The MSF cooks

Oct 24 – Rio Sucio – Colombia

As my wise friend Maricela said today, MSF is not a job, it is a lifestyle. Living the MSF style of life is definitely not for everyone. After a while privacy and private life are vague concepts of the past. We do just about everything together: eat, sleep, work, and I have had to even to go the bathroom together for security reasons in areas where we cannot walk around alone.  As a friend said, you know more about each other than you know about your own family sometimes. If somebody has a diarrhea or something, everybody knows it. There are no secrets. I guess in a sense we are a big family, looking after each other and with our own dysfunctions.

The majority of the team are women, and we share a lot of similar characteristics: young, beautiful, smart and educated women (yes, of course I am including myself on the list ;) ). But this gypsy lifestyle also has its disadvantages: mostly of us are single and either smoking or trying to quit (no, I do not smoke yet, but give me a few years on this job and I might just get started). But the most interesting characteristic we share is our lack of cooking skills: the women in MSF can’t cook, that is a fact. Well, most of us can pull off something to survive if necessary, but as a general rule, the men are the ones doing the cooking.

Last night I walked in the kitchen of our common house in Riosucio, at 10pm to grab a glass of water before going to sleep. Rosmira had finally decided to cook something to eat and was attempting to cook a fine and delicate meal: white rice. The pot she was using was too big and the lid too small. While waiting for the rice, her and Isabel were making plans about finding a suitable man and having children one day. Rosmira then decided to check on the rice and found out that the lid was stuck to the pot. I came to the rescue, could not open it either. Isabel tried, nothing. We stood there looking at the sealed pot: “Decio!”, we yell. The only man in the house comes to the rescue: “you have to let it cool down”. We are all laughing by this time at the complicated task that making rice has become. Rosmira than has the brilliant idea of putting the rice pot under cold water to cool it down. The pot starts to steam up and make noises, they run from it: “It is going to explode!”. Oh goodness… and then they wonder why they are still single… By the way, after Decio finally opened the pot with a hammer, the rice was uncooked. Anybody up for a sandwich?

If I were an animal...

Oct 19 – Apartado – Colombia

If I could be an animal I would be a dolphin. People that know me already know that. I love their freedom, their agility, beauty and they’re super smart on top of it all. I also love the water, and the ocean even more. It is a good thing I grew up inland or I would have never studied as much as I did. I would just spend my days on the beach, with a surf board or other similar sport.

This weekend I went to a scuba diving course and I found out that I can fly in the water. What a wonderful sensation! To be suspended in the water, “flying” effortlessly over beautiful corals, among beautiful fish, turtles, rays; traveling in between huge beautiful big walls; just gorgeous. The sensation is amazing and I experimented as much as possible: going fast, slow, upside down, rolling around. It is just so much freedom! More than that was the peace you feel down there. Everything is so calm and silent, no noisy cars or people, just the sound of the bubbles my regulator makes every time I breathe while the fish swim calmly by. Even when I saw the shark it was peaceful (although I was a bit scared of it). He really didn’t have the slightest interest in us and swam away.

Capurgana is a little village on the boarder with Panama, only accessible by boat or plane, with lovely beaches and absolutely no cars. You can feel the energy change as soon as you walk out of the boat, into the village. People are just so much more relaxed and friendly. No cars zooming by, just the traffic of people walking around calmly on the cobble stone streets and the sounds of the waves gently crashing on the shore. That was before the party started, of course…

I got a room, dirt cheap, with an ocean view and a balcony with a hammock. There was a festival going on during the weekend, “El festival de la sigua” like a mini mini Carnaval I would say, or just an excuse to party all day and all night long and drink a lot. So, at 5:30am of the first day of festivities, the band (2 drummers, one flute and one sax., or something like one) was going around the streets and the people following it. They were quite good! I went to the balcony with my wrinkled face and my mop-style hair (typical “I just got out of the bed” face) to watch them go by. My friend Johanna also came out in a less jolly mood: “if they do this every day I’ll kill them”. Isabel just rolled over in bed, and with the wisdom of the locals informed: “they will do this every day”. Turns out that they didn’t need to do it everyday because the party never stopped (except for the wonderful moments when the electricity was off, but of course somebody made sure everybody stayed awake with those fireworks that make a huge noise, which I hate, and that dogs tend to hate even more). There was loud music just about all day and all night long.

But I was away from all that by going into the sea, down where I can hear the bubbles. I saw just about everything you can find on a warm Caribbean ocean (ok, that is exaggerating a bit, but I saw a lot of stuff): a shark (called nurse shark, how appropriate is that?), a turtle, rays, lots of colorful fish, a lobster, and on the last day, which was my birthday, they came… dolphins! 12 of them, soooo cute. It was the best birthday preset. We saw them from the boat, on the way to a dive site. I jumped in the water to try to get closer, but they were not interested in getting any closer. I did hear them under the water though. It was just great!

My birthday was great by the way. Johanna kept me awake the night before until midnight so I could hear Stevie wonder singing “happy birthday”, kindly provided by the bar below. I am so blessed to find nice people everywhere I go. The night of my birthday my new diving friends got me a cake, balloons and all that jazz. Too bad the electricity was gone and I couldn’t dance as much as I wanted, but well, nothing is perfect. I can’t complain: I rebalanced my mood, recharged my energy and found a new passion (diving). Life is great.

The world is going to end in paper

The world is going to end in paper… one day we will all be gone and the only things left will be paper and cockroaches, equally useful things.

This last week I was in Riosucio again. The river has gone down, but the mosquitos have gone up; oh well… At least it wasn’t as insanely hot as it usually is, which worked out perfect with the fact that the hospital had no electricity and therefore we didn’t have fans. The MSF clinic (which is inside the “hospital”) had a small generator only powerful enough to provide light to one of our consultation room, our two computers and a printer.

On Tuesday, 23 children from a indigenous tribe came down to the hospital looking for health care and were promptly denied it by the hospital, since none of them had any register of even being born, never mind health insurance.  So they came to ask for our help. The health system in Colombia is drowning in paper; I have never seen something like that. You haven’t seen bureaucracy until you try to understand how the health system is organized here, and the sick people are caught in it without proper care.

Take these children for example: they live in very poor conditions, up in the middle of nowhere because of decades of displacements, from colonial to modern times. Aside from what nature can provide them, they have very little resources. It is not easy or cheap for them to get down to the “city” and get registered, so  they often don’t register their newborns. It is not only that, papers don’t seem to have a whole lot of importance in the indigenous world, I don’t think it makes a lot of sense to them that they only exist if they have this paper, so they tend to neglect it.

Anyways, they went then to register all the children and the registration place didn’t have paper… yes, that is right. Now the children have to wait until the paper is back, so they can get registered, then apply for the government health insurance and then health care, in that order. So, they came to us.

In Riosucio the MSF strategy is a bit different. Instead of just offering medical attention to everybody we try to strengthen the local health system to work as independently and efficiently as possible by covering a few specific programs and offering support to others. Therefore, we usually don’t do consults for children, since this should be a responsibility of the hospital, but seeing these children stuck in the paperwork we went to help.

We negotiated with the hospital and saw 11 of the children, and the hospital was supposed to the see the remaining, which they never did. We then decided to see all of them ourselves, but then they didn’t come back. Hopefully they will come back this week, or maybe they all got miraculously better. I know that it only took 5 days for their papers to get ready.  Now I just have to hope that they don’t lose it. 

No Holiday

Sep 23/2010 – Llano Rico – Colombia

When I go back to my regular job in Canada, and when I have a really busy day and feel tempted to complain about workload, I will remember this day: Sep 21-2010, Llano Rico, Colombia. And then I will think: “Work? What work? This is a holyday!”

We got here on Monday, coming from Balsita, that is, down the mountain driving in a one-lane gravel road, after a whole night of heavy rainfall. I had my doubts we would make it through the road. There were several landslides partially blocking the road.

Our first stop was a very large tree that had fallen on the road. We all got out of the car and the drivers managed to get the cars through the bush on the side of the road (God bless Toyota Land cruisers). Then a man on a bike stopped our car to tell us that there was no way through. Great… We went to check it out and found a landslide and a river that had just about washed the whole road forming a little waterfall as it went down the other side of the road into the cliff.  Now what… We all got out of the car again. This obstacle was harder than the big tree, the water was fast and the rocks loose. We tried to even out the rocks, some using their feet others with the 2 shovels we had. The car tried to make it through, slid a bit towards the cliff, then got stuck on the rocks. Out with the shovels again, I started to pray. Second try… and we got through. Phew.

Arriving in Llano Rico the people started to follow our car as soon as they saw it. Before we had turned off the engine or gotten out of the car, there was already a lineup of people by the clinic. The clinic is an abandoned and partially destroyed health center recently renovated and recovered by MSF. Before renos there were only moldy walls with no roof. Now the roof is completed and this was the first time we saw it after the painting was done. There is still no running water or electricity, but things are coming along and we had a generator.

We started consults as soon as we organized ourselves and oh my god…  I thought we would never stop. We worked like crazy all day on our first day and on the second day, our poor doctor didn’t even stop to eat. Things started well with a very sick pregnant woman that vomited on our triage floor first thing in the morning and the rest of the people followed the rhythm and kept us insanely busy all day long. By 7pm when 3 victims of a motorbike accident arrived (one light chest trauma, a little girl with an injured knee that required stitches and an elderly woman visibly upset but thank goodness physically well) I lost hope of ever going to sleep that day. There comes a point when you just accept it that you will work till you drop and just keep on moving like a dead zombie.  You name it, we had it: burn victims, the motorbike accident, really sick pregnant women (besides the vomiting one), loads of sick children (with high temperatures) and lots of malaria. To give you an idea of the situation, we ran out of gauze, and we carry A LOT of gauze.  By 9pm when we finally saw the last patient out the door and organized our things for the next day, I was waiting for a woman in labor to come in, because really, that was all that was missing. Thankfully, God decided we deserved some rest and nobody decided to have a baby that night.

People started to arrive by 0530 the next morning. One angry father made his thoughts known saying something like “ How come this people sleep while the children are dying. They send you here to work and that’s what you should do.” Well, we were all too tired to argue with him that thank God, at the moment nobody was dying and that his baby had been seen by us the day before and already given treatment. That was the most frustrating thing… to work so hard and to feel like the people don’t recognize it and only expect more. Well, maybe I would be just the same if I were in their shoes without health care for long periods of time.

We couldn’t see all of the people that came to us, which always makes me worried, but I have to realize that we simply cannot take care of all the sick people in this world. We did our best and we saw the sickest of them. The rest I can only recommend to God and feel reassured that we will be going back there soon. 

I want rooster soup

Sep 19/10 – Balsita – Colombia

This morning the rooster came to visit early again, at 6am. At least he was not as early as the day before, when he came at 4am, but he was just as keen, and was not happy just singing loudly at my door but actually had to go around the whole room, several times, just to make sure that I would wake up.

I never thought that I would say that in Colombia, but it was quite cold. Balsita is a small community up in the mountains. The population here is what they call “paisas”, which is white people. The men wear some sort of scarf around their shoulders, a hat (cowboy style), a machete tied up at the hips, and boots. It is quite different. They also talk very fast and with an accent almost impossible for me to understand.

Tensions about the conflict are very high, with active groups present in the area and so the impact on mental health is the main cause why MSF comes up here. We had a slow day yesterday since there was a communication problem and the local radio station did not broadcast our arrival until the evening. Therefore, all the people came down from the nearby villages today.

Lots of horses parked on the street where the chickens, pigs and dogs also lived. Keeping the dogs out of our clinic was an almost impossible task. It looked like we were the veterinarians without boarders (hey, here’s and idea for the vets out there, those pets need you!).

Since it is Sunday, it was like a big event. The men played soccer all day. There was music, dancing, little shops selling treats, and a movie in the evening set up by the red cross: Shrek, a classic, followed up by a documentary on nature subjects.


Anyways, tomorrow we leave early to Llano Rico, so I better get some rest.

 

Where are the heroes?

Sep 17/2010 – Balsita – Colombia

I have finally understood what is the problem in Colombia. Why do people fight so much here? What fuels and motivates people to fight? It is because the place is just too beautiful, too rich.

We went up the mountains today to a community called Balsita, where people also had to run away due to conflict. The drive was absolutely gorgeous, although a bit scary, through a narrow one lane gravel road, with lots of sharp curves going up the mountain with a big cliff on one side. The view was just spectacular, mountains, rivers and the forest… beautiful.

So, back to my original question, why is it that people fight so much here? Simple: greed. Greed for the rich and beautiful land, Colombia’s greatest asset and also its biggest problem As a friend of mine here wisely pointed out, also greed for power and control.

Sometimes, thinking about all this greed , I get these waves of disappointment and loss of hope for humanity. Everything we do seems like a waste of time, because men are just evil and will destroy whatever good we do. But then I think about all the good people around the world that support good causes. I look at the amount of resources that MSF has, the cars, the boats that take us to the communities, the medications, professionals and all the network of support. It takes A LOT of money to keep this organization running and it ALL comes from good people that donate it, because they just want to help.  Then I think of the number of projects that MSF has around the world and then I am really blown away just trying to figure out the amount of money necessary to keep it all going… I have a friend working with MSF in Zimbabwe, where they see from 800 to 1000 people per day, all with HIV. Huge projects all over the world. There must be A LOT of good people out there providing the money. There must be more good people than bad ones in this world. That is how I recover my hope for humanity and the joy to work.

Thank you so much, so very much, to all the good people out there that donate their money and make it possible for us to do the work we do. You are all the real heroes. 

The MSF "super concert"

Union Chogorodo Sep 15 - 2010

Almost 200 consults in 2 days of mobile clinic. I am not sure if I should be happy or sad. If all these people were lining up to see a concert, it would be one thing. But no, they are lining up for hours, waiting on the sun with their children held close to their breasts for health care. And for BASIC health care. It’s not like they are waiting to see a specialist, or to have an expensive exam done. They are waiting for basic health treatment and a simple malaria test.

Managing that kind of crowd was a real test on us. Triage was transformed basically into crowd control and mechanical work: get the baby, measure, weight, name, fever?, next.  I felt like we were offering the bare bones quality of care compared to what we can actually offer, but there was just not enough time. Better have some care then none at all I thought. I think we did manage to at least recognize the sickest of the sickest and to see the children first.

We took 3 children out to a center for nutritional recovery that exists in Rio Sucio (an 8 hour boat ride on a good day). They were all so sick and small… One of them was a year and a half old and only weighted 5 kg (a bit more than 10lbs). She could not walk or talk yet. On the boat, I watched her hold a piece of toast and fall asleep with it. Afraid that she would drop it, one of the girls tried to take it, but she was holding on to it with such determination that she would not let it go. She held on to it the whole way and nibbled at it here and there.  She was the one too sick to smile or play with me.

The last day we had to send some people home without being seen, and we were finally done at 8pm after packing up everything with flashlights, I thought we would have people coming in the middle of the night, like the night before, but we only got one couple.

We plan on going back there soon, and spend more days and hopefully bring a dentist in November, we’ll see how it goes. 

Strange desires

Sep 12/ 2010 – Union Chogorodo

Tonight the sky is absolutely beautiful. For once the clouds have gone away and I can see the stars high up there somewhere in space. The moon is not full, but the light so powerful that it illuminates the sky enough for me to distinguish the silhouette of the tall coconut trees against it. I am sitting outside, contemplating it, with the frogs and night crickets as my soundtrack. What is on my mind, you ask me. Well, actually, all I can think about right now is… coconut water. I know, it is the silliest thing to think about now, but there’s nothing I can do! I have been thinking about it all day… ice cold coconut water as they sell it on the beaches in Brazil… humm.

So, one of our logisticians today, learning about my unexplained sudden desire for coconut water, kindly asked the locals for 4 coconuts and indeed they sent somebody up the tree and he successfully retrieved 4 coconuts. Then they proceeded to drink it, all 4 coconuts by themselves :( I am not sure where the communication line got lost there. All I know is that now, more than ever, I want coconut water. Oh well, I will survive. I am so tired anyways that I will fall asleep in no time and dream about coconuts and Brazilian beaches all night. It will be wonderful.

Today we saw 67 patients, which is a lot of people for one day of mobile clinic. I was between triage, lab and pharmacy. It was crazy the amount of work we have done to be able to cope with the amount of patients. We again saw many of the children malnourished, more malaria and other diseases.

At lunchtime I went to the river again. This time 2 little kids, I would guess about 5 years old, were playing with a machete about as tall as them. They were using it like a bat to pass a small object (that I could not distinguish) back and forward. I was looking around to see if some adult would intervene but the natives didn’t seem disturbed at all. I waited for a chopped finger or something, but the little guy really knew how to use his toy. No chopped fingers or toes, just me, once again, impressed with the skills of these children and their adaptability.

Anyways, I am so tired, enough talking for now… I’ll go dream about my coconuts

MSF fitness plan: canoe pushing

Sep 11 – 2010 – Union Chogorodo

Well, yesterday was “interesting”. We set up for consults in Chicao, where usually a lot of people show up, and only 7 people came. We found out that it was some sort of protest by the displaced community that used to live there because MSF is not going to their new community.

Usually we set up camp there and the sick from the community are brought by boat. Getting up there ourselves is a real logistic problem since only very small canoes can get in and the walking path is very difficult, up and down the mountain. Well, I guess we will have to figure out what to do next.

Meanwhile we enjoyed the day in a beautiful community and I had a wonderful bath in the river with the butterflies, followed by an afternoon nap on my hammock, diner and more sleeping. I new I would pay for all that tranquility later. As my boss said “Raquel, when we are running like mad women, trying to keep up with the work, please remind me of today”.

The next morning we left early to our next stop. This time our destination was an indigenous community up the river called Union Chogorodo. Our travel time, well, anywhere from 2 to 8 hours depending on the river conditions.

The river was quite shallow, which meant we had to get off the boat and physically push it up the river. I am not too sure if my help pushing the boat actually made any difference, since I have no strength and most of the time I felt like I was just hanging on to the boat to avoid being taken away by the fast water.  Somehow we managed to push it up the river and through the current.

We arrived early, at 1030, thoroughly soaked and tired. We set up the clinic, had a meeting with the community and started consults in the afternoon.

Union Chogorodo is a beautiful place and the people very nice and helpful. It was cute to see all the little kids looking for the smaller items that they could help carry out of the boat, and the line up of people helping unload everything. We definitely felt welcomed.

Like other indigenous communities here the houses are also built elevated from the ground and there is a big tent-like large and open house with a tall straw roof that serves as a community hall where several men and children gather to watch a TV playing Colombian music videos with the generator as background noise. Most of the women don’t bother wearing tops and a lot of the children just run around naked.

I sat there too while waiting for lunch, but chose to watch the river instead of the TV and marvel once again at the adaptability of children. There were several of them, running naked on the rain and mud. A little one found a small wood board and invented mud surfing. I had to smile at that. Another little girl came in carrying a huge thing of plantain, so big that I wouldn’t be able to carry it. When some of them fell on the floor I thought her little brother would go and help her, but he just helped put the plantain back on her shoulders.

Anyways, we were very, very, very busy all afternoon and have already found several malnourished children and 2 cases of malaria. Tomorrow the promise is of even more people, as there are people also coming from nearby communities. So I better turn off my flashlight and go to bed, I mean, hammock.