Health in the Hills


I rarely know what I’m going to write about with a blog entry, before I start writing it. The blog’s always been about the photos and trying to give my family & friends – wherever you may be in the world – a visual on my life now. Or on my cranial and facial hair levels now… This is also always a personal blog, about my own personal & life experiences in this world since I ditched the shortsighted and shallow corporate world and took up this wandering, experiential lifestyle. That is, it’s not even a semi-official blog related to the wonderful work of the organization which has been my only employer since then, even if it’s nearly impossible to avoid referring to my work every now and then since….well, when you do what I do, work = life usually. Which may be why – now my current assignment is so utterly all-consuming (and the internet connection so utterly underwhelming) – I seem destined never to post anything except when I’m far enough away to relax a bit, and find sufficient internet bandwidth.

As I type these words into my little notebook computer, I lounge in a cafe in the village of Shela on the island of Lamu off the coast of Kenya. Lamu, from what I gather, is an older, smaller and quieter cousin to Zanzibar – and Shela is the smaller, quieter (but newer) village on Lamu. (Lamu is described as the oldest living village in East Africa. What, precisely, would that mean in the birthplace of humanity?? Perhaps more on that later, when I get around to posting about Lamu itself…) So me voici in great comfort on a daybed with tons of pillows & ceiling fans whirring above to dispel the mid-day equatorial heat, while chador-clad women alternate with bikini-clad Westerners walking past on the terrace out front, in the small strip of land between me and the water. This is the waterfront of Shela – where the dhows & motorboats that ply back & forth to Lamu town stop by, where the handful of watefront shops & restaurants are clustered, where the high tide laps right up onto the sidewalks and the low tide leaves a strip of runnable beach. Across the sound is Manda island, though I admit to being confused about Manda island. To get to Lamu you land on something called Manda airstrip and take a boat over to Lamu island; long story short, the island I landed on is defninitively separated by a big channel from the island people now tell me is Manda, and it ain’t no high-tide channel either so maybe the Manda airstrip is trying to consfuse us all by hiding out on yet another island. Or maybe I was just having a blond moment when I landed and have become quite geographically confused & challenged. Who knows, and I’m sure you really don’t care. 🙂

Anyhoo, if you are reading this more than a few days after I post it, you will likely already have seen photos of Lamu and environs, because I’m taking many each day and hope to sort and color-correct them for posting before I leave Lamu, early next week, for the arduous and many-segmented return journey to my current home of Mweso.

So yeah, about Mweso. It’s a lovely village and I really ought to get out and take more photos of it! In these two entries you will see…precisely three photos that were shot in the village of Mweso. Oh well. But you’ll see LOTS of others that were shot in the teeny little mountain village of Ihula. And here’s where that boundary of personal blog starts to blur. Because, you see, I’d also like you to understand a trifle about what it is that fills my days so full now. We’re in Mweso because the general reference hospital resides there – source of nearly all secondary care for a physically large & very mountainous zone with a great shortage of even vaguely-passable roads and a great abundance of health, nutrition & sanitation needs among a large, diverse and generally quite vulnerable population. The hospital is the largest and most time & resource-consuming activity we run from the project I’m currently managing – lots of patients both in- and out-, on all wards, etc. In addition to this we support two health centers.

Americans and others from highly-developed and over-health-cared nations might want to step back a bit and look at the structure & theory briefly. (The US is over-health-cared, even if tens of millions can’t access the system easily or affordably and the current republican lunatics are fighting to the death to keep those tens of millions locked out…) In DRC there are rural health zones – roughly 23 or so in the province of North Kivu, which is very roughly the size of the former West Germany. We work entirely in the rural health zone of Mweso — though Mweso is not the largest town in the zone (Kitchanga, 45 minutes down the road and site of an MSF sister project, holds that distinction). Mweso has the zonal offices and the eponymous HĂ´pital GĂ©nĂ©ral de RĂ©fĂ©rence. Our own base (house & office) is next door to both. Each zone is broken into a number of smaller units called an ‘Aire de SantĂ©,’ each of which has its own health center. Kicker for all you tea-party supporters among my readership: in DRC the theory is all patients see a nurse first, not a doctor; all health centers are nurse staffed and the only doctors in the zone are based in the hospital, though two of them make oversight visits to the dozen+ health centers in their zone. A really large aire de santĂ© might have health posts under it, but at least where we are not much of this can function very well unless there’s a partner agency – like us – to fund it all and preferably, again like us but unlike many other agencies, to help supervise and support it with medical expertise and training rather than just medicine and funding for staff incentives.

So coming back to what we do: aside from the hospital, we we also support two health centers in Kashuga (lots of IDP’s, smaller number of regular residents; IDP or internally displaced person is what the UNHCR calls a refugee who’s not crossed a recognized international boundary even if they have crossed from one zone of armed control into another) and Kalembe (better balance of regular residents & IDP’s there). Kalembe is the center for an enormous honking aire de santĂ©, and that aire has villages in three different political territories (think county in the US, Landkreis in Germany) — Masisi, Rutshuru and Walikale. We have a mobile clinic on the other side of the river in Walikale territory, high up in the mountains in a little village called Ihula. Ihula is literally the end of the (dirt, this being DRC) road. And since it’s such a big aire de santĂ© with a lot of population spread out over mountainous areas with some funky stuff going on here and there, we and the people of the village & the good folks of the health zone management all thought it would be a nice idea to establish a regular health post up there, so the mamas can have a place to deliver their babies or get their sick kids cared for every day of the week, instead of just the one day a week we manage to get our cars and team and meds up there. So – we’ve been working w/the village for the past two months or so to actively get this thing built. It’s been a tough slog – logistical and other complications, as you can imagine. Then there’s the always interesting general context in which we work, but that’s something I’m sure as heck not going into on a public blog, sorry. 🙂 Suffice it to say I am mightily proud of what we are accomplishing and deeply hope that, within the weeks after I return from this island idyll in the Indian Ocean, we will actually have a fully funcitonal health post operating up there. Fingers crossed, one and all, please.

gotta have a little bit of wildlife, folks – true, ants massing are less interesting and strangely more scary than an elephant seen in the distance, but this is what I can offer you, sorry…

…ok, ok, ok: I know the whole ‘women with things on their heads’ is as overdone as the whole ‘adorable kids smiling big huge smiles’ thing is. But, rather like stereotpyes, there’s a reason it’s all so overdone: the kids are just more naturally less shy than the adults, and … well … the whole carry things on head thing never ceases to amaze me. How do they manage without hurting their necks?!

Above, my friends, is the start of the health post (private blog, I know, but I’m both publicly and privately proud of what we’re doing here), and below is a young patients (at our current mobile clinic, with his Mom) in the single most popular form of t-shirt worn by kids in our zone: the Obama t-shirt, which comes in dozens of varieties and can be seen everywhere.

I’m learning a lot about the traditional building style in the region – you may have noticed that the foundation goes in last? – and about the anti-insect properties of used motor oil on wood. The planks are shaved so they’ll overlap each other nicely, thus providing a touch more weather protection.

Enough about the work. A bit about the life. There’s not much of it. Flying from Nairobi via Malindi to Manda Airstrip on Saturday morning, I had a delightful chat with a doctor from Scotland who worked in Kenya for 20 years before deciding she needed to get work back in Scotland in order to send her kids through UK secondary school and university…and the point is, yes: I said something to her about working 70 hours weeks & really needing a vacation, and then I stepped back to see if I was exaggerating. I actually came up – for myself – with a likely average figure of between 65 and 75 worked hours per week. It’s all cool – not like there’s a lot of multi-plexes and orchestral and theater performances to take up the rest of my time, so I’m quite happy to do the work; there’s that added nudge when you basically know that, yes indeed, your work really is saving lives every day especially when your project has been scrambling since early May to keep up with the periodic outbreaks of cholera scattered here and there around the zone (oh yeah, on top of the structures we support all the time with everything, we also do epidemic response even in places we don’t usually work, if it’s close enough and no one else really can), and the ongoing never-ending seasonal fight against malaria in Kashuga which came back with the heavy, late rainy season and so far WILL NOT go away. Enough about that – it’s been frustrating, but we’re doing good work. What was my point: we work hard, and don’t mind it since we know it yields results. Right.

Look closely at the image above and you’ll see how steeply the hill drops away: the center of Ihula village is on a saddle with very steep drops on either side. Pictures can’t quite capture it but it’s really a very dramatic landscape.

One response

  1. Stephen Brockmann

    Hi Paul! Wow, these are wonderful pictures! So beautiful! I really love the one of the mother and child with the Obama shirt on. I imagine the President himself would probably get a kick out of that! And nice to see that we have someone running the country who is actually popular in a very different, much less privileged place. I hope you’re having a great vacation, with lots of R&R!

    August 3, 2011 at 13:15

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