Thursday, October 30, 2008

Cooking Okra in Bo and Other Stories

The Bo market is a hectic and anarchic experience, one that pulls you from the street clogged with motorbikes behind tall storefronts through small dark passageways full of people hawking Chinese-made shoes, cloth, rotten bananas, Irish potatoes, onions, and strange, simply designed boxes of pills that promise to cure colds. Then the chaos really starts on the narrow paths between zinc roofed wooden stalls, coated with a thin mud greyed with fallen produce, sewage, and other unknowns. The paths are chock full of children with baskets of broad brown beans, women with buckets of cassava leaves on their heads, shoppers with heavy loads of food for the lunch time meal, and then me, standing out in my clothes and my skin (I was recently jokingly asked if I would stay overnight at the nurses’ house so that I could light up their electricity-less living room) and stooping underneath baskets and basins on heads and contorting my body around women’s curves as they lean over piles of okra and tomatoes, stacks of dried, twisted smoked fish and bowls full of every type of rice imaginable. Each part of the market offers different fare, with one area dedicated to citrus, another to greens, one to clothes that were obviously donated from the US, and a section across the road for bush meat—large bush pigs, tiny deer-like creatures, monkeys of various sizes and species. Loudspeakers blast loops of “TWO THOUSAND TWO THOUSAND TWO THOUSAND”—prices for the various goods on sale. Men with large cartloads of rice yell their way through the crowd, pushing people out of the way with their voices. No one wants to play chicken with the sheer weight of the carts and the force of the men muscled like Michelangelo statues pushing them. Women offer me palm oil—“buy dis fine pahlm ohl, ma”—as a joke, knowing I won’t buy, and when I did make a purchase of cassava leaves—a bunch as thick as my forearms together for 200 Leones, or about 6 cents, everyone wondered at me and asked me, incredulously, “You eat cassava leaf?”

The food here is not that dissimilar from Senegalese food and what I gather most people eat across West Africa—lots of fish, always rice, and a stewlike concoction made with copious amounts of oil. My favorite so far is okra stew over rice, a slimy sauce made with chopped okra, smoked and fresh fish, and those broad brown beans slathered in bright red palm oil and lots of hot pepper (which is called “peh-peh,” like Pepe le Pew). There’s also cassava leaf, potato leaf, and crain crain stew, the anonymous “stew,” pepper stew made with goat meat (a Nigerian delicacy as well), and others I don’t know yet. They all taste the same to me. Also foofoo—cassava pounded into a paste, gari—flaked cassava powder, and sweet potatoes, coco yams, bush yams—they look like alien eggs, and other tubers.

Rice can be imported and nutrient-deprived white or rich brown, fat grains called “country rice.” After the economic crises of the 1980s and intervention by the IMF and World Bank, who advocated the subsidization of imported rice, local rice culture declined, worsened by prohibitively expensive plowing machinery and the destruction of cattle herds by rebels during the war. Now, only old farmers know how to grow rice. I’ve come to the conclusion that a program that preserves these rice culture techniques and introduces oxen-pulled plowing would be incredibly beneficial for both farmers’ livelihoods and nutritional standards here, since white rice is stripped of most of the good stuff. The malnourished kids I’ve seen out at the Doctors Without Borders Facility—stick arms, red tufted hair, and big swollen bellies—got enough food to keep them alive but not enough to keep them living, if that makes sense. Starchy cassava (or yucca in the Spanish speaking areas of the world) and sweet potatoes can grow year-round here, and they can sustain, but not reinforce, until the next rainy season.

I eat some traditional food, though this is curtailed by the fact that I cook for myself and have no idea where to begin. I generally eat pasta gloop (Helen’s creation—pasta with tuna on top, and I add fresh tomatoes, onion, garlic), salad with whatever overly-inflated vegetables are available, canned hummus spruced up with raw garlic and cumin and cucumbers (I was greatly encouraged by the post on hummus at, and lots of beans. I’ve attempted my version of soul food with African ingredients--an idea of which I was particularly proud--okra stewed in tomato sauce and cassava leaf fashioned as collard greens, but both were heartily rejected by the Sierra Leoneans I work with as too hard to chew, lacking spice, or downright nasty. I found avocados (called pears) once and I eat as much fruit as I can stand—green oranges and grapefruits full of seeds but sweeter than many American (though certainly not Ojai) varieties; various kinds of bananas that make one view American bananas as terrible tasteless blobs that are infinitely easier to transport but not in any way worth avoiding the bruises; “plums,” which look like mangoes but are sour and a little spicy; pawpaw—nothing like that slightly vomit-y tasting papaya you get at home—but sweet and soft, a bit like melon. I’m looking forward to mango and pineapple season.

I will admit that I’ve had a can or two of “luncheon meat,” made less worrying by its guaranteed Halal status but not less disgusting, theoretically (it’s delicious chopped thin and fried like bacon). Eggs are a staple—they’re 15 cents each, raw or already boiled for you--as are groundnuts—boiled, ground into a paste, or roasted in hot sand. I had a sandwich today made with balls of ground up chicken--50 cents. When John, our Logistician, came in holding one, I saw it and said I wanted one too. He ran off after the woman who sells them, calling “Hey, Mama Chickie Ball! Mama Chickie Ball!” All of us in the office collapsed into laughter. I buy a lot of Fula bread, handmade baguette-like loaves baked by the Fula people, which the drivers find infinitely funny for some reason. Breakfast is bulgur, corn flakes (the cheap knockoff ones), fruit salad. When I’m feeling in need of comfort, I go for a bag of peanut M&Ms or a Mars bar from the Lebanese supermarket. I’ve recently cut back on the cookies—I originally thought it was necessary to sample all the different kinds but have since reconsidered that my health might be more important. I make a lot of popcorn in a big metal pot—so much better than the microwave stuff and a lot better for you—and add cinnamon and sugar or salt and hot pepper. Lipton Yellow Label tea is the main staple of my day, made with powdered milk that I hope isn’t imported from China. Occasionally I’ll pick up a Coke Light imported from Morocco and emblazoned with whatever the equivalent of “Coca Cola” is in Arabic. Most of the canned foods I get are imported from random places—Germany, the UK, Lebanon, the US, Brazil, United Arab Emirates. World Soup.

Going out to dinner is an unvarying menu of the same “European” dishes—hamburgers, shwarma, chicken and chips, chicken and rice, fish and chips, fish and rice, spaghetti, and kebabs, with a Fanta, Sprite, or a Star beer—the local beer made with sorghum. I’ve not tried palm wine yet, but I’m as fascinated as I am afraid. Which might define most of my food experiences here—even the canned beans are a mystery to me—and as long as I try to ignore the storage and handling of the food (did the rats crawling over the cans have Lhasa fever? Did the guy grinding the peanut paste wash his hands? How old is that fish?), everything’s fine, and I haven’t had a bad night of food poisoning…yet. It’s exciting to lean over a dish of food or open up a bag and have no idea what it’s going to taste like or whether I’m going to cook it correctly. It’s a bit like squeezing my way through the market—I have no idea what’s around the corner, or even what’s right in front of my nose.

Lost (and Regained) in Translation

I conducted interviews two Wednesdays ago for two catering positions in the organization. I have never conducted an interview before--in fact, I've barely been interviewed before. I do know, however, the typical, cliché questions you ask in an American interview: "what are your strengths and weaknesses?", "give an example of a problem you've had on a job and how you solved it", "How do you feel about being a leader and working with a team?", and the crowning question, I thought, to figure them out: "Please name a breakfast, lunch, and dinner you'd serve to a Sierra Leonean patient and then what you'd serve to an American volunteer." I felt proud of myself for my level of preparation, especially after I'd read and reread their resumés, and any worry that I had that interviews would go differently here was assuaged by our Logistician, who told me that my questions were "very good." How wrong I was.

One person told me, with a blank stare, that he never had problems on the job, so he couldn't answer the question. I gave up asking about strengths and weaknesses after the first interview. All the applicants said that it was important to work nicely with everyone and that they would be very good employees, skirting their teamwork and ignoring their leadership skills entirely. My perfect menu question completely backfired. Some interviews said they didn't want to cook for patients. Others said they had no experience with European food. Every interview initially said, "Well, I'd ask you first what you wanted to eat." Upon being pressed, one woman said she'd make me shwarma for breakfast--a pita wrap with roasted meat, lettuce, and mayo--not really early morning fare. A man offered up his vast menu of "European" foods (including a Whopper sandwich and a Big Mac sandwich--the former has cheese and the latter two patties) and then told us he wanted a salary that is well above that of our nurses. Another woman selected "chicken and chips"--which was shot down immediately by the Head Nurse (Matron) of the entire hospital as an easy-out. "Chicken and chips is the national cake," she said. "Everyone knows how to make it."

No one understood a word I was saying. I was only vaguely comforted when the national staff on the interview panel repeated the questions again, rephrased and simplified or translated into Krio, and the questions were still met with blank stares. I think my favorite moment occurred as I was asking about the sanitary measures that an applicant took in the kitchen. Picking her nose, she answered that she was always very clean. Just to clarify, picking your nose in public is completely acceptable in Sierra Leone. But it was still pretty awesome.

Overall, I learned much about Sierra Leonean culture and comportment. People do not talk about themselves (a Sierra Leonean blog would be interesting...) and are not used to "selling themselves" like a product. Deference to "superiors"--no eye contact, lowered voices, no expression of opinion--are expected, not consistent eye contact, gregarious manner, and an attempt to demonstrate how much of a genius you are. These can be tough issues--as flattering it is to have someone almost curtsey to you because you're interviewing them, I feel very uncomfortable with the complex hierarchies, pecking orders, and superior/inferior relationships that make up life here and across West Africa. When I studied abroad in Senegal, I had a hard time watching my host grandmother, a terrifying matriarch, eat three fish and a large plate of fries and salad for dinner while the children, maids, and wives (plus me) pick at one fish. I'm happy I wasn't distinguished in that house in the way that I often am here (people try to carry things for me, clean up after me, and drag chairs around for me to sit in). All the same, as much as I tried to understand and to accept that this was how it was, and that my grandmother probably did a lot for the family that made her entitled, in their eyes and in hers, to that treatment, it was hard to understand.

Cultural differences are tricky—for my first month or two in Senegal, I suspended all (or most) judgement for a while. I even questioned the importance of education for a girl who would end up married in a rural village with many children and long hard hours of manual labor. Then, I came back around, finding a balance between understanding cultural differences and reaffirming the values I’d gleaned from my own culture and upbringing. And I again saw that education was imperative because it brings protection to those women and gives them the ability to fend for themselves. I understood that even though my host grandmother was the distributor of the family and should be treated with respect, the children needed to eat more. I again felt uncomfortable with hierarchies. And as for interviews, I need to continue asking what meals an applicant would cook and further request detailed preparation instructions, since I can determine leadership skills, cultural and nutritional considerations, experience with African and Western dishes, problem-solving and improvisation skills, and sanitary measures from the way he or she answers. In short, I can see all the applicant’s strengths and weaknesses. So, maybe my perfect question wasn’t such a failure after all.

Tuesday, October 21, 2008

Marching and Dancing out of the Apocalypse

Apparently, Saint Luke’s is a big holiday around the world (see Jim Sligh’s blog This Analog Life), at least in places where there happen to be copious Catholics. Though I think the ratio of Catholics is lower in Sierra Leone than some other places (this is based on people I’ve met and/or history—since SL was colonized by the Anglican British—and not any real statistics), St. Luke’s day was celebrated by medical professionals around the country, and WAFF collaborated with the staff of Bo Government Hospital for a march, church service, and festivities at the hospital. Below is what I managed to notice while being dragged around and rushing to and from a visit with the First and Second Ladies at the ward.

We were late, as usual. I trudged up to the nurses’ house to get them moving, already sweating a little after a cup of hurried tea. I called the driver and sat out on their porch, as children from the neighborhood shyly (and boldly) approached with expectant faces, hoping for the candies we occasionally give them, only to be disappointed by my hands empty of a telltale black plastic bag. Finally, we were off, dressed in our bright WAFF t-shirts. We rushed to start preparing food at a house near the hospital, as Jackie and another nurse, Victoria, peeled potatoes with dull knives faster than I could have wielded a vegetable peeler. I told them we were late, and we ran for the meeting area for the march to the church, where nurses in their various uniforms (white for the top nurses, blue for the assistants, and blue-edged-white for the nursing students) had already started marching out, leaving us the most dilapidated marching band to follow. Their green and gold uniforms, clean and sharply pressed, were old and shabby, worn by countless decades’ worth of trumpeters and drummers. Some had no uniforms at all and made due with white t-shirts and counterfeit chuck taylors. Their instruments, hand-me-downs dented and patina-ed with age, rang out clear but a little flat, the band rag-tag but soulful. It was an amateur New Orleans funeral, a parade after global catastrophe, a final attempt, post-apocalypse, to reassert some order.
I keep referring to things as apocalyptic—and maybe it is the environment of the nation after the civil war or due to years of crippling poverty and decline of developing infrastructure, but perhaps I am rather sensing a continual insistence on making do, on taking something and reinventing it with the tools at hand. It could be that I imagine that after everything around the world collapses (hey it could happen any day), we’ll all be out marching in parades with our cracked tubas and too-large, frayed band coats, showing that we can’t be beaten down. That’s a striking aspect of the people here in Salone—despite all of the incredibly difficult things that have happened to each and every person here, almost all are still optimistic and active in trying to change the state of the country.
So, we danced-shuffled to the church, held back at one point as self-important soldiers and police cut across our line, the last few marchers. We had to double time it to catch up, though the fast walking was easier than the slow rhythmic dance-walking we were supposed to be timing with the music. We brought Lebanese to their balconies—old Muslim grannies with headscarves, skin pale from life indoors—and people sleeping away Sunday behind their ramshackle shops to the streets. Then, suddenly, we were through a slimy, moss covered gate and into the churchyard. The service had already started.
For a godless heathen, I’ve had decent exposure to Christianity from my time in Episcopal and Catholic school to my brief childhood stint at the Ojai Presbyterian Church. This was nothing like any of that. There was dancing (maybe a bit more booty shaking than some more Puritanical elements would be able to stand, though it was in no way sexual) and singing to a live band based in reggae and other Caribbean sounds. The Offertory was in three stages—very, very long stages. There was no sermon per se, the multitude of selected readings were only 4 or 5 verses, and the service, at 20 activities on the program, was longer than even a High Mass. So long that I passed through varying states of emotion and energy, timing my sleepy period to prayer time, so I could doze and pretend to be praying. But all in all, if church had been that fun (maybe not that long) when I was a kid, I might’ve been swayed a little more to religion…for a while, at least.
Thankfully, we were pulled out early to go meet the First and Second Ladies, a brief and semi-terrifying affair. The entourage of security, soldiers, handlers, hangers-on, hospital staff, and press was overwhelming. Both were in lavender robes, and it took a minute to figure out, based on behavior, which one was First. Everyone was sweating, even the Ladies, and I tried to communicate welcomes and thanks over our patients singing to them. Then, suddenly, it was silent, and everyone was staring at me, which was even worse. But I stumbled through and then, after some words assuring their dedication to our cause and expressing surprise at the cleanliness of the ward, they were gone. After this weekend of meeting Sierra Leonean politicians, I have never been more grateful for my (very brief) experience lobbying for student financial aid in Washington in college—I’ve gotten better at remembering the key points to hit as fast and as clearly as possible.
The women all started dancing to music videos in the ward (including the video for “First Lady,” which was just bizarre), and then we took off again to catch the march around Bo from the church. We picked up the rest of the WAFF crew already marching and sped up to the front of the parade, behind our raggedy band. One of the nurses, Marian, is a wild woman—yelling and whooping at every dance move and getting everyone to join in. Jackie and I led our procession, and I tried to imitate her swaying walk, which brought even more hoots from Marian. Our Head of Facilities, Benjamin, came roaring by in the van with sodas for everyone, and we tore it up on our way to the hospital, abandoned by our band at the last stretch of road as rain threatened us all the way through the gates.
Then, we did some more dancing with the patients and waited for food in the ward. I was so tired by this point that I fell asleep in a chair while the music blasted. No one seems to mind having music at volumes that start to press the eardrums a bit. But still, I managed to sleep. Later, as I stood eating canned green beans and salad with my fingers (we were out of forks and it was infinitely amusing to the nurses to watch me), a group of men with drums in grass skirts and nurses in matching outfits came dancing and yelling into the ward. We jumped around with them and then they were gone as suddenly as they had appeared. I shuffled back to the van to go home, too tired to do anything except dig my room key out of my purse and collapse for a few hours.

Monday, October 20, 2008

As Winona Ryder Once Said, So Cheesy, Please Read with Crackers

To atone for having compared Grace's eating mannerisms with that of a monkey (it was supposed to be a compliment), I'm going to talk about our patients, as per her request. Discussing patients is a bit sticky, given the stringent ethics surrounding patient confidentiality and privacy rights, so I'll do the best I can in generalities for now...
When I first met the women, I was completely exhausted, overwhelmed, and still hadn't figured out that I was actually in Sierra Leone. It was the same day that we'd bumped our way to Bo from Freetown, about six hours on a less-than-pristine road. The second I came in the room, they immediately began singing to welcome me. In the first few days, I remember, I was struck with the sadness behind their eyes. There is a strange dichotomy in them--they have largely created a new community for themselves, all 26 of them, in lieu of the communities and families that abandoned many of them. Just below every happy moment is loss, pain, and some anger for their pasts. But there is unspeakable joy and, unsurprisingly given the vast numbers of women (and very nice and non-threatening men working with us), a lot of uninhibited behavior. This is not to say that everything is perfect on the ward--there are disputes and cliques.
Sometimes I'll catch myself watching them and realize that many of them are younger than me--the youngest is 15 and others are not out of their teens. When this hits me, I can't believe that they've gone through what they have at such a young age. All the same, they usually act their age, giggling and joking around. Despite the fact that we have enough beds for everyone, some of them insist on doubling up so they can gossip and whisper all night, just as I did in boarding school and college. The older women look tired, but they still join in when there's dancing and singing. Everyone is always in on the joke. At our first staff meeting, the nurses left the ward unsupervised, and after about 20 minutes (we were just outside on the verandah), we heard them making a huge racket singing and dancing. One woman, Kaburreh, who has her teeth filed into points, is the lead drummer and picks up plastic basins and buckets to beat out the rhythm to the songs. The other day, as we were perparing for a visit from the First and Second Ladies, Jackie organized the women into two groups, based on language/ethnicity, to practice welcome songs and then started pitting them against each other to sing the best and the loudest, whispering to the group of Krio, Kissi, Kono, and others that she'd heard that Mendes were the best singers and then sneaking over to the Mendes to whisper the same about the Krios et al.
I don't mean this to sound stereotypical, but it's true that what strikes me most is their singing and dancing--there is always music in the ward, and we specifically chose the ward that we did so that we'd be a little separate, to be able to be loud and not disturb the rest of the hospital. I think what sums up the women best is the party the other day after the visit by the First and Second Ladies. We'd set up music videos on the ward TV and were blasting music. Almost every single woman, including one who is several months pregnant, the older ones, and those who had just undergone VVF repair surgery, was dancing. The VVF post-op women just chucked their urine bags in front of their feet on the ground and danced. It was wonderful.
Many of these women came in nearly dead, suffering from a host of other medical problems, and were often abandoned or maltreated. That they can find enough strength, both mental and physical, to be so enthusiastic and to create a new family for themselves can be a little mind boggling. At one point, the water got shut off at our old facility, and they marched down to the volunteer house to get water out of our well. Even the women with nerve damage, or foot drop, brought down buckets and carried them back on their heads, limping a bit but smiling and joking. When we moved them in a single day from our first facility to our current hospital, and had them double up beds in a not very comfortable temporary ward, no one complained. Many work incredibly hard at their studies and skills training classes, even women that are 35 or older, who might be expected to see basic literacy as a lost cause at that point in their lives.
Whenever I'm having a hard time here, I go to the ward and sit with them. And in very little time, I'll be soothed, through getting my hair braided or attempting Mende, or laughing at their jokes, and, though this also sounds totally cheesy and like one of those "I didn't teach them, they taught me" cliche moments, I'll remember that I'm here for them and that nothing else is important. And in a weird way, watching the post-op patients recover now is bittersweet because I know that nine of them will be leaving us behind to return to their families or to start new lives, hopefully a little fatter and a lot happier.

Saturday, October 18, 2008

Weird things that have happened to me in the past 12 hours

I got completely turned around while being driven to the house and felt like I was in an entirely different world than Bo, one that was regenerating after some catastrophic event, as the gas lights shone out from the simple wooden stands of street sellers. Just as suddenly, we were on the road home.

As I sat, waiting for the Minister of Health to come to the hospital, I heard the unfamiliar sound of sirens and realized that finding sirens unfamiliar in a hospital was, in fact, unfamiliar. Assuming a medical emergency and hoping that the hospital by some miracle had procured an ambulance, I stepped outside, to find six or seven green jeeps full of soldiers armed with AK 47s followed by white landrovers with tinted windows that hinted at the women in the cars, their finery and elaborate head wraps outlined in the silhouetting electric lights behind them. It was the First Lady, the Minister of Health, and their entourage of soldiers and police. They drove around the dirt area in front of the hospital and sped off.

I met with the Minister of Health as he ate his dinner and realized that it was completely insane that I was talking to such a high-level Sierra Leonean government official about how nice San Francisco is (he lived in the States) as he picked at chicken and fries with his fingers and I gripped a can of Coke (when given the choice between Fanta and Coke, before I could answer, the Minister instructed the caterer to give me the Coke because I was American).

We got our big generator finally set up yesterday and when it was turned on, I felt that I had never seen electric light before, it was so bright and cheerful in the house.

As I sipped tea and tidied the kitchen early this morning, one of the boys that does casual work at the house popped up at the window. He deposited a live monkey on the window bars. After I was assured that it wasn't for consumption (bush meat here is common), I watched it pick at the bugs and scraps around and was struck with how human it was. In fact, sitting there with its hand held just so to its mouth, it looked a little bit like my dear friend Gracie munching on a leaf of rainbow chard.

Friday, October 17, 2008

Making Do With Soda Soap

I'll probably change it again, but I've (obviously) changed my blog title. "Adventures in Sierra Leone" is lame, let's admit it. Anyway, soda soap is a handmade soap (you can buy the ingredients in the market here) that was shunned before the civil war here in favor of imported soaps. During the war and in the refugee camps, however, it was all that was available and having any soap at all was a luxury. Listen to one of my favorite Sierra Leone's Refugee All Stars songs--Soda Soap--for the title's origin.
So, I guess "Making Do With Soda Soap" means that we're doing the best that we can here with what we have
. Fancy imported soap is now available and widely used (we have a couple of bars of "Juliet" soap at the Guest House, which everyone finds immensely funny), and similarly, our organization has a lot of support that it once didn't have, but for me, the concept remains: as we strive for something better, we can make great gains with the simplest things we already have. Call it cheesy, but there it is.

Cos Julia's Been Working for the ??? Squad

No day is the same, I realize as I sit here listening to various staff members argue over where the WAFF car disappeared to, as workers tear down and build up walls for our new storage room, as children dropped off by Doctors Without Borders (MSF) at Bo Govt Hospital for treatment cry and cry and cry right outside. I do a lot of policy/program writing--job descriptions, work contracts, web site text, meeting minutes--because I have, as was once better said in Black Hawk Down, a mysterious illness known as the ability to type. You can probably tell from here that I don't have any other computer skills than that, but I'll be teaching the nurses how to scan patient charts and save them as a pdf, I give occasional pointers on shortcuts on Excel (my least favorite program ever), and I type, type, type away. Now that we've finished surgeries, things have settled down. I went on rounds with our Medical Director yesterday. Most of our post-op women (we did 16 surgeries, mostly for VVF and RVF) are doing wonderfully. I sat in on several of their surgeries, and when the staff was shorthanded, I opened up packets for the sterile nurse, moved stools around, and tried to stay out of the way. Today, I'll meet with the First and Second Ladies of Sierra Leone, as well as the Minister of Health, and we'll tour our new ward. I've been helping ready the ward for the last two days, organizing supplies and setting up curtains, which were dyed by the women during skills training classes into the colors of the SL flag--green, white and blue.

Essentially, I do anything that needs to be done, from my aforementioned ultrasound adventure to designing beds that will be built for our volunteer house. I go with our skills trainer to the market to help select materials and just sit with the women, letting them braid my hair (not so painful as I thought) and watching the cheesiest Nigerian soap operas--either about very evil rich women being mean to poorer ones (the rich male protagonist is always very sympathetic) or "village stories" that have a lot of demons in them. It occurred to me that The OC and Gossip Girl would go over very well with our patients, so I'm going to try to get a couple seasons brought over.

Other things: I sat with a woman as we explained that she had terminal cervical cancer. I held a flashlight as we connected a generator. I acted as the guinea pig for various volunteer needs, including registering at the US Embassy (the Embassy requires its own post down the road...), getting my passport issues settled, and eventually, hiring and training a cook for the volunteer house.

I find it's easiest to assume that I will have no idea what's going on from day to day or even hour to hour. Situations change very quickly here, and plans must be flexible. I try to get a series of things done every day but know that it won't all happen--I chip away at things. Pretty much everything will go wrong at the same time--the generator breaks, the leak in the wall gets much worse, cell phone service drops, all the computers go kaput simultaneously, and then someone has to leave for a family emergency.

I try to put out fires without having any idea how to turn on a fire hose. That's my job in a nutshell. And I love it--I love every frustrating, inefficient second of it. Because every day I feel that I did at least one thing that was good or helpful or that took care of one problem, no matter how small. It makes me realize that nothing feels more natural in the world to me than being sweaty, dirty, and most likely frustrated, as I watch a generator get lifted into our house by a dilapidated crane or as I stand watching a surgery or as I write one more page describing the role the caterer plays in our program. Everything takes five steps when it could take one, but it's perfect.

Monday, October 6, 2008

Up-Line in Bo Town

There are people everywhere: on motorbikes, crammed into vans, in cars, walking, many carrying things on their heads—small children with loads of firewood that I could barely lift off the ground. There are no stoplights, and the rules of engagement are simple: fend for yourself. No one slows down or moves, meaning that there are close shaves at every turn, people walking so close to your big white SUV with its conspicuous snorkel exhaust pipe, NGO plates, organization name on the door, and white people in the back seat. I’ve never felt so conspicuous. The Land Rover/Land Cruiser hints (or screams) of colonialism and neocolonialism—not quite as bad as the old pictures I’ve seen of French colonial administrators getting carried through the jungle in hammocks, with their stacks of luggage on a stream of black porters behind them, but still, an uneasy symbol for me. Though I have to admit that it’s entirely necessary on pitted roads made even worse by the rainy season, which has left giant potholes that throw you back and forth violently. At first it’s kind of like a ride, maybe the Indiana Jones ride at Disneyland, but it gets old fast. It makes it even more unbelievable to imagine traveling in a crammed car from Bo to Freetown, riding low due to the weight, ramshackle enough to maybe fall apart on the way or to tip into the waterlogged ditches that run along both sides. We saw two vehicles, an abandoned truck and a passenger van, tipped nosefirst into ditches on my first trip up from Freetown to Bo, and many of the people we coming to the hospital are from wrecks. People risk this everyday. There’s a short stretch of road in town here that’s abysmal—apparently the asphalt was taken out during the war as a blockade or something like that, but I haven’t gotten a straight story out of anyone, and I’m nervous about asking questions about the war yet. Many people have pain in their faces and seem to carry heavy psychological burdens from the conflict, which ended in 2002.
Bo is a rambling conglomeration of people who flocked to the nearest semi-urban center, setting up simple shanty shops at the market without any forethought to logical placement or planning. The city could have anywhere from 200,000 to half a million—I’ve heard both numbers but incline towards the higher, just based on how many people I’ve seen out and about everyday. Every possible space is filled with stalls selling everything from used clothes (I saw a guy in a Carmine’s Restaurant shirt yesterday!) to lettuce, soap to shoes. You can do all your shopping without leaving your car, either. The markets are neverending, a part of streetlife on every corner and lining every road. Even in the rural areas, there are roadside stands with businesslike girls hawking bright red sweet potatoes to fry, boil, mash, or turn into a vivid pink juice that kind of reminds me of lemonade. 2,000 Leone, or under a dollar, will get you about three pounds of sweet potato. Rice, cassava, potato, corn, pawpaw, mango, and palms are everywhere, as well as the more mysterious foods—garden eggs, bitter balls, crain crain, something called a “plum” that is nothing like any stone fruit I’ve ever seen.
The roundabouts are terrifying, the motorbikes filled with women coming back from the market after buying dinner, finding no way to get home but helmetless on the back of a stranger’s bike. Plus I hear most of the motorbike taxi drivers are ex-rebels, and just as nihilistic now as they were then. All drivers honk incessantly to warn of their approach to cars that have swerved to the other side of the road to avoid potholes, to the negligent motorbikers, or to pedestrians that might sway out into the street without looking. There are countless churches and mosques, peeling but eerily beautiful, post-apocalyptic, almost, especially near dark when the gas lamps come out in both Bo and Freetown at the market stalls, replacing the unreliable to nonexistent electricity.
The houses are either small and crammed, some of them traditional huts with thatched roofs and mud bricks, or large and half finished, concrete monsters that ran out of capital before the cement blocks could all be stacked, painted, and fitted with doors. The houses with high walls topped with razor wire identify their occupants as local dignitaries, or possibly white (like our house), Lebanese, or just wealthy. Laundry hangs on the razor wire, or spread on the ground, bright sheets and clothes, and in our case, the patient’s pink, purple, and magenta uniforms and the sheets that our skills trainer, Auntie K, taught them to tie dye themselves as part of their education, which covers simple ABCs, math, and English, as well as skills training for possible use in micro credit enterprises, which we’re planning on setting up as the program is more established.
It’s so hard to be in a rush here. Greetings are very important, even though they seem less elaborate in Salone (the Krio shortening of Sierra Leone) than in Senegal, where you could be shaking someone’s hand for a good two minutes or more while asking the same questions over and over and repeating each other’s names back and forth. But a barrage of “How de mornin’?”, “How you sleep?”, “How de body?” is incredibly important, as is the recognition of everyone in the room. Furthermore, few people pay attention to the time, and even if they do, traffic, stray dogs, pedestrians, and cars swerving all over the road slow down everything, not to mention the occasional torrential downpour and gutted-out road.
There is constant noise. No car is muffled (or smogged—they all release clouds of reeking diesel), radios blast at full volume, people talk loudly over one another. Goats bleat, frogs proclaim their eligibility, dogs roll into the street and fight all night. Mosques call the faithful to prayer at different times, the dawn prayer sung several times by separate muezzins. Luckily I learned how to sleep well in New York City, so it’s not so bad—the sounds here are mostly soothing and aren’t nearly as noxious as a street cleaning truck at 8am after a few too many dollar drafts at Lion’s Head.
So, that’s a bit of a portrait of Bo—it’s one of those fantastically dear, dirty towns that you can’t help loving, even though I haven’t done much exploring, just because it’s so dear and dirty, if that makes any sense. I’ll try in the next few posts to go over what I’ve been up to and what I’m doing here and all that good stuff. As a good historian I wanted to lay down some background information first, so sorry for leaving you in the dark.

And sorry, still no pictures! I tried for an hour today and got too frustrated. Any computer whizzes out there got suggestions on how to make pictures smaller/make the internet work here...crikey...

Thursday, October 2, 2008

Riding in Trucks with Ultrasounds

If someone had told me eight years ago, when I met my friend Ian’s mom freshman year of high school, that she would lure me to West Africa to do volunteer work, I never would have believed it. If three months ago, as I sat watching endless amounts of TV and freaking out over my future, someone had asked me where I would be in the fall, I couldn’t have told them. And if five days ago, someone had asked what I thought I’d be doing over this week, I’d never have answered that I’d be hanging onto an ultrasound in the bed of a packed pickup, trying to keep from falling out on the potholed road, and keeping a hand free to wave to the hordes of children yelling greetings and pumoi, pumoi, pumoi (white person in Mende), as we moved our organization’s operations from one hospital to another. All the same, I now find myself sitting in a house with my friend Ian’s mom, Helen Weld ( listening to the ward cooks, our drivers, and our caretaker haul water out of our well to take over to the 24 fistula patients we’ve transferred to Bo Government Hospital, as mothers ready their children for school, women sweep, backs bent over brooms made of gathered switches, and roosters crow, each one attempting to outcry the last.

The West Africa Fistula Foundation (WAFF) ( is a non-governmental organization (NGO; welcome to the world of acronyms) that works in Bo, Sierra Leone to socially and physically rehabilitate and surgically repair women suffering from obstetric fistula. Obstetric fistulas, usually classified as Vesico Vaginal Fistulas (VVF) or Rectal Vaginal Fistulas (RVF) are abnormal connections between the bladder and vagina or the rectum and the vagina typically as the result of obstructed labor. These labors can last anywhere from 2 to 15 days and mostly occur in remote rural areas where there is no access to trained medical doctors or not enough money to cover medical costs. The baby’s head and the woman’s pubic bone essentially form a vise that cuts off blood flow to the area, resulting in the death of the tissue, which is sloughed off, leaving holes, or fistulas. In most cases, the child does not survive. VVF and RVF cause uncontrollable incontinence—a woman will be literally leaking urine and/or feces—as well as possible nerve damage that leads to a limp, abandonment by the husband, and social ostracization. The majority of the women we’ve seen are destitute, and most are illiterate and untrained in skilled labor, since they have spent most of their lives toiling in subsistence farming. Many come in nearly dead.

WAFF finds women throughout the country with VVF and RVF, whether through word-of-mouth, referrals from other hospitals, or taking our van “upline” to the rural regions far from the capital city of Freetown. We bring them back to health and prepare them for surgery. In some cases, the VVF or RVF is too extensive to repair, which means that the women must either wait for a specialist to arrive from abroad to do urinary diversions (making a new bladder that has to be catheterized throughout the day through a hole in the stomach) or for us to find a supportive place in which they can live. Luckily, many of the women can have their fistulas repaired.

Dr. Darius Maggi, a retired ob/gyn from Texas, started WAFF in 2004 to address this preventable issue and as well as the staggering rates of maternal and infant death in Sierra Leone and across West Africa (though we don’t have official numbers for SL, all you have to do is walk into a hospital or talk to a Sierra Leonean to see bad they are). WAFF does not stop at surgeries, however. We work under the umbrella of the West Africa Institute (WAI) to regenerate sustainable futures for our female patients and, eventually, the people of West Africa as a whole. Through education and skills training at the ward, and in the future, the implementation of appropriate technologies and agriculture, micro credit enterprises, and a medical center that will bring in people from all over the region, we hope to aid in regenerating communities. WAI and WAFF strongly emphasize training local medical personnel and others to take over its work, so that volunteers from abroad will one day be unnecessary. In this way, WAI and WAFF are not looking to set up shop and simply sustain life as it is. We’ve been calling those kinds of programs “Band-Aid work,” which means that they simply patch up a problem instead of solving it. Rather, we are looking forward to a future in which preventable deaths are actually prevented, people feed themselves nutritional foods that don’t destroy the soil or forests, small businesses thrive without worries about day-to-day survival, and solar technologies break the cycle of dependence on fuel sources that are scarce, environmentally destructive, and incredibly expensive.

And so, I find myself volunteering for an unspecified number of months in Bo for the West Africa Fistula Foundation. I’m doing anything and everything that I can, from typing up reports and entering inventory to hanging off the back of said pickup.

PS - sorry for the lack of pictures...the internet's too bad at present to upload...