Nurse take care of thy self!

Self-care is a big part of my work here, especially with mental health treatment. Since using medication for many of my cases isn't realistic, I like to teach self-care. Many times, when I am counseling someone, I focus on self-care and self-empowerment.

However, here in South Sudan self-care is so much different than it is back home. I have to educate my clients about realistic self-care for themselves. They have limited access to so many things, so advising someone to book a massage, or take a hot shower, or do something as simple as taking time to read an enjoyable book, are not realistic here. Not much access to these things in my area.

Along with my work I have to practice my own self-care. Here my personal self-care also looks much different than it did in the US. I try to make sure I do a "self-care" day once a month. That is usually a day I do a face mask (I brought a few of those along with me) and soak my feet in a bucket of hot water. I nap and relax and give myself a day to do absolutely nothing. Lately my self-care time has come when I am getting over being sick so I feel a bit better.

But I have to do other forms of self-care regularly. On the weekends I like to go for walks. I usually go in the morning so that I am not out when it gets very warm, especially mid-day. Also, on the weekends I sometimes go to the UNMISS compound near me where they have a restaurant that serves more American style meals. No, they don't taste like home but they do taste good.

Self-care takes a lot of practice and more consideration and effort here I believe, than it does in the US. You have to be a lot more deliberate in choosing to do self-care and what it is that you are doing. With more limited resources self-care is a conscious act. That can be good because it means I am more mindful of making sure I am taking care of myself.

I am fortunate because I know what things work better for me when I do self-care. I know that walking is one of the best ways I can help myself when I am upset. I also have access to music I like when I am unable to go for walks. Harder self-care to participate in is doing things like taking time to read during the week, and just sitting out and enjoying the environment around me.

Working in a harsher environment with all sorts of new stresses is chaotic most weeks. When I first came to South Sudan, I struggled more with figuring out how to really practice self-care and how to adapt but I picked a few things and gave myself goals which helped me. I practiced at different self-care activities. There have been plenty of days that I didn't want to do things but pushing myself at times has put me in a better mindset here. I guess that just goes to show why self-care works.

 

Tindoka Graduation

So, last week I posted a blog about the poverty here and I think I may not have been clear about the poverty here and the homelessness. There are homeless people, but I see them more infrequently than I do in the US. I think part of this is because, to some extent, families take care of people, even if the person would normally be homeless in other countries. Maybe I am just not seeing the extent of homelessness. I am not sure.

That being said, there are still homeless people here. More than that, though, I think I need to talk about the street kids. I read a book before leaving the US called "Now I am Known" which is about a guy who grew up a street kid in Uganda until one gentleman took interest in him and invested in his future by sending him to school. From there he was able to lead a productive, positive life. If you have not read the book, I highly encourage it. The book is great and the author is very down to earth and funny. I follow him on IG and have written him before and he has written back.

Anyways, there are street kids here. It seems like street kids are more prevalent than homeless adults. I am unsure of exactly why this is, but it seems to be a more common reality, or obvious reality in Eastern Africa. These kids run the streets, steal, sell drugs, and engage in other dangerous and illegal activities. Most of the kids who grow up on the street either die by a young age, or they turn into full fledge criminals, who die in early adulthood or end up in jail.

There often seems like there is little hope for these children. Sometimes the reason they end up on the street because they are displaced children, because their families are too poor to care for them, or because they have run away from home. These are just some reasons.  Also, here people have many children due to the fact that so many die at an early age, because it is seen as the way to show what it means to be a true husband and wife (producing many children is seen as a status of higher being), and due to lack of birth control and sex education that exist here. It is complicated to understand why people who live in poverty or without much money keep having large families but it is the way it is here, as of now.

On Monday I went with a group of CMMB colleagues to Tindoka Vocational Training Institute. I believe I have written about this place before but it is the place that takes the CAAFAG (Child soldiers), IDP (Internally Displaced Persons- in this case children), and several children with disabilities (including one in a wheelchair and one who is deaf). Monday we were celebrating that 50 of these children graduated from the training institute. They graduated in trades such as tailoring, plumbing, electrical, carpentry, and metal working. They have spent the last 6 months doing the training.

Watching them graduate was pretty touching and motivational. They spoke of being street kids and heading towards being criminals but now were given positive tools for the future. I may have cried a little when the kid in a wheelchair graduated and all of his family cheered for him. Even in the US people with disabilities are not given appropriate opportunities, but this young man has a chance for a better, more meaningful and productive life. Here opportunities are limited for many people, so the fact that there were several people with various handicaps included in the program shows progress.

Watching these young men and women, who were dealt very harsh and heartbreaking childhoods, have a better chance for a good future is wonderful. The Tindoka VTI is funded and run by NGOs, particularly CMMB, but also WFP and others who help provide some funding and food to keep these children in the program and give them the literal tools to do the trade work. More programs like this should exist and there are certainly others, but I hope that in the future even more are created. Not all of the children here are able to go to traditional schools, but getting to be involved in these trade schools help the children end that cycle of poverty and be productive, positive members of society.

Check your ego at the door

 

I am not a savior. I am not a hero. I am not here to rescue or save the people here in South Sudan. I am here to try and help. I am here to try and serve the community and serve the people in it. I am here to try and provide a service that is in need in the area, and to try and teach a few people here to also use this skill I have so that when I leave, the work that I am trying to help with, does not stop.

I did not choose to come to South Sudan to "earn a spot in heaven" or other such phrases that people say to me to express that they are proud of the work I am doing or impressed by it. While I appreciate the sentiment sometimes, I think that people put too much emphasis on the service I am trying to by making it to be some larger act. I am proud of the work I do but it is not to make myself better, at least like that. I am here to learn and help.

It is easy here, or serving in many of the underserved and undeveloped communities and countries, to get a feeling of superiority, especially of a "white savior" complex when people only see your acts of some higher act of superior knowledge and being. I know I have knowledge and skills that are very much needed here. I know the work I am doing and what I am teaching needs to be done to make improvements. I know I can help.

But sometimes you have to step back and remember you are one person. You are not going to save the world. You are not a hero here. You are simply trying to help. Trying to make small improvements. And sometime your ego and hubris get too big, and you feel too important and you have to remind yourself of your place.

I am proud of my work. I am endlessly grateful for the work I am getting to do. I am excited and want to teach and help. I want to make a difference. I am hoping I will be able to make a difference when my time here is done. But this work is done side beside others, with others. I cannot do this work alone. I will continue to do what work I can, and hope that I remember that I am just one person trying to help, and trying to learn whatever I can, in that process.

Prevalence of Poverty

 

On Monday I am awaked before 6am by the sound of crashing thunder and the heavy thwacks of rain on the tin roof of my apartment building. The storms are coming more often these days. Sometimes we get 2 or 3 in a day. On Tuesday the later in the day storm offers some relief in the heat. It is still warm for me.

My co-workers bundle in their heavier coats. Sometimes I see people in the community wearing heavy "winter" coats here when the temperatures dip into the low 90s or high 80s. People ask me if I am cold. I laugh usually. I have rarely been cold since coming to South Sudan. I think the only time I am cold is when I have the AC on and I am tired. Even then you won't find me with longs sleeves on. The only times I have worn long sleeves is when I am trying to hid from the swarms of mosquitos.

I am endlessly blessed here. Now, don't get me wrong, I still complain of things and miss the comforts and luxuries of life back in the US. But I also acknowledge there is a certain beauty and joy in living without so many material possessions. There are things that I would like from home, like a pair of shorts, and an Incentive Spirometer for a patient of mine, but most of the “things" of life at home I miss less than I thought I would. I miss food from home. And of course, my family and friends there. And my dog too! But I have all that I realistically need here, and more because I have things like easy access to internet, electricity, running water, indoor plumbing, and my AC.

But out in the community we come face to face with real poverty. I have seen poverty in the US.  I have seen the tent cities that are nestled in different bigger cities, like in D.C. But, despite that certainly being poverty, it does not prepare you for the poverty that we experience and see here. Poverty here is so different than what it is in the US. We have soup kitchens and programs that help provide housing and food and food stamps and other things to our communities at home. No this does not mean that this isn't poverty, but the poverty here is so different.

With how spread-out communities are, lack of technology, lack of access to roads, money, food, or transportation poverty takes on a whole new level. People dress in rags, some dirty, others clean but faded through due to so many washings. People are thin and struggle to make enough to feed themselves or their children. In the bigger villages like Yambio or Nzara poverty looks different than it does in the bush. In these larger villages there are ways for people to access services of NGOs to get some needs met.

In the bush that is different. Access to anything you don't produce with your own hands is limited. Trucks that show up with supplies at seemingly random times impacts the access someone might have to things like a mosquito net, which is essential in trying to slowdown and prevent the spread of malaria. The clinics for healthcare are few and far between. Many women deliver babies at home because they do not have easy access to a facility to do it safely there.

Some of the bush communities, and villages in general, have boreholes thanks to NGOs. Hopefully these work and their women, children, and sometimes men, pump the water they will use to cook, clean, and bathe with. Lots of pumping, and carrying of jugs of water happen. Hopefully the community has a working borehole, or the water used is dirty and often contaminated. The water in the boreholes certainly isn't to the level of clean in the US but that water helps prevent infections, sickness, and death that come from drinking the water in streams and puddles here.

Homes are different here too. It is not uncommon for the floor of a home to be a packed dirt. The walls made of homemade bricks fired in homemade kilns near the site of the home. One room homes that will shelter from the weather, animals, and other people. The compounds families live in are open and have different buildings on them like outdoor wash areas for showering and outdoor bathrooms. There is no running water. Then there are cook houses where meals are made on charcoal and wood fires. People who have more money have better floors, steel doors, ceramic bathroom floors, windows that have actual glass in them,

The roof of homes here are made with thatched grasses. They have an ability to weave the grasses in a way that keeps the rain out during the heavy storms. I have watched them build the thatched roofs and make bricks and it is pretty impressive work. A roof that is built correctly can last 3-5 years before needed to be replaced. People with more money have tin roofs that can last much longer before needed to be replaced.

People cannot afford healthcare costs here so clinics are run by donor funding by NGOs like CMMB which provide free or low-cost care to people. There are clinics here that people pay to go to certainly. But others, like some of the labor clinics provide free services so women have a chance to deliver their babies in a safer environment with trained medical staff, rather than at home unattended or unassisted. This helps when many times people cannot afford to pay for basic medical care. There are different types of clinics and facilities funded by different organizations to help combat the poverty here. Some focus on nutrition, others on medical care.

It is hard to properly describe what poverty looks like here. You won't see many homeless people because the culture does not support homelessness, meaning that people live with someone even when there isn't money for it, because of duty or obligation to family members or friends. Certainly, there are some and there are still those homes that are put together with tarps and sticks and mud and are the "more traditional" photographed or displayed forms of poverty in developing countries but poverty looks different and feels different here. But the "look" of poverty is different and sometimes it is more of a "feeling" of knowing that the person does not have the means for certain things and the knowledge that that person may not have the means to get food or that their home is deteriorating.

Not only does poverty look different here. Instead of poverty being an exception in life, here poverty is the normative to life. People remain in the cycle of poverty for generations. Finding people who are weather or, more likely, simply not living in poverty is rare. Saving money is rate. When someone gets money it is used to sustain life ad keep death a bay, not to dig one’s way from poverty.

I am not certain how to describe it or show it in a picture that wouldn't be totally cliché and unrealistic. It is something experienced in waves of understanding and through the actual interaction with the community and with those people who struggle with it daily. And poverty is different here than in the capital region. Poverty takes shape and presents itself differently, but no matter where you go here, there is poverty. But there is also hope for things to come, like the flower that grows in the crack of a stone or a tree that grows on a rock ledge. There is hope for the future and potential for people to get help, but first one has to look at and acknowledge the poverty here and find constructive, lasting ways to help.

A Bug's Life

Alrighty, in at least 2 of my previous blog posts, I have referenced how I have made friends with the dirt, or at least made peace with it. There is no fighting the dirt and dust here. Only quiet acceptance that it is part of life. On the other hand, I am not making friends with the bugs here and I have no intention of making friends with them.

Certainly, there are the bugs that are awesome to look at and different than the ones we have at home. Even the ones that are similar to the ones at home, that look interesting and are not dangerous, are fine. I enjoy watching the different butterflies and moths that float around the air. The butterflies here are much harder to catch a picture of than those at home. I even accept the moths that sometimes manage to get into my room, though they are promptly escorted out when I am able to catch them.

I have been fascinated by the different crickets that are here. There is a cricket that has spots on it that I find very pretty. Then there are the ones that look like leaves. They are very interesting to look at. I find them randomly different places. There are the crickets that look like very large grass hoppers. They are fun to chase around and try and grab pictures of. Sometimes at night their chirping is annoying, but overall, I don't mind any of the different crickets.

I have found other interesting bugs since coming to Africa. Again, they may be found in the US but they have been pretty cool to spot here. I found the very small, about the size of a quarter, praying mantis one day while I was sitting on my veranda. I also found a stick bug on the veranda wall of a hotel room I was staying at in Uganda. These bugs were pleasant to watch and take photos of.

On the other hand, there are the bugs that I wish I saw less of. One of the biggest (though physically small) bugs I absolutely hate seeing and hearing is, of course, the mosquitos here. I have already had malaria (you should know that if you've been reading these) and that was before rain season. Now that there is more rain and therefore many more breeding grounds for these obnoxious bugs, there are so many more mosquitos. I layer on the DEET repellant and wear layers of clothing, if possible, but mostly I pray. I don't want bites, and I REALLY don't want malaria again.

Other bugs I have come across frequently are cockroaches. I hate them. They are gross and all over and you shouldn't kill them inside your home because they often have eggs inside that, when you kill them, end up spreading and hatching in the house. I had one land on me when I was showering one day and I didn't scream (I am proud of myself for this) but it was gross. However, if I get up at night for any reason, I have to make sure I use lights to get around my room and bathroom because I never know if or where a cockroach might be.

There are not many but there is no stopping them from finding a way in. We try to stop them, spray and clean the rooms, but they find their way in regardless. Plus, any time you use a latrine here (which is the only bathroom option most places here) you will inevitably find a cockroach. Get used to it, but do not make peace with them. I now know more places to expect them which helps me not be bothered when I see them, which is good.

Thankfully I sleep under a net every night. I tuck my net around the edges of the mattress I sleep on. I try not to pull it from under it if I can, and then I pray and hope it keeps all the bugs out of my sleeping area. There is no way to make my room completely bug proof. They get in. And even my net has a few small holes and patch areas in it. But it seems to do its job most of the time. I check before sleep that I am safely enclosed in my net (like I am camping) before I sleep.

Another fun bug experience here is that when the rains first started there was a mass hatching of bugs. It was very weird to experience. It seemed like there were geysers of bugs shooting out of the ground and then these little white bugs were flying through the air everywhere. There were swarms of them. Then 24 hours later they had shed their wings and were crawling on the ground. There was a fine layer of wings everywhere on the ground. In the darkness, when bits of light hit them, they even sparkled.

There are so many different bugs here. There are these red cotton bugs that live near some of the cotton trees here. There are many types of ants. Some are able to be eaten. Others are small and annoying but harmless. Those ones are fun to watch when they swarm something that they use for food, carry it off, and then completely disappear. Then there are the ants that bite and sting and form ant bridges. I don't like these ones.

It has been an interesting experience with all of the bugs and little critters I have come across here. There are more than I have mentioned but these are the ones I seem to come in contact with most. And while I have not made peace with these bugs, I have accepted that they are a part of the life here so I have to have a plan for dealing with them, whether it is a plan on how to get them out of my room, spraying my room or myself with bug repellant, or how to just plain avoid them. It is all part of the adventure here!

Another week done

I have been sick for the better part of two weeks. I am on the mend. Now before you start to worry about me, I picked up a parasite somewhere along the way, and thankfully I work with a group of medical professionals. I just go into work, tell them my symptoms (I went to the clinic and did quick bloodwork just to make sure no malaria), and then my colleagues tell me what medications I need to get. When I told one of the doctors I work with I was sick, he asked my symptoms then asked if I have ever been to Africa before. When I tell him "no" he kind of chuckles and tells me that it is no surprise I am sick. I am in a very new environment. But he makes sure I got my medications and am feeling better, but also reassures me that this is an unfortunate but realistic part of living here. And I am feeling so much better now.

But work has been slow. Part of that is because I was sick and wasn't feeling up to doing as much as I normally do during the week. Part of that is because this is the week after a major holiday here in South Sudan (Easter is a 4-day holiday here) and many of my colleagues are traveling or are out of the office, so work is a little on the slow side.

Easter here was quiet for me. I went to the 7am church service at the Catholic mass. There were many people there, at least 1000 I suspect. I sat outside on the edge of the borehole pump structure because there were no spots inside the large open church. Mass lasted 2 hours, was in English, and was very well done. There was music and decorations and lots of singing and talking. It is not the same as services at home. The sun was hot by the time services ended. I went home and spent the day just relaxing. I did video chat my family which was nice. I went to dinner at the UNMISS restaurant that night. I suspect many people had big family gatherings here with good meals.

I spent much of the week in the office trying to work on a few of the projects that I have started during my time here, in the efforts to create a mental health program here. Now that I am formally half way done with my time here I have to start planning on how I am going to leave some of my projects. I want to have an idea of how I will leave things. Being the only person whose sole focus is mental health it is challenging to acknowledge that some of my efforts may 100% fail when I leave.

But I have hope. We are starting to talk about mental health. I have colleagues come up to me and ask to talk about their mental health. Everyone here struggles with mental health. This environment is harsh and living here is a challenge. I am pleased when people come up to me and know that they need and want the help. This brings me hope.

I don't know what things will look like in a few months. I still have time to make some changes and try to help some people. I am trying. I suppose that is all any of us can do in these situations. There is no guidebook on how to conduct things. Each area, each country, each state needs something different, has different customs and history. So, while I try and research things from other regions that have programs, I have to keep in mind that some things may not work here.

I am excited for the work I have done and some of the projects I still have coming up. Things are falling into place. I am hoping that I will see more patients in the next few weeks. These past two weeks have been slow so it seems like I am seeing only a few right now. I pivot between teaching and seeing patients. Some of the clients (pediatric) that I will be working with had exams this week so they haven't had a chance to meet but I hope in the coming weeks that will change.

Anyways, I don't have much more to write on now. I should work on some teaching topics as I want to have some specific classes in the next few months to work with different areas of the community and I have some planning I want to for a few potential "easy" projects. I am hopeful for a productive next few weeks.

 

Storms

As I sit here writing this post I am in my office at work, my windows open and my fan on. My desk and computer, both of which were clean this morning, now are covered in a fine layer of dust. A wind storm abruptly swept in and blew the dust and dirt that was loose into any available space it could. A few minutes later, after listening to my door and the other metal doors of the offices near mine slam loudly, the rain starts.

The rain is thick and heavy. There is thunder and of course lightning. I could shut my office door and windows but the fresh air feels so good, it seems a shame to cut it off. Besides I enjoy listening and watching the storm. People who know me well know I love to dance in the rain and that I love a good storm. So, I am going to sit in my office, and enjoy this simple pleasure.

When I arrived in South Sudan is was the dry season. Here they only have 2 seasons: dry and rain/wet. So dry season is hot and the air is, of course, dry. So, the 104* days that stretched on and on were not as bad as they could be. The air is dusty in dry season, as there are not grasses or lush vegetation to keep the dust down, but the days are clear and sunny, and of course, warm.

The earth is very, very dry during dry season. Not much grows and finding certain foods in the market is harder during that time of the year due to the dry climate and it being out of season for certain things. Nothing holds the dust down so when a strong wind picks it up it creeps into everything. I've made peace with the dust, and that my white socks will probably never be white again.

I don't know how the livestock survive well during dry season. Packs of sheep and goats wander the town searching for food. Thankfully they seem to be good scavengers so they seem to do okay. The horse wanders to different patches of grass in the town to find his own food as well. The cattle are skinny, as they are moved to different areas to feed. Hopefully the rainy season will bring them more food.

Now it is rainy season. It started mid-March and seems to be slow in progressing. The first week or so there were several bursts of short storms almost every day. Now it seems like there are days with no storms, but then when a storm rolls in, it does not last a mere 20 minutes but for several hours.

Today the rain is feeding the dry and parched earth. It rains for several hours, eventually tapering off to something light and pleasant. There are puddles around the office, which I can mostly avoid thanks to some raised pathways. In a few hours those puddles will be gone. The wind has blown over one of the wooden fences.

For the rest of the day the sky remains grey and gloomy. I am actually grateful for this. Sometimes after it rains it becomes immediately sunny again and hot. Therefore, it hot and humid and somehow the weather is more oppressive than it was before the rain. However, today we are graced with grey skies and cool temperatures. It is only 88* here. My colleagues are all bundled up in warm coats but I am still sitting in my office with my fan on, enjoying a reprieve from the heat.

I enjoy the weather changes and I enjoy the storms. It was fun to watch the wind storm blow in and then the rain again. I am looking forward to more days of rain. Maybe one of these days I will show my colleagues what a Khawaja dancing in the rain looks like.

A very brief post

I left home 3 months ago. I have been living in South Sudan for that long. It is both challenging and rewarding being here. I have met some truly wonderful people and had some great experiences. I have also had some not so wonderful experiences.

I am happy to be back in my apartment in Yambio. I spent the last weekend in Juba and since I am not super comfortable being outside in Juba alone, I spent most of the time in the hotel. The hotel was okay but the food there isn't that good. But after a quick flight I am in my home away from home.

It was also good to go back to work after my week off. I mean I went to the Juba office Friday and did some work but this week I was able to go back and do some clinical stuff. I have some cases I am following and some other work that I am doing with my time and being on leave gave me an opportunity to brainstorm some of the things I want to do during the remainder of my time here.

The week was challenging. Not work so much but the general feelings I have over being here. When I first got here, I read a book that is supposed to help prepare someone for living overseas. One of the chapters talks about culture shock. Some people experience culture shock right away, usually on short trips.

However, other people experience culture shock later on. Particularly during longer trips or when moving someplace overseas. In my case I think I am starting to experience some of that culture shock. This is when the newness and excitement of coming to a new location wears off and more of the harsher and more negative sides comes through.

This week, and even shortly before going on R & R, it has become challenging. I won't lie and say that I am struggling a bit. I find myself getting frustrated on things that I wasn't getting annoyed by before. I am trying to remind myself to take a step back and think about things and just reflect on where I am and what I am doing. But things can be hard too and I have to acknowledge that.

Easter is coming and it is a big holiday here. I missed Palm Sunday because I was in Juba with no idea where there was a catholic church and feeling uncomfortable going there by myself. Tomorrow, I hope to make it to church. Easter feels different here. It is a big celebration here as well, but there are no Easter baskets, bunnies, or colored eggs. Church will play a big role in tomorrow’s celebration. There are small signs of Easter preparations, like food preparations.

Otherwise, I don't have much to write about now. I hope everyone has a good Easter and I hope for more to write soon.