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 Hôpital Général de Référence. Our own base (house & office) is next door to both. Each zone is broken into a number of smaller units called an ‘Aire de Santé,’ 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 santé 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 santé, 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 santé 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.

August 3, 2011 | Categories: DR Congo | 1 Comment

Various Views of North Kivu

So this is the miscellaneous photos section – various items accumulated over the months and stuck here as the second of two entries I’m posting same time, more or less. Above: from the hillside in Rwanda, descending toward Gisenyi and the border, the north shore of Lake Kivu and the a bit of North Kivu in the DRC. You know it’s shot from Rwanda there are no roads even vaguely as decent as that in all of North Kivu – at least none in Goma or anywhere I’ve been! Below – other shots of the lake from the expat houses, of the base in Mweso, a rainbow over Kitchanga, and a few miscellaneous shots of Kashuga. The rest of my lengthy text continues…below. 🙂

We do, however, live wonderfully well within our compound, and when we have the energy we even pop a movie onto a computer and beam it onto a sheet hung on the wall in our common room. I usually cook something lovely from the garden on Sundays – if you’ve ever known me any place I even vaguely live, you’ll know that my thing is to cook for the folks I like, or love, or wish would love me or like me or…whatEVER. Anyhoo, so when Hosanna came to the project back in February she brought tons o’ seeds: we’re talking swiss chard, kale, string beans, basil, you name it. And I admit to some pride at the pretty fine soups, quiches, stuffed calzone-type items, and pot pies I have been churning out. It goes like this: wake up early Sunday (because I always wake up early, because I always go to bed early, because there’s nothing else to do in the evenings in Mweso except look at the amazing stars in the amazingly dark sky or listen to the beautiful chorus of frogs – there are different kinds and they sing in shifts; no kidding), sit on the porch (picture in the second of these two posts over which I plan to string this text; if you look closely you’ll see my cup of tea & my book on the table at bottom of photo…yup, that was a Paul Sunday morning in Mweso) drinking tea & trying the internet (if it takes less than five minutes to get an email to display, it’s a good morning; usually I give up after about ten minutes with no results) or, as a backup, writing in the ol’ journal or reading. After that: maybe yoga, maybe a session on our cool new elliptical machine (miracle for stress management, that), maybe some eggs (lately, Raghu’s been developing a fine way with a frittata and we’re all benefiting), and perhaps a nap.

If the workload is too heavy, I might actually spend middle o’ day working, but I try to wall Sundays off and not even enter the office once. Then in the afternoon I’ll grab the sheers and fill a basket with what looks good in the garden, then start cooking. Usually Carla will help me chop and peel, unless she’s in the operating theater. Usually others will be playing cards or listening to music on the other side of the porch; and if I can, I’ll join them. Or we’ll all play a game of Risk. Then, when the food’s ready, we light some candles in the paillotte (two photos of it all decked out for easter brunch in the same set as the porch photo) and settle in for dinner. Sometimes after that comes a movie, or a campfire; sometimes it’s back to the card games or Risk or just off to read and relax before bed. Then, the next day, the work week starts up again and before you know it another week’s gone. And that, my friends, is how my past eight months have swept by rather like a river in flood – amazing, overwhelming, intensely educational & rewarding, and really rather exhausting. Hope you enjoy the photos. If all goes as planned, I’ll have a bit less than two months to go still in Mweso after I return; and with any luck, I’ll return from this vacation with more than enough energy to have a strong finish. Let’s hope so. :-).

August 3, 2011 | Categories: DR Congo | 1 Comment

Hills & Villages of North Kivu

smw, slt has finally made it to a place where bandwidth is both sufficient and reliable enough to permit the posting of photos to the blog. Sadly smw, slt has also been more constantly and consistently busy than ever before in life, so not very many photos have been taken but herewith we share those that have. Last night I sat  with H&G in the stalls at Sadler’s Wells & watched the Russell Maliphant company perform an astonishingly beautiful piece called AfterLight. Earlier in the day while enjoying views of London from the upper deck of a bus I’d been reading a Harper’s article on the tendency in hyper-developed consumer democracies (my words, not theirs) to fight constantly against pain or discomfort or any general acceptance of (real) pain, impermanence or unpredictability. “There is a terrible blindness in happiness. Just as trash, in the consumerist universe, ends up invading every space and reminding us of it existence in countless nauseating ways, so suffering, unable to express itself, has begun to proliferate, increasing our awareness of our vulnerability. The West’s error, in the second half of the twentieth century, was to give its people the mad hope that an end would soon be put to all the calamities; famines, poverty, disease, and old age were supposed to disappear within a decade or two, and a humanity cleansed of its immemorial ailments would appear at the gateway to the third millennium having proudly eliminated the last traces of hell. Europe was supposed to become, as Susan Sontag put it, the sole place where tragedies would no longer occur.”

I think those last words are the give-away: Europe (and by extension the US, Japan, Canada – the G7 or G20 or however many hallowed nations were to be allowed into the new world order’s club of the blessed) were to become that lucky zone of infinite possibility. Literature and popular culture are rife with futurist stories in which the wealthy & powerful invent ever-new ways to protect their own wealth, power and comfort while maintaining their control over the legions of have-nots. And I guess that’s the thing – it feels to me on some level as though Americans, whom I know best, sit uneasily with our unfair access to and domination of the world’s resources, so we invest vast amounts of time into convincing ourselves that not having the latest i-phone app  is a legitimate tragedy. This way we can remain focused on ourselves and our own pains and woes, and ignore anything else in the world.

I remember when I was first introduced to the concept of existentialism, in ninth-grade French classes. 15-year-old Paul was singularly ill-equipped to ponder a philosophy of life’s bone-wearying essential emptiness. Ever the pragmatic optimist, such deeper questions as why am I here, and is there really any meaning anywhere  never grabbed much of my attention. (Young Paul’s answers: a) because Mom gave birth to me;  and b) does it matter, as long as we’re learning & getting good grades & having fun? ) However one side-effect of my current global-wanderer lifestyle in which I toggle back and forth between two worlds that often seem barely connected (even though both have lovely human beings in them and both occupy space on the same rock hurtling through space) is that I find myself pondering the deep imponderables much more often than young Paul did. When minor culture shock – or at least a deep sigh of relief – can be caused by the simple act of crossing from the DRC into Rwanda by walking around the little border-barrier – and then hopping in a nifty modern seat-belted little car to hurtle towards Kigali along the flat, even, paved roads of Rwanda after six jolting hours on the usual volcanic-rock strewn “roads” of North Kivu, you can imagine how other-worldly the view of Oxford Street in full swing from the top of London Transport bus can seem.

Where’s my point? There are two. I’m definitely in some culture shock, but the concerts and dance performances seem to be calming my mind and freeing it from the virtual lock-down its been in. (Did I mention that we’ve been working unusually hard of late? All good, and all important, but one does become a bit tired and work-obsessed.) More importantly, I find myself still troubled by how much we developed-world powerful folks, most especially my sadly blind American compatriates, remain wedded to the dream that we can divide this precious earth and this precious humanity into different worlds and treat some of its places, and some of its inhabitants, better than the others. It’s just not very sustainable, my friends. And if you think that your wealth and comfort have no connection to the lack of wealth and comfort in so many other parts of the world…ask yourself how realistic and logical that is. From what I hear and see when I’m back here in the developed world, it seems a lot of the folks here (developed = where I am now) would benefit – really, in a meaningful way, and I’m not being cynical – from spending a little more time with the other half. And there’s little doubt that a lot of the folks that I work with in my usual work life – whether the populations we serve or the specific people I work with day to day – would benefit from a bit more access to what we have here. It’s not about equal access to i-phone apps; developed-worlders seem constantly to complain about the lack of meaning and the lack of connection. These are not complaints one hears where I work – there the complaints tend more often to be about lack of food, lack of educational opportunity, or lack of treatment or testing for malaria.

It’s about, in the words of the sixth UU principle, “The goal of world community with peace, liberty, and justice for all.” I’m trying to live so as to put meaning to those words. This does not make me a hero (much as a few friends try to tell me it does every so often), it makes me someone who is trying to answer the existential question and greatly enrich my own life by choosing to live in constant awareness that there is, truly, a whole world out there and I am one very small piece in it. And my sense of life and worth and joy and sadness are all much greater when I connect myself with that flawed whole, rather than trying to live my life in some state of semi-perfect numbness, disconnected from contact to other people and other places.

OK, so much for the deepness. Can’t much help it when I’ve done the leap from one side of the global divide to the other, sorry. Readily admit, though, that dance at Sadler’s and vegetarian Vietnamese Pho on Wardour Street are lovely things to have access to. 🙂 Be well. Enjoy the pics. Keep in touch.

..and now for the captions: I don’t carry the camera around much on road trips – for security and other reasons, a good rule of thumb on the roads is to only take what you really need and don’t much mind losing – so most of these photos are from the town of Mweso; but some are from Kashuga and Kalembe, towns where we work with ministry-of-health health centers. I show quite a few of life around the compound in our office hours, including an example of how well we use our front porch for those lazy Sunday afternoons when it’s gotten a bit hot and everyone’s a bit tired. Tip: if you put your cursor over any of the photos, you’ll see the name of the file, which I’ve tried to keep informative.

Above: a lovely sunrise view of the front door to our compound and the hills to the west; below, part of our garden (we grow lots of our own vegetables and of our newest expat arrivals brought kale and sugar-snap pea seeds!), and if you look through the fuzzy focus (sorry) you can see some hill in the background and might make out some of the huts from the IDP camp on the hill up there.

Ok, this may or may not work because the photos keep trying to overlap each other but I try to mix up the layout a bit…anyway if it works out you’ll see this caption in between two shots of me talking at the farewell party for my successor (back in December), then down below a shot of the whole team as of late January; of this team which I inherited only three still remain and one of those will be leaving the day I return. (Sob. Constant turnover, a fact of life with us…)

Below, a few other shots from that farewell party.

April 5, 2011 | Categories: DR Congo | 4 Comments