Edge Notes Day 2

The bougainvillea and acacias whisper in the evening wind as light fades and the dust and heat of the day slip away.  I am just back from a walk through D-b town with Luke.  Not sure it would have occurred to me that we could leave our UN-zone bunker but it did, of course, occur to him.  No one objected.  After being herded and jostled from base to camp to base, it was freeing to simply walk out the gate into the evening's quiet bustle of any African town.  Well, not any town.  There are more Landcruisers per square km here than probably any place on earth.  But outside of the UN compound there is a semblance of normal life.  A huddle of sheep in the middle of the road, pausing heads down, as if in prayer.  Wandering donkeys.  Pairs of men striding along the roadside.  Veiled women sitting at sewing machines.  And the signs:  you know you're in a refugee zone when the small tin shacks along the road, each selling the usual assortment of soap and sugar and plastic basins and other life necessities, have the following names (not making this up):  Tehran Fashion, Bosnia Shop, and others named Soweto, Baghdad.  Not the names that would entice customers in some parts of the world, but the life experience of the NGO-following crowd here I guess.  Luke chatted in Swahili with a few people until we located chapatis, and for bargain (50 shillings a piece) we ordered two that came with a beef stew.  Hygienically sketchy place, but atmospheric.

This morning started with the real deal convoy.  This time we were in the main exodus from D-b town to the largest set of camps to the north-east.  Though they are only 5 or 10 km away, it takes a major motorcade production to get there.  It really has to be seen to be believed.  A dozen or more nearly identical Landcruisers, each packed with aid workers, again mostly Kenyan, all mill about and vie for position at the police headquarters.  Engines idle.  Windows open and close.  People chat.  Then suddenly the police appear and zoom off, and everyone follows.  The idea seems to be to drive as fast as possible through any potential danger zone.  So we careen down the dirt highway in a cloud of dust, across open scrubland, until we reach the outskirts of the largest camp, home to 188,000 people in three sections.  The windows are closed against the dust and the back of the "ambulance" is stiflingly hot, the wash-board road and swerving around ruts forces us to cling to our seats, but the trip is mercifully short.  We see bent-stick igloo-shaped homes covered in plastic bags, thorn fences, and worn signs for various NGO's.  We turn off the main road and pass deeper into the camp to reach the hospital, the gates open, and we roll to a relieved stop.  Everyone piles out for a day of work, until the convoy will re-collect and re-careen back in the evening.  

Once again patients were waiting, patiently as patients do, squatting in the small shade of the overhang of the main hospital administration block.  There was the usual confusion and negotiation as Erik and Ken set up at table, chairs, a small exam area, met translators, decided on crowd control.  Luke and I moved on with the Matron to tour the facility.  This one was 5 years instead of 5 days old, so a bit more worn, more lived-in.  Again an impressively stocked pharmacy and lab.  18-bed wards in neat rows.  All with mattresses and nets.  Oxygen concentrators humming in two wards, the generator buzzing in the background.  Malnourished kids with stick-thin arms, listless moms.  Eerily calm, little crying or commotion, resigned people just sitting on their beds, waiting.  We asked questions and looked into rooms and checked our check-lists.  I was asked to consult on a febrile newborn, whose antibiotic choice had not been very appropriate, but the IV fluids and oxygen were well done.  Then I also got pulled in to examine some admitted and outpatients.  Most of the day, though, I spent teaching.

The morning was mostly auxillary nurses, with a few maternity staff.  The afternoon was mostly clinical officers, nurses, and the one medical officer.  Both groups were about 25 people each.  I used the flip charts and baby models to teach newborn resuscitation, because that is the crucial intervention that can save lives.  A couple of the nurses were very adept at handling the ambu bags.  Most were not.  They laughed and helped each other.  I then taught two topics (pre-prepared lectures I've done before) in the morning and two more in the afternoon.  So I was talking, listening, cajoling, trying to draw out participation, to stimulate thinking, to praise, to inspire, for about five hours today.  My hat is off to teachers.  It was very tiring, especially considering that English isn't anyone's first language but me, there are multiple cultures and levels of training represented.  But they asked questions and wanted more and I was literally zipping up my bag as the convoy vehicle was beeping for me as they finally let me go . . 

The surgical team once again had fewer patients than expected, so went back to base camp mid day.  I ended up on my own at the hospital for lunch and the afternoon, which was fine, it didn't waste their time waiting for me.  But I am still glad to be safely back with the guys.

One more day, one more camp.  There are many hard-working people here doing a pretty reasonable job in a difficult situation, and it's a privilege to give them a boost.