i had been planning to take a long weekend in the interior of Guinea, in search of clean air and a repose from traffic jams. but then life spiralled downward for a wee bit there. i started brewing feelings of anxiety and borderline panic, but without any particular source. at first i thought maybe something bad had happened to someone i know, or something bad was going to happen. my colleagues insisted it was just normal fatique and need for a holiday, confirming that all MSFers start to feel really poor after three months or so. (this was kinda reassuring, yet also not at all!) i am not generally an anxious person, so it was interesting to live with symptoms of anxiety for a week there. then just as the anxiety started to lift, a serious fever stepped in. it came overnight and the next day i tested positive for malaria and typhoid fever. it was mighty interesting accessing heathcare services for myself, rather than being the healthcare provider. i was sent to one of the best private clinics in the country, and was shocked at how seriously poor the care was. i laughed to myself as i felt there was no choice but to be a "non-compliant patient". i refused the non-sensical treatments they proposed, signed myself out against medical advice, and took appropriate treatments from our project's medical doctor. but it made me really trip out on how poor the healthcare provision really is here. if one of the best clinics is offering ridiculous screening tests and treatments (surely as a means of making money), you can certainly imagine what is going on in the lower quality services. and don't get me started on the process of just getting to the clinic! imagine feeling as sick as you can possibly imagine, then imagine yourself feeling sicker than that. next, imagine getting into the back of a four by four, and bouncing through massive potholes for over an hour, inhaling noxious fumes from trucks that spew toxic black tar, smoke from burning garbage piles, and a bounty of smells related to various manifestations of human waste. seriously...it was sooooo less-than-fun.
anyhoo...i put in my three days of sweaty delirium (will spare the details), survived the worst headache of my life (which followed a fainting spell with a head crash on the concrete enroute to the bathroom), and i was tip top shape for christmas eve. so my fears of spending christmas home alone in bed vanished with the noise and stank of the city, as i got to go into the interior afterall. it was a beautiful trip through rural areas into a town called Kindia. the landscapes here are absolutely incredible; some of the most lush forests, beautiful rolling hills, drastic mountains and rock faces, sweet typical mud and straw homes, and fruit stands a plenty! the difference between urban and rural Guinea is really impressive. one step out of Conakry and there are few vehicles, few shoes, few recognizable items from the occidental world. instead, there are lots of naked kids running around, no shortage of back-breaking agricultural work, lots of friendly smiles and waves to the white folk (rather than requests for money or help)! it was all a welcomed shift if only for a few days.
stepping away from our project not only gave me some needed rest, but it gave me the distance i needed to put things into perspective a bit. you can't underestimate how challenging it can be to work and live with the same team, with security rules that really limit your freedom, all within a context that i am finding uber stressful and within a cultural context that can feel so hard to integrate. i had the space to really acknowledge that i have been readily losing motivation for my work here, and the layers of mounting frustration and roadblocks have left me feeling exhausted and lacking hope. we are trying to improve quality of care with a team of healthcare providers that generally chose their profession because it can earn them money to feed their families, not because they have any particular interest in the vocation. we are trying to improve access to equipment and medications, that consistently disappear. when i try to research current practices within the centres, everyone lies to cover up what they really do, knowing that their practices aren't optimal, and leaving me with an array of stories, but no idea what the truth is. not surprisingly, it can feel hard to move forward. but this weekend, while walking through fields of grasses and swimming in rivers, i was able to shed some of my frustration and gain some clarity about how i want to approach my next few months here. some internal spring cleaning was needed this holiday season indeed!
so i tried to shed some of my cynicism, my toughened shell, and my fatigue, to create space for a renewed sense of the humanitarian spirit. MSF requires volunteers to leave the country on holiday every three months and i now understand why. the humanitarian spirit may be strong among many of us, but it needs to be continually nurtured, as it can take a violent beating in these environs!
to say there are challenges is an understatement, but as i only have a couple months left, i figure i need to at least walk away feeling like i kept some sense of my original motivations alive throughout my actions here. so i am going to step away from teaching and try to instead just demonstrate. i find that when i teach, there can be alot of resistance, especially from the older midwives and doctors who have probably had enough white people who know little about their worlds, come and tell them what to do and what not to do over the years. i can definitely understand why they are not always receptive to external input, and while it is hard to watch them do things we know are unsafe, i am not really getting anywhere by trying to teach them. so i am going to try to just demonstrate and influence those who are receptive, rather than spending energy trying to convince those who are not open to change. a simple enough idea, but it takes a lot of patience and tongue biting to witness some of the things i witness (particularly for an Aries like me), without stepping in to try to convince people to change their actions.
let me give an example of one of the issues i am working with. episiotomies (cutting the vagina to make it bigger at the time of birth) are practiced really routinely here. we know that routine use of episiotomy leads to increased infections, poorer healing than natural tears, and more longterm pain, etc. already, 97% of women are circumcized here, so they already tend to have scar tissue and other side effects from the procedure. i have been encouraging them to consider only performing an episiotomy if the woman already has significant scarring or if the baby is in danger. but they don't listen to baby heart rates here, so they don't know how to identify if a baby is in danger. so we put a handheld ultrasound doppler in the centre so that staff can listen to heart rates and avoid cutting women if the heart rate is normal. but the battery is always running out. the hospital director is supposed to pay for replacement batteries with money he receives from NGOs but he instead spends the money on air conditioning for his office. the gel that we need to use with the doppler is often stolen, so some of the midwives bring in their own karité butter, which then gets stolen. so then everyone is mad that the batteries are never replaced and the gel is always stolen, and everyone is then afraid that the machine will be stolen next, so they have decided to keep it locked up in the director's office. so there it sits, safe, without a battery, and not in use. and the episiotomy rate maintains...
my other ongoing issue, is handwashing. there is no water. so MSF pays the cleaning women to bring buckets of water into the birthroom. we also provide soap. it gets stolen. so the soap is stored safely in the director's office as well. everyone is happiest knowing that it won't get stolen there. so nobody washes their hands. we give donations, they sit nicely locked in offices and all carries on as usual...
so i have to hop off to work now, and i will keep my chin up...demonstrating good practices, but teaching nothing. we will see if my spirits can stay up this way ;)
