Sailing Anarchy

Raki Raki Hospital, Fiji

If the National Movement for the Liberation of Azawad (MNLA) had not fallen out with its Islamist supporters in The Movement for Oneness and Jihad in Western Africa (MOJWA) I would probably be sailing today. That’s because when they started fighting amongst themselves the Government of Mali decided to ask the French government to help them recapture the northern parts of Mali that these rebels had taken control of. As a result, my mission to neighbouring Nigeria with MSF in March was cancelled and I was reassigned to go to Aweil in June – but I had been planning to be back from Africa by May, put the boat back in the water and go sailing. Honestly, I wish these people would start thinking about how their plans might affect other people before they go rushing off and rebelling all the time!

But “life” is what happens to you while youre busy making other plans, right?

So here I am back in Fiji, an incredibly interesting year after sailing here from Tonga and putting Sapphire into a trench – where she remains!  Since arriving here I have been working at the hospital in Lautoka as a volunteer locum Obstetrician. I don’t get paid – officially – but my accommodation and car is paid for, and I get a daily allowance for living expenses. I am going to earn in six weeks what I would earn in three or four days in Australia – but I am not complaining – its another interesting challenge and in a beautiful place with lovely friendly people, pawpaw for breakfast, and my Yacht is just down the road!

I had been thinking I might repaint Sapphire because I had left her with some untidy gouges along the starboard side following a close encounter with a wharf in New Zealand and she was really looking worn and untidy. My plan was to work on her in the evenings after work and on the weekends but that quickly proved impossible, as evenings are very short here and I often work till late. I am on call and get tired at times and  Ive just finished a whole week on call. Instead I decided to get a local yacht painter to do it for me. I had a couple of quotes and decided to go with Rons as it was the cheapest – I didn’t need a Superyacht finish, just a basic tidy up along with antifouling before going back in.

So I took the hydrovane off the stern – again! – and some of the deck fittings, and left him to it.  He’s probably going to be finished this week. After that there will still be dozens of things to sort out before I can go sailing.

 

Covers off after undercoats

Meanwhile Ive ordered- and received from Whitworths marine in Australia - a box of parts I need, like the wind instruments off the top of the mast, a small sheet winch that I smashed on the way over from Tonga, some plastic vents that the harsh sun here destroys in no time…

I will have most of October and November to go sailing

Out of Africa

TukTuk and Tree

The last few days in Aweil were hectic. Quite apart from having to find the time and energy to write a comprehensive report on my six week mission and a “handover” document, there were patients to look after, emergencies to cope with, heat and rain and mud to put up with, and the endless round of exclamations, regrets, questions and farewells from anyone and everyone who realized my mission was about to end -  How was it?, where are you going? When are you coming back? Already? On Wednesday night everyone gathered at dinner time and thanked me for my contribution and wished me a safe trip home in the morning. All the goodbyes were said and I became a person in limbo, killing time before the flight in the morning.

 

Maura, Thomas and Kristin : wonderful colleagues

Looking back, I realize there were so many incidents and events and dramas I could have written about during those six weeks, so many near death experiences, so many extraordinary  examples of extreme obstetrics, of extreme poverty and awful neglect, that one merged into another during the hectic day that by the end of it, food and rest and escape from the flood of urgent crises was all that was on my mind.

I tried to maintain a diary, to keep track of everything swirling around me, and heres a couple of days from it – they are quite typical days:

Saturday 6^th July

Started with emergency Caesarean before breakfast for cord prolapse : All good

The ward round

The hand seems to be improving   ( a patient had a horribly infected hand)

The SABO is not improving  ( = Sub acute bowel obstruction)

–      took her to Green World Health Centre for AXR confirmed SABO, then gave enema with large result – tomorrow if not improving for transfer to Gogriel where there is a surgeon

–       Green World was interesting, a collection of tiny shacks labeled Wards, the Xray building another concrete shack, and Margaret a big sexy woman from east Sudan somewhere

Evacuation of Molar Pregnancy after ward round

A spontaneous vaginal breech in primigravida

An iufd at 25 weeks delivered after arm and synto (IUFD - Intra Uterine Fetal death)

NVD twins   (Normal Vaginal Delivery)

Diabetic almost sorted!

Sunday 7^th July

Busy day though its supposed to be the day of rest:

The hand is improving

The cachexia is not – she is dying and I don’t know why – probably TB

The SABO is not and needs to go to Gogriel where there is a real surgeon but its very hard to make this happen – pt has to be accompanied by a family member prepared to donate blood and to accept that if she dies MSF will not be able to return her to Aweil this seems inhumane to me especially as this weekend we have an MSF Official flown here from new york for god knows what reason, and another director from Juba also here. Got NG tube passed and large volume of bile stained fluid aspirated

Two casears  – a face and an obstruction with ROP in  multi

Destructive Delivery  – IUFD primigravid LOT after 2 days in labour, putrid hot mec stained pus and liquor. Demonstrated technique to Paulino

Bloody footprints

But even though  42 days on call is quite enough for anyone, its also too short a time, because I realized it took most of that time to learn everyones name and to learn which people I could rely on, and who I could call for help and and what systems and processes were in place that I could use to get things done, what was possible, what was not. I realized I had learned enough to start to become really useful just as it was time to go. But now at the end, mentally unwound I became ready to go.

 I was watching the weather and woke early Thursday morning to the sound of rain. I went in to do a quick ward round at 7 am so I could be back to go the airport at 9 – the rain had stopped, the clouds were lifting, word came through that the flight was “ON” and saying a last farewell to the few people still in the compound at 9, I hopped into the Lancruiser and went to the Airstrip.

 

Aweil Departure Lounge

There was an hour to kill so I just stood about avoiding the puddles and waiting. The “Terminal” was an open sided shed with a soaking dirt floor and a few puddles. A tiny drizzle of rain appeared – there was also a tiny new patch of blue sky on the horizon – and then a guy with a walkie-talkie had a quick look at the sky and cancelled the flight – “too wet” he announced. I had heard they tended to cancel flights at the drop of a hat and this was certainly an over-reaction – I was stunned.

Half an hour later the sun had broken through but it was too late; the flight was cancelled and I was taken back to the compound. It was a strange afternoon, because I reappeared in the compound and then went back to work in the hospital to everyones surprise, but no-one wanted to go through all the goodbye process again – I was sort of ignored, I felt like a ghost that nobody could see, as we coped with another round of dramas and traumas, anaemias and bleeding and pain and birth. I was mentally unwound and in a different space but had to  wind back up again.

 

In case I needed some?

The Nile at Juba

The next morning we went through the same process but this time the plane arrived and we left on time for Juba, a day late leaving but too late for my connecting flight.  I would have arrived in Sydney on Saturday evening, but with that delay the next available flight got me to Sydney on Tuesday,  the day after the end of the five day annual Sydney Boat Show. This was something I had been thinking of as a kind of reward for all the hardship of Aweil, something I had been looking forward to attending for months and it took me a while to get over my  disappointment.

But I was back in Sydney, back in the Hotel that had hot showers, really soft pillows, airconditioning, and Room Service! But better than that was seeing  family and friends,both in Australia and New Zealand a week later. From there I flew to Fiji, back to the boat and another beginning!

The Face of the Future in Sth Sudan

This scary looking guy works with me in Maternity just about every day, and he is a very valuable member of our staff, a friendly intelligent and reliable guy with pretty good English, excellent judgement and work ethic. Despite his appearance he is surprisingly gentle and softly spoken. He represents hope for the future of this struggling country, the necessary human bridge between the traditional and ancient ways of the Dinka people, and the world of modern medicine. Those lines on his forehead were made with a knife when he was about 15. It must have been agony to have the skin on his head incised right round to the back on both sides, several times, but he had to endure the pain without the slightest grimace or hint of emotion, or else risk humiliation. You cant see it but he also had the two front lower teeth knocked out, something  the Dinka women also endure for an apparently desirable cosmetic effect. The Dinka women also cover their abdomens with patterns of dots and dashes, scarring made by nicking the skin with something sharp. One Dinka father with similar markings told me his sons wont be subjected to this ritual, so clearly these traditional ways are going to largely disappear.

I am running out of time with only a few days left before once again I pack my bags. I have been so much busier here than I ever was in Ethiopia - the problems are much the same but there are three times as many. There are many posts still unwritten and I am not sure how much free time there will be for them. What I have to do in the next few days is write a report for MSF on my time here, and create a document I can give to my replacement who will be arriving here on the Plane coming to take me away on Thursday. Ideally the replacement arrives a day or two before, so he can be  shown the ropes by the person leaving - I got here a day later than I was supposed to because of the weather, so my "handover" was at the Airstrip - just a "hello, goodbye and good luck"  - but its a mystery why this time no time at all has been allowed for handover. All I am hoping for is good weather, because if I dont leave here on Thursday I will miss my connections back to Australia.

My Room for 42 nights

Outlook for Thursday

After the Rain

It’s the wet season here and what seems to happen is that after several days of hot and humid weather with mostly blue sky, clouds  approach from the horizon with lots of lightening and then with strong winds and a drop in temperature that makes sleeping quite comfortable for a change the rain arrives in a heavy downpour that lasts a few hours. When its finished it can be pleasantly cool for half a day but the heat quickly returns. The massive potholes have of course filled up once again and the walk to work becomes a slippery filthy obstacle course as we try to avoid the worst of the mud.  The mud dries over several days till only the deepest holes remain, and then the cycle starts all over again.

Another effect of the rain and storms is that airtravel to Aweil may be interrupted. Theres a surprising stream of MSF Staff coming and going – some are Officials doing the rounds and others are arriving or leaving at the end or the beginning of their missions in Aweil, or taking their mid-mission holiday. Last week and again yesterday, people who were expecting to leave didn’t, and others, such as the replacement anaesthetist, didn’t arrive. Maybe they will fly today – the rain has stopped. One of the people leaving has been visiting for just a few days, a French doctor called Romy Brauman who is one of the original MSF Doctors. He went to the Thai-Cambodia Border on his first mission in 1978 or thereabouts and was completely on his own. It was fascinating to hear his views about where MSF has been and where it is going. He predicted that once MSF leaves  Aweil, as in every other mission ever completed by MSF, the local infrastructure will not be able to maintain the standard that was set by MSF, that there is always an inevitable collapse to something a whole lot less than what had existed before, and that our success will not be so much in what remains, but in the help we gave to the people who needed it while we were here. He didn’t seem in the least a starry eyed idealist wanting to change the world, but a very pragmatic humanitarian.

 

One realises what a luxury a sealed road is

Next Thursday it will be my turn to head back, after six very fast weeks, weeks which have been much busier than the ones I spent in Ethiopia – there are more than three times the number of births here and again I am the sole Obstetrician. I am looking forward to a break but I don’t feel desperate to leave. In fact the  longer I stay the more work I seem to find and the more I discover that needs to be done , especially in what the local staff need to learn. In spite of what Romy believes – and I agree with him about the future of this place – none of us wants to leave and think that once we have all gone, nothing enduring will remain. What we hope is the people we are trying to teach will do better when we are gone than they otherwise would have done, and therefore, indirectly, South Sudanese will continue to benefit from this mission. What I am finding with teaching is firstly that there is an enormous amount needed, but that we are so busy dealing with the day to day challenges of sick women that there is hardly any time left for it.