, and boy do those make a HUGE difference. Sometimes anything different is great! but I know what you’re thinking- you have a cook, get over it! I know! and it gets even better- they do my laundry (Except socks and underwear), and press everything! I don’t even do that at home! The washer and driers consist of 2 buckets and a clothes line, which makes drying very interesting when it’s been raining 2 days straight. But, the irons are pretty fantastic…image I was completely fascinated the first time I saw them using this, and they laughed as I watched them work.

This is the dining tukul which also houses the TV that the regional staff is usually watching a movie (I’m yet to recognize one even though they are frequently in English), or soccer. imageI’m quite up to date on everything in the soccer world, as is anyone in the vicinity when some one scores!

This is the common tukul that is where the expats seem to congregate for meals and after work.  image The white is a drape we had up for movie night in Thursdays. We do a little rearranging, and we have a lovely objector that projects on the sheet that usually falls down a few times during the movie.  But I found some pins this weekend and I have a brilliant idea to keep it up this week! On the other side of the drape is 1 row of tukuls and then to hospital. More on the hospital to come later.

I’ll control myself and not post pictures of the showers and latrines, though I find them amusing. I’ve been caught in the shower a couple of times when e water suddenly went off; always fun. It goes back on in a couple minutes, but the soap can get rather irritating pretty quickly.  And I’m still mastering the art of getting my leg out of my pants so I can go to the bathroom (Have I mentioned the latrines are just a hole in the ground I must squat over?). I’m also very conscious of how much I drink after dinner so I don’t have to try to do that in the middle of the night. All together, with the hospital, I think compound is about the size of half a football field. We are surrounded by farms on all sides (across the street on the front). the views can be pretty beautiful as storms roll in.image We had our first clear night since I arrived this weekend. There are some pretty bright lights on throughout the complex after dark. I had just stepped out of the common tukul after dinner, was standing right in front of a very bright light, and when I looked up, it took my breath away. I thought I saw the Milky Way, but realized it was probably a cloud since, you know, I was standing in front of a light. So I moved away and realized that it was,  in fact, the Milky Way. I braved a 50 foot climb up our water tower to check out the sky (no small task for those that know how afraid of heights I am!), and I’m sure I’ll be up there a lot in the next 5 months- the Milky Way was like a rainbow across the sky. Unbelievable!! and all the other constellations… So cool!!!! I’m very grateful for my star app on my phone. I’ll never get tired of watching that sky.

I got out for my first run this past weekend. I ran 10 minutes up the road, then 10 minutes back. It was a very muddy run, so it was like running on wet sand through an obstacle course (those being the goats, puddles and watery divets), and it felt amazing!!! the kids along the road were calling out and waving as I ran past, and I heard a few “why are you running???”s from the adults; it was great! They also had an elliptical machine delivered last week which I braved and managed to not fall off of; I’m quite excited about that feat!

So, that’s home here. I realized pretty quick that filling up my free time, especially during my weekdays off, will be a challenge. Having the Internet only after 5pm and on weekends makes those days rather long sometimes, especially if I haven’t done a night shift the night before. I’ve already read quite a few books, and I pulled out my movies this weekend after trying to hold off as long as I could. For someone who’s used to big cities and going, going, going, it’s a big adjustment. I admit it was quite a shock when I first got here how simple things were. I have to smile sometimes at things like scrubbing my socks by hand in a big bowl and rushing to get my pants off before I pee on myself. And then it hits me that this is the way of life for people here. Actually, it’s better because I have clean water and soap. I have access to fresh food and bread. And a bed to sleep in. I know how to read, so I can occupy myself for a while during the day while I have patients at work that leave their thumb print on a consent because they can’t write their name. Then I get redirected and realize how lucky I am. I can’t say I will be able to stomach eating chicken anytime soon here, but I can say I will continue to try to remember how lucky I am to have the option. While laughing at the chicken walking through the kitchen. Happy August friends!