Chris is currently out of the office

We are invited by an Australian HIV/AIDS NGO to speak about our clinic at a training session they have arranged. Rugby Captain introduces us for 10 minutes, I talk about MSF for 10 minutes and a nurse talks about the services we provide, including treatment that is given to those who may have been in contact with HIV.   Our hosts give out free condoms, as do we in our clinic and all places of work. Later in the vehicle, rugby captain and I are chatting about condoms.

“Do you think we could give our female condoms in the clinic?” he asks.

I joke about how difficult female condoms are to use.

Then he explains: “Women on long bus journeys wear them. Just in case they get raped”.

I stop smiling.

We had another earthquake last week. It woke me up. I don’t know the details on it, but it was bigger than the last one. I enjoy them, it is like being on a rollercoaster while still at home.

MSF outreach

Tuesday is day one at the gym with our “outreach” coordinator. He’s the captain of the local rugby team and they train hard. I’m pleased with my work, but they other guys at the gym are beasts.

Wednesday is another first for me; we do some “outreach” where we take the Landcruiser, some posters and leaflets and visit a community outside the town centre about our clinic. The local councilor has invited us and introduces us to the crowd who gather and listen intently. They nod their heads and are impressed to hear our services are free – hospitals charge money here, for entry, for X-rays, for each night, everything has a cost. But we even pay bus fairs and any hospital fees associated with our services. I can tell the people are impressed as the megaphone is passed between the boss and our Papua New Guinean rugby captain. We end with questions and there are many, I mingle and field a few. I try to speak as clear as a Glaswegian accent can be, but there is no need. Many of the villagers speak excellent English and engage in debate about the causes of domestic violence. Everyone has informed opinions and a story to tel. I am humbled by their stories. I am asked about our counseling which one elder gentleman is very enthusiastic about and I talk about the problems of getting patients back, as we know many come to us in secret, fearful of what their partners may do if they talk to others about their experiences.

Later I learn the story of the day. A “miracle” no less: at 2am on Tuesday night a patient in the hospital died and was taken to the morgue. She awoke at 6am (presumably somewhat surprised). She is now a minor celebrity. I doubt the doctors are offering any alternative theories to the “miracle”.

Later that day I go running, it is tough in the heat but I manage 30 minutes. “Go Chris” a guy shouts as I run past. I don’t know him, but it seems word get round town quick about anyone new in town!

Thursday I am organising the facilities for some Post-Exposure Prophylactic (anti-HIV treatment program) training that MSF and the World Health Organisation are putting on for both hospital and MSF clinic staff. On the way to the training room I see that a missing part of the elevated walkways between the wards is being replaced. The air is filled with a white dust. Immediately recognising what is going on I hold my breath for as long as possible as the asbestos cloud passes over me and get funny looks from hospital staff as I gasp for air after passing the walkway.

I’m so tired. In theory I work five and a half days each week, but the reality is quite different. I’m woken by barking dogs and crawing roosters at 6am every day and I’m working 7 days. I think I’ll actually sleep a bit more over the next few weeks and take Sunday’s off as I am worried that my
work will suffer if I don’t.

Worrying is something I’m trying not to do too much, there are many things to think about when my job remit is basically “everything not medical”. I felt quite impotent the night before last when I heard a neighbour violently beating his wife. We advocate to the communities we meet that violence is
unacceptable and that people should stand up to wife beaters. If my neighbour in Scotland did this, I would feel compelled to act, but here it could bring trouble to everyone I work with if I were to challenge someone over their business. I tried to get on with the business of putting new stickers on our vehicle and ignore the screaming, but it is tough. I hope the extra stickers will increase our awareness and reduce the carjacking risk slightly.

We have a nice home with 5 bedrooms, hot running water and a place to sit outside at night as it is currently uncomfortably hot to sit inside much of the time. (Apologies to all the other MSF volunteers dodging mortars in sandy desserts).

The MSF clinic

Like all the houses in our neighbourhood we have a razor-wire fence and guards, with a dog a night. So I immediately make it my priority to meet the neighbours, to walk about and to talk to the people who sit on the street. I am pleased to see wide grins and warm people where ever I go. Just like Scotland, people are pleased to know their neighbours. A smile and a handshake is well received.
I decide to buy a thermos flask for both our sets of guards (home and clinic) and to make them coffee when the nightshift starts. I am horrified when I realise one morning that I have confused the salt and sugar jars – our guards have been too polite to tell me that I have been adding 4 spoons of salt to their coffee.

Hospital ward

At the clinic our “neighbour” is the hospital who provide the land we use for our little clinic. The clinic consists of 5 demountable buildings linked under a canopy. Our battered, bruised and bleeding customers are patched up and provided with counseling from our wonderful expatriate and local staff. We also provide basic advice on their legal rights and will talk them through the legal system. Some arrive via the hospital, some arrive straight to us. I frequently shiver with horror when I see them arrive with congealed blood and obvious injuries. Between rushing about I’ll give the waiting people water, as they always seem too meek to help themselves to the free water. Many of the people I see are also men, who are also welcome as patients in the clinic. The men might also be concerned brothers, uncles or fathers. And they might also be the perpetrators of the injuries. We welcome all and (providing they behave decently and do not carry weapons) so I always try to imagine they are the concerned brother and not the violent husband. I frequently find myself having to splash water on my face to try and clear my mind or taking a walk around the back of the clinic where it is quiet to get myself together after seeing a wailing client stagger in though our doors.

Our clients tend to fit into three categories: domestic violence, sexual violence from strangers, sexual violence from within the extended family. But as I said below, the first categories inevitably tend to also be the victims of sexual violence too. I’m on a bit of a roller coaster of emotions between enthusiasm surrounding my new job, pride in working for MSF and helpless horror when I see and hear our patients. I could hear one today screaming in one of our counseling rooms.