Farchana Nights

Every place has something about it that makes it unique. It is the background that provides the relief against which all is made contrast, visible, and dynamic. It does not tell a story, but it is the timbre of the voice in which it is told; the flicker of the flame that holds us rapt for hours; the scent that ushers in a distinct memory that we’d long forgotten that we ever knew, and transports us entirely. It is not sustenance, but the flavour. Not music, but the silences that circumscribe rhythm and cadence. I have been here for three cycles now, and from morning to night, it is becoming clear that in Farchana, all stories start with the sky. It is a soft, back-lit, baby-blue hue that has been washed a thousand times over and clings onto its brilliance still.

It feels that all that springs forth from this harsh land has been carved from the sky, sitting atop a flat and dusty soil, like miniatures on a piece of softly curving sandpaper: the adobe and straw walls that demarcate the small squares of land allotted to each Sudanese refugee family, the tents constructed by myriad NGOs to house food and supplies; the wood and plastic-sheeting structures that offer sitting areas and consultation rooms for the sick, the malnourished, and those seeking mental health or perinatal care; the concrete slabs that look like a heavy strip mall in the early stages of construction that serves as the school; the water pumps at which women in brightly-coloured swaths of fabric move to and fro with large pots and buckets balanced on the heads, small children in wobbly tow; the thatch-roofed tukuls in which we sleep; the wandering donkeys and occasional chicken; the thorny brush.

This morning, the sky opened up as it has every day since I arrived; it is impossibly large, stark, and embracing. It defies us to enter into it, and we do, out of our camp, through the mango grove, over the dried up wadi (but the water still runs a few metres beneath the sand, I’m told), through the small town of several stalls, and into Farchana camp, of about 22,000 Sudanese refugees from the Darfur region.

But this is not the story for today. Today was a sad day. The sky witnessed a group of Somali bandits who yesterday attacked some MSF vehicles:

My condolences go out to their families, friends, msf team, and their communities. And when I say communities, I mean both those from whence they have grown up and onwards, but also the community in the town of Kismayo, near the hospital where the attack took place. I don’t know whether MSF will decide to stay in Somalia or evacuate the other projects, and the situation is so complex that I would not hazard a guess nor valuation. But I do have a sense as to the stability and hope that these projects bring to people. The following is an excerpt of a speech given by David Michalski, the then Head of Mission in Somalia in early 2007, when it was delivered:

Many children die from easily curable disease every day including malaria and respiratory infections. A vast majority of Somalis have no access to health care.

Of course, my description of the humanitarian condition is slanted towards the medical field. However, the situation with regards to education, water and sanitation, and other fields are equally precarious.

In 2006, we performed more than 300,000 outpatient consultations, and 10,000 inpatients were admitted in our hospitals. In general, the quality of the work is verified by high cure rates, low defaulter and death rates. To our regret, we do not have programs in the main urban centers, namely Mogadishu and Kismayo.

This has not meant that our projects are small. In the tiny town of Huddur (approximately 20,000 population), we have the largest inpatient department in southern Somalia with 250 beds full almost every night. Many come from long distances, some traveling for over a hundred miles away to receive care.

(The rest of the speech can be found at: http://tinyurl.com/ywkos2)

At that time, there were over 40 international staff and 600 national staff. They operated in 12 independent sites. I’m not sure how many there are now, but I imagine a similar number if not more. I’ll look into it.

What will happen to these communities if MSF pulls out of this situation, as so many other NGOs have done in recent years owing to the precarious security situation?

Anne Frank once remarked, while observing the extent of human depravity in the second world war, that “humans are really good at heart.” While I suspect that Anne herself was good at heart, and saw the world that way, I think that she was wrong. Some are, many are not, but there is a remarkable plasticity. We know this by opening up a newspaper, by flicking on the TV, and by listening to anyone with stories to tell. Which is pretty much everyone. Humans are capable of terrible things. Experiments by Philip Zimbardo and Stanley Milgram suggest that you can take an otherwise respectful and ethically-minded person and turn them into an obedient animal, quickly capable of cruelty, cunning, degradation and torture. We can likewise fashion ourselves into caring, compassionate and generous persons, looking out for our brother, neighbour, countryman and beyond. This malleability of spirit has been co-opted by those who inspire us to use our superpowers for good. Stability borne of living wages, accountability (the rule of law), and hope for tomorrow by having our basic needs met.

This morning I walked along in our small compound, returning to my tukul after brushing my teeth, and found Bienfait, our Congolese doctor, talking on the satellite phone. He is one of those people who Anne Frank was talking about, he is good at heart. A teardrop rolled down his cheek and his eyes welled red as he told us of the news from Somalia. To my mind, his tears were for those that died, and for the suffering in Somalia that may come for many.

The journey to Farchana is moving along at the pleasant pace of a water-logged pinball. I was expecting a one-day turn-around time in Abéché, but the logistics just worked out such that the scheduled departure is on Friday, so it’ll be four days. Our Abéché-departing Land-cruiser meets the one sent from Farchana at a half-way point to transfer passengers in both directions. This operation, done twice a week, is uniformly and rather endearingly called “the kiss.” As much as I’m psyched to finally get to my project, I’m finding these extended layovers a great way to get a feel for how MSF operates. Today’s briefings were on security and the regional politics in eastern Chad, and it was no gloss. Lots of details, but I won’t write my opinions on this. (When I did, in a previous post, it was edited out by someone in Germany. And just for the record, while it sucks to be censored, I am not upset, nor particularly surprised. My writing was noted to be too political and, at times, factually uncertain. C’est la vie. It is the mark of expertise to speak broadly on a complex subject while still maintaining accuracy; needless to say, I’m not there).

So I’ve got time to dither, and when I’m not playing scrabble on my laptop (about eight games today… it’s awesome) I’ve been musing on the set-up here, and getting to know some of the in-country management team better. I’m having a hard time understanding the French spoken by the Chadians, mostly because of my poor ear for these things, and in part because ot the dialect. It’s going to be a slog to function in French with the team in Farchana.

Abéché: the most environmentally trenchant fact about this desert town, which is the largest in eastern Chad, and it’s second largest city, is dust.  No paved roads, no grass, just dry earth. It feels like how I imagine Marrakech would have been in the early-mid1900s, but with cell-phones and white Land Cruisers. We’re in the heart of winter now, and it’s actually pretty chilly at night (about 15˚C), while the days get up to 27 or so. I awake to the sounds of birds chirping, and from the tin door of my small room at the compound, I can see streams of them lined up on the coils of barbed wire. While walking from the sleeping compound to the office, there is a chorus of chirping while they flit from barbed metal to spaces between shards of broken glass embedded on the tops of the walls. It’s a rather cheerful sound, and if you add their stochastic hum to that of the generator and the occasional yelping of the new puppy (named Tonto), you have the deep soundtrack to morning life here.

I’m trying to figure out who the other people are who are on the airplane.It is a 100-person flight from France to Chad’s capital, N’Djamena.The fellow sitting beside me works for Exxon, and at the airport he and many others are greeted by people holding Exxon placards with various names on them.As well, people in military fatigues are greeting other passengers.A young fellow with a bright smile that shows all his teeth wanders calls out my name and looks relieved to have found me.“Papi” introduces himself and takes me directly to the bar, where I meet the administrative coordinator (AdminCo) who seems a bit fatigued, but offers me a beer almost before saying hello.This is a good thing.We chat briefly before heading back to the MSF compound, and I’m shuffled into the back of a 4X4 and we zip off.Very quickly, however, we’re off paved roads and traveling slowly on bumpy ground in what looks like a sprawling shanty-town.There is nothing that would betray that this is the capital city of a country.Nothing.You know you’re off the beaten path when you’re in the capital city of a country and there’s no Starbucks.I’m not being anti-corporate, because if there were a Starbucks I would probably be there right now, and it wouldn’t be for the coffee.As it stands, there is one (count it: ONE!) internet café in the city that the staff here know of, and it ain’t wireless. (The UN people may have wireless…)

Fast-forward a day.

I’m now on the patio under the thatched-roof gazebo.High white walls topped with barbed wire surround the compound, and there are guards 24/7. Most neighbourhoods that I’ve seen so far have this look, with the lucky ones having paved roads in front (ours does not). Muslim garb adorns people in the street, with goats and chickens running free amidst the ubiquitous vendors of gasoline (in old 2L drink bottles) and cigarettes. Also common are “recharging stations” for your cell phone. White Toyota land-cruisers are the call-sign of humanitarian aid workers, and are surprisingly common, emblazoned with large identifying logos.

As it turns out, rather than scooting through N’Djamena in a day, I’ll likely not get my in-country “circulation” certificate for a week.This is due to an unfortunate incident about a month ago wherein a group of French aid workers (working with the group “Zoe’s Ark”) tried to leave the country with 103 Chadian children.

At the training session for this mission, we were give talks by a number of people, but that by David Trevino stands out, probably because he is diva-like in his dramatics, brief, and has one of the best jobs of anyone I know (logistical consultant). He said that there were only three things we had to take from this week: 1) If you want to leave, just say so, and you’ll be on the next flight out, 2)If you are told to leave (ie. you’re being evacuated), don’t argue the point, just go where you’re told and argue later, and 3) never forget that your actions affect other MSF and NGO staff, even long after you’re gone.

It’s this third point that’s the most interesting. I’ve made comments to friends about the “brand management” that is done by MSF. They’re a $400 million-dollar outfit and collect most of it in donations from grandmothers to bake-sales. At any given moment, there are about 3000 expats, and many more inpats, in the field, all with the MSF logo on their sleeves, hats, car doors, etc. In this world of viral information transmission, a story or picture can be seen by thousands of people, and have greatly unintended consequences. To this end, in my briefing today, I was reminded that drug use leads to direct repatriation; sexual liaisons with local staff and Chadian nationals are forbidden; that I have to radio my whereabouts at all times; and even that my blog postings must be read and approved before being posted. Usually my big-brother hackles get raised pretty quickly with these things, but not this time. It just strikes me as uber-prudent so far. And well thought-out.

Non-sequitur: this arabic keyboard is bloody hard to navigate…   damned punctuation.

Well, I was told this afternoon that I’m off to Abeche tomorrow morning and then the day afterwards in the field! The next post will be from Farchana I hope.

I awoke to the feeling of my thudding heart.  The rate was the same old 55, but it was pounding. This may just be the unholy by-product of malaria prophylaxis and the alcohol from last night’s impromptu dinner party, but it likely has something to do with the fact that I’m off for my mission today.  Packed and stoked, I am! First to Berlin for a briefing, and then Amsterdam for another briefing, and then to Chad on the 17th, I think. Nobody’s given me tickets to anywhere except Berlin, so that’s where I’ll go. I feel like the humanitarian equivalent of a sure thing.

“How are you feeling?”

This is the question that I’ve been asked more than any other (yes, there may be a bias here in that lots of my friends are in the psy discplines…). Mostly, I’ve had a bland response. Other than some non-specific giddiness that could just be gas, my feelings haven’t betrayed (until maybe this morning) an imminent six-month trip to do cultural psychiatry in war-torn central Africa. And I have a guess as to why: I’ve got nothing to compare it to. I’ve never worked abroad, nor have I really travelled in Africa. I was born in South Africa, and immigrated to Toronto when I was 3 years old. And despite heading back every summer for about 7 or 8 years, I feel no more than a vague-yet-oddly-meaningful kinship with the place. A white privileged kid in an apartheid nation cannot validly empathise with the whole continent any more that a glass-bowl goldfish can with the open ocean. But more than that, I realise that I’m being careful with my assumptions.

“Are you always analyzing people?” / “Are you analyzing me?”

This is probably the most common question I get when I tell people that I’m a shrink. (The second most common is “Are you serious?” to which I like to answer “Hell, who lies about that?… If I was gonna make something up I’d tell you I was a surgeon.” This doesn’t make things less awkward, but somehow it does make it less weird.) The training for this job is 5 years. That’s 3-4 years of medical school, plus an extra five to specialize. It’s a bloody long haul, and a few ingrained habits are (hopefully) beaten out of you, the most entrenched being the idea that you can know something or someone quickly and surely. Yes, first impressions and intuition are invaluable tools, and you’d be a fool to discard them, but they’re just guesses that more often tell you about yourself than the other. As Anais Nin said: “We see the world not as it is, but as we are.” She was clever.

In my view, you gotta listen to a lot before assuming anything to be the case. How many jokes are there about the psychoanalyst who just sits there, like some inert rock, for the first 6 months of therapy, repeating in some nauseating voice: “and how did this make you feel.” The kicker is that despite this being some mix of cliché and farce, it’s a stellar question. It’s the answer to this question that hints at who someone is in the world, and you’d never know otherwise.

When a patient’s partner or parent dies and you say “I’m so sorry for your loss,” it’s more common than you’d think to get a “I’m glad he’s dead… he was an asshole!” in response. Or you congratulate someone for a promotion or accolade, and they only see it as a way for the higher-ups to substitute better pay for some empty title. They’re fuming inside. It simply pays to ask….

Back to Chad. I’ve simply got no clue what it will be like… I have nothing to meaningfully compare it with; I’ve got no ability to empathise with my projections. Just some vague notion of something coming that’s gonna be big. My dreams have some danger, adventure and disorientation, though, so that’s a place to start guessing, for what it’s worth.  In some way, though, I do feel ready.