januari 26, 2009

I’ll share an experience with you. Maybe it’ll help you imagine this place and the atmosphere that surrounds us. Fortunately, it is not only the impressions of human suffering that remain with you when looking back on a MSF mission. The smells, sounds and tastes of everyday life in a community so profoundly different from your own make an equally important contribution to a memory. There are a numerous different ways to make these experiences, but some carry more weight than others. Partaking in the celebrating of a wedding in the local tradition is a must, and equally important is dining out. emmanuel_forsen_darfur3

Serif Umra is the centre point in a bigger locality, and consequently the place to be on a market day, soukh day. Hundreds of craftsmen, camel herders, farmers and men with influence gather to trade, make money and above all make connections. Tuesdays and Saturdays means a significant influx in the movement in and around the market, and are also our busiest days in the clinic.

Today, together with a number of colleagues from the office, I ventured out of the dispensary premises to join in the commotion, a welcome break from the house-office-dispensary routine. We walked the road along the wadi, reduced to a wide stream of sand now in the dry season, towards the market. You must picture the movement around us as we followed the stream of movement to and from the marketplace. Camels, bound together in groups of fives and tens trotting by, men in sunglasses on motorbikes, men with whips on horseback, women in colourful scarfs on donkeys or on carriages and finally big trucks whipping up dust engulfing the moving crowd. We join our assistant field coordinator under a shelter in the meat section of the market. Now, here is a man who knows the circles, truly irreplaceable when it comes to navigating the complicated politics of this place.

Anyway, we assemble among butcher’s benches, cooking fires and tealadies, where the scent of blood and guts is strong in the air. Soon we are guided into the back of one of the butcher’s shops where carpets are spread out on the ground under a shelter. There’s the mandatory hand-washing, thank goodness, and many greetings and handshakes, after which we take our shoes off and sit down, gathered on the carpets around two big plates. This is the way to dine in the Sudan, you eat from one massive communal plate, filled with little dishes from which everyone help themselves, using fingers or flat bread. I make a second experience with camel meat, I expect there’ll be many more, much better than my own failed attempt at a Christmas dinner anyway, and on the side we have tomatoes, fried liver, spicy sauces and bread. I stuff my face and enjoy, there’s something particular about eating with your hands. Someone told me that the real question is why anyone would like to use a foreign, cold, metal object like a fork to eat with when you can use your fingers, which are natural and familiar? Well, I’ll leave that for you to think about. The eating process itself is quite swift without a lot of conversation.

Inevitably, towards the end there’s the whole competition in politeness where the local staff make sure to offer the expatriates have the last pieces of meat and the expatriates in their turn try to respectfully offer back. In the end there’s some sort of a draw and we leave to make room for the next group of diners. We search for a good spot to relax after dinner and finally spread our carpets and ourselves out in the shadow of an old truck.

This is the true moment of communion where you discuss manly matters over a glass of sweet tea while digesting. I learn that marrying is quite expensive these days and that love is complicated also in Darfur. Someone brings and chops up sugar cane for dessert, and hence the conversation stops once again. Looking at this stick in my hand I wonder what in the world to do with it, though I presume it’s somehow for eating. Glancing right and left I learn how to peel one section of the cane at a time with my teeth, chew off the flesh and suck down the sugary juice before spitting out the starch. Imagine us sitting on that carpet with a pile of canes in the middle, piling, chewing, sucking, spitting; a striking picture. Spending time together with your co-workers in this way is precious and probably the best way to remove barriers between staff, not to mention it’s great fun and a nice perk to aid work. It lasts an hour, then we head back towards the office, duty calls.


december 9, 2008

It’s now five days since the WFP (World Food Program, you may as well get used to the abbreviations) helicopter dropped me off at the airstrip, and the first working week in Serif Umra is coming to a close. Needless to say, the time runs by quicker than you realize. The crew here has graciously allowed me to take my time to aimlessly run around, trying to orientate
myself, learn names and stalk whoever seems to be up to something interesting. In a few days Laura, the coordinating nutritionist, more commonly known as the Flying Nut (really, a title to be jealous of), will leave the dispensary and see to some of the other MSF projects here in Darfur.

The therapeutic feeding centre will then be left under my supervision, and consequently I’m mostly following her to learn how things run. I go about it with much respect. Some three years of nurse work in Sweden has naturally left me with little or no grasp of malnutrition, or even paediatrics. Here,overseeing the work and quality of care for these little ones in the feeding centre will be one of the main responsibilities. So I’m following, taking every opportunity to listen in as Laura coaches the local staff or does the round in the inpatient department. I couldn’t imagine a more profound way ofproviding health care, and indeed, the care for the malnourished and dehydrated children is likely to be the source of both my greatest satisfaction and my greatest frustration during the time here. Lack of food and clean water pulls away the foundation for every other area of life, and while it may seem nothing is easier to address than this, nothing tears your heart like watching a child die from something so easily prevented.

This week I’ve also seen my first case of tetanus in a newborn. Again, tetanus is easily prevented through vaccination and through proper hygiene and care of the umbilical cord after birth. Still, it’s not uncommon here and fatal in almost 80 percent of the cases. Once it hits, it causes spasms in all the muscles of the body, and the only thing you can do in this setting is try to feed the child through a tube to the stomach, then wait and hope for the best. Our little treasure in the paediatric ward is still hanging in there. Maybe we’re lucky enough to see this one wear off. In the meantime, we go about our work to try and provide a basic level of care to this population. If nothing else, this is primary health care.

I feel privileged to be here.


december 4, 2008

Darfur. The word stands out. It disturbs, if only a bit. Sometimes we recognise it as it sails by in the daily stream of news and information bombarding our senses, and flinch as it fires its guns at our guilty conscience. We know of Darfur, or at least it rings a bell, and it causes us unrest. Some would even give one or two facts about the conflict and sit with wrinkled foreheads discussing the state of the world. Usually it only holds our attention for a little while though. Soon our defence mechanisms kick in and helps us sort the unpleasant reminder into locked cupboards in the back of our heads.

Like with most news of human suffering we find it distant, difficult to comprehend and even more difficult to do anything about. Of course, we can only take in so much information about how people across the world are miserable. Usually we come to the conclusion that it’s sad an all, but unfortunately there’s not much we can about it, and ultimately it’s not really our business. It goes for me too. It was too hard to imagine, and not really my business.

Now I’m here, in Darfur. I’m inhaling its dust, exchanging phrases in staggering arabic with its smiling people and its sand fills my sandals. If it was previously hard to imagine, it’s now as real as a slap in the face and I’m trying my best to figure out how to deal with the impression. It’s a fantastic, rather sobering, feeling to find yourself dumped into reality like this. Ever since getting in involved with Medecins Sans Frontieres (I will use the abbreviation MSF henceforth) ten months ago, I’ve tried to picture what it would actually be like to arrive in the field. Well, this is it.

For some six months I will call this place home. This is Serif Umra, a community on the border between North and West Darfur. Following the conflict it has grown considerably from people seeking a refuge here. There is a small camp in the outskirts, but mostly people have been absorbed by a gradual expansion of the town, now holding an estimated total of 55,000. The population is now composed of internally displaced  persons, in humanitarian lingo commonly referred to as IDPs, permanent residents and nomads from the bigger locality.

For MSF and its team here on the ground, the task at hand is to provide secure access to health care to these people. Though generally covering primary health care, emphasis in the project is put on woman health care and nutrition. It seems women and children will always be the ones to take the hardest blows when the structures and safety nets of society collapse. Every man should ask himself why.

So, I’m here, and I’m only just trying to digest the first impressions and familiarize myself with the structure of the dispensary. It’s not all that spectacular. The reality rarely is. It’s just real.