South Sudan Journal, Parts 10 & 11 (of 29)

Message #10 Sunday November 2, 2003



Hello Mom and Dad.

What a busy week. I think the week started a couple of weeks ago, but this morning, when the sun came up and there was nothing more to do, the week was finally declare, "over." It is Sunday, the day of rest, and rest we will have.

Besides last week, being busy with the work, on the weekend I did a medical storeroom (pharmacy) stock check with Helena (the Financial Coordinator, who regrettably asked, "so what do you do all day on a Saturday?") Since some stock numbers were off, and the two storekeepers could not account for the losses, we have taken control of the med store.
On that Saturday we were going to do a stock check, to see how far off the numbers were.

Stocks and the stock cards to account for them are a funny thing. There are math errors, there are writing errors, there are sometimes urgent needs and no time for paper, and there are thefts. We wanted to find out how much of each has happened, and also good stock management dictates a check every two months, doesn't hurt.

So, with eager hearts, we went to count, but first we re-organized the storeroom. After my experience in Sri Lanka, where we had very large pharmacies, I feel like I actually know how to organize a pharmacy, for efficiency of use, and accounting. So, the oral drugs here, the injectables there, the medical materials over there, slowly the pharmacy took shape, and started looking very good and organized.

The reason we were re-organizing it, (and good project continuity says "don't change a thing until you are there a month or two.") is that it was re-organized before, to try out another system, but that trial is over, and it didn't work.

In short, Saturday and Sunday, was spent investing in an organized stock, and counting it. What a pain, but it has already proven to have paid off. Time in there every day is less, and it just feels a lot nicer to work in.

The week started soon after that. Monday the usual onslaught of asking began. "Can I have one of these?" "Give me a bottle." "My boots are worn out..." I have been able to fend off most requests, except for with one person, Simon. Simon is a Community Health Worker working for us. Apparently, he is one of the better ones too. Simon has Polio, which has left him quite handicapped. His lower legs are very thin, too thin to walk on. As such, he gets around on his hands and knees. Simon has a three-wheeled chair, but it needed some work on it before it could work. In the heat of the asking for other things, Simon asked for some oil, just 20ml to put on the chain of his chair, so that he could get around.

There I was, handing out "No's" left and right, then his question. I dismissed the group around me, and asked Simon to come with me, so I could steal away a little oil without an audience to judge my actions. I pulled out a syringe and got 20mls for him. As I stepped out of the storeroom and handed him the oil, I looked up and saw the group had reassem­bled around me, and witnessed me handing out something, after judging their cases quickly, and judged negatively to everyone. Simon said thank you, and crawled away. The group came closer, and started with louder talking towards John, their English advo­cate. "You said you weren't giving anything out, and now you lied! Why wont you give us things? Why don't you like us? Why him and not us?"

I don't usually raise my voice. At that moment, things slowed down, an energy built from within my soul, and I paused. They stopped, and we looked at each other in silence. There was a forgien feeling building up, a storm brewing. I leaned forward, and slowly, softly told John, in answering, "why him and not us?" "You can walk, that's why." And I walked away and slowly let the storm settle. I don't like that feeling. There was no more talking from behind me.

A couple of days later, Simon's wheeled chair was working, and it was great to see him getting around in great style. When he came up to me, I was expecting him to say some­thing relating to how the oil, and the tires we had given him, had helped him out, but instead he said, "I need some paint for my bike. Give me some paint!" I was a little con­fused, 'is this another want from the great MSF store-room?' I thought.

"I will have to check our stocks." I said, in hopes of slowing down a natural reaction to promising something.

"Red. I want red." He said as I thought about where the lines were drawn between want, need and what MSF's role in providing medical aid to these people covers. Does it cover red paint, or just oil? Where is black and white when all I see is the grey in between?

The following came to me then: 1) Whatever it is, it is never enough. This was true to my life back home, and it is true here as well. There is always something more wanted, and there is a risk of disappointment ("why don't you like me?") if it isn't given. 2) These are also just questions to the people with it all, MSF. There is no acknowledgement that everything in our stores is there for the project, and there is little, extra. Maybe a way of answering these questions is to express that these things are not extra. 3) I need a blan­ket, "No!" phrase. Something that could be used for anything, every time. And there my quest began.

The quest, or question, is, "What can one say, to inform people that the material and equipment under my control, cannot be given out freely, but has to follow the reason why MSF is here in Lankien."

Well, to summarize, the storekeepers answered that, when I asked them how they refused people in the community. (Assuming they did.) "I cannot give out MSF property." They say. And so, by mid-week, that was my catch phrase. "That is MSF property, I cannot give it out MSF property!"

That worked well, until Thursday.

Thursday was the first day of an initiative to start a training program again. The medical people were going to hold two teaching sessions in the afternoons, and they asked if I could do some Math lessons for the non-medical people. Sure thing, I know a little math.

So, Thursday I began a beginner math class. This was one of the hardest math classes I've taught. "How basic should I start?" I asked Hannah, the Doctor who had initiated the teaching sessions. "As basic as you can go." She advised.

Well, I guess that means with numbers. And so it began, "What is a number?..." What a class. It was only an hour, but in that time I was given a powerful lesson on education. BE NICE TO YOUR CHILDREN'S TEACHERS!

The class consisted of people that knew some numbers in English, (the Neur use English numbers when writing them, so at least that was easier) but I know enough numbers in Neur to do a bit in Neur too. Some people could write the numbers, and some people have never held a pencil before. I (despite my crusade to not start a flood of new asking) handed out 10 notepads to the first 10 people to attend. (We have a national staff-training budget, so I think that is okay.) The first half of the lesson was all about numbers, and what they meant. I think people were amazed and pleased that someone was explaining it to them. We even dipped a little into adding two numbers. (We may have to review that this week.)

We ended up with about 25 people. As I finished, I asked if people would want to con­tinue next week, and I got a round of clapping. Success! I held an advanced math class for three of the staff (storekeeper, log assistant and site supervisor) because the better their math skills, the easier my job will be. After our first advanced math class, they too were very pleased, (even though I gave them a lot of homework too.)

The next time someone asked me for something, and I refused, I heard John explain something to him. I asked John what did he tell that person. John told me he said, "Steve likes us, because he is teaching us maths. He doesn't give us stuff, because it isn't his stuff to give. He does like us though." That seemed to work out well.

That was Friday.

Friday we also got a plane in, but without the staff salaries. The salary issue has become huge. The issue is as follows.

Sudan has a currency, the Dinar. The south, (the area I am working in, and the area that is fighting for their independence from the North) does not use the Dinar, for it is the "Money of the North." So, they want US dollars. In this land of different things, the common US Dollar isn't good enough, it must be the series of bills, with the larger head printed on it. These are known here as, "big headed US dollars." Small-headed ones won't do.

It is a problem to get these specific bills from the bank in Kenya, since that is a silly request to them. (Can you imagine? "May I please have 20 rolls of loonies, the ones with the parliament buildings, not the ones with the loons on it.") So, it takes longer to get the specific money up here.

In months past, the payments have been delayed a week or two. There was talk this week, that the money should be here, or there would be problems. Friday the money did not arrive, and Saturday, to our surprise, there was a general strike in the clinics.

We employ just over 100 people to do everything from injecting medicines, cooking the therapeutic foods, distributing the medicines, cleaning the compounds, supplying water to the clinics, guarding the compounds, etc etc etc. On Saturday, after some heavy discus­sions with our Project Coordinator and Head of Mission, work stopped and people walked out. Further, there was a demand to have the money there by Monday, or people would stay out. (We expressed how the next plane would be here Tuesday, and that we couldn't change, but we were talking to deaf ears.)

After the dust settled, there were about 450 hungry eyes looking towards us for an answer. In the TB clinic there was the weekly food distribution for 80 people. We used the patient's relatives to help us get the food over there, and the distribution went well. In Kala Azar, the medicines were handed out to the most severe cases, and the rest were to return Monday, once we had things under control and had a better plan. In the feeding centre, things were not so easy. There are approximately 140 hungry, actually starving, people that have 6 feedings through the day. So the rest of us got on the job. There was porridge to make, special milk to brew, and protein/energy bars to hand out. It was sloppy, maybe some would even consider it messy, but between the team, we seemed to replace a good portion of our 100 staff, and carry out the essential parts of the clinic.

Yesterday was difficult. The actual physical part was tiring, but not stressing. The stressing part was that our staff, consisting of people from the community, walked out on their mothers, fathers, sons, and daughters and we were left feeding them. At some points in the day, a general feeling was to say out loud, "sorry, we thought we could come here and help a few people live. In fact, you were asking for us to be here. We tried, we tried hard, but we can't do it, we can't save everyone, give out enough to satisfy everyone, AND pay people in bigheaded US dollars. We tried, we failed, we are going home! Good luck with it! But we didn't. Some of the patients and people here have become our mother, father, sons and daughters, and we will try harder before throwing in the towel.

As some of us were cooking with big 50 and 75 litre pots over fires, others were in meetings and discussions. The result is, the staff came back to work today. There is a big mess to sort out. A lot of hurt feelings and frustrations back and forth. A lot of the staff know it is not us, but MSF they are upset with. A lot of us realize that payment one or two weeks late, every month, wouldn't be accepted back home, so there are fewer bad feelings towards them too, today.

I think one of the best things that have come from this, are our team has solidified over this issue. "What do you need?" and "What can I do?" were common words yesterday, and that is just a great team to work with. Hannah, one of the doctors, has decided to extend her mission end from December till March. She says this is because of the great team here. I think she has a very good point.

So, today is Sunday, the holiest of days, the day of rest. In the afternoon I'll finish some reports and maybe place an order or two to fill up our ever-depleting stock; but that is later. Right now, the music is playing, the heat in the office is a little lower than the really hot outside, I have a large glass of water, full belly of food, and nothing that need my attention. Another day in paradise really.

That is all for now. Thank you for the letters I am receiving.

Lots of love,
Steve
Message #11 Wednesday, November 5, 2003



Hello Mom and Dad.

I'm in Wudier now with the BHCU team. Long story, to get from Sunday, labour disputes, to Wednesday small small village closer to the middle of no where; I'll try to get it all in this email.

The BHCU (Basic Health Care Unit) team, travels between three BHCU sites assisting national health care workers at the different sites. The team includes two nurses, Lief and Shibohn. (A third nurse, Dennis, has come in, he will replace Lief), and myself, for the next 10 days.

The actual sites are very limited in their resources. The purpose of these sites is to provide basic (very basic) health care to the communities, and to have a health outpost to observe trends and verify health conditions.

There is another Log, Charlie T, who usually goes to these sites with the team, to provide log assistance, (construction, supplies, etc), however Charlie T wanted to learn a little more about the supply chain system, so he has gone to Lankien for some time to get a handle on things there. There is talk that Charlie T may leave in December, possibly to another project, so it would be good for him to experience that other side of a project.

Further, if Charlie T was to go, I would be responsible for the logistics on these sites, and as such, I should know a little about them. So now was a good time (not the best time, but we are only shooting for good here) for Charlie to come in, and me to come out.

Tuesday we had a plane come in, and it was going to pick the BHCU team up from Magang and drop them off in Wudier, so I joined them.

My goodness. I thought Lankien was in the middle of nothing, then I got on a small plane, flew NNE for an hour, then landed in an even smaller community. In the pursuit of no-where, I think I am getting close!

Wudier (Lat: 9.5 degrees N, and Long: 33.6 degrees E) is closer to the Ethiopian border (approx 40 kms), near Daga Post and Longochok. It is also in a more fertile area. It is quite nice; there are large trees (including coconut trees) and just a more fertile smell about the place. (Not the dustbowl Lankien is becoming with the dry weather we are having there.)

The compound is extremely basic. There are two tukels, the office and the kitchen. There are two plastic sheeting enclosures, the latrine and the shower. There are some tables, for the solar panel, the hand washing basin, and a table for eating outside. There are two large trees to shade a large portion of the compound, and that is it. We are sleeping in tents.

The BHCU is also very... basic (don't let the name Bhcu, fool you.) There are two tukel there as well; one for out-patients (those patients that come to have something looked at, then get some advice, medicine, cleaning wounds, etc, then they leave) and one for in-patients (those patients that stay in the facility over-night.)

This morning we had a meeting with the 11 staff members to introduce Dennis and myself, and to say hello to everyone, since the team was away for a couple weeks since the last visit. Most of the staff spoke English, and they were very happy to have us there. In the facility, there are two trained health workers (trained on a 3 month course) and that is all the trained staff. It is nice to have expats come in, to consult on the different cases and do some added training.

After the meeting, the clinic began. People are treated for Kala Azar, sometimes TB, and then also a whole assortment of everything. There were approximately 20 people waiting outside for consultation. Plus, there were 5 people waiting for their daily (painful) injections for Kala Azar. Also, there were about 3 in-patients.

Most of the time, the clinic is fairly quiet, but in some busy times, more people are employed, and a clinic is run under a big tree out front.

This is really all there is to Wudier. It is a quiet quiet place, with some nice looking trees, beautiful sunsets, friendly people, and a small clinic. It is nice, and nice to be here.

Why it is nice to be here....

After the semi-slower day off, Sunday morning, the afternoon got busier. All the staff came back to work, and there was a clean up to do in the clinic. By Monday, things were working, but not great. Evert (our Project Coordinator) and Arjan (our Head of Mission) were in a 5 hour meeting with the local authorities, SRRC, who had been asked to mediate by the staff. The SRRC really laid into them for all sorts of reasons, like we were not training people well enough, not paying on time, not giving enough gum-boots, not this that and the other thing. It was hard to see that delivered to our team.

Fortunately, there is a cultural difference in the way these labour disputes are dealt with, and more fortunately, Arjan was aware of it, and helped us understand why this process was quite difficult to accept. It seems that this is the way it is done, voice all your complaints, and get it all out, agree or disagree with the other party, then it is over, not to be brought up again, despite the frustrated feelings the international team may still hold.

Tuesday we had some more meetings, and from all this meeting, there were commitments on both sides to move forward together. There is a lot of good in having MSF in Lankien, and we all agree to start there, and have that in mind when compromising and accepting. The meeting was drawn to an end as the Casa flew overhead, and off I went.
Yesterday afternoon was filled with setting up the compound (getting the electrical system wired-up, the tents up, etc) cooking up the goat meat we got from Loki that day, and enjoying the wine and cheese Dennis brought from Amsterdam, just for that moment. It was a little busy setting up, then dinner, then sleep by 2200, as usual.

Today, it hit me. I was up by 0630, as I have been these last few weeks, ready to go. My mind racing with details and solutions. I got up, thanked my maker for another wonderful sunrise, and then proceeded to make breakfast and tea. As I slowed down to sipping tea speed, I reviewed what I had to do today... nothing. Charlie had given me a small, small list to do, but it was all fancy stuff, that could wait, if I didn't have a moment to do it, in the 12 days I will spend here. I toured the clinic, then back by lunch, made that, ate that, then put my head down by 1300. I woke at nearly 1700. I was exhausted.

I think over the last few weeks, the constant go-go-go has worn on me a little, and it was only now, that I have very little to do, do I notice it, and my body is slowing down. It is nice to take this break, the last while has been tiring, and I will enjoy this time here.

Well, the sun is setting against the palm trees and tukel silhouettes. There are children playing down the paths, the team has found the beer, and distributed it, the day is over, and slowing down will take on new meaning for me.

Have a good night, lots of love.
Steve