Making Do With Soda Soap

New Blog

2009-09-25T06:47:00.001Z

I'm sure no one's checking here anymore, but since I left SL in May, I'm not writing here anymore. My new blog is over at juliacoynerrobinson.blogspot.com.

Sending For Visas

2009-05-07T10:41:00.001Z

After just under a month at home, I will be traveling to Cape Town, South Africa, to be a fellow in the main office for Mothers 2 Mothers, a program that, in brief, strives to prevent the transmission of HIV from mother to child. I’m in a whirlwind of paperwork and logistics—insurance, financial concerns, and of course, the dreaded visa.

I lived in France when I was 13 because my parents took a sabbatical from Thacher, the boarding school where I grew up and that I attended for high school. We didn’t get visas because the French application process required extensive paperwork, including handwritten forms in triplicate (as I remember it). This meant that we entered the country as tourists and had to leave the country every few months so that we could remain legal. Now, with the Schengen Agreement, which dissolved internal borders between some European countries, it would be more difficult to dodge the visa. But it meant that every so often my sister and I were pulled out of school (or not—the French get a ridiculous, though very nice, number of holidays) for trips. We would traipse off to Switzerland, or across the Chunnel to London (which was a letdown—I had imagined it to be really cool inside, like the mine in The Temple of Doom—it was actually just dark), or to the Isle of Jersey. This was my mother’s favorite because, despite the rough ferry ride, she could stock up on cranberry juice. We would go for day trips, always careful to have our passports stamped going into Jersey, with large rolling suitcases so that we could buy enough Ocean Spray cranberry juice to keep her happy. We’d go to this great Thai restaurant that had a contest in the men’s bathroom that challenged the viewer to pick the woman who was once a man out of the pictures of scantily clad fancy ladies on the wall. On one occasion, my mother got my dad to check the bathroom so that she could sneak in and make her guess—and of course, she got it right. This was my first experience with temporary residence in a foreign country.

When I was in college, I studied abroad in Senegal for just under five months. I expected a seriously confusing visa process—Senegal is an ex-French colony, after all. The application was one page long and only required a trip to a New York Post Office. I got my visa in less than five days. Granted, I was going as a student and had a sponsoring letter from my program, but I was shocked, especially once Senegalese friends began to outline the process for obtaining a visa to the US. I did overstay my visa by a few weeks, but there were no raised eyebrows or questions as I passed through the airport—I was leaving.

The visa process for Sierra Leone was equally easy, and I completed it between New Orleans and Atlanta during a road trip to return my sister to college. I also got my visa in under a week. Once I got to Sierra Leone, things got a bit more complicated. It turns out the multiple reentry visa, good for one year, is actually useless. All visitors receive a one-month stamp upon entry to Sierra Leone, and that is the golden ticket, not the visa. Outstaying your stamp date can result in “fines” paid without a receipt to the customs agents that shake you down at the airport. I tried several times in Freetown to get my stamp extended (on one occasion the entire immigration office was closed for a funeral), only to find out that it required exorbitant fees, paperwork, “honorariums” to various officials, and trips to multiple government bureaus that had decided upon different regulations that would increase their individual piece of the pie. It turns out that an expatriate, especially one coming to volunteer for an international NGO, is seen by the government as much as by the average Sierra Leonean as a vast and untapped source of unimaginable and fabulous wealth. Unfortunately, this will ultimately result in deterring NGO work and volunteers—who wants to pay several hundred dollars after shelling out airfare and visa fees (not cheap), and committing to work for free for a humanitarian purpose? It’s especially hard to say yes when you know that the money will be eaten. So, I did what many NGOs in Sierra Leone have done in the past: I went upline to deal with my paperwork in the more relaxed and friendly atmosphere of Bo.

In Sierra Leone, it’s relatively easy to get away with things. As long as those activities don’t involve smuggling kilos of cocaine from South America and involving high ranking government officials, which caused a huge scandal in September (though I can imagine that a lot of the planes transporting coke from South America to Western Europe don’t get stopped). Actually, the men arrested for this and tried were recently convicted. The day of their conviction, American forces of one kind or another (allegedly) entered their cells and whisked them to a helicopter and then to a plane that had been waiting several days for the conviction to fly them to the US for drug-related crimes committed on American soil. The US Embassy had no comment. I haven’t found a report online for this yet, but I heard it on the BBC here. Apparently President Ernest Bai Koroma issued a deportation order, which made the American action legal, but all I can imagine is a bunch of spooks in riot gear and balaclavas throwing tear gas into the prison, tearing down the doors, and pulling terrified men out of their cells, putting bags over their heads, and throwing them into the trunk of a car. Though I’d wager that US prison might be a bit more comfortable than the Salonean variety.

Anyway, it’s easy to get away with things—thieves are so brazen precisely because the police don’t respond (unless given a “gift” by the victim, I am told, or unless the victim has good connections), and there is no version of 911 outside of Freetown, and even then, you have to have a certain cell phone carrier to call it. We have the personal phone numbers of friendly policemen in Bo should there be a problem. Almost anything can be bought or swept under the rug as long as you can “remember” or “send for” the responding officer. This means that there is a lot of vigilantism—thieves might be able to get away without being arrested, but they could be severely beaten or even killed by a mob of people should they get caught.

Now, I’m looking at a visa form for South Africa that requires things I’ve never had to do before: chest x-rays to ensure that I am TB-free, proof of financial means, and a background check from the FBI. It all feels a bit excessive. But then again, I’ve been in Sierra Leone for almost eight months now.

Ordinary Oddities

2009-05-05T14:08:00.000Z

As it’s beginning to sink in that I will be leaving Bo in under two weeks and Sierra Leone in less than a month (after a brief detour to Morocco), the ordinary parts of life for me here start to surface as strange, as things that I will not encounter when I return to California. No traffic lights or stop signs, no strict attention to staying on a particular side of the road, children and mothers clutching newborns helmetless on motorbikes, for example.

What hit me last night, as I was shuffling out to turn on the generator for its daily four and half hour run from 6:30 to 11pm, was the strangeness of having 24-hour light. I have not had a day of 24-hour power since December, when my family came to visit and we stayed in a nice Freetown hotel. I’m not trying to lay a guilt trip on anyone reading this or trying to prove that I’m tough (I’m not—the generator broke about 2 weeks ago and I had a mini-meltdown). The hospital (and all of Bo) was without municipal power from Thursday evening until this morning, so we had over 5 days without light. The city is powered by a hydroelectric dam that relies on a high water level to function. Now, at the very last gasp of the dry season, there have been longer periods of blackouts. Although the government is supposed to supply the hospital with fuel or with money to purchase fuel, it has all been “eaten” on its long journey from Freetown to Bo, through so many bureaucratic hands. It costs just over $100 to power the hospital for five hours—a considerable expense in a hospital that requires patients to provide their own food, linens, dressings, syringes, and blood, even in emergency situations. In a hospital, lack of power is a serious problem, as one can imagine.

Our house is one of a handful of structures that have generators in our neighborhood—the others include a motel, a private hospital, and a district councilman’s house. It becomes immediately apparent at night who has a generator and who doesn’t—if the flares of light don’t give it away, the chugging of the engines certainly does. Lack of power is a fact of life in Sierra Leone. Most people don’t have it or have it intermittently. Some people have visited me at night just to be able to plug in their cell phones (which became apparent when there was no conversation beyond “How are you? Can I charge my phone?”). Cell phone charging stations are a thriving business. When I returned early from work last Friday, a neighbor, Hawa, asked me a standard greeting: “How de work?” I ended up complaining, with an exasperated gesture “Light no deh na hospitu,” only to realize how ridiculous a gripe this was, since Hawa does not have a generator or even wiring in her house to support a generator. I didn’t feel bad about it—we do need power to function as an organization, and it’s incredibly frustrating to come to work and know that nothing is going to get done until the power comes back—but I did realize how absurd it was.

To have power, I have to request for fuel, get the money, get the jerry cans, take them to the gas station, fill them, bring them back, and then get the tank filled (our caretaker, Amara, siphons the fuel into the tank. I am way too much of a wuss to attempt anything that will most likely end in a mouth full of diesel fuel). Then I have to turn it on and sometimes turn it off, making sure that we aren’t keeping it on too long so there’s enough fuel for the whole week.

It’s the same with water—we have a well, we have to turn on the generator to pump up the water to the tank, and then we have running water. When I first got here in September, we had no power and therefore no running water. When Helen first arrived, Amara was hauling water up to the tank by hand so that she could have running water. Once she figured out what was going on, she asked Amara to stop and enacted bucket showers. We recently had to stop allowing our neighbors to use our well (many do not have one of their own) because of concerns that our well will dry up. As it is, I can see the bottom when I lean over and stare down into the water for a while. And two of our neighbors just dug wells, one of which is under 20 feet away from ours. At the hospital, the pump that WAFF donated broke due to some power surges that destroyed the circuits. The patients usually have to fetch their own water for drinking and then we pay a truck to come in twice a week to fill our ward tanks so that the patients can bathe (in a fistula ward, this is pretty vital).

What’s strange about utilities here is that their sources are so near and so apparent. It’s not turning on a light switch or a faucet and what you need is right there—it’s having to see where the power and water come from everyday and knowing everyday that something could go wrong to stop them coming. The house pump or the generator could break. The gas stations could begin hoarding fuel to create an artificial shortage, as they did when the government forced them all to lower to a standard price (Le 12,500, or $4.15). Fortunately, this did not work, and the brief shortages were more annoying than anything else. I’ve never been so aware of water and power, even though I’ve lived in California during “rolling blackouts” and severe droughts, including the one we’re currently experiencing. Here, every minute the generator is on, I am aware of it and aware of the fuel that it is consuming. Every second I’m in the shower, I feel the water draining out of the tank and being pumped out of the ground.

I’m not optimistic, however, that once I go home I’ll be taking cold army showers and keeping the lights off during the day. These amenities are so convenient and beyond that, so important to functioning as a person, family, or society. Yes, you can get along without them. And yes, the vast majority of Americans and other Global Northerners/people in developed nations/Westerners should conserve a lot more power and water than they currently do. But when I go to the hospital and sit in the dark, listening to the patients pass the office to and from the hand pump, I’d take wasted water any second or lights left on when no one is in the room, if it meant that there was, at the very least, running water and power for the hospitals here. And I can only hope that once I go home, I’ll shave a few minutes off my showers and I’ll remember to turn my computer off at night and unplug it. But first I’ll have to get used to turning on the light switch outside the hours of 6:30-11pm.

Grasping at America

2009-05-01T11:23:00.001Z

Recently, I had a conversation with a man named Commandah. He detailed his various attempts to get to Europe illegally. Once, he tried to cross the Sahara through Mali to Morocco and from there, a boat to Spain. Like coyotes leading illegal immigrants from Mexico to the US, the “boys” guiding across the Sahara often cheat or rob their desperate clients, forcing them to march until exhaustion or taking away their water and then removing them of all valuables. Commandah marched all night, fearful of desert snakes or being cheated, before he turned around and headed back to Mali. He also tried to stowaway on several boats with the help of bribed accomplices on board. Once, he had to stay strapped into a tiny cot, unable to move except briefly at night when the crew was asleep. He abandoned that venture. I asked him if he would try again to enter Europe. “Not the bad way. Not through the back door. It is the main gate for me,” he said. He now has a wife and child.
Almost everyone I have talked with in Sierra Leone has expressed a desire to go to the US or Europe (except for the 5-year-old daughter of a patient, who shook her head when a woman asked if she wanted to leave with me—clever girl). With the patients, I’ve gotten into a long joking routine where they ask to come with me to America and I tell them they’ll have to stop eating to get “small body” as I open up my purse and point inside, saying “No fine. You body BIG.” This never gets old for them. They’ll ask whether there is palm oil, cassava leaf, and crain-crain (another leafy green) in America. I say no, and I warned them, when they bundled up on mornings that were no cooler than 68 F, that they would be miserable. The usual response is that they’ll pack a five-gallon jug of palm oil with them and they’ll dry cassava leaf. Winter cold, as one may experience in New York or Boston (we won’t get into Chicago, Maine, or the Dakotas) is not a concept for them. One man I spoke to told me that his friend had gone to America legally—a long, intensive, and extremely costly process that often results in a rejection with no monetary refund—only to wish that he could come home. Family pressure kept him from returning to Sierra Leone, after all the money and stress spent on getting him there, and he’s gotten used to it.
It’s sort of strange that the image of the US to people living in such dire circumstances has never changed. Replace a Sierra Leonean wishing to immigrate with a Russian, Italian, or Irish person in the late 1800s/early 1900s, and it’s the same. Everyone is rich and free. The streets are paved with gold (though I prefer “Fievel: An American Tail”—“Where the streets are paved with cheese”). Etc. As I’ve written before, I once had to explain in Senegal that America was still struggling with racism and that Martin Luther King, Jr. had not solved racism in our country. I feel like I’m constantly explaining—the cost of living is so expensive, work is hard to find when you don’t have a lot of experience or education, it will be so different, the food will not be the same, etc, etc, etc. I guess, however, that for most people in the US, things are almost infinitely better—medical care (though expensive) is generally safe and effective, water is almost always clean, malaria, polio and other tropical illnesses are rare to non-existent, and there are job opportunities that will pay incredibly higher salaries than Sierra Leone as long as you can work hard under poor conditions (which is, of course, the standard here anyway). People will work for 60,000 Leones ($20) a month and even lower. Some stay in volunteer jobs for years hoping for full employment. And seeing an expat working for an NGO here reinforces this idea—we have enough money to get over here, at least (one patient was shocked to hear that it costs six million Leones to fly here, then admitted that she wasn’t sure how much six million Leones is), and we drive around in shiny NGO cars and eat out in restaurants or buy expensive groceries from the Lebanese supermarket. But we’re the lucky ones that can afford to come here. And the idea of a world economic crisis is widespread and discussed among Sierra Leoneans, but the image of the rich American is unshakeable, and the dream of becoming that rich American endures.

Resurfacing

2009-04-30T10:03:00.001Z

It’s been so long since I’ve written here. My friend Jim wrote over on his blog that after a long time, coming back to writing to attack the big stories or events or thoughts is difficult, if not impossible. Which is my sorry excuse for this long absence. How do I fill in the gaps from the past months?

Our Book Keeper, Musa, died of a stroke, suddenly and unexpectedly. I turned 23 the next day. A patient gave birth to twins and once the stress of her pregnancy subsided, she stopped leaking urine. An employee celebrated her engagement to our landlord with a traditional ceremony that included the presentation of kola nuts, envelopes of cash handed out to the many relatives of the bride, and three decoy brides before the entrance of the genuine article. We took the patients to an orphanage for Easter and had a “lolly hunt” and kite flying and dancing and singing. We hired a third driver, an administrator, a nursing director. We are in the process of hiring an accountant. I stopped my work as the Acting Administrator and took over as the Acting Finance Officer. I crunch numbers, I think.

Dr. Maggi came and many operations were done and hordes of patients sent home dry or to wait for more complicated surgery. We renovated a ward for skills training and as a living area for those few patients that have become part of our staff. The pump that WAFF donated to the hospital broke. The garden dried up. When the water truck breaks down, the patients carry water from the hand pump installed near our office, which means that they pop their heads in and ask, while watching me read the paper online, whether the pictures of New York Times Op-Ed columnists are of members of my family. The volunteers found a new walk across scorched fields and through tunnels of green thickets to a tiny village close enough to the road that we could hear trucks rushing by on their way to Freetown but remote enough that we were unsure how the nine-months pregnant woman we met would ever make it to a hospital when she went into labor. Many volunteers came and went and are still asked after now that they are gone.

I was bitten by countless mosquitoes, awakened by countless mice, tempted to pet countless dogs. I hit a rooster with a pillow after it crowed too early too near my window. It was the burning season, and I awoke from an afternoon sleep more than once to flames reaching higher than our wall, stopped only by a short stretch of road, taking trees and leaving termite mounds, driving mice and snakes into the safety of concrete houses. It was the first straining moments of the rainy season and I sweated through my clothes several times, waiting in the blackouts for rain to come as a relief to the dusty wind, to the unbearable heat, to the thick humidity, only to be disappointed day after day. It rained and kept me from sleeping as the drops pounded the zinc roof until it sounded like a flood would wash us away. It has not rained since and the strain has returned.

Everything moves along much as it did before, with new things flaring up here and there, with things coming together and falling apart. Things are as they are. Ideas become projects become accomplishments, or they shrivel while still ideas or fail as projects or are shuffled off before they can reach the stage of being termed accomplishments. Patients, staff, and volunteers come and go. I will be one of the ones going, after some time in Morocco. In a month, I will be home.

unfortunately, no medical excuse for gin and tonics

2009-02-17T12:48:00.005Z

When I woke up last Thursday, I knew something was off. My neck was stiff and my body ached. Helen calls this a cellular ache. Everything hurt—my eyeballs, my liver, my back, my hair. But that was all that seemed wrong. I figured I’d go to work and come home if things got worse. I lurched out of the car and sat down in the office, assessing within the first five minutes that I needed to go back to the house. Once I got home, the chills set in—it was at least eighty degrees outside, and my nose was cold. Anything touching me was painful, but it worse to be out of the sheets. I tried to imagine being suspended in warm air. The door to my room seemed to zoom in and out, and time slowed to crawl. I tossed and turned, sleeping on and off in the morning and awaking once the chills diminished and my temperature went over a hundred and two in a frighteningly short amount of time. At this point, I took some Tylenol, which dropped me down to a comfortable 99.9, lessened the aches, and brought back a bit of an appetite. It also makes you sweat like crazy, so I spent the afternoon drenched and stinky. WALL-E restored some comfort as well, until my computer battery crapped out. I made the mistake of picking up a book we have at the house that talks about all the various diseases that you can catch in Africa, which gave me several hemorrhagic fevers, infections, parasites, and typhoid as possibilities, though I was pretty sure this was malaria. I’d stopped my anti-malarials, figuring that nine months on antibiotics that make you photosensitive would be a bad idea. I had a treated mosquito net and tried to wear bug spray, but that wasn’t enough, even in the dry season. My dad later called me an idiot, which I guess I had coming.

The volunteers came back, and Helen and I decided it would be wise to get a malaria test the next day. I spent the night mostly awake, running to and from the bathroom, which was neither pleasant for me or for Helen, who woke up every time I got out of bed due to the loud creaks the slats make. She was a wonderful nurse, advising me on what to take, giving me the oral rehydrating salts and Tylenol that I of course did not bring myself, making me drink fluids, flipping my mattress, and even offering to give me a sponge bath (I declined). After spending the morning completely limp and wiped out, I somehow climbed into the Land Cruiser, dizzy from being emptied out, and went to the hospital, where our office neighbor told me that she would “pray for my life” so that I could return to my family in the US alive. This was not reassuring.

Helen I went to the Rayan Laboratory with an order from our Medical Director for blood tests for typhoid and malaria. The building was run down, with peeling paint and the black patches of mildew that gather on all walls in tropical climes. There were horrific posters of the oral sores that most often manifest in HIV-positive patients on the wall. I was a bit nervous, given the infection control methods and bedside manner I’d witnessed in various healthcare situations I’ve experienced here, but the receptionist was fast and efficient. I didn’t even wait five minutes before I was sitting in a high chair (I felt like a small child at the dinner table again) watching the lab tech pull out a fresh pair of gloves and a syringe in a sterile package. Helen looked on with hawk’s eyes, which was reassuring. He pulled the tiniest piece off a cotton ball and swabbed my arm. When he put the strap around my upper arm, he apologized. Please excuse, he said. He found my vein faster than any other nurse, doctor, or blood mobile technician I’ve ever had take my blood, apologizing again—excuse—before sticking me. I was struck by how polite this was—so much better than having someone say Ok, you’re going to feel a slight pinch. He then pulled off another tiny piece of cotton and a tiny piece of cloth tape and bandaged what would become a very nice track mark. Despite the fact that there was no sharps container, everything was done very nicely—labels on the vials, new gloves, needle opened in front of the patient, irreproachable bedside manner. The only scary part came when Helen said, just before he stuck me Are you OK getting blood drawn? I thought this was a polite way of saying This guy did something wrong, which was not exactly soothing as the needle was coming closer, but it turns out she meant Are you going to pass out? Which I did not. The results came back a few hours later—right on time, shockingly—as P. falciparum, the most common, most dangerous, and most responsive to treatment of the four strains of malaria. Falciparum can cause brain hemorrhaging if left untreated but is not recurrent.

Contracting malaria made me think about several things. First off, malaria is strange as a concept because it can be taken so seriously and so lightly. At home, malaria is thought of as some terrible, debilitating illness that leaves the victim in a hallucinatory, feverish nightmare. In Sierra Leone and probably most malarial zones in sub-Saharan Africa, malaria is commonplace, something that makes you feel bad for a bit, but not a big deal—people here will often come in to work, and many won’t use bed nets because they are too hot (true) and claustrophobic.

What malaria should be seen as, for both the US and Sierra Leone, for the Global North and the Global South (or developed and developing countries—there is no good term for this), is as the great killer in Africa and in tropical zones around the globe. Malaria kills more frequently in places like Sierra Leone because health and nutrition are already poor and because people who contract it cannot get to health centers or buy treatment, either because they’re too remote or too poor or both. Malaria is not as much of a problem for me, for example, because I have easy access to transportation, several nurses and doctors, and medicine. I’m well fed and in good health. I could probably buy most medicines without a prescription here because of my skin color, for that matter. Malaria does not need to be thought of with panic (I’m afraid my dad was not so happy when I told him I had it), but it does need to be taken seriously. Malaria kills, but it would kill less frequently if there were more health clinics, or if the roads were better, or if hospital visits were cheaper. Or if children could get enough to eat or weren’t sick most of the time with other things—worms, chronic coughs, malnutrition, diarrhea, etc, etc, etc. Malaria can still kill a well-fed, healthy individual; don’t get me wrong. It’s just that everything becomes so much worse once you add in the factors that put Sierra Leone at the bottom of the Human Development Index this year.

After my results came in, the Medical Director told me what to buy (no prescription needed) at the pharmacy. The man at the pharmacy started when I asked him how to take the Artesunate tablets. He laughed, explaining that he thought I was a doctor, and then advised, once he realized I was the patient, that I should be on anti-malarials and sleep under a bed net. Thank you. Even one pill later, I felt better. I’m still not one hundred and ten percent yet, but I’m getting there. The child of one of our patients came down with an undiagnosed fever yesterday, almost burning to the touch and crying out of discomfort. Her mother sharply told her to quiet down.

Why Poda Podas are Trouble and Other Stories

2009-02-09T12:06:00.004Z

After leaving Banana Island back in November, we dozen or so pumoi on the trip had a bit of an adventure. The poda-poda (a minibus/large van vehicle that can seat anywhere from 10-20 plus livestock depending on your comfort level) named “Make It Rain” that we had hired out for the weekend did not meet us on the mainland at the scheduled pick up time. A call revealed that the poda-poda had not even left Kissy yet, at least 2 hours away with the evening Freetown traffic. After waiting several hours, as the night grew darker and the block party that spilled off the beach and onto the streets grew rowdier, we got a call. The poda-poda was stuck at a police checkpoint due to some paperwork that was out of order. Numerous pleas over the phone to the officer were unsuccessful, so we decided to walk through the party and meet the vehicle at the checkpoint. We were more than a little conspicuous, and though I felt nervous as we walked by, I made an effort to make eye contact, to walk with squared shoulders. Men grabbed at my arms; I yanked them away. After we’d made it through, a small group of young (and inebriated) men followed us, heckling and asking for money. The road grew less lively, the lights disappeared, the houses looked closed and empty. At the bleakest point on the road, the men suddenly surged forward to grab at stragglers’ packs, back pockets, anything, even targeting the larger men in our group. We tried to chase them, yelling for help, but they kept coming back, and in greater numbers. That was the scariest part—their brazenness. I moved ahead, looking for shelter. Cold Drinks, the sign said. There was light. Thinking it was a bar, I yelled for everyone to get inside, but as we entered the compound, a startled family tried to shoo us out. After begging for help, they ushered us into their living room, an unbearably hot, ramshackle space with dirty lace antimacassars on the shabby chairs and phones plugged into every outlet in the wall—a standard business for any house lucky enough to afford a generator. They asked us to stay inside, locking the door behind us. But the windows were wide open. We could hear yelling and scuffling outside. All of us were unharmed, none of us had been robbed, and everyone was calm.

A check of our cell phones revealed that none of us had service in the house, so a few of the better connected among us (not me) went out to make calls to security buddies at the US Embassy, to bosses at the UN Special Court, to the British High Commission, the Ministry of Foreign Affairs, landlords, powerful friends, roommates. Discussions with the household revealed that the men had called professional thieves and that they had set up a roadblock to catch us if we tried to leave. A few rocks thumped against the side of the house and the women and children of the house were rushed inside with us, huddling in the corner as I moved an electric fan, supplied by our gracious hosts, over the room, trying to keep people from passing out (it was that hot). That was when I got scared—what dangers had we brought on this family? Rumors reached us of a woman unconscious outside, possibly injured by a rock thrown by one of the thieves. A trained medic among us offered help, but the family told us to stay inside, explaining that the thieves may have sent her as a decoy to lure us out on the road, since they assumed that we were all doctors (sidenote: once at the hospital in Bo, a sizeable group of angry friends and relatives of a man critically injured in a car accident gathered around the office and vehicles and it was suggested that I leave, since they thought I was a doctor and were beginning to angrily wonder why I hadn’t come out to help yet).

The entire neighborhood heard and began gathering at the house. Eventually, enough people showed up, including the incredibly kind staff at Banana Island, who boated over to help us, to chase the thieves further down the road. The poda poda arrived, and the driver and apprentices tried to nonchalantly high five a few of us, offering zero apologies and even less remorse. After two hours or so, a large truck full of local police arrived, and an hour later, a UN escort of two vehicles. We thanked the family, the neighbors, the well wishers, the children. They seemed ready to see us off but not in any way upset that we had invaded their house. Many of them had turned the situation into a social event, sipping soft drinks, catching up with neighbors, and boasting about their exploits in the “battle” with the thieves. Making do with soda soap, so to speak. This was the lesson learned: despite the poverty that causes criminal behavior in a few in Sierra Leone, the vast majority of the people will protect you, offer you shelter, and go above and beyond as hosts. I tried to imagine what would have happened if I’d been threatened in New York in a similar way, and I can only think that it would have ended a lot worse. Sierra Leoneans don’t stand by idly when someone is in trouble.

The four who were employees of the Special Court rode in UN vehicles; the rest of us crammed back in to the poda poda, which spun out on the gravel in front of the house and almost crashed when we tried to depart. Needless to say, most of us were ready to kill the driver, especially because he acted as if nothing had happened and that none of it was his fault. We pulled out, the UN vehicles in front, then “Make It Rain,” then the truck full of police. We made it back to Freetown safely, having learned that poda poda drivers are always not trustworthy, that block parties should be avoided, but most importantly, that the people of Sierra Leone are good, generous, gracious people, who will offer the best that they have to guests, even ones that force their way in with danger on their heels.

Catching Up

2009-01-18T16:53:00.000Z

It’s been a long time since I’ve posted. But a lot of things have been going on since my last post that kept me distracted—Dr. Maggi showed up, then my family came to visit me here in Sierra Leone, and then the day that they left, six volunteers arrived from the United States! So, it’s been a very busy month. Dr. Maggi performed about 15 surgeries, mostly fistula repairs. We finally got running water at Bo Government Hospital, since WAFF purchased and installed a pump for the well. This is the first time the hospital has had water since 2004. Unfortunately, it’s also the dry season, which means that the hydroelectric dam that powers Bo and Kenema is running low, causing frequent blackouts. We’re dealing as we can, though the power shortages certainly cut into surgery time and make the office even more inefficient.
One of our patients delivered her baby boy, named Doctor Maggi, in early January, so we have a new little wrinkled face on the ward. We’ve said goodbye to two of our most dynamic patients, Alice and Sama, who have been discharged following successful surgeries along with three others. I feel very close to both of them, and their leadership and liveliness is lacking in the ward. We took Alice back to her village, and though watching her return to her element made it easier to leave, I miss her. She gave us a giant cocoyam, a bunch of green plantains, a large papaya, and a live chicken, which spent its trip in the car trussed up in a shopping bag, its head poking out of a hole in the plastic, its angry red eyes dilating at every movement. Every so often it would go ballistic in the back of the car and roll around squawking and flapping inside the bag. It made me a bit nervous, and Alice made fun of me for jumping away from it when she told me to pick it up and it lunged away in a rustling of plastic and pinned feathers.
While returning Alice, we also looked for new patients in the surrounding villages, and we ended up on a wild goose chase for a prospective patient who walked from one village to another before we could find her. Eventually, as the sun began to set over crowing roosters, goats grazing among the cement ruins of houses burned in the war, and sooty kitchens full of hanging baskets, bunches of dried okra, and stacks of clean pots awaiting the evening meal, we found her. On the trip back, she couldn’t stop smiling and spent a good portion of the trip holding my shoulder and stroking my hair, which had become a rats’ nest in the wind from the open windows.
It was amazing to have my dad and sister come out over their winter break to visit. My dad came to see me when I was in Dakar, so he had some frame of reference for what Sierra Leone would be like, but my (vegetarian) sister had never been on the continent before. Both of them were incredibly patient with the transportation issues of this country (a blog post to follow on transportation, at some point) and the other things that go with visiting a place that has very little in the way of a tourist infrastructure. We went to the Tacugama Chimpanzee Sanctuary to visit rescued chimps, which were very adept at throwing rocks at visitors and were terrifyingly human. We saw endangered red Colobus monkeys at the Tiwai Island Nature Preserve, where we slept in REI tents and ate beans cooked over an open fire. It made me yearn for the Sierra Nevada, where camping is a lot less humid. We ate, in age-old Robinson tradition, good food, trying out grilled lobsters, Chinese noodles, paneers, various experiments from the Bo market, and a lot of fresh fruit. My poor sister had to eat a lot of falafel, which was often the only vegetarian option, as my dad and I gorged on perfectly roasted, juicy chicken with garlic mayonnaise and Lebanese cheese pies, which are a bit like a white pizza. We did a bit of exploring in Freetown and found it too hectic to endure for long, but we watched masked Sande dancers shuffle through downtown waving green branches and followed by women with drums and shakers and bells.
Now we’re at the end of the trip for three of our volunteers, two of whom were working on a documentary film and one who helped set up our garden, which is now full of sprouting cucumber and squash, and little green shoots of corn and peppers. It’s very exciting. We traveled out to Taiama, a village near Bo, for a church service on behalf of the family of one of our consultants, Samuel Pieh, who is directly descended from Sengbeh Pieh, the leader of the Amistad revolt. It lasted four hours, which would test the limits of a faithful person but for me was tortuous, but our visit was made worth it when a troupe of “cultural” dancers, including Sande maskers and other “devils,” a man on a very thin high wire, and many drummers, showed up at the Pieh household. We also drank palm wine with our host, which isn’t too bad in small doses, if you can avoid the bees and other bugs that get into the drink during the tapping process.
Since then, we’ve been gardening, doing arts and crafts in the ward, and sitting with the patients. I’m still working in the office and I’ve done what I can to help our volunteers with educational programs (family planning/reproductive health as well as first aid) get started. I’ve followed the cinematographer and writer team around as they shot various locations and conducted interviews a bit and taken the volunteers to the market and other Bo hotspots. We’ve begun frequenting Georgetown, a local guesthouse and bar right up the road from the house, and it’s been nice to have a bit of relaxation. It’s a very exciting time to be with the program, since it feels like all of this new blood has increased enthusiasm and excitement within WAFF. And it feels so good to grow things that we will, with hope, be able to offer to the patients (or to eat ourselves, if the patients aren’t feeling brave). Watching little seeds push up and fold out leaves is one of the most satisfying things I’ve ever done. We’ve started our compost pile and built up different types of raised beds. The patients come down when they see volunteers heading for the garden and point out the various ways in which we are doing things completely wrong. We listen to them most of the time, since they are professional farmers and we are amateur putterers at best, but we’re hoping our weird experiments and ideas pan out, so that we can pass on some knowledge to the patients as well, with the goal of giving them the opportunity to improve their diets and those of their families once they go home. So, for now, we’ll be the crazy pumoi with our weird raised mounds for gourd cultivation and we’ll keep our fingers crossed that it will work.

Indiana Jones, Granfalloons, and Finding Ways to be Good

2008-12-05T10:00:00.005Z

As a young child, I dreamed of being an archaeologist à la Indiana Jones. When I was a little bit older, I found out that archaeologists spent most of their time writing grants and begging for money, and my dream of spending my life in secret caves floored with the crunchy, fortune cookie consistency of millions of crawling insects, my path lit by a torch made out of a human femur and my goal some forgotten idol that belongs in a museum, crumbled a little bit. Unfortunately (?), my life has again led me to a job that is entirely dependent upon the kindness of strangers. I don't like begging for money, but donations are essential to the survival of non-profits and non-governmental organizations like WAFF.

I know how hard it has been this year with our tanking economy. I had hoped that out of this experience, the American people as a whole (if not the global population) could begin to rethink the way they spend their money and to look beyond themselves to see the broader scope of shared humanity and experience, if that makes sense. That we are not alone or simple individuals in little predefined groups (Bokononists call these granfalloons), but that there is a whole world full of people that are a distinct part of who we are and how we live. That buying a brand new car or a pair of shoes or the next generation video game is not as important as being with and caring for others. I think, to some extent, that this has happened. The story I recently read about the stampede at Walmart that killed a temporary worker, however, illustrates that we're not there yet. That it will take longer to heal our need for new things, for possession. Consumerism is certainly something that I struggle with everyday, as I covet this or that, as I see how attached I am to my things. All the same, I have to say that one of the best and most thoughtful gifts I was ever given for Christmas was from my good friend Nickole, who donated money in my name to the Save Darfur Coalition.

All that I ask is that this holiday season, or as birthdays roll around, is that you remember that we are all in this together, that we are all a part of the same living, breathing thing. I've long maintained that if everyone made a sacrifice, even a small one, in their own lives, then the world would be a better place--take shorter showers, give $5 a month to the cause of your choice, buy a bus or subway pass for the person behind you, smile at someone, anything. You don't have to be a liberal or a conservative, a Democrat or a Republican or an Independent, a communist or a capitalist, to do this. Anyone can, and almost every philosophy, or political belief, or religion, or whatever system you adhere to, advocates some form of philanthropy or sacrifice or aid to others, whatever you wish to call it.

I'm not asking you to donate to my cause, the West Africa Fistula Foundation. I won't be disappointed if those few of you reading this blog decide that you'd rather spend your money elsewhere. I'm just suggesting that, as the holidays approach, you think about donating money to a non-profit or an NGO as gifts for family and friends. If you want to donate to WAFF, you can follow the instructions on the site here (no pressure, I promise). If you have another organization you'd rather give to, please do so. If this doesn't sound like your bag, then keep doing your holidays as you've always done them. We're all here, thrown together, in this incredibly messy and complicated place, and it's not always pretty or happy or encouraging. But it only takes a little bit, the simplest acts of kindess or selflessness--things that are so small that they seem insignificant--that change everything, that affect everyone. So, take a chance on one of these small acts, and no matter how or where or when you choose to do it, you'll have done something good for all of us.

From Slow Slow to Fever Pitch

2008-12-01T13:15:00.005Z

This might seem a little silly, but as we were narrowly avoiding the tenth pedestrian who stepped out a little bit too close to the car, bouncing through bad stretches on the road, and trying to keep all of the boxes stacked in the car inside the car and not falling out the windows, I thought of a Disneyland ride based on a typical jaunt through Bo. It starts off innocently enough--you have to clamber into a very tall van while managing about 5 bags, then somehow get your seatbelt on. The car is chock full of people--the nurses, a laundry assistant or two, several neighbors who need a ride to the lorry park--and boxes of medical supplies, which seem to move in a neverending stream from one place to another. The boxes, in fact, look as if they've all been kicked to death, catheters poking out the cracks, disposable gowns about to float out of the ripped top, a bottom or two collapsing its contents all over the floor. Then, we're suddenly climbing up an alarmingly steep hill, wheels spinning madly for traction, stones sending us all flailing. Sharp turns, sudden drops, quick whiplashing stops. Children dart out on the road on the way to school, women carrying baskets wobble a bit towards us, men with no apparent regard for their own safety walk in twos and threes on the narrowest stretches of road, holding hands. It is a ride of constant stress--aren't we coming up a bit fast on that parked truck? Is that baby going to fall off the motorcycle? Why isn't that dog moving?--and quick intakes of breath at the close shaves. Then, all of sudden, we're facing a World AIDS Day parade, coming straight down on us--Get us OUT of here!--and a truck whips around us at the last minute, just before we're about to make our move. We're careening down the street, and it feels like we're going to go up on two wheels at the next curve, and then four motorcycles almost all run into each other in front of us and we brake hard, that feeling of helplessness as I continue to press down on the floor with my right foot, where the brake would be if I were driving. Christmas-themed music blasts out of shops, open trenches leer at the car as if daring us to slip up and get caught in them, police traffic controllers arbitrarily tell us to stop and go (I have seen one stop light my entire time in Sierra Leone, and it was in Freetown). It's a daily adventure getting to work, a series of near-misses and close calls. Everyone seems to have been trained from an early age that pedestrians are supposed to jump backwards when they hear a car horn (I tend to look up, which only further roots me to the spot), and that there is no minimum clearance requirement--as long as no cars are touching, it's all good. Everyone drives and everyone walks like this: courteous behavior is only shown to old women leaving the market and children going to school, and it's beyond dog-eat-dog. Fortunately, the system seems to work for us, for the present, anyway, and maybe our close calls aren't as bad as they seem to me.

Things here have two settings: slow-slow and fever pitch. Slow-slow is what happens when things are inefficient, or a meeting gets postponed again, or when someone is explaining why we don't have something we were supposed to have two weeks ago. Fever pitch is when we're driving, moving heavy things, or just before our Texas surgeon, Dr. Maggi, comes. His visits tend to get everyone into a tizzy of activity, which is of course part of his visit. The rest is for him to complete as many surgeries as he can, and to do them all safely and skillfully (watching Dr. Maggi operate is amazing. I can't explain how nuts it is to watch him essentially make a bladder out of a hole with jagged edges of scar tissue). So, we're about to reach critical fever pitch, since Dr. Maggi arrives tomorrow and beyond his visit, there's the impending return of Helen, our volunteer coordinator and director of program development, with a whole team of volunteers in early January.

Not that we haven't been working hard before, but in anticipation of the transition to volunteer programming, things are starting to speed up. I can't believe it's December, even, though I guess without fire season, mudslides, and Santa Ana winds, it never really feels like winter. Even in New York, when I kicked myself for 4 months for having decided to go to school on the east coast, it wasn't the same. But here, it's just been getting progressively drier and hazier, before the Harmattans set in and bring the real dust from the Sahara and before what I hear are cooler December and January months, cool enough to grow healthy carrots and large tomatoes in the North, or maybe even here. We'll be experimenting when the volunteers come with tomatoes and carrots in our volunteer/patient cooperative garden, so I'll be able to see how much truth there is in that. All I know is that for now, the thunder rattles farther and farther off, the lightning continues to flash, but the rain never comes. Or it comes in little spurts that sound like someone has thrown a bucket of water on one part of the roof. And that I'll be in Freetown tomorrow, and then the December sprint begins in earnest.

Being Thankful

2008-11-27T09:08:00.004Z

Thanksgiving is hard to explain here because the notion of "thanksgiving" already exists as a mostly Christian event that typically raises money (I think for the church hosting the event--haven't quite figured it out). For example, I was invited to a Mother's Day Thanksgiving this coming Sunday at the New Harvest Ministries, and the invitation is an envelope--so you know right off the bat that this is all about the collection plate. The parade and "Medical Sunday" I wrote about in October was also a Medical Thanksgiving. This makes describing American Thanksgiving a little more difficult. As I told my friend Lisa last night, Halloween was easier to explain because it was an entirely new concept. Plus it's easy to convey in pictures, unlike Thanksgiving, which is a typically American display of overindulgence (in the best way possible, of course) coupled with awkward family moments. Yes, it is also a nice time to have the family all together and to remind oneself to be thankful for what one has. None of this comes out well in pictures.

So, when I say that today is Thanksgiving to the nurses and administrators, it doesn't really come across. Maybe partially because I'm in a country that survived the bad end of colonialism, while American Thanksgiving is a celebration of the arrival of the very kind of people that brought colonialism in the first place. It's sort of weird to explain the history behind it, and it always reminds me that America is in fact a settler colony. The difference between the success of these Anglo-Saxons (and other foreigners, of course) and those that were in, say, Rhodesia/Zimbabwe or South Africa or those French in Algeria is that our forefathers managed to kill off such a large portion of the indigenous population that resistance was easier to quell. That's the simplified version, anyway. And again, sorry to be an obnoxious historian on Thanksgiving--as a foodie, I love the holiday, as a historian, I feel the need to bring this stuff up. I apologize.

But here are a few things that I am thankful for:

--The patients on the ward and the ones that have gone home. They are my emotional stability and the reason that I can get through the frustrating moments. I was looking at pictures of the women who have gone home (I even dreamed that one of them had come back last night), and it made me so happy to think of them getting back to their lives but still sad that I wouldn't see many of them again.
--Gmail. Although it's always dumping me, there is no better way to bother people at work and bombard them with questions about their lives. I do not think I'd have made it this far without it, and the idea of trying to do this without internet or computers is daunting--Thanks, digital age.
--Rat traps and bug spray. Not a lot of explanation needed, though I did try to kill the world's largest cockroach last night and missed, which was not ideal. There was also a wasp the size of my thumb in the kitchen--jet black with an orange warning circle on its butt--but I was too much of a wuss and had to have our caretaker, Amara, kill it.
--Really good fruit and pretty decent bread. You have never tasted a banana until you've gotten away from those nasty American one-variety tasteless ones and tried the fat little yellow ones, the red spicy ones, etc, etc, etc. The papaya here? Amazing. I am so excited for mango season, I don't know how I'm going to make it to March, when the first ones are ready. The handmade Fula bread is pretty nice, especially toasted in the oven.
--My friends and family back in the US and around the world. Some of you have been better than others at keeping in touch, but I love and miss all of you and can't wait to see you all again.
--Being here. Yeah, it's cheesy, but I feel so lucky to be in Bo doing what I'm doing. I love it here. Again, all I have to do is to walk down to the ward and see all the patients sitting together laughing at the television, or remember driving through villages with our speakers blasting outreach advertisements while women scramble to write down our number with their fingers in the dirt, or dream about the plans for a ward garden that will be started in January, and that's enough for me--it beats getting stared at all the time, or being seen as another foreigner with endless amounts of cash, or having my head bang against the car window as we navigate a bad road.

I know it's been a tough year economically, which always dampens the holidays, but I hope all of you (Americans at least) are having a good day with family and friends and that you take time to think about what you're really thankful for. I won't get into one of those self-righteous "be-thankful-for-what-you-have" rants, no worries.

Oh, and to end, I have to put two very nice opinion pieces in the New York Times about Thanksgiving history and food. Two of my greatest loves.

Sutures

2008-11-25T13:06:00.006Z

In my inventorying duties, I sorted thousands of surgical sutures (the needle and thread that you use to sew up a patient) into grey plastic bins by a tiny number at the top of each packet. These were homeless sutures that had been taken out of boxes or that had fallen out or that were rescued from boxes that were falling apart. At best, a tedious enterprise. I spread them out over the living room floor in a carefully-constructed system so that each bins of sutures of the same type (silk, prolene, chromic catgut--my favorite) were touching and unlike sutures were not. This task satisfied my compulsive list-making sickness but reaffirmed that I have a difficult time with small repetitive tasks. We finally got them over to the office today, a somewhat anxious procedure for me as we had to put the topless bins in the car to be jostled around on the bad roads. Fortunately they all made it, and they were counted and stacked into neat rows and inventoried. Actual "packing" into the storeroom is pending, but I am triumphant as I write that, barring earthquake or civil unrest (both pretty unlikely), we have won the suture war. My war against the insects, however, is not going well ever since our détente failed in early November. One step at a time.

Catching Up

2008-11-21T11:39:00.008Z

Wow, it's been a long time since I've posted. Since Barack Obama won the election, I've been out on a mini-vacation to the Banana Islands off the Freetown area coast, attended countless meetings, ridden government buses for a total of 18 hours, and attempted to make cookies, which came out weirdly cakey from the powdered milk and margarine and blackened on the bottom from the intense heat of the oven, which does not go much below 400 Degrees Fahrenheit. Not sure what you're supposed to cook in there, though it makes great toast.

We've now sent off twelve patients and gotten I think 10 more from various outreach programs. We sent nurses out to the rural areas, and they recruited patients through advertising on the radio and driving around in the car with a megaphone blasting, as well as collaborating with our outreach coordinators and various friends in the public health/medical sector in different regions. Some patients were sent solo and picked up at the lorry park, others came with nurses, and some are staying home until after the holidays and the local chieftancy elections. Which is good because it means that these women are voting and are passionate enough about voting to put off their medical problems.

Banana Island was a strange, almost eerily sleepy place. The trees were imposing but beautiful, old buttressed cotton trees that shaded the beaches. We had to cross through the jungle to get to the best beach (Big Sand Beach). I saw vines crisscrossing up trunks and choking the trees, so incorporated into their hosts that I couldn't tell where one plant ended and the other began. Tiny flowers peeked out from the dark soil, and termites demonstrated their presence in jutting mounds and in the fallen branches on the ground that had been eaten from the inside out, so that they were left as sawdust in the shape of branches. The water was warm but cool enough to stay in for hours, the high salt of the water making it easy to lie, toes pointing upwards, and float on the waves. I managed to borrow a pair of goggles for a few minutes and watched subtly beautiful fish--small but bright, or large but only colorful when they caught the light the right way. The tideline detrius was not what one typically sees at the beach--shells, kelp, bits of styrofoam and sea glass. Rather, it was jungle castoffs from the trees threatening to overtake the water--vivid green praying mantises, small red bugs with huge antennae, leaves in various states of decay, and strange seed pods and plant buds plucked off by wind and driven into the water. We ate fresh fish grilled for us on charcoal fires and lobsters caught in traps and stored, live, until dinner. We swam at night, using the moon and the bonfire lit for us to keep our bearings and slept all day on the beach between swimming and volleyball (I didn't play--not a great game for we shorter ones). Like many things here, it had that element of decay or of recovery that I've sensed in parades and ramshackle buildings and the little kerosene lamps lit for nightmarkets. I also traveled out to the village of Charlotte outside of Freetown before heading to Banana, and it was much the same--old, mossy walls, rusting zinc-walled Krio houses, a shaded garden of found objects, plants potted in old shampoo bottles and benches made of car scrap metal. Children fishing with string and a bent nail. There was also a waterfall.

The new patients are quiet but already seem to have integrated into the "family"--they're getting their hair braided, carrying water (still no water at the hospital and the Bowser water trucks can't come today because the dam has some problems that has prevented them from being filled), watching soap operas. We're trying out best to fatten them up for surgery. We also have a new baby on the ward, who is going to be named Julia, I am told. I find this completely terrifying--there is something very scary in having a little life named after you, especially when you did nothing to merit it. The baby is huge, her head still deformed a bit from the natural birth, but the labor was quick, I'm told.

The calm or feeling of commonplace-ness that surrounds these births is also so new to me. The mother started feeling pains at 7pm, waited until midnight to tell the nurse, who waited until 4AM to tell the doctor that she was ready to deliver. It was treated like no big deal, and the mother was up and walking around just a few hours later and was out carrying water today. Women routinely do hard manual labor in their later terms, walking long distances with heavy loads for the market or fetching water. I know this is all healthy and fine, but it's so funny compared with the lack of this commonplace-ness in the US, which is partly because you don't see as many pregnant women or hear about as many births. I've been around more pregnant women in the past couple of months than I have in my entire life, though I guess it's cheating a bit since I'm in a hospital. All the same, I see tons of pregnant women walking around on the street just on my drive to and from the hospital. I once tried to compare the number of pregnant women I see everyday to the number of men I see urinating in public, but it was too hard to count because there was one or the other or both at every turn.

So, things are changing and progress is being made. My own activities have been relatively uninteresting--inventorying, writing documents, signing things, etc--but I feel like we're getting there, or getting somewhere. Sorry for the long delay between posts--I'm hoping the internet at the hospital continues to hold out, because otherwise it's hard to stay up-to-date.

Staying Out of the Hammock

2008-11-04T08:58:00.004Z

I feel so far away from the U.S. here that I can't accept the election is today and that in a few hours, the polls will open. There is constant talk about the election--everyone has asked me whether I'm voting for Obama or McCain--and the radio has been buzzing with it, especially the BBC, which has termed it "the U.S. election--the vote that effects your world." It's amazing and a bit embarrassing that people here know more about the election than I do and actually listen to the campaign speeches. It really shows how prominent the U.S. is globally and how important this vote is, not just for we Americans, but for everyone. It actually makes me a little sad that I'm not home to witness this, "the most watched election in history," though I'm so apathetic at this point (heartbroken would be more like it) that probably I'd be even more removed than I am now if I were back in Ojai. I was listening to the BBC's special "Black in America" series this morning. The segment was on Morehouse and there was a discussion about MLK. I was shocked upon remembering how recently the entire nation was essentially at war over civil rights. A couple of days ago, thinking about the psychic damage that civil war inflicts on a nation and the differences and rivalries that still exist between North and South, and realized the American Civil War wasn't that long ago either. In Senegal I sadly corrected friends of mine who said that they wanted to go to America rather than France because there was no racism there--that we'd solved that issue with the civil rights movement.

Race in Sierra Leone is a strange thing. There are definite colonial throwbacks, where white people working for the NGOs have instituted behaviors and have expectations of treatment that I find extremely uncomfortable. Being given more food during parties and gatherings is one example. I've been called "a real African lady" because I do some of my own laundry, occasionally eat local food, (very) rarely wear African clothes, and carry things around, like shopping bags, chairs, and other items, both heavy and light. I'm not tooting my own horn here for being such a good person that I carry my own bags; what I'm trying to say is that the expectations of what expats/white people are capable or willing of doing is very low because many of those pumoi (the Mende word for foreigner) don't do anything for themselves. It's actually a little frustrating at times to have everyone on the staff smile at me encouragingly because I was able to figure out cooking okra all on my own. This frustration comes out of embarrassment that the people who come here to work for NGOs allow others to do the things they should be doing for themselves. I'm not saying everyone who comes here to volunteer should do all their own laundry (I'm certainly not capable of washing my own sheets by hand), but I think that there is a fine line between seeking out help when you need it and becoming a neocolonialist. The image (that I've already evoked) of French colonial administrators getting carried around in hammocks on their tours through "the bush," while lines of forced porters carry their clothes, phonographs, pernod, carpets, and tents behind them, never leaves me.

Furthermore, I've had confusing conversations with a few merchants of Lebanese origin (most of them were born in SL but don't have citizenship--a sticky subject). They consider themselves Africans but hold themselves apart, generally speaking, and there's a continual "us and them" mentality, even for the black Sierra Leoneans that have worked for them for years. One Lebanese diamond merchant said that the reason why Sierra Leone was "backwards" (his words, not mine) was because they kept their "superstitious" beliefs. Another Lebanese shopkeeper said that "they" can't be trusted because his workers steal from the shelves. In both cases, I didn't know what to say. There's also some tension in this of class/economics, since the Lebanese community has a fair amount of influence, despite its lack of citizenship (and vote, I think--I keep hearing different things) and has cornered the diamond market. Most of the merchants we buy bulk food from are Lebanese, and every "supermarket" has a Lebanese son behind the register.

I think about all of this often but don't have much concretely figured out. What I've written here feels clumsy. Race and racism is complicated here, as it is anywhere. The system is always different and is always subject to the history of the place. Racism in France is different from racism in the U.S. is different from racism in Sierra Leone. I try to be aware of my behavior, speech, and expectations, so that I don't end up in that "us and them" mentality that is so easy to accept, especially as a foreigner as well as being of a different race. And I continue to seek out what the different communities think of each other here. And, I keep washing my own underwear by hand because that, I can do on my own.

Cooking Okra in Bo and Other Stories

2008-10-30T15:29:00.011Z

The Bo market is a hectic and anarchic experience, one that pulls you from the street clogged with motorbikes behind tall storefronts through small dark passageways full of people hawking Chinese-made shoes, cloth, rotten bananas, Irish potatoes, onions, and strange, simply designed boxes of pills that promise to cure colds. Then the chaos really starts on the narrow paths between zinc roofed wooden stalls, coated with a thin mud greyed with fallen produce, sewage, and other unknowns. The paths are chock full of children with baskets of broad brown beans, women with buckets of cassava leaves on their heads, shoppers with heavy loads of food for the lunch time meal, and then me, standing out in my clothes and my skin (I was recently jokingly asked if I would stay overnight at the nurses’ house so that I could light up their electricity-less living room) and stooping underneath baskets and basins on heads and contorting my body around women’s curves as they lean over piles of okra and tomatoes, stacks of dried, twisted smoked fish and bowls full of every type of rice imaginable. Each part of the market offers different fare, with one area dedicated to citrus, another to greens, one to clothes that were obviously donated from the US, and a section across the road for bush meat—large bush pigs, tiny deer-like creatures, monkeys of various sizes and species. Loudspeakers blast loops of “TWO THOUSAND TWO THOUSAND TWO THOUSAND”—prices for the various goods on sale. Men with large cartloads of rice yell their way through the crowd, pushing people out of the way with their voices. No one wants to play chicken with the sheer weight of the carts and the force of the men muscled like Michelangelo statues pushing them. Women offer me palm oil—“buy dis fine pahlm ohl, ma”—as a joke, knowing I won’t buy, and when I did make a purchase of cassava leaves—a bunch as thick as my forearms together for 200 Leones, or about 6 cents, everyone wondered at me and asked me, incredulously, “You eat cassava leaf?”

The food here is not that dissimilar from Senegalese food and what I gather most people eat across West Africa—lots of fish, always rice, and a stewlike concoction made with copious amounts of oil. My favorite so far is okra stew over rice, a slimy sauce made with chopped okra, smoked and fresh fish, and those broad brown beans slathered in bright red palm oil and lots of hot pepper (which is called “peh-peh,” like Pepe le Pew). There’s also cassava leaf, potato leaf, and crain crain stew, the anonymous “stew,” pepper stew made with goat meat (a Nigerian delicacy as well), and others I don’t know yet. They all taste the same to me. Also foofoo—cassava pounded into a paste, gari—flaked cassava powder, and sweet potatoes, coco yams, bush yams—they look like alien eggs, and other tubers.

Rice can be imported and nutrient-deprived white or rich brown, fat grains called “country rice.” After the economic crises of the 1980s and intervention by the IMF and World Bank, who advocated the subsidization of imported rice, local rice culture declined, worsened by prohibitively expensive plowing machinery and the destruction of cattle herds by rebels during the war. Now, only old farmers know how to grow rice. I’ve come to the conclusion that a program that preserves these rice culture techniques and introduces oxen-pulled plowing would be incredibly beneficial for both farmers’ livelihoods and nutritional standards here, since white rice is stripped of most of the good stuff. The malnourished kids I’ve seen out at the Doctors Without Borders Facility—stick arms, red tufted hair, and big swollen bellies—got enough food to keep them alive but not enough to keep them living, if that makes sense. Starchy cassava (or yucca in the Spanish speaking areas of the world) and sweet potatoes can grow year-round here, and they can sustain, but not reinforce, until the next rainy season.

I eat some traditional food, though this is curtailed by the fact that I cook for myself and have no idea where to begin. I generally eat pasta gloop (Helen’s creation—pasta with tuna on top, and I add fresh tomatoes, onion, garlic), salad with whatever overly-inflated vegetables are available, canned hummus spruced up with raw garlic and cumin and cucumbers (I was greatly encouraged by the post on hummus at stuffwhitepeoplelike.com), and lots of beans. I’ve attempted my version of soul food with African ingredients--an idea of which I was particularly proud--okra stewed in tomato sauce and cassava leaf fashioned as collard greens, but both were heartily rejected by the Sierra Leoneans I work with as too hard to chew, lacking spice, or downright nasty. I found avocados (called pears) once and I eat as much fruit as I can stand—green oranges and grapefruits full of seeds but sweeter than many American (though certainly not Ojai) varieties; various kinds of bananas that make one view American bananas as terrible tasteless blobs that are infinitely easier to transport but not in any way worth avoiding the bruises; “plums,” which look like mangoes but are sour and a little spicy; pawpaw—nothing like that slightly vomit-y tasting papaya you get at home—but sweet and soft, a bit like melon. I’m looking forward to mango and pineapple season.

I will admit that I’ve had a can or two of “luncheon meat,” made less worrying by its guaranteed Halal status but not less disgusting, theoretically (it’s delicious chopped thin and fried like bacon). Eggs are a staple—they’re 15 cents each, raw or already boiled for you--as are groundnuts—boiled, ground into a paste, or roasted in hot sand. I had a sandwich today made with balls of ground up chicken--50 cents. When John, our Logistician, came in holding one, I saw it and said I wanted one too. He ran off after the woman who sells them, calling “Hey, Mama Chickie Ball! Mama Chickie Ball!” All of us in the office collapsed into laughter. I buy a lot of Fula bread, handmade baguette-like loaves baked by the Fula people, which the drivers find infinitely funny for some reason. Breakfast is bulgur, corn flakes (the cheap knockoff ones), fruit salad. When I’m feeling in need of comfort, I go for a bag of peanut M&Ms or a Mars bar from the Lebanese supermarket. I’ve recently cut back on the cookies—I originally thought it was necessary to sample all the different kinds but have since reconsidered that my health might be more important. I make a lot of popcorn in a big metal pot—so much better than the microwave stuff and a lot better for you—and add cinnamon and sugar or salt and hot pepper. Lipton Yellow Label tea is the main staple of my day, made with powdered milk that I hope isn’t imported from China. Occasionally I’ll pick up a Coke Light imported from Morocco and emblazoned with whatever the equivalent of “Coca Cola” is in Arabic. Most of the canned foods I get are imported from random places—Germany, the UK, Lebanon, the US, Brazil, United Arab Emirates. World Soup.

Going out to dinner is an unvarying menu of the same “European” dishes—hamburgers, shwarma, chicken and chips, chicken and rice, fish and chips, fish and rice, spaghetti, and kebabs, with a Fanta, Sprite, or a Star beer—the local beer made with sorghum. I’ve not tried palm wine yet, but I’m as fascinated as I am afraid. Which might define most of my food experiences here—even the canned beans are a mystery to me—and as long as I try to ignore the storage and handling of the food (did the rats crawling over the cans have Lhasa fever? Did the guy grinding the peanut paste wash his hands? How old is that fish?), everything’s fine, and I haven’t had a bad night of food poisoning…yet. It’s exciting to lean over a dish of food or open up a bag and have no idea what it’s going to taste like or whether I’m going to cook it correctly. It’s a bit like squeezing my way through the market—I have no idea what’s around the corner, or even what’s right in front of my nose.

Lost (and Regained) in Translation

2008-10-30T12:53:00.000Z

I conducted interviews two Wednesdays ago for two catering positions in the organization. I have never conducted an interview before--in fact, I've barely been interviewed before. I do know, however, the typical, cliché questions you ask in an American interview: "what are your strengths and weaknesses?", "give an example of a problem you've had on a job and how you solved it", "How do you feel about being a leader and working with a team?", and the crowning question, I thought, to figure them out: "Please name a breakfast, lunch, and dinner you'd serve to a Sierra Leonean patient and then what you'd serve to an American volunteer." I felt proud of myself for my level of preparation, especially after I'd read and reread their resumés, and any worry that I had that interviews would go differently here was assuaged by our Logistician, who told me that my questions were "very good." How wrong I was.

One person told me, with a blank stare, that he never had problems on the job, so he couldn't answer the question. I gave up asking about strengths and weaknesses after the first interview. All the applicants said that it was important to work nicely with everyone and that they would be very good employees, skirting their teamwork and ignoring their leadership skills entirely. My perfect menu question completely backfired. Some interviews said they didn't want to cook for patients. Others said they had no experience with European food. Every interview initially said, "Well, I'd ask you first what you wanted to eat." Upon being pressed, one woman said she'd make me shwarma for breakfast--a pita wrap with roasted meat, lettuce, and mayo--not really early morning fare. A man offered up his vast menu of "European" foods (including a Whopper sandwich and a Big Mac sandwich--the former has cheese and the latter two patties) and then told us he wanted a salary that is well above that of our nurses. Another woman selected "chicken and chips"--which was shot down immediately by the Head Nurse (Matron) of the entire hospital as an easy-out. "Chicken and chips is the national cake," she said. "Everyone knows how to make it."

No one understood a word I was saying. I was only vaguely comforted when the national staff on the interview panel repeated the questions again, rephrased and simplified or translated into Krio, and the questions were still met with blank stares. I think my favorite moment occurred as I was asking about the sanitary measures that an applicant took in the kitchen. Picking her nose, she answered that she was always very clean. Just to clarify, picking your nose in public is completely acceptable in Sierra Leone. But it was still pretty awesome.

Overall, I learned much about Sierra Leonean culture and comportment. People do not talk about themselves (a Sierra Leonean blog would be interesting...) and are not used to "selling themselves" like a product. Deference to "superiors"--no eye contact, lowered voices, no expression of opinion--are expected, not consistent eye contact, gregarious manner, and an attempt to demonstrate how much of a genius you are. These can be tough issues--as flattering it is to have someone almost curtsey to you because you're interviewing them, I feel very uncomfortable with the complex hierarchies, pecking orders, and superior/inferior relationships that make up life here and across West Africa. When I studied abroad in Senegal, I had a hard time watching my host grandmother, a terrifying matriarch, eat three fish and a large plate of fries and salad for dinner while the children, maids, and wives (plus me) pick at one fish. I'm happy I wasn't distinguished in that house in the way that I often am here (people try to carry things for me, clean up after me, and drag chairs around for me to sit in). All the same, as much as I tried to understand and to accept that this was how it was, and that my grandmother probably did a lot for the family that made her entitled, in their eyes and in hers, to that treatment, it was hard to understand.

Cultural differences are tricky—for my first month or two in Senegal, I suspended all (or most) judgement for a while. I even questioned the importance of education for a girl who would end up married in a rural village with many children and long hard hours of manual labor. Then, I came back around, finding a balance between understanding cultural differences and reaffirming the values I’d gleaned from my own culture and upbringing. And I again saw that education was imperative because it brings protection to those women and gives them the ability to fend for themselves. I understood that even though my host grandmother was the distributor of the family and should be treated with respect, the children needed to eat more. I again felt uncomfortable with hierarchies. And as for interviews, I need to continue asking what meals an applicant would cook and further request detailed preparation instructions, since I can determine leadership skills, cultural and nutritional considerations, experience with African and Western dishes, problem-solving and improvisation skills, and sanitary measures from the way he or she answers. In short, I can see all the applicant’s strengths and weaknesses. So, maybe my perfect question wasn’t such a failure after all.

Marching and Dancing out of the Apocalypse

2008-10-21T14:31:00.002Z

Apparently, Saint Luke’s is a big holiday around the world (see Jim Sligh’s blog This Analog Life), at least in places where there happen to be copious Catholics. Though I think the ratio of Catholics is lower in Sierra Leone than some other places (this is based on people I’ve met and/or history—since SL was colonized by the Anglican British—and not any real statistics), St. Luke’s day was celebrated by medical professionals around the country, and WAFF collaborated with the staff of Bo Government Hospital for a march, church service, and festivities at the hospital. Below is what I managed to notice while being dragged around and rushing to and from a visit with the First and Second Ladies at the ward.

We were late, as usual. I trudged up to the nurses’ house to get them moving, already sweating a little after a cup of hurried tea. I called the driver and sat out on their porch, as children from the neighborhood shyly (and boldly) approached with expectant faces, hoping for the candies we occasionally give them, only to be disappointed by my hands empty of a telltale black plastic bag. Finally, we were off, dressed in our bright WAFF t-shirts. We rushed to start preparing food at a house near the hospital, as Jackie and another nurse, Victoria, peeled potatoes with dull knives faster than I could have wielded a vegetable peeler. I told them we were late, and we ran for the meeting area for the march to the church, where nurses in their various uniforms (white for the top nurses, blue for the assistants, and blue-edged-white for the nursing students) had already started marching out, leaving us the most dilapidated marching band to follow. Their green and gold uniforms, clean and sharply pressed, were old and shabby, worn by countless decades’ worth of trumpeters and drummers. Some had no uniforms at all and made due with white t-shirts and counterfeit chuck taylors. Their instruments, hand-me-downs dented and patina-ed with age, rang out clear but a little flat, the band rag-tag but soulful. It was an amateur New Orleans funeral, a parade after global catastrophe, a final attempt, post-apocalypse, to reassert some order.
I keep referring to things as apocalyptic—and maybe it is the environment of the nation after the civil war or due to years of crippling poverty and decline of developing infrastructure, but perhaps I am rather sensing a continual insistence on making do, on taking something and reinventing it with the tools at hand. It could be that I imagine that after everything around the world collapses (hey it could happen any day), we’ll all be out marching in parades with our cracked tubas and too-large, frayed band coats, showing that we can’t be beaten down. That’s a striking aspect of the people here in Salone—despite all of the incredibly difficult things that have happened to each and every person here, almost all are still optimistic and active in trying to change the state of the country.
So, we danced-shuffled to the church, held back at one point as self-important soldiers and police cut across our line, the last few marchers. We had to double time it to catch up, though the fast walking was easier than the slow rhythmic dance-walking we were supposed to be timing with the music. We brought Lebanese to their balconies—old Muslim grannies with headscarves, skin pale from life indoors—and people sleeping away Sunday behind their ramshackle shops to the streets. Then, suddenly, we were through a slimy, moss covered gate and into the churchyard. The service had already started.
For a godless heathen, I’ve had decent exposure to Christianity from my time in Episcopal and Catholic school to my brief childhood stint at the Ojai Presbyterian Church. This was nothing like any of that. There was dancing (maybe a bit more booty shaking than some more Puritanical elements would be able to stand, though it was in no way sexual) and singing to a live band based in reggae and other Caribbean sounds. The Offertory was in three stages—very, very long stages. There was no sermon per se, the multitude of selected readings were only 4 or 5 verses, and the service, at 20 activities on the program, was longer than even a High Mass. So long that I passed through varying states of emotion and energy, timing my sleepy period to prayer time, so I could doze and pretend to be praying. But all in all, if church had been that fun (maybe not that long) when I was a kid, I might’ve been swayed a little more to religion…for a while, at least.
Thankfully, we were pulled out early to go meet the First and Second Ladies, a brief and semi-terrifying affair. The entourage of security, soldiers, handlers, hangers-on, hospital staff, and press was overwhelming. Both were in lavender robes, and it took a minute to figure out, based on behavior, which one was First. Everyone was sweating, even the Ladies, and I tried to communicate welcomes and thanks over our patients singing to them. Then, suddenly, it was silent, and everyone was staring at me, which was even worse. But I stumbled through and then, after some words assuring their dedication to our cause and expressing surprise at the cleanliness of the ward, they were gone. After this weekend of meeting Sierra Leonean politicians, I have never been more grateful for my (very brief) experience lobbying for student financial aid in Washington in college—I’ve gotten better at remembering the key points to hit as fast and as clearly as possible.
The women all started dancing to music videos in the ward (including the video for “First Lady,” which was just bizarre), and then we took off again to catch the march around Bo from the church. We picked up the rest of the WAFF crew already marching and sped up to the front of the parade, behind our raggedy band. One of the nurses, Marian, is a wild woman—yelling and whooping at every dance move and getting everyone to join in. Jackie and I led our procession, and I tried to imitate her swaying walk, which brought even more hoots from Marian. Our Head of Facilities, Benjamin, came roaring by in the van with sodas for everyone, and we tore it up on our way to the hospital, abandoned by our band at the last stretch of road as rain threatened us all the way through the gates.
Then, we did some more dancing with the patients and waited for food in the ward. I was so tired by this point that I fell asleep in a chair while the music blasted. No one seems to mind having music at volumes that start to press the eardrums a bit. But still, I managed to sleep. Later, as I stood eating canned green beans and salad with my fingers (we were out of forks and it was infinitely amusing to the nurses to watch me), a group of men with drums in grass skirts and nurses in matching outfits came dancing and yelling into the ward. We jumped around with them and then they were gone as suddenly as they had appeared. I shuffled back to the van to go home, too tired to do anything except dig my room key out of my purse and collapse for a few hours.

As Winona Ryder Once Said, So Cheesy, Please Read with Crackers

2008-10-20T19:58:00.003Z

To atone for having compared Grace's eating mannerisms with that of a monkey (it was supposed to be a compliment), I'm going to talk about our patients, as per her request. Discussing patients is a bit sticky, given the stringent ethics surrounding patient confidentiality and privacy rights, so I'll do the best I can in generalities for now...

When I first met the women, I was completely exhausted, overwhelmed, and still hadn't figured out that I was actually in Sierra Leone. It was the same day that we'd bumped our way to Bo from Freetown, about six hours on a less-than-pristine road. The second I came in the room, they immediately began singing to welcome me. In the first few days, I remember, I was struck with the sadness behind their eyes. There is a strange dichotomy in them--they have largely created a new community for themselves, all 26 of them, in lieu of the communities and families that abandoned many of them. Just below every happy moment is loss, pain, and some anger for their pasts. But there is unspeakable joy and, unsurprisingly given the vast numbers of women (and very nice and non-threatening men working with us), a lot of uninhibited behavior. This is not to say that everything is perfect on the ward--there are disputes and cliques.

Sometimes I'll catch myself watching them and realize that many of them are younger than me--the youngest is 15 and others are not out of their teens. When this hits me, I can't believe that they've gone through what they have at such a young age. All the same, they usually act their age, giggling and joking around. Despite the fact that we have enough beds for everyone, some of them insist on doubling up so they can gossip and whisper all night, just as I did in boarding school and college. The older women look tired, but they still join in when there's dancing and singing. Everyone is always in on the joke. At our first staff meeting, the nurses left the ward unsupervised, and after about 20 minutes (we were just outside on the verandah), we heard them making a huge racket singing and dancing. One woman, Kaburreh, who has her teeth filed into points, is the lead drummer and picks up plastic basins and buckets to beat out the rhythm to the songs. The other day, as we were perparing for a visit from the First and Second Ladies, Jackie organized the women into two groups, based on language/ethnicity, to practice welcome songs and then started pitting them against each other to sing the best and the loudest, whispering to the group of Krio, Kissi, Kono, and others that she'd heard that Mendes were the best singers and then sneaking over to the Mendes to whisper the same about the Krios et al.

I don't mean this to sound stereotypical, but it's true that what strikes me most is their singing and dancing--there is always music in the ward, and we specifically chose the ward that we did so that we'd be a little separate, to be able to be loud and not disturb the rest of the hospital. I think what sums up the women best is the party the other day after the visit by the First and Second Ladies. We'd set up music videos on the ward TV and were blasting music. Almost every single woman, including one who is several months pregnant, the older ones, and those who had just undergone VVF repair surgery, was dancing. The VVF post-op women just chucked their urine bags in front of their feet on the ground and danced. It was wonderful.

Many of these women came in nearly dead, suffering from a host of other medical problems, and were often abandoned or maltreated. That they can find enough strength, both mental and physical, to be so enthusiastic and to create a new family for themselves can be a little mind boggling. At one point, the water got shut off at our old facility, and they marched down to the volunteer house to get water out of our well. Even the women with nerve damage, or foot drop, brought down buckets and carried them back on their heads, limping a bit but smiling and joking. When we moved them in a single day from our first facility to our current hospital, and had them double up beds in a not very comfortable temporary ward, no one complained. Many work incredibly hard at their studies and skills training classes, even women that are 35 or older, who might be expected to see basic literacy as a lost cause at that point in their lives.

Whenever I'm having a hard time here, I go to the ward and sit with them. And in very little time, I'll be soothed, through getting my hair braided or attempting Mende, or laughing at their jokes, and, though this also sounds totally cheesy and like one of those "I didn't teach them, they taught me" cliche moments, I'll remember that I'm here for them and that nothing else is important. And in a weird way, watching the post-op patients recover now is bittersweet because I know that nine of them will be leaving us behind to return to their families or to start new lives, hopefully a little fatter and a lot happier.

Weird things that have happened to me in the past 12 hours

2008-10-18T09:21:00.004Z

I got completely turned around while being driven to the house and felt like I was in an entirely different world than Bo, one that was regenerating after some catastrophic event, as the gas lights shone out from the simple wooden stands of street sellers. Just as suddenly, we were on the road home.

As I sat, waiting for the Minister of Health to come to the hospital, I heard the unfamiliar sound of sirens and realized that finding sirens unfamiliar in a hospital was, in fact, unfamiliar. Assuming a medical emergency and hoping that the hospital by some miracle had procured an ambulance, I stepped outside, to find six or seven green jeeps full of soldiers armed with AK 47s followed by white landrovers with tinted windows that hinted at the women in the cars, their finery and elaborate head wraps outlined in the silhouetting electric lights behind them. It was the First Lady, the Minister of Health, and their entourage of soldiers and police. They drove around the dirt area in front of the hospital and sped off.

I met with the Minister of Health as he ate his dinner and realized that it was completely insane that I was talking to such a high-level Sierra Leonean government official about how nice San Francisco is (he lived in the States) as he picked at chicken and fries with his fingers and I gripped a can of Coke (when given the choice between Fanta and Coke, before I could answer, the Minister instructed the caterer to give me the Coke because I was American).

We got our big generator finally set up yesterday and when it was turned on, I felt that I had never seen electric light before, it was so bright and cheerful in the house.

As I sipped tea and tidied the kitchen early this morning, one of the boys that does casual work at the house popped up at the window. He deposited a live monkey on the window bars. After I was assured that it wasn't for consumption (bush meat here is common), I watched it pick at the bugs and scraps around and was struck with how human it was. In fact, sitting there with its hand held just so to its mouth, it looked a little bit like my dear friend Gracie munching on a leaf of rainbow chard.

Making Do With Soda Soap

2008-10-17T16:39:00.004Z

I'll probably change it again, but I've (obviously) changed my blog title. "Adventures in Sierra Leone" is lame, let's admit it. Anyway, soda soap is a handmade soap (you can buy the ingredients in the market here) that was shunned before the civil war here in favor of imported soaps. During the war and in the refugee camps, however, it was all that was available and having any soap at all was a luxury. Listen to one of my favorite Sierra Leone's Refugee All Stars songs--Soda Soap--for the title's origin.
So, I guess "Making Do With Soda Soap" means that we're doing the best that we can here with what we have. Fancy imported soap is now available and widely used (we have a couple of bars of "Juliet" soap at the Guest House, which everyone finds immensely funny), and similarly, our organization has a lot of support that it once didn't have, but for me, the concept remains: as we strive for something better, we can make great gains with the simplest things we already have. Call it cheesy, but there it is.

Cos Julia's Been Working for the ??? Squad

2008-10-17T12:15:00.005Z

No day is the same, I realize as I sit here listening to various staff members argue over where the WAFF car disappeared to, as workers tear down and build up walls for our new storage room, as children dropped off by Doctors Without Borders (MSF) at Bo Govt Hospital for treatment cry and cry and cry right outside. I do a lot of policy/program writing--job descriptions, work contracts, web site text, meeting minutes--because I have, as was once better said in Black Hawk Down, a mysterious illness known as the ability to type. You can probably tell from here that I don't have any other computer skills than that, but I'll be teaching the nurses how to scan patient charts and save them as a pdf, I give occasional pointers on shortcuts on Excel (my least favorite program ever), and I type, type, type away. Now that we've finished surgeries, things have settled down. I went on rounds with our Medical Director yesterday. Most of our post-op women (we did 16 surgeries, mostly for VVF and RVF) are doing wonderfully. I sat in on several of their surgeries, and when the staff was shorthanded, I opened up packets for the sterile nurse, moved stools around, and tried to stay out of the way. Today, I'll meet with the First and Second Ladies of Sierra Leone, as well as the Minister of Health, and we'll tour our new ward. I've been helping ready the ward for the last two days, organizing supplies and setting up curtains, which were dyed by the women during skills training classes into the colors of the SL flag--green, white and blue.

Essentially, I do anything that needs to be done, from my aforementioned ultrasound adventure to designing beds that will be built for our volunteer house. I go with our skills trainer to the market to help select materials and just sit with the women, letting them braid my hair (not so painful as I thought) and watching the cheesiest Nigerian soap operas--either about very evil rich women being mean to poorer ones (the rich male protagonist is always very sympathetic) or "village stories" that have a lot of demons in them. It occurred to me that The OC and Gossip Girl would go over very well with our patients, so I'm going to try to get a couple seasons brought over.

Other things: I sat with a woman as we explained that she had terminal cervical cancer. I held a flashlight as we connected a generator. I acted as the guinea pig for various volunteer needs, including registering at the US Embassy (the Embassy requires its own post down the road...), getting my passport issues settled, and eventually, hiring and training a cook for the volunteer house.

I find it's easiest to assume that I will have no idea what's going on from day to day or even hour to hour. Situations change very quickly here, and plans must be flexible. I try to get a series of things done every day but know that it won't all happen--I chip away at things. Pretty much everything will go wrong at the same time--the generator breaks, the leak in the wall gets much worse, cell phone service drops, all the computers go kaput simultaneously, and then someone has to leave for a family emergency.

I try to put out fires without having any idea how to turn on a fire hose. That's my job in a nutshell. And I love it--I love every frustrating, inefficient second of it. Because every day I feel that I did at least one thing that was good or helpful or that took care of one problem, no matter how small. It makes me realize that nothing feels more natural in the world to me than being sweaty, dirty, and most likely frustrated, as I watch a generator get lifted into our house by a dilapidated crane or as I stand watching a surgery or as I write one more page describing the role the caterer plays in our program. Everything takes five steps when it could take one, but it's perfect.

Up-Line in Bo Town

2008-10-06T13:01:00.005Z

There are people everywhere: on motorbikes, crammed into vans, in cars, walking, many carrying things on their heads—small children with loads of firewood that I could barely lift off the ground. There are no stoplights, and the rules of engagement are simple: fend for yourself. No one slows down or moves, meaning that there are close shaves at every turn, people walking so close to your big white SUV with its conspicuous snorkel exhaust pipe, NGO plates, organization name on the door, and white people in the back seat. I’ve never felt so conspicuous. The Land Rover/Land Cruiser hints (or screams) of colonialism and neocolonialism—not quite as bad as the old pictures I’ve seen of French colonial administrators getting carried through the jungle in hammocks, with their stacks of luggage on a stream of black porters behind them, but still, an uneasy symbol for me. Though I have to admit that it’s entirely necessary on pitted roads made even worse by the rainy season, which has left giant potholes that throw you back and forth violently. At first it’s kind of like a ride, maybe the Indiana Jones ride at Disneyland, but it gets old fast. It makes it even more unbelievable to imagine traveling in a crammed car from Bo to Freetown, riding low due to the weight, ramshackle enough to maybe fall apart on the way or to tip into the waterlogged ditches that run along both sides. We saw two vehicles, an abandoned truck and a passenger van, tipped nosefirst into ditches on my first trip up from Freetown to Bo, and many of the people we coming to the hospital are from wrecks. People risk this everyday. There’s a short stretch of road in town here that’s abysmal—apparently the asphalt was taken out during the war as a blockade or something like that, but I haven’t gotten a straight story out of anyone, and I’m nervous about asking questions about the war yet. Many people have pain in their faces and seem to carry heavy psychological burdens from the conflict, which ended in 2002.
Bo is a rambling conglomeration of people who flocked to the nearest semi-urban center, setting up simple shanty shops at the market without any forethought to logical placement or planning. The city could have anywhere from 200,000 to half a million—I’ve heard both numbers but incline towards the higher, just based on how many people I’ve seen out and about everyday. Every possible space is filled with stalls selling everything from used clothes (I saw a guy in a Carmine’s Restaurant shirt yesterday!) to lettuce, soap to shoes. You can do all your shopping without leaving your car, either. The markets are neverending, a part of streetlife on every corner and lining every road. Even in the rural areas, there are roadside stands with businesslike girls hawking bright red sweet potatoes to fry, boil, mash, or turn into a vivid pink juice that kind of reminds me of lemonade. 2,000 Leone, or under a dollar, will get you about three pounds of sweet potato. Rice, cassava, potato, corn, pawpaw, mango, and palms are everywhere, as well as the more mysterious foods—garden eggs, bitter balls, crain crain, something called a “plum” that is nothing like any stone fruit I’ve ever seen.
The roundabouts are terrifying, the motorbikes filled with women coming back from the market after buying dinner, finding no way to get home but helmetless on the back of a stranger’s bike. Plus I hear most of the motorbike taxi drivers are ex-rebels, and just as nihilistic now as they were then. All drivers honk incessantly to warn of their approach to cars that have swerved to the other side of the road to avoid potholes, to the negligent motorbikers, or to pedestrians that might sway out into the street without looking. There are countless churches and mosques, peeling but eerily beautiful, post-apocalyptic, almost, especially near dark when the gas lamps come out in both Bo and Freetown at the market stalls, replacing the unreliable to nonexistent electricity.
The houses are either small and crammed, some of them traditional huts with thatched roofs and mud bricks, or large and half finished, concrete monsters that ran out of capital before the cement blocks could all be stacked, painted, and fitted with doors. The houses with high walls topped with razor wire identify their occupants as local dignitaries, or possibly white (like our house), Lebanese, or just wealthy. Laundry hangs on the razor wire, or spread on the ground, bright sheets and clothes, and in our case, the patient’s pink, purple, and magenta uniforms and the sheets that our skills trainer, Auntie K, taught them to tie dye themselves as part of their education, which covers simple ABCs, math, and English, as well as skills training for possible use in micro credit enterprises, which we’re planning on setting up as the program is more established.
It’s so hard to be in a rush here. Greetings are very important, even though they seem less elaborate in Salone (the Krio shortening of Sierra Leone) than in Senegal, where you could be shaking someone’s hand for a good two minutes or more while asking the same questions over and over and repeating each other’s names back and forth. But a barrage of “How de mornin’?”, “How you sleep?”, “How de body?” is incredibly important, as is the recognition of everyone in the room. Furthermore, few people pay attention to the time, and even if they do, traffic, stray dogs, pedestrians, and cars swerving all over the road slow down everything, not to mention the occasional torrential downpour and gutted-out road.
There is constant noise. No car is muffled (or smogged—they all release clouds of reeking diesel), radios blast at full volume, people talk loudly over one another. Goats bleat, frogs proclaim their eligibility, dogs roll into the street and fight all night. Mosques call the faithful to prayer at different times, the dawn prayer sung several times by separate muezzins. Luckily I learned how to sleep well in New York City, so it’s not so bad—the sounds here are mostly soothing and aren’t nearly as noxious as a street cleaning truck at 8am after a few too many dollar drafts at Lion’s Head.
So, that’s a bit of a portrait of Bo—it’s one of those fantastically dear, dirty towns that you can’t help loving, even though I haven’t done much exploring, just because it’s so dear and dirty, if that makes any sense. I’ll try in the next few posts to go over what I’ve been up to and what I’m doing here and all that good stuff. As a good historian I wanted to lay down some background information first, so sorry for leaving you in the dark.

And sorry, still no pictures! I tried for an hour today and got too frustrated. Any computer whizzes out there got suggestions on how to make pictures smaller/make the internet work here...crikey...

Riding in Trucks with Ultrasounds

2008-10-02T16:27:00.001Z

If someone had told me eight years ago, when I met my friend Ian’s mom freshman year of high school, that she would lure me to West Africa to do volunteer work, I never would have believed it. If three months ago, as I sat watching endless amounts of TV and freaking out over my future, someone had asked me where I would be in the fall, I couldn’t have told them. And if five days ago, someone had asked what I thought I’d be doing over this week, I’d never have answered that I’d be hanging onto an ultrasound in the bed of a packed pickup, trying to keep from falling out on the potholed road, and keeping a hand free to wave to the hordes of children yelling greetings and pumoi, pumoi, pumoi (white person in Mende), as we moved our organization’s operations from one hospital to another. All the same, I now find myself sitting in a house with my friend Ian’s mom, Helen Weld (www.hwph.blogspot.com) listening to the ward cooks, our drivers, and our caretaker haul water out of our well to take over to the 24 fistula patients we’ve transferred to Bo Government Hospital, as mothers ready their children for school, women sweep, backs bent over brooms made of gathered switches, and roosters crow, each one attempting to outcry the last.

The West Africa Fistula Foundation (WAFF) (www.westafricafistulafoundation.org) is a non-governmental organization (NGO; welcome to the world of acronyms) that works in Bo, Sierra Leone to socially and physically rehabilitate and surgically repair women suffering from obstetric fistula. Obstetric fistulas, usually classified as Vesico Vaginal Fistulas (VVF) or Rectal Vaginal Fistulas (RVF) are abnormal connections between the bladder and vagina or the rectum and the vagina typically as the result of obstructed labor. These labors can last anywhere from 2 to 15 days and mostly occur in remote rural areas where there is no access to trained medical doctors or not enough money to cover medical costs. The baby’s head and the woman’s pubic bone essentially form a vise that cuts off blood flow to the area, resulting in the death of the tissue, which is sloughed off, leaving holes, or fistulas. In most cases, the child does not survive. VVF and RVF cause uncontrollable incontinence—a woman will be literally leaking urine and/or feces—as well as possible nerve damage that leads to a limp, abandonment by the husband, and social ostracization. The majority of the women we’ve seen are destitute, and most are illiterate and untrained in skilled labor, since they have spent most of their lives toiling in subsistence farming. Many come in nearly dead.

WAFF finds women throughout the country with VVF and RVF, whether through word-of-mouth, referrals from other hospitals, or taking our van “upline” to the rural regions far from the capital city of Freetown. We bring them back to health and prepare them for surgery. In some cases, the VVF or RVF is too extensive to repair, which means that the women must either wait for a specialist to arrive from abroad to do urinary diversions (making a new bladder that has to be catheterized throughout the day through a hole in the stomach) or for us to find a supportive place in which they can live. Luckily, many of the women can have their fistulas repaired.

Dr. Darius Maggi, a retired ob/gyn from Texas, started WAFF in 2004 to address this preventable issue and as well as the staggering rates of maternal and infant death in Sierra Leone and across West Africa (though we don’t have official numbers for SL, all you have to do is walk into a hospital or talk to a Sierra Leonean to see bad they are). WAFF does not stop at surgeries, however. We work under the umbrella of the West Africa Institute (WAI) to regenerate sustainable futures for our female patients and, eventually, the people of West Africa as a whole. Through education and skills training at the ward, and in the future, the implementation of appropriate technologies and agriculture, micro credit enterprises, and a medical center that will bring in people from all over the region, we hope to aid in regenerating communities. WAI and WAFF strongly emphasize training local medical personnel and others to take over its work, so that volunteers from abroad will one day be unnecessary. In this way, WAI and WAFF are not looking to set up shop and simply sustain life as it is. We’ve been calling those kinds of programs “Band-Aid work,” which means that they simply patch up a problem instead of solving it. Rather, we are looking forward to a future in which preventable deaths are actually prevented, people feed themselves nutritional foods that don’t destroy the soil or forests, small businesses thrive without worries about day-to-day survival, and solar technologies break the cycle of dependence on fuel sources that are scarce, environmentally destructive, and incredibly expensive.

And so, I find myself volunteering for an unspecified number of months in Bo for the West Africa Fistula Foundation. I’m doing anything and everything that I can, from typing up reports and entering inventory to hanging off the back of said pickup.

PS - sorry for the lack of pictures...the internet's too bad at present to upload...