Time for some R & R

 Traveling requires flexibility. Traveling in Africa requires a special amount of flexibility. I like to think that I am a pretty flexible traveler and that I have enough experience to be flexible with my travel, but nothing has properly prepared me for the flexibility I needed for this travel in Africa (*Side note: I don't think all travel in Africa resembles this. Probably just because of my location).

On Thursday of last week, I boarded a very small plane bound for Kajjansi Uganda. This is a small town near Entebbe and Kampala Uganda. I have never been on a plane that small before. There were only 5 people on the plane (Plus the pilot) on the first portion of the flight. It is a shuttle flight so we made a stop in Arua Uganda before 3 of us flew to Kajjansi.

When we were near Kajjansi there was a storm coming in. We had gotten some rain but nothing super significant as we flew. A smaller plane like the one we were on doesn't fly as high so we were in the rain more than above it. When we got closer still, we hit some turbulence. I have been in planes through storms before but this was a whole new experience. When a little plane like that one hits turbulence, it is rough. We dropped and dipped a few times. One time was pretty freaky but overall, we landed without issue. The pilot was excellent.

In Kajjansi, at a very small airport, I got to see a little but of the different plant life that is there while I waited for a taxi to pick me up. My driver came and drove me about 30 minutes to my hotel. On the way he explained different parts of the cities that I was seeing. Uganda has a lot of similarities to South Sudan, but near the capital it is much more built up than where I live in Yambio.

Entebbe was the first place I have been to in 2 months that has a paved road or a mall. It was a bit of a culture shock moment seeing all of that again. I won't lie, I was very excited to go into the mall or go grocery shopping. The mall wasn't very large but it was nice, especially since it had a grocery store in it. I walked to the mall, which wasn't very far from my hotel and spent over an hour wandering the isles, finding foods I hadn't had in weeks, and bought food to take back to Yambio with me.

The hotel I stayed at in Entebbe was pretty nice. It is right on Lake Victoria, the largest lake in Africa. The lake is beautiful and it was nice to stand down by the edge of the water for a while. I also had a balcony overlooking the water from my hotel room. It was nice to be out there and overlook the water and enjoy the ice cream I bought.

On Friday I boarded another small plane. This time there were 10 of us, plus the pilot. Everyone on that plane was there for volunteer services working with refugees, other than me. On the way to Adjamani (where I was getting off the plane), I got to chat with a few of the other people on the plane who happened to do mental health care in South Sudan and now in Uganda working with South Sudanese refugees. It was a good chance to talk about how things function and some other things. I got contact information so I can ask questions and maybe work together in the future.

When I arrived in Adjamani I was surprised at how small their airport was. Each time I have gone somewhere new in Africa I get a little more surprised by the way things are. I got a taxi and headed to the hotel. I booked a hotel outside of the town. It was a nice-looking hotel with a pool and different places to hang out. The room was pretty nice as well, with a nice bed and mosquito netting (a must!). There was a restaurant there as well.

After relaxing at the hotel and going for a swim in their pool, I decided to head towards town and also see if I could find the store that I had found on google. I walked through the village. It was a really nice and peaceful village. I walked for quite a while, through different portions of the village. I never actually made it to the town or to find the store. But I liked walking around. I even met a few people who I chatted with. Everyone was nice.

I hung out at the hotel that night and ate at the restaurant. The next day I got to experience what a refugee camp was like. It was challenging to see because the people there live such a hard like and there is so little that is done to help them. Most of the people there have lived in the camp for over a decade because of the insecurities in their portion of South Sudan. The refugee camp I was in was home to only South Sudanese. My friend's family was there with my friend so I met up with them.

It was a humbling but good experience. I was able to bring some food for the family, which was about all I was able to provide them. I wanted to do something to thank them for having me. We shared meals together that day and talked a little (though it was hard because there was a language barrier). Mostly I caught up with my friend. We also walked to the town and I was able to explore and see a little more in the area. I also got to take a boat ride on the Nile River. I saw a hippo but he was too fast so I couldn't get a photo. (Hippos are the most dangerous animal on the planet so we were lucky he just ignored us).

The next two days I spent more time with my friend and their family. This time we went to my friend’s aunt's house. I won't lie, I am feeling a little homesick and it was hard at first to be around their family because I was missing my own, but they welcomed me in and made me feel like a part of the family as well. In the end it was nice to have that family feeling again. It actually made me a little less homesick. I really enjoyed being with my friend's family. I was able to learn so much.

One of my favorite things we did was I was taught by my friend's cousin how to make paste, their version of peanut butter. I ground the peanuts on a stone with another stone by hand. It is hard work but I actually thought it was pretty fun. It takes a while to grind the paste but it tastes so good. Paste tastes even better than peanut butter. It isn't as sweet, which I actually like. I really had a wonderful few days with my friend and their family. We shared lots of good food and some good conversations.

My last day in Adjamani was quieter. My friend and I wandered around town for a little while. We got grilled pork for lunch which is one of my favorite meals. The food is good. We also went swimming in the hotel pool and just hung out around the pool. It was a very relaxing day. I am grateful to hang out with my friend, and to get some time exploring another part of Uganda. I enjoyed being in Adjamani more than Entebbe.

On Wednesday I flew down to Kajjansi again. The flight was good. We flew over the Nile River again. Of course, I took tones of photos out the plane window. I really enjoyed being on the plane and seeing the different parts of Uganda from the air. I hope to come back one day and see more of it on the road. They drive on the left in Uganda and I struggle with that. Plus, the driving is much more challenging, with different road manners than I am used to.

When I got to Kajjansi I found out my Thursday Flight was canceled. It was time that I started to panic a little. Thankfully I was less nervous than I could have been. I went to my hotel, which didn't have internet, but did have a rooftop bar. I sat up in the bar lounge, and used data to try and book a flight. Unfortunately, I didn't manage to book one due to issues with my credit card. A series of texts to my office, and one of the guys who helps with flights booked my ticket for the next morning.

I found another grocery store that afternoon and wandered around there for a while, buying food for dinner and then some goods to bring back with me to Yambio (like protein bars, chocolate, and some things for work). After getting what I wanted from the store, I headed back to the hotel. It was nice driving around and seeing Kajjansi. I didn't feel like walking around there too much but I liked the drive. At the hotel I ate dinner from some of the food I bought and lounged around. It was a relaxing but early evening.

On Thursday I intended to go to the animal sanctuary but the driver who was taking me got confused, didn't speak English, and we ended up deciding that I should just go to the airport. This time I was flying out of Entebbe instead of Kajjansi. Entebbe's airport is larger, and more like a normal airport. I got there and headed to the information desk for the flight I was booked on. When I went and talked with the woman there, we discovered I had accidentally been booked for a flight on April 30th instead of March 30th. A series of calls and texts to my office and I was rebooked on a flight in a few hours. It worked out that I didn't go to the animal sanctuary so that I could get the flight corrected.

So, I flew back to Juba without much issue after that. I spent some time wandering around the Ugandan airport before the flight. The flight itself was smooth. When I got to Juba a colleague met me and brought me to the office. There I found out that my Friday flight was not going to happen. It was too full. I am going to be in Juba for the weekend. It will work out okay, and I have a nice hotel to stay at.

But all of this requires flexibility. There is more that happened with random other travel things that required flexibility, but I won't get into that. Overall, the trip was great but everything had to be handled with some sense that when things go left, you have to lean in and go left to. Eventually it all works out. Just embrace the adventure and remember to be flexible.

Work Update!!!

         Okay time for a little bit of a work recap. I feel like it has been a while since I gave an update on what I am getting up to with my work. And a lot of it is kind of hard to write about because it is complex and confusing but I will write what I can.

Not sure where I left off with work updates but I will start with my supervision of those I helped train in TOT for Mental Health. I am overseeing people in 4 counties in W.E.S. I have 4 focal persons that I try to reach out to every few weeks, some I talk with more, about how each of their colleagues is doing with the training. The 4 focal persons come from each of the 4 counties. It is easier for me to oversee the two nearer me but the other two I rely on the focal people to keep me updated.

As of now things seem to be going well with those who have been trained. We utilize a secure group chat to connect and talk. Sometimes participants share information and advice to the group. Other times people reach out with questions and we are able to discuss cases and questions in a timely manner. We make sure not to share sensitive information but present enough of the cases to talk about what we need to discuss and problem solve.

Some of my participants are really diving into their mental health training, alongside their other duties, and others still need more education and assistance. I try to provide what I can. It is challenging, especially with the farther counties, to know what challenges they are facing or what further education they need, but I am pleased that there is progress.

There are only 2 people who solely focus on mental health, out of all of the people I train and that is challenging. For them it is especially challenging because they have so very few resources, even less than me. At one point they invited me to a meeting with other people from their facility. During the meeting it became clear that they were hoping I was going to provide them with the resources they need to build their mental health department. Either they wanted me or my NGO to provide the support. Unfortunately, neither me nor my NGO are in a position to support their proposal, but I am glad that they are seeking to create a better mental health department in W.E.S. It is greatly needed.

At least once a week I travel to Nzara to see patients. I have a long-term patient there who has developed some mental health complications, who I regularly see and am trying to treat. It is a challenge because the patient is very resistant to trying any of the things, I want to do with them, and the care team (I tend to agree) feel that putting them on medication is not advisable at this time. So, each week I try new ways of giving them help. Some weeks things go better than others.

I see other patients too while I am there. I have worked with mothers who have lost their children, a family whose daughter was dying following delivery complications, families whose children are dying, a family who had a child in the hospital for and extended stay, and a pediatric rape case. Every single case I face is challenging in its own way. Some are harder, emotionally, for me as well. Some people want to talk to me and others decide they do not want my help.

It is all a process, and I often rely on other staff to translate what I am saying and what the patient is saying. In the US we would use specific people for translation and there tends to be rules about how translators translate things, like that they have to translate verbatim. Here I hope that the person I am working with is translating fully. There are certain people that are better about this than others. Some, especially those who are not as comfortable with mental health, tend to not translate as fully. Often, I have to encourage a better dialogue. It is all part of the challenge of this work.

I really like when I get to see patients and work with them but my resources are so limited. Many times, I will only see a patient once so my goal is to see if they are in acute crisis, suicidal or homicidal, and what their needs seem to be. Then I try and do education, especially on coping skills and self-care, which many people see to struggle with, and refer if possible.

Along with traditional mental health cases I often see epilepsy cases, because in much of Africa, epilepsy falls under mental health as it is an umbrella category known as MNS (Mental, Neurological, Substance). That is a new challenge for me. Many of those patients that I see for epilepsy are young adult males that seem to suffer from epilepsy in conjunction with another mental health issue or a traumatic brain injury. Those cases are challenging, so prioritizing care and referring is very important.

Soon I hope Nzara's hospital, St. Theresa, will open up the mental health clinic. At this time, we decided it will only be a once-a-week clinic. If the need grows, I hope they can expand it, but for now, even having one day a week when anyone in the community can come and get mental health care is huge. I am hoping it will be successful. I will continue to support it while I am here, and do what I can for it once I leave. I also have to work on getting mental health education and the existence of the clinic out to the community. More small projects for me to work on. 

This week I also identified my next larger project. I will be working at one of Tindoka Vocational Training Institute (VTI). There the institute supports many CAAFAGs (In the US we know them as Child Soldiers). The program aims to train those who participate in useful trade skills that they can use. Most of the participants are in their mid to late teens. There are both girls and boys there. They learn skills like mechanics, carpentry, and sewing.

This week I went with a social worker and counselor to the site. I was given the opportunity to talk with a group of about 30 participants about mental health. We talked briefly on a variety of topics and issues. The big one presented was trauma. I tried to encourage the teens that it is okay to talk about mental health and to have mental health struggles.

The best part of the conversation was when several of the participants started speaking up about their different mental health struggles. One even mentioned a significant trauma. By these participants sharing what they experienced it allowed for a very real dialogue to start. Not everyone was willing to share so openly but I was so happy that a few did. This helps.

Going forward I plan on going once a week to work individually with different people from the VTI. Several people shared that they were unwilling to share so publicly but they were willing to talk one-on-one. That is perfectly fine with me. I want to do that with them. So, we are creating a plan for a day of the week when they can expect that I will be in the VTI and that whomever wants to meet with me and work with me can do that.

I will continue doing staff training as well. I try to do a general staff education at least 2-3 times a month at our Monday morning meetings. I also want to do more specific staff training. I plan to educate the midwives in the different clinics I work in, as well as with the social workers and counselors so that they have more tools when they come across mental health cases. There will probably be others I train in the future too.

The work is hard and often I feel frustrated with how little I can do, especially with certain cases. But I am celebrating my "small" victories. In the end they are not so small but, in the moment, they can really seem that way. It is also hard being the only mental health provider who is specifically doing just mental health care, to the extent that I am, in W.E.S. I am an island on my own. But we have to start somewhere so this is where the work is starting.

That's all for the work update for now. I'll share more later.

3 Parts in 1

         Life here is a bit of an emotional rollercoaster, especially as a volunteer and as an expat. I feel like I live in 3 separate worlds that clash is very weird ways. Sometimes that makes life here challenging, or at least mentally draining. I have the old me, the person I innately am, the person who is an expat, living in a very specific NGO community here, and then there is the part of me that is a volunteer working out in the community, interacting with the community in a very raw way.

There is the part of me that is innately an American female, with my education background, travel history, and other specific parts of my being and history. The part of me that grew up in the US, went to school there, and has lived there for the majority of my life. That is a big part of me. So, this part includes many of the views and beliefs I came in with. This is the person I was before I got here.

This part is the part of me that is learning and changing in this new environment. You have to adapt living here. There are many growing pains, learning that things I am so used to in the US, things that you wouldn't even think about in the US, are not a part of society here. There are such intrinsic parts of society in the western world that are not present here and when I run headlong into one of those things, I have to take a step back and re-evaluate the situation I am in.       

Of course, I will change living here. I expected that much before I left. If I was not willing to change and adapt then this was not the place for me to visit. So, I have started to change and adapt. It is part survival and part learning. The world here is so much different than the world I come from. So that innate part of me is being challenged and changed.

Then there is the part of me that is living as an expat among other NGO workers. The NGO community is a weird, sort of wonderful, sometimes harsh community to be in. There are different personalities that are in the community. I don't know where mine fits in, or if in some ways it doesn't, as unlike most other people here that I interact with, I am a volunteer and they are employed by their NGO. I am in healthcare and they are not.

It is a weird interaction with the other NGOs living in my compound. Sometimes it is absolutely fantastic. I have those that I have befriended who hang out as a group on the weekend. They are fun to just sit and chat with and learn more about the different communities and countries they are from and the work they are doing here. I am learning a lot from them. I am getting ideas for potential future projects and trips I could take. The other NGO workers teach me a lot.

But there is also the challenge because among all of the different people that I have met in the compound, I am the only volunteer living there, and I am the only healthcare worker. So, there are days when I want to talk about my experiences and I cannot talk with anyone there. I know of one other healthcare volunteer and she does not live in Yambio and it is hard for me to connect with her at times to talk about what I am experiencing. Plus, as the only mental health specialist in W.E.S. I have no one here to talk about my challenges with. It can be lonely, as much as a community.

Finally, there is the part of me that is the person interacting in the community. It can be on my walks to lunch or to the office, or during my work, and other interactions moving amongst the community, I am here because I want to give to the community and learn to be within it. But I cannot give money or food to every person who asks for it. And it can be challenging to decide if you should give someone something. You want to help but the help should be sustainable, and I cannot give money or food every day to everyone. But you want to help. Or I do. I am trying to. But there is only so much I can do. And it breaks my heart at times to not be able to do more.

But then there are the times where I am able to try and help someone. There are the days that I can see progress in the work I am trying to do. There are the subtle signs of change and growth and I can see the impact that I can have. This is such an incredible feeling. I am on an island alone in most of my work. There are people around who support my work and who I am training and working with, but I am the only identified mental health provider in this state. It is a daunting feeling.

Life here is an emotional rollercoaster. There are days where things seem so positive and the potential for good things and a better future is powerful. Then there are the days where I feel defeated and hopeless. There are the moments where I breakdown and cry. Then the moments where my face hurts from how much I am smiling. There are the bits of me that are challenged by the "norms" of Western life that just don't exist here.

Life is what we choose and what we make of it. If nothing else, being here has shown me that there are many ways to live life and that you can change how you live and think. Maybe it doesn't have to be a profound change or a profound thing but subtle and little ways that you can change. What things do I truly? What are my priorities in life really? What do I want my future to look like?

I have no answers. I have lots of questions. As I keep moving forward it is time to make some choices, probably some changes, but I will keep seeking answers, asking questions, and challenging myself. And the 3 different parts of my life will continue to challenge me to grow and change and seek more.

Food for thought

         Food here is so much different than it is in the US. Shopping for food is also very different then it is in the US. So that means when I do make food it is also much different than when I am in the US. The food took some adjustment when I arrived and it still takes some adjustments but it has been part of the adventure.

So, let's talk a little about the food. Now this will hopefully be a short blog post. Many people asked me what kind of food I eat, what I make, and where I get it so I figured I would try and describe it.

Let's start with shopping. A few times a week I go to the local market. There are no grocery stores here. Refrigeration is limited. Most of the fresh produce can be purchased from women who sit out in a big open area under awnings with their goods. They call out to me as I wander through the different rows trying to figure out what I want. Right now, it is the end of dry season so some things are limited.

From the women I can usually purchase things like pineapple, lemons, potatoes, bananas, plantains, tomatoes, and carrots. They also sell things like greens, casava leaves, okra (dried and fresh), and other foods that I cannot identify. Since the communication skills between both the women and I is limited, I have yet to figure out some of the goods. Even things like sweet potatoes look very different from the one's at home. There are other foods that are not available now, like watermelon and corn.

There are actual food stalls that are the closest to a "store" here. Most, if not all, of these are owned by men. But inside you can find some traditional "American" goods. Here I have found Nutella, some cereals, a package of cookies, coffee-instant, and a few other goods that I would find in the US. I can also find goods that are at least a little more western in nature that I have looked for.

From the food stalls I purchase things like popcorn, pasta, Tahini bars (the closest thing to a protein bar I could find- for days that I don't make it to lunch), Nutella (not something I eat at home in the US but here it is a nice treat), and sugar. I tried to buy flour but they sell it in open container before they bag it for you and upon arriving home with it, I discovered it has bugs in it. I could try and sift them out but it makes me sick to think of it so I have decided I just don't need to use the flour. There are a few sealed bags of flour but I am declining on purchasing it.

Now you may have noticed I have not talked much about meat. Meat here is sold without refrigeration, in stands that hang or display the meat on counters. There are also dried meats. The hygiene standard for the meat is not where it is in the US. Also, they sell "jungle meat" which always makes me a little nervous. There is such limited refrigeration here that most things are not reliably refrigerated. I saw milk being stored at room temperature, which is not uncommon, but with how hot it is, there are certain things I prefer being refrigerated, meat and milk are some of those things.

Grocery shopping here can be expensive or cheap depending on what I am getting. Some goods are really cheap, like lemons, tomatoes, onions, and garlic. Others can be more expensive, like pineapple. However, inevitably anything I buy that comes from a stall is more expensive. I try to limit these items but since they are shelf stable, I have many of them in my room so that I can cook. I go to the market to get fresh produce more often.

I am able to cook my own meals in my room. I have a 4-burner stove with over (though I have yet to figure out if the oven works). I have a fairly larger counter top where I store and prep my food. I have a sink and water that I can use for cooking. There are a few cooking utensils, pots, and a pan. It is very basic but at least I can cook. My fridge doesn't work and there is no microwave. Those are the only downfalls.

There are a few staples I have taken to make myself in my apartment. Pasta is easier to come by than I expected it to be so that is one of the few things I make myself. I have tried a few different ways to make it. I make a more traditional one with tomato paste, onions, garlic, and a few spices I brought with me. Another way I make it is with peanut butter, Asian spices, and garlic (attempting a version of a peanut sauce over noodles).

I have other foods in my room. Sometimes I have paste (homemade peanut butter- better than what you get in the store). I also make stovetop popcorn. I have found cereal, not as good as the ones at home but something to munch on. I have fruits, and sometimes some veggies but I need to buy a peeler to get more veggies (like carrots). I have sweet potatoes, but these I can peel (carefully) with a knife. And there are a few sweets for the end of the day.

But I have already confessed, I do not do a lot of cooking most weeks. I take many of my meals either out in the community or at the cafeteria here in the compound I live in. There are "restaurants" here. Nothing fancy or like what you would find in the US but they serve good food. There are street vendors that sell food. There are also food stalls near businesses, and near where I work, where I can take my lunch.

In the compound I live in the cafeteria cooks the same style foods each day. I almost always eat breakfast there. Usually this features an egg omelet with onion, tomatoes, and sometimes peppers. Usually there are potatoes at breakfast, sometimes bread or chapati, always plantains, and sometimes porridge. I have never seen breakfast meats here. There is also a selection of tea, instant coffee, powdered milk, sugar, and sometimes hot chocolate. On rare occasions there is juice.

Other meals are rice and beans here. There is often boiled meat, like chicken and beef. It tastes better than it sounds. They make cabbage or eggplant here too, sometimes greens as well. But the meals rarely vary and dinner is always leftovers, left out, from lunch. I don't eat at the cafeteria for lunch or dinner as often as I did when I first got here, and often I stick to a more vegetarian diet.

For lunch I have begun going to one of the two food stands that are near the CMMB offices. Many of my colleagues eat at these places. I usually get Gadia, a cassava leaf "stew", that is very tasty, even though it looks off. With it I either have rice or aseeda, which is some type of millet mixed with water and salt and cooked to be a firm damp blob. It also doesn't look great but tastes good. I eat the aseeda and Gadia with my hands. I have learned to eat several different style meals with my hands as that is common here.

There are a few restaurants that I have tried since coming here. They are much more different than US ones. Here, everything is cooked over a fire. The food is good though. The restaurants offer different styles of cooking and it has been fun to try some other locals’ foods from other places around the area. I feel like I get a better taste and sense of the area by trying some of these things. I am able to try things I would not normally try, such as intestines and liver, eating at the restaurants.

I also eat street food from vendors. You can get pork, chicken, goat, or lamb from the vendors. Often the meals come with potatoes, maybe tomatoes, lemons, and garlic and onions. Often this is eaten family style and with your hands. I have shared these style meals with a few of my friends here and it is rather fun. The food is grilled over charcoal and very tasty. I like the pork and chicken the best.

And when I am really missing home there is the kitchen at the UNMISS compound here. There they serve “American” style food. It is more western in nature but doesn’t taste the same as home. However, it is good, but limited in availability. It is a nice treat. I can get things like a burger and fries, or pizza.

Food is part of the adventure here. It is part of getting to know the culture and customs. There are certain foods eaten for certain meals or events. Food is a part of the community and a part of the insecurity here. What I eat and where I eat show me more of the world, I am living in. As a vital part of life is sustains, but it also educates. Some meals are great and others not so good, but it is all a big part of the experience here and I am trying to embrace all of it.

Alright well this post is longer than intended but I hope it shows a little of the food culture here, and of course I will have plenty of photos of food to share.

Women's Day Celebration

 

I did not so much forget, as was unable to, write a post about International Women's Day last week. On March 8th the world celebrates International Women's Day. Now in the US I have never really seen a celebration of International Women's Day. I see things on the news and different promotions on various networks for it, but I have never been to a full fledge celebration.

Here in South Sudan, it is a different story. It is a holiday here. South Sudan takes the day off to celebrate its women. This surprised me. South Sudan is not the most progressive on women's rights and the women movement overall, but there are moments where you can see the society does have value for the women. It is also a day that lets society take note of the issues that women still face.

I met my colleagues at the CMMB office here in Yambio and then we piled, squished, and crammed ourselves into the vehicles that would take us the hour drive to Gangura. Initially, the office had thought that only 7 people would go to the celebration but many more than that joined. We barely fit in the two vehicles we had for transport. But we did.

            We took the "shorter" route to get to Gangura, a smaller village in WES. This route takes about an hour less than the normal route but the road is not in the best shape. However, I loved the route and the road. You need a vehicle that handle the rough roads and the constant shifting of gears but we were truly in the bush, passing small villages and huts along the way. The road is barely passable in a few areas, and would be much harder in the rain season, but this was the route that the convoy for the celebration chose to take.

We arrived in Gangura late. No shock as I think we are late a lot. But the good thing was, everyone else was late and we were not ready to start the celebration yet anyways. While several people set up booths for immunizations, GBV information, and other services offered by the NGOs represented during the celebration, I wandered through the stands of foods and different wares. There was clothing, reusable feminine pads, and sheets and clothes with decorative patters sewn in them. I made a few purchases and headed back to the celebration area.

There were chairs for the NGO partners, military, government, and other officials on one side. On the other side there were chairs and places for the women, men, and children that came to participate in the celebration. There were over 100 women there. There were lots of children, especially younger girls, among the crowd as well. It is good to see the younger crowd, and even better that they had a voice and representation for the celebration.

The celebration started with cheering and shouts, and a parade while the officials and the guest of honor paraded in with many women. There were opening remarks, discussions in both Zande and English, requests for a better road, and for other support, a speech by a teenage female against child brides, dancing, and singing.

The celebration lasted 4 hours. It was long and it was hot but it was good to be a part of. After the celebration I walked for a while around the different vendors and chatted with a few people. I also looked around a bit at the different parts of the village that were nearby to where the celebration was.

After we all piled back into our vehicles. The ride home we took the longer route, which took about 2 hours to drive home on. It is much smoother but it was long. We stopped along the road which I was grateful for, so I could stretch my legs and un-squish from the car. It rained along the way and was interesting to see how driving changes when it rains.

All-in-all it was an interesting day. It was good to get out and see what the celebration was like here. I also enjoyed getting to see another part of WES. It was a very good day and one I am glad I got to be a part of.

These are a few of my favorite things...

Alright, so I am on the mend from malaria. At least I pray I am. I have been back to work this week. The first part of the week I was pretty exhausted during the day and needed to sleep early. By Thursday I walked to work and walked back from the clinic. This is a good sign. I am happy I am getting back to feeling normal.

So, in the spirit of being happy I want to talk about some of the things that I love about South Sudan. I want to say that I really do like being in South Sudan. I am loving my time here. Don't get me wrong, it is challenging and heartbreaking but I love the opportunity I have been given. I feel very fortunate to be doing what I am doing.

A list of a few of my favorite things:

- The dry hot weather (surprising for me)

- The beauty of the environment here- the trees and vegetation

- The beautiful clothing the women wear

- The sense of community, especially from the women

- The NGO community

- The wild and fun drives

- The kids

Maybe one of the most surprising thing to me was how much I enjoyed the hot dry heat when I got here. I sweated a lot, I am not going to lie, and I didn't want to be out in direct sunshine for long amounts of time but I really enjoyed the weather, especially now that the humid air is here. But sitting under a mango tree in the shade during mid-day is special. I actually really liked it. 

The environment here is beautiful. Along with the weather right now it is still really dry. Rain is coming and when it does rain the earth smells amazing. I like the different types of trees and other flora and fauna here. I like watching for monkeys. I have only seen one so far. I like watching the hawks in the sky. The environment is so different than home and so enjoyable and beautiful to see.

Going along with this is the fun different drives that I get to go on, and on them I see more of the environment. I haven't seen a paved road since I left Juba in the beginning of January. Now a smooth road is one that only has 2 ruts running down it, rather than the craters that some of the roads here have. We have good vehicles so on the occasions that I get to drive down some of the rougher roads I grin like a child as we navigate the rough trek. I find it fun to go down these roads.

A fun part of being here is getting to enjoy the different clothing that the women are wearing. I like to watch the different clothing as women go about their lives. There is no one particular style. Some wear casual clothing, skirts and t-shirts, and others wear gowns. It seems that there is no set style for the women here and I quite enjoy it. I especially love all of the different colors people wear. I have gotten a few dresses made from locals here and I may buy a few more before I leave. 

Speaking of the women, I have talked on them before, but the sense of community it wonderful. I love to watch the women support each other and empower each other. It is a great sight. Additionally, as I wrote about earlier the kids here are great to. "My kids" as I affectionally call them now, greet me most days either going to or walking home from work and they are such a joy that no matter how rough a day is they make it so bright.

And the other community I really like is the community of NGO workers that I meet at the UNICEF compound. I am learning so much about what it is like to be an NGO worker and the different roles and ways that NGO workers operate. I am hearing stories from people who have lived and travelled all of the world. I am inspired and humbled and enjoying my time being a part of this community.

There is a lot of good and wonderful things in South Sudan. There is beauty and goodness. It can seem like such a harsh place because there is a lot of things that need help, but there is good. And it is the good that keeps me going through the tough days and the hard times. I really, truly like it here. I know I am lucky and am thankful for this always. I hope I can share just a bit of the good in South Sudan with anyone who reads my blog, because it really is a special place.

Admitted

*If you don't like ick don't read.*

In the early hours of Thursday morning, I am awakened by the sudden and urgent need to use the bathroom. I proceed to get sick. I spent the next 8 hours running to and from the bathroom. There is nothing left in my bowels or my stomach by the end.

Around 8:30 I sent a message to my bosses letting them know I was sick. When they asked me what was going on I told them I have been sick all morning. My one boss decided I needed to go to the clinic. I don't think I would have gone if it weren't for her. At least not at that point.

So, 2 hours later I was being picked up and brought into one of the local clinics here. It's a 24/7 clinic that does all kinds of medical care. It's not a hospital. But they were able to run tests on me. The tests are basic. But they know what they typically are looking for. I told them my symptoms and they decided on three different tests.

Within 30 minutes I had my results. Despite being on prophylactic antibiotics to prevent malaria I somehow manage to be the lucky one who got it. Medicine isn't perfect. I don't regret taking the medication and honestly it could be worse.

So, I'm definitely sick. And I'm dehydrated. I can barely get water into my stomach without having it come right back up. Forget food. But I am blessed with a midwife I work with named Vicky being my co-patient. She helps remind me I need to drink and nags me about making sure I'm eating and taking in fluids. They say medical workers make the worst patients and I totally believe that.

I get hooked up with an IV site. They then proceed to push several different medications of which I ask the names but I'm not familiar with them. That's not uncommon as many of the medications have different names in what we use in the US. Here Tylenol is called paracetamol. Anyways they push a medication for nausea that works really quickly. Finally, some relief. And then there's the antimalarial medication. 

After getting these medications I am hooked up to an IV line for fluids. I'm definitely dehydrated. I can tell you as soon as I start feeling the effects of the hydration and the other medications, I feel a significantly better. I'm not going to go running around and jumping in the air but I feel better.

So, I stay hooked up to the IV for a while letting it run. There are no pumps here so it's running to gravity and being titrated by the little knob. Tape is used to keep my IV line in place. It's a much different IV line than the ones we have in the US. There are no alcohol swabs to clean between medications. There are no flushes either.

At one point when they were drawing up the antimalarial medication, they are using ampules. You have to break the glass of the ampule to drop the medication. When they break it, the glass goes flying and a piece lands on my neck. Thankfully it doesn't cut me but it's still frustrating. And of course, there are no filter straws so they draw the medication up with a regular needle. It's not what we do in the US but it's what they have here so it's better than nothing. 

Once the IV is done running I feel up to walking to the bathroom. My stomach is still upset but nothing like it was earlier. However, I still don't have a desire to eat. I've tried to eat bites of bread but it's hard. I want nothing more than to lay here. But Vicky encourages me to try some tea and to keep drinking my water which has electrolytes and rehydration salts in it.

Like I said earlier Vicky is my co patient. What that means here she is the one who helps make sure I have things like bedding which they typically don't supply though I was fortunate that they had a sheet that I could lay on. She also makes sure I get food and helps me with other things. There are one to two medical professionals running the entire clinic. There's not enough staff or resources to treat the patients like we do in the US.

I nap on and off for the afternoon. A bunch of my co-workers stop by to check in and see how I'm doing. A couple call and to check on me that way. Everyone wishes me a speedy recovery. I feel silly having gotten Malaria even though many people have gotten it since I've been here. There is a brief debate of moving me to Nzara for more care. But I don't feel like I'm up to the drive and okay here as things are. If for some reason I start to get worse I will go there.

I head back to my apartment when it's apparent that I'm going to have to spend the night in the clinic. As previously stated, there's not a lot here. Just a bed. So, I go home and grab my mosquito net, shower, gather clothes and some food. I decided to skip on a pillow. I have sweatshirt in case I get cold and that I will uses a pillow. 

By the time I return to the clinic I am tired. I have started to feel nauseous again and feel worn out. I try and sip some water. I rest and make my bed, except the mosquito net because there are no sticks to pull it up with Vicky has yet to come so I am just hanging out until she arrives which gives me the perfect amount of time to make a nap.

Staff come in to check on me and I doze on and off. Vicky comes back. She can tell I'm not feeling well again. She encourages more food and fluid. I try my best but I'm still struggling. Eventually I have to rush back to the bathroom because my stomach can't handle how much water I've tried to drink. It really wasn't that much but I still am struggling. 

When I return, I tell Vicky that I have once more gotten sick. She advocates for me with the medical team and they decide to hang some extra fluids and some medication for the nausea. The dehydration is a bad side effect. I mean I know I'm still fine. I am only slightly dehydrated but it makes you feel horrible. It's hotter tonight than it was in the morning and I'm also starting to sweat which is making it not as good.

Eventually the care team comes in to hook me up to the IVs and give me more medication. I have been dozing on and off. We joke that I won't be able to sleep at night but I know that's not true. My body is tired and weak and still wants to sleep. So, I rest on and off and half lucidly answered questions. I say goodbye to the daytime care team as they head out for the night and I start to sleep again.

Around midnight I am awakened when new medical personnel come in to give me my next round of medication and another IV. She efficiently adjusts and checks my IV line and provides me with the medication. I'm sure she spoke to me a few times but I have no idea what we discussed. I am definitely exhausted. After she gives me the medications I go back to sleep.

I awake early in the morning. My stomach feels better but not 100%. I am still sick but I feel stronger. I have a slight hunger which is a good sign. And I'm thirsty which I also think is a good sign. My body is still showing signs that it's fighting off this stupid parasite. I make my way to the bathrooms here and start my morning slowly.

When I arrived back to the room Veronica, my boss, is there waiting for me. She brought me some bread and tea. I'm actually feeling up to drinking the tea and eating the bread so that's good. She wanted to check in on me. All day Thursday people from work had come by to see me or had called. On Friday less people came by but I still got some phone calls. And I was okay with that. It was nice to know they cared.

I ate and drink I was able to keep that down. We waited for the care team to round. I was given the go ahead to go back to my apartment until my next injection. We hung out for a little while we waited for the ride. I was brought back to my compound.

The cleaning crew had already started to take care of cleaning my room so any idea of resting was not possible. I was grateful to be back home and to be able to use my own bathroom though. And deciding that I felt that I could try and eat some breakfast I headed to the cafeteria to get food. I actually ate everything and felt good.

While I waited for the time to be for my next injection I worked on some work. I can sit on my veranda and do work. Mostly it consisted of sending emails and answering a few phone calls. I wouldn't say I worked super hard on Friday. Then I made my call to go back to the clinic.

When I get back to the clinic I am brought back to my room where I waited for my next injection. It wasn't a long wait. The clinician is prompt and friendly. The rest of my test results were normal so it seems that it's just the malaria making me sick. He gave me my injection and we chatted briefly.

With the IV injections done I have to be on medication for the next three days. Fortunately, it's all oral medication so that's good. As long as I see progress and stay hydrated, I hope I will not have to come back to the clinic. I am feeling hopeful and saying prayers of gratitude. Malaria can be pretty serious. I am grateful that it wasn't worse and I pray that I continue to get better.

***

The remainder of Friday and Saturday is spent mostly in bed. I am tired and weak. I attempt to eat but plain food is all I can manage. I sleep a lot, going to bed early and sleeping in late. On Saturday I start to feel a bit better, managing some laundry and some other things in my apartment. But I am still moving slow and feeling off.

Sunday, I wake up feeling hungry. I take this as a good sign. I wander to the cafeteria to get breakfast and manage to eat everything. I still feel off and tired but I have a bit more energy. I don’t want to wander too far from my compound but I am up to a bit more stuff. I need to clean and organize my room and go through some things. Little things on Sunday seems like a good plan.

***

Fun fact that I can't remember if I've talked about before but they don't have Western toilets in much of Africa. They have squat potties. If you've never seen one go ahead and Google it. It's an interesting experience. Fortunately, I've used them before getting sick. That's all the hospitals and the clinics here have. It's not the most pleasant experience when you're sick. One of the best parts of going back to my apartment was my bathroom. And the air conditioner. And my bed.

Another fun fact is that throughout my time in the clinic people kept coming in and checking on and talking with Vicky. The idea of patient privacy is something very different here. So, everyone knew I had malaria. And a few of them even made the comment that they wanted me sent to Juba or somewhere else in case something happened to me. I don't think I was ever that sick. However, they were concerned that if something happened to the Khawaja that it would look bad for the Yambio.

People do seem to genuinely care as well. People checked on me day and night, even those who didn't know me but were co-patients to others. It is a different sense of community in that way. Something I have never seen in the US.

Also, the bill was very cheap, under $100 for everything!

While I wish I hadn't gotten sick, I know my experience could have been so much worse.

Maternity Nurse I am not

Maternity is an area I have never been interested in. Whenever someone said to me they didn't know how I could be a psychiatric nurse, I would joke back and say I don't know how people can be Labor and Delivery nurses. Now I have been thrust straight at maternity. It is a whole different work than the psychiatric departments I am used to. I serve two different maternity units in two different counties, for their mental health education and other mental health needs.

Nope I do not think they will make a L&D nurse out of me yet. However, I am finding the work a little more interesting than I thought. I think part of that is due to the fact that I want to be doing something clinical and at least when I am in the L&D unit here, I am closer to being clinical. But no, I am not delivering babies. I have watched many deliveries now, which has been pretty amazing.

I am interested in learning more about their work in maternity and doing more on the clinical side of things, but not the actual deliveries themselves. I have begun to ask them for things that I can do to help. Most of them do not want to ask me to assist. I am unsure why. However, with the help of Taban, my midwife friend, one or two of the other midwives have begun to give me little things to do.

The other day we worked on cleaning the unit. It is very dirty, literally. Because of all of the dust that comes in from the open windows and doors and the fact that dust is everywhere here, things get dirty quickly and then the layers build up. So, we worked on cleaning the unit a bit more thoroughly and identifying where there are some needs and where more work should be done.

Another day one of the midwives asked me to help hang IVs. The first was relatively easy. It was one that was just open to gravity as a fluid bolus for hypotension. Simple to do but it was still new to me. IV sites look different than what I am used to in the US. They do not have the ability to flush lines here so there is none of that. And there are no pumps so everything is calculated and then done by hand. So, my second IV that I hung was not just done to gravity but had to be titrated by hand to run at 60 drops a minute. Not as easy as it sounds, and even though I did it in nursing school, it still took me some time to get adjusted.

I already mentioned the dirty unit, well it is a complicated matter. Sometimes supplies are limited. Sometimes water is limited. Sometimes people bring in things like dead chickens into the unit. I cringe when I saw that one and wanted to shoo the person away but thankfully, he left shortly after. There are toddlers covered in dirt wandering around. It hard to keep the place clean, especially in Yambio's PCHH where they are completely open to the public and have no way to limit who walks in or out of the facility.

In an earlier post I wrote about how I look forward to Fridays because I get to go to Nzara. However, this Friday there was an issue going due to lack of a vehicle so I ended up spending the day in the maternity unit in Yambio. We scrubbed the unit down completely: walls, floors, furniture. Everything we could. It took a large team and still took us a while. I wish I could show all of the dirt and filth we got cleaned. It is great, but by the end of the day dirt and trash have started to creep back in.

In Nzara there is a guard at one gate of the facility and it seems that less people wander in and out there. However, I don't spend as much time there as I do other places so maybe I am just not seeing things. Nzara's unit is bigger and seems cleaner. However, it is also built differently, higher from the ground and therefore the wind cannot kick up as much dust, and people are not permitted to wear shoes in the clinic unless they are workers. When they tried that in Yambio people's shoes were stolen. There is no easy answer to keeping the unit clean but there are suggestions and things being worked on so let us hope for progress.

There is a general lack of resources in the hospitals here, and in maternity it can mean some very challenging situations. One of the first ones I was told about was the fact that it is not uncommon for the unit to run out of gloves. Most times it is a matter of calling whoever has the storage room key to get more but sometimes there are simply no more gloves. That means IVs are placed without gloves, and babies are delivered without gloves. I cringe at the thought, but what are they supposed to do? The baby has to be delivered so no gloves it is.

Other times the lack of resources comes in the form of light and electricity. There are nights, I have been told, when the generator and solar power was not enough for the night so mothers labor in the dark. Babies are born and delivered by the light of a battery powered light or by the light of a cellphone flashlight. Other times the midwives rely on a headlamp to deliver a baby. Electricity can be scarce.

It also means that when it comes to getting ultrasounds for the expectant mothers a decision must be made. Is better to scan more women who come in for an ultrasound and risk not having light for nighttime deliveries and possible emergencies or do they conserve electricity? This is a daily discussion. An ultrasound could diagnose a potential problem, but could it wait until the next morning when the battery has more time to charge and less chance of draining the little that is left for the night. I don't know how they choose but they have to.

Sometimes the lack of resources comes in the form of having basic items, similar to the gloves. Medicine is not always available or runs out at the clinic. At those times the staff will send the co-patient to a pharmacy to purchase the needed medication for the patient. Sometimes there is no ability to make a phone call to Nzara from Yambio to tell them of an incoming emergency the Yambio PHCC is sending to Nzara's Hospital because it cannot be handled in Yambio. Supplies are conserved and used carefully, and things are repurposed, like IV fluid lines cut and used to hang other IVs. You have to think before you use something here, not the careless waste of supplies in the US hospitals.

Like I said earlier, I am no maternity or L&D nurse but I do see a purpose to me being in the maternity unit, though it can be hard to acknowledge at times. Over the past two weeks I have watched the staff, particularly the midwives, become more and more frustrated and stressed in their work. There are conflicts here, especially between different disciplines and ways of practicing medicine. This happens in the US too. But I am watching the staff struggle and watching as people become increasingly stressed and frustrated.

So, this presents an opportunity for me to try and help. I have spoken with management and doctors at both Nzara and Yambio to try and provide support for the staff in the form of different mental health improvement opportunities. I want to start a group or at least have a few debriefing and discussion sessions with staff. There have been several challenging deaths of mothers, and several fetal and infant deaths since I have come. This is not new but I have been alerted that there are some staff that are struggling with this. That is expected, so if I can help then that is good.

I am hoping to have several opportunities to teach the staff about ways they can help each other and help themselves. I want to work with them on self-care and stress management. I want to work with staff of debriefing and discussion situations in constructive, productive, and therapeutic ways, especially the challenging cases. I hope that I will be able to encourage the staff to do what they need to do to better take care of themselves and to deal better with the heartbreaking work that they sometimes face.

Soon rain season will be here and I am warned that the number of deaths will increase and so will the potential issues for patients, families, and staff along with this. I can try and help them prepare and better face the challenges and struggles. I have plans on how to help and am starting those discussions now, but I am sure more challenges will arise. However, I am glad that the management and teams are willing to discuss the situations and proposed ways I can help. Over the next few weeks, we will see how I am able to actually do these things. We shall see...

The Women of WES

I am forever astounded by the women here is Western Equatoria State (WES). There is an incredible community of women within WES. No matter if I am in Nzara, Yambio, or another area altogether the women here continue to impress me. In honor of March and Women's Day approaching here are some of my thoughts on the women here.

While on the front of things it seems like men run things here it is very clear that women run many things from behind the scenes. Women make sure that the children are raised well, food is prepared, laundry done, homes made and maintained, and when needed or when they choose, they work as well.

Women run things and enable the men of this country to do what they choose to do. Maybe the women do not realize the power and potential they have in this. Many men, from what I see, rely on the women to meet their basic necessities. Perhaps if more of the women were able to band together, they would do more to improve the society here. I think if women understood just how much power and potential, they have South Sudan would be in a different place, a more positive place.

Okay so let's talk about some of the random observations I have made about the women here...

One of the first comes from when I was privileged enough to meet with one of the women's groups. These are formal groups run by different women in the community. They get together and each work on raising money for each other. The money they give to another woman in their group then is used by that woman to do things like start her own business so she can get funds for herself or her family.

The women's group also is a place where the women can talk and can share with each other. They provide support for each other. They also can teach each other new skills. The women's group is an incredible place and one where you can see the network and strength that the women have. They engage and participate with each other and support each other in ways that would make their lives significantly more challenging if they did not.

I really enjoyed my time with the women's group. While I don't think I should join the group while I am here, as I don't feel that would be beneficial, I do hope to work with them. I think I have already blogged about them and this idea a little but I truly think that the women's group is an amazing resource and has wonderful potential for so many different things here.

Many women here are mothers and housewives. I am sure this is not an easy job. As much as I thought I would want to do something like this when I was much younger, I can say I would not be happy doing that now. I am happy I have the option not to do that. Many women here are not given the option or opportunity to choose to do anything other than be a wife and mother. And there is so much work that goes along with the role wife and mother.

Those that do move beyond those roles also are inspiring. Even when a woman gets a job outside the home, she is still expected to maintain the traditional roles. This may be the case at times as well in the US but given the extra burdens here, like hand washing clothes and cooking over a fire, the role is even more demanding. So, women who take a job outside the home often shoulder the traditional role along with anything they do for work. How they find the time to do it all I do not know but that they are stressed and overworked I do not doubt.

One of the ways I see women juggle the role of wife, mother, and employee is when I am at the maternity clinic. Several of the women I work with there have young children, several under 1 years, and other's toddlers. It is not uncommon to see one of these women with their child in a wrap, tied to the mother, on her back, as she works. It was a bizarre sight when I was in with one of these women and she had her son on her back and she was busy delivering a baby. Ideally, having a small child in the clinic is not great but this is how women balance working and being mothers.

Even the women who come to deliver at the clinic or come in as patients, often bring their children in with them so that they can attempt to look after them, until a family or community member can help. The balancing act that exists as a woman and her various roles is amazing to watch. I am glad that I do not have this challenge. I do not think, at this point in my life, I could rise to the demands that these women face with the grace they do.

Speaking of maternity and the role as mother, I am impressed with all of my post-partum mothers that I work with. The women seem to bounce back from their deliveries quickly. After a woman delivers here it seems like she goes home within a day and then quickly returns to her "duties". I have watched women here cradle their newborns on the back of a motorcycle as they travel home, just hours after delivery (thankfully most women here sit side-saddle on the motorcycles so I hope their pain is less traveling this way, but still) (also, I am impressed when they can sit sideways on a motorcycle down these rough roads-no thank you).

There are several activities and actions that women take that I have observed that the women do that I think are absolutely incredible. The first is the women's ability to balance objects on their heads. I have long tried to learn how to balance things on my head and walk. I am not great at it. But here I watch women walk long distances with buckets full of rice or beans, on their heads.

They can carry so much this way, and they make it look so effortless while they gracefully transverse down the road. Sometimes they even have a child on their back and are leading another one by the hand. Young girls, and some boys, are taught how to carry things on their heads as well. It is always interesting to watch them walk, but their grace not as fluid as the older women.

Another thing that has been fascinating to watch is how the women do laundry here. Now this probably sounds weird, or you have started to picture women down at a river with a rock washing clothes. Nope. Not here. Sure maybe a few people wash clothes like that, but that is not what I am talking about. But the women do wash the clothes by hand and it takes skill and effort.

I have sat and watched and tried to learn how they wash the clothes and get them so clean and nice. I do not get it but I can tell you it certainly is a lot of work. I am grateful most of my wash is done for me here, as part of my arrangement at my compound. I wash just personal items so this is relatively easy, except my socks. I still have no clue how to get the socks clean. They are stained red and orange from the dirt.

I hope to pick up on the skills and have chatted with the women a little but watching them with their various buckets of water cleaning, wringing, soaking, and rinsing the clothing I remain in awe. I am lucky. And I am grateful to the women who I know was my clothes. After they are cleaned, they are then ironed, something I dislike even more than the washing part.

I don't often know how I can help support the women of WES. I know I want to do education and promote maternal and women's mental health, and by doing this I am supporting them some. Sometimes it does not feel like enough. There is only so much I can do. So, since I am limited, one of the ways I try and help is by buying mostly from the women at the market. The money may go back to a man, especially if they are married, but I hope by doing my best to support the women who are selling their good there that I am able to do something a little more for the women.

I continue to be impressed and I believe I will see and learn more from these women over the next few months, and I hope beyond. They are truly amazing and have so much potential to grow and improve this country. I look forwards to learning more from the women as I am here, and hope to help them a little along the way.