Je n’oublierai pas le cas de ce petit garçon qui souffrait de blessures causées par une explosion. Il était allongé au milieu des blessés dans toute cette agitation avec son grand frère à peine âgé de neuf ans qui prenait soin de lui. Ce grand frère veillait très calmement à ce qu’il ait toujours de l’eau à boire, et montrait une extrême bravoure… Et cette image m’accompagnera longtemps.

Il y a aussi cette petite fille, elle doit avoir 7 ou 8 ans et a perdu sa jambe. Elle ne sait pas où se trouvent ses parents. Quand on lui a parlé, elle était très nerveuse. Les infirmières m’ont expliqué qu’au Sri Lanka les petites filles dansent la danse traditionnelle. Alors je lui ai promis qu’elle pourrait danser de nouveau. Et, vraiment, notre mission sera de rendre ça possible, un jour. Elle devra attendre que ses blessures guérissent, puis on lui posera une jambe artificielle ce qui serait très difficile à réaliser, ici, au Sri Lanka. Mais simplement de lui promettre que cela sera possible un jour, je le prends sur moi.

Entre le 20 avril et le 8 mai, les équipes du ministère de la Santé et de MSF ont procédé à 963 opérations chirurgicales dans l’hôpital de Vavuniya. Plus de 90% d’entre elles concernaient des blessures causées par le conflit.

Cette dernière semaine dans l’hôpital, on a assisté à un changement radical. Un grand nombre de patients ont pu sortir, on a pu prendre en charge les patients moins graves qui s’étaient accumulés la semaine précédente et enfin, on a pu décharger des patients.

Tout ceci signifie beaucoup d’opérations chirurgicales, dont une grande majorité sont mineures. Ces dernières semaines, l’équipe n’a pas quitté le bloc opératoire. Grâce à l’aide de l’équipe sri-lankaise qui travaille avec nous, on a pu commencé à réinstaller les patients qui jusqu’à présent s’étaient entassé dans les couloirs et dans les allées. On peut désormais leur offrir une bonne prise en charge dans des lits et pour certains, on a pu les décharger aussi.

Aujourd’hui, nous avons environ 380 patients qui nécessitent de la chirurgie. C’est la première fois depuis mon arrivée que l’on passe sous la barre des 400. Cela montre qu’un grand nombre de patients ont pu quitter l’hôpital. J’ai effectué plusieurs visites dans les camps de déplacés, là où les patients se rendent à leur sortie. J’ai discuté avec les représentants du ministère de la Santé et des médecins pour voir comment on pouvait continuer d’assurer un suivi à ces patients.

Des patients quittent l’hôpital pour les camps avec des plâtres aux bras, un traitement à suivre pour leurs jambes qui requiert un suivi, des membres amputés. Certains d’entre eux ont même leurs bras ainsi que leurs jambes et nous essayons de voir ce que nous pouvons faire pour eux.

J’espère laisser derrière moi une équipe bien organisée, bien préparée, un hôpital qui fonctionne mieux et qui continuera de le faire pour les prochaines semaines.

Paul McMaster a quitté Vavuniya le 8 mai. L’équipe chirurgicale composée de 3 chirurgiens et d’une infirmière de bloc continue le travail, à l’hôpital de Vavuniya.

MSF Blog: Chiradzulu part 22 (final blog)
February 2009

On the roadside in Chiradzulu... UNICEF sign against child trafficking in Malawi (photo by Pat Carrick)

I’m leaving in a few days, but as someone different than the person who arrived. I never thought I could be sick of papaya. I can cook for a dozen people with minimal planning and no recipes. I have survived for one year with the same 2 skirts, 3 pants, and 5 shirts (all of which I’m ready to burn). I can find humor in the most serious circumstances. I think living in Africa has helped me simplify my life, and that has made all the difference. Henry David Thoreau said that when you simplify your life, the universe makes more sense. Perhaps in our developed, industrialized, first-world we have so many distractions that we have forgotten how to simply be, and we are on this inevitable, insatiable quest to find ourselves.
I’m just a data manager, someone who crunches numbers. I loved mathematics as a kid because I could figure it out. It was like looking for patterns. I didn’t have to memorize grammatical rules or dates or biochemical pathways. But now I find history fascinating. I’m convinced that a good historian can predict the future. If you look back far enough you will find that we continue to repeat the same mistakes we made before. You will find patterns. But then people like Martin Luther King, Gandhi, Einstein, and now perhaps Barack Obama change the rules and shift the ground beneath us. During his inaugural address President Obama reminded us that a nation cannot prosper along if it favors only the prosperous.
And my next step? I imagine crawling out of the number world and writing something longer than a blog. Sometimes I even fantasize about being a guest on Stephen Colbert’s show as a best-selling author promoting her latest book. I’ve thought about this in practical terms – if I had my own 15 minutes of fame, if I had the attention of millions of people, what would I say? Perhaps just this: Do something, something that will help someone else. And somewhere along the way you will find yourself.

JAN 17, 2009
I have successfully worked myself out of my job. My staff – these 10 people – is the most dedicated and motivated team in Chiradzulu. They have taken over nearly all of my responsibilities and they have an interest and pride in their work that makes me proud. But it has left me with little to do. I have spent the last few weeks typing up my end of mission report and handover notes. The truth is, I have lost my motivation because of the lack of support I have received from management.  I suppose it’s a good thing that my team can carry me through these final weeks. They probably don’t even realize the burden they are bearing. It’s a shame that I’ve lost enthusiasm but I do feel a freedom to speak my mind now. Is freedom really just another word for nothing left to lose?

Road to the hospital in Chiradzulu, photo by Cecile Brucker

If you have robbed someone of everything they care for, doesn’t that free them to respond in any manner they see fit? What is happening in Gaza now is beyond my understanding. I only get snippets of it from BBC radio. Last weekend I was in a pizzeria which had a television and I couldn’t stop staring at it. Though muted, the images of people, children surviving the bombing – surviving but maimed and perhaps mentally scarred for life – and the ticker tape below counting the death and casualties had me mesmerized. What has been the international response to this? Is the US really standing behind the brutality and trying to justify it by saying “but they started it”?
If you lost everything, would you care anymore? A friend showed me a news clip of an Iraqi journalist throwing his shoes at George Bush. My eyes nearly popped out with incredulity, but then I was more surprised that my instant reaction was an eruption of laughter. How does a journalist in a country in which the US has invaded have the audacity to throw his shoes at a sitting president of the only superpower on the planet? Janis Joplin knows.
Why are we continuing to rob people of what they have if it’s just going to make them mad and then liberated to do desperate acts? Wouldn’t the more prudent response be to listen to them, understand them? Einstein said that peace cannot be kept by force. It can only be achieved by understanding. Why don’t we listen to our great thinkers more? Some people believe we are a doomed planet, a string of failed civilizations, continents of misguided societies. Yet we turn to our artists, musicians and writers as if they have the answers. And when they tell us, we praise them, but then don’t listen.

Martin Luther King said that history will have to record that the greatest tragedy of a period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people. Are you listening?

Sandy, A - chiradzulu, Malawi

MSF Blog: Chiradzulu part 20

These last six months have been somewhat magical. There are a dozen people living in Chiradzulu representing every continent on the planet (except Antarctica). We expats arrived, stripped of our normal uniforms, our usual decorations, our regular badges of career, family, friends, clothes, cars, and neighborhoods. Things that would normally define our status, our place in society, sometimes even our identity. On this mission we are so starkly ourselves.
Perhaps being less inhibited, not as bound to what we are supposed to be doing, leaves us freer to be who we really are. I think it’s one reason everyone is so much more attractive. It’s a bit of a perfect storm, the freedom to be truly oneself, learning about oneself, and making true friendships. Perhaps none of us will realize the magnificence of it all until we are apart. Our nurse from Japan is leaving this week, and it’s the beginning of the exodus. I will leave in a few short weeks and am wondering if I can stay this open and honest when I return to my home country. Is it more fun to live with your guard up, or project an image, or simply being true in this moment?

We went to the lake on Christmas weekend and our doc from Colombia threw me into the water – fully clothed. I was a flash or rage in one moment and then a ball of remorse for shouting the next. Even after apologizing to him I felt like telling everyone sorry for having overreacted. But it’s fun to be human, to feel every sensation. We bear an orchestra of feelings, capable of a symphony of emotions. What a pity to be limited to the select chosen socially-acceptable few. If I have just this one life, I want to feel them all. The key is not to hold onto any, or you risk preventing the next one in full crescendo.

Like the feeling of awe when a Malachite Kingfisher flew into my office on New Year’s Eve. One of my staff caught it and set it free, but not before I could get a picture of it. It’s a beautiful bird with iridescent colored feathers and a bright orange beak. I hope it’s a good sign for the New Year. I try to begin each year with resolutions to become a better me. Five years ago I resolved to call my parents more, but as communication is so expensive here, they’re the ones with the large phone bill in 2008. This year I decided to resolve not to change myself, but give others the space to change. Every January 1st we hope and aspire to be better than we are, and too often we fall back into our regular patterns and habits. Some of that is due to our friends and families expecting that we simply stay who we were. If we gave people the space to reinvent themselves, would they? Even if only for a day. And if they were successful one day, could they repeat it?

I know changing behavior is hard, and removing an old habit leaves behind a gaping hole. Maybe if that void were filled or substituted with something else, the emptiness wouldn’t be so painful and more resolutions would be fulfilled. In that context, I will replace my judgment of others with curiosity; I will substitute expectation with encouragement. Gandhi said that we should be the change we want to see in the world. After all, a waterfall begins with a drop.

MSF Blog: Chiradzulu part 18

The rains have arrived and I can smell it

. The clouds roll in dark and low, like the Nothing from the Never Ending Story. When living on a mountain, you don’t look up in the sky to see if it’s going to rain – dark clouds tell you nothing. Instead, look across the landscape for a grey curtain passing along as hills and valleys disappear behind it. It’s raining everyday now. The humidity has exploded my hair and made drying clothes a multiple-day chore. We’ve adopted the Asian practice of going barefoot in our houses, leaving our shoes caked with red mud at the door.

Despite these inconveniences, I like the soggy interruption during the day. I’ve become too accustomed to my daily rhythms and the raindrops beating on our metal roof are a nice percussive interlude. It’s raining again and I’m distracted from my work. When it rains like this I just want to stare out the window and watch it come down. Fortunately I’m alone in my office lately, and being the data manager, there is no one to scold me back to work.

I may be the only “manager” at MSF France. MSF doesn’t like to use the word “manager,” instead they use the term “coordinator.” I guess they figure people prefer to be coordinated rather than managed. Data doesn’t have any feelings on the matter. Perhaps management is more about managing expectations than managing people. People have different motivations for their job, and making an honest living is noble in itself. In public health, there’s not much money to be made, or let’s say there are more efficient ways to make money. People are drawn to this line of work for other rewards. There is a motivation to help others, and a good manager knows how to nurture that seed. It can be frustrating as an employee to be planted with no opportunity for growth. Still, once I start any kind of daily grind back home, I know I will ache for the management frustrations, political discourse, and technical difficulties in Chiradzulu. But I miss my
family and friends. Thanksgiving has come and gone and we’re headed straight for Christmas.

I’m starting to feel a twinge of sadness that comes with the bittersweet end of something good. I’m two months from completing my mission and will spend these last eight weeks trying to preserve each moment. My favorite is the 15 minutes of chaos in the morning – people rushing about finding their teams, land cruisers and assignments for the day. It’s an organized madness that I relish. On my rides between Blantyre and Chiradzulu, I stare out the window and try to absorb images like a sponge. I want to remember the piles of fruits and vegetables sold on the side of the road, currently mangoes. Or the bicycles piled high with chickens, eggs, or some other commodity ready for the market. Or the children and their wide-eyed curiosity at the Mzungu in the white land cruiser. Meanwhile the landscape is turning green. Maize fields are showing their sprouts. I’m preparing the job profile for the next data manager. The cycle continues.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 8 - WORLD AIDS DAY

Today is World AIDS Day. But there is also Malaria, Meningitus,  opportunistic infections to many to count and of course Tuberculosis.
Outside the hospital as I write this there is a huge public rally to  mark the day. For some it is a day of mourning, for others it is a  celebration and an affirmation of life.

Today is World AIDS Day.

On the wards it is another day of work for the  doctors and  another  day of struggle or reckoning for the patients. Tuberculosis is resurgent in places like Homa Bay-places where people  live in poverty. The living quarters are dark and  cramped with many people sharing  a single room house.

HIV  compromises   immunity and allows TB to take hold. The living conditions contribute to  its  spread. The treatment for TB iscomplex and long.

Lillian, an MSf patient is in the hospital today with a  relapse of  TB. She is  hooked up to a tube that drains the pus from her lungs.  She has  at her bedside table a small purse, a purple plastic cup filled with porridge, a mobile phone charger, many satchets of pills and a small red mirror.

“I want to see my face. So I brought the mirror. In the morning after I wash I look to see myself.3

“I want to see my face. So I brought the mirror. In the morning after I wash I look to see myself. When I loked before I saw some fuzz from the blanket. I brushed them off and  I was amused.”

Her eyes are lively, inquisitive and probing.

“Before when I looked in the mirror I was  fat and more beautiful. Today I see I am thin and not looking like myself.”

Lillian knows that  if the treatment works that  she may  again look like she did before. When she looks in the mirror in the future she may be fat and beautiful once more.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 7 - DAILY LIFE

In covering HIV AIDS stories over the last 4 years I am always struck by how much this medical condition is also a social condition.  One way or another the hand  of HIV touches  everybody and everything in a place where  prevalence rates are above  30%.

Weekend rituals include funerals which are usually held on Fridays and Saturdays. For those on ART daily rituals  include  punctuating each day with pill taking and  bi-weekly or monthly doctors appointments.

People adjust. And those that don’t die; or they contribute to the epidemic in ways they may not realize.

Photographing the epidemic is always a challenge. It is vast and  it is everywhere and nowhere  at the same time. The  focus could be the clinics and hospitals where treatment is given. But that is only the most obvious place to look.

There are always opportunities to  make pictures of the  destruction - the destruction of bodies. We know those images well. The  real challenge is to effectively show the way that  the epidemic is infused in daily life. People really do live useful and full lives with HIV. Their continued presence is important to the people they love.

And yet we can not ignore the fact that people are still dying everywhere. Especially in  areas far from clinics. Communities that are not isolated from the spread of the virus are sometimes isolated from the spread of information that may save them.

When they do have the information they may not have the means- emotional or financial- to convert  that  information into treatment or prevention. In order to reach the hospital  some people have to travel 5 Km  just to reach the road and  another 30 Km  on that road to the clinic.

Sometimes you see generational change. I spoke to  a woman  named Jane who  found a way to deal strategically with her life only after she  began ART treatment. She began in the fish business trading her body for the opportunity  to buy fish. “If you didn’t sleep with them  they wouldn’t sell you fish” she told me.

Most of the fishermen and  the fish buyers she knew in  her youth have died.

There is a new generation on the small islands and beach  communities  that has taken its place and will  likely repeat  the mistakes that she made.

“You would need a lot of money to reach these places and organize the women and educate the men” she told me.

Jane’s  story:

“When I started in this business of fish there were so many of us. Competition was strong. Getting fish to sell was a problem. There were men admiring us and  ready to sleep with you in broad daylight. There were women going along and they bought fish very easily. My husband was still alive and had no job. We had children. So it forced me to compromise for the daily bread.”

“If I look for  the lives of my colleagues at that time I cant see them. They have all died.
“When I realized I had the virus I realized I would die if I continued living that way. With the ARVs I knew I would live longer and it gave me a moment to plan.
My husband was dead and I was alone. I needed to respect my children. I had to plan how I was going to live.

“People understand things differently, they perceive things differently. I understood my life differently  than others and decided to live it in my own way.

“What I am trying to say to whoever will listen is that you must think strategically- especially if you are HIV positive. You have to think, take care and not poison other people. There is no reason to die early. Life is how you take it.”

Treatment has changed my life and  replaced despair with hope.”

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 6 - MILKA’s DREAM

Milka Anyango Odondi wants to be a grandmother someday. Today she gave birth this morning to a healthy baby boy. They are both HIV negative.

“When I was pregnant I wanted to know  my status- I wanted to take every precaution to protect the life of my child. This is my third child and  we are all Negative.
I have been taking care of myself well. I don’t move around with other men and I believe my husband is the same. We stick to each other.

My husband tests every three months and is not going around with other women. We sat together and spoke about our lives and  pledged to concentrate our love in our family.

I encourage  my friends to take care good care and to not move around with other men.
If they stay  healthy they can take care of their children for a long time. If they move around they  might die and  leave their children  at too young of an age.

I want to be a grandmother; I am dreaming of it. I want the pleasure of  seeing my children grow and I  figure that  by old age I’ll have a lot to teach the younger ones.

I have known some wise women and I want  to be among them someday.  I have seen their homes grow well through their wisdom. I wish to be the same.”

Hours after the birth, Milka hadn’t chosen a name for the boy. She hadn’t talked to her husband yet. He works on a tea plantation in another district. In the rush to the hospital she  forgot to bring his phone number. When she speaks to him she will ask if he likes the name Ian Anyango.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 5 - 11,622 HUMAN STORIES

Until today single themes or powerful stories emerged organically  giving me something to explore, photograph and write about. This day was different and I was left with several scattered moments that reveal the scope of what is happening  here in Homa Bay.

I visited Pamela, the head nurse, who sits at a large table in a big room lined chest high with filing cabinets.

As  we were talking people pulled out and returned stacks of files and  I became curious.

The cabinets were  numbered and the numbers climbed from left to right in a circle around the room.

The last number is saw was 11,622. “There are more files in another room” she told me. “11,622 human stories.” I thought. And Pamela said “ These are the lucky ones. They can come in for treatment. There are so many more out there in rural areas that don’t ever make it here.”

Earlier in the day Eric Aghan the MSF doctor brought me to see Henry. On Monday  we saw him unconscious- comatose from Meningitus.

Everyone was afraid and half expected that he would die. He had tubes in his nose and   hand.

“Here, when the family sees the tubes go in it’s like watching the  child  being taken to St. Peter’s Gate” Eric told me.

Yesterday Henry showed strong signs of recovery and Dr. Wanjala, the ministry of Health doctor removed  the tubes. “The patient does his part, we do ours and God does his” he told me.The boys mother found Eric on the ward and called him over. “She said ‘look Henry can eat on his own again!” and when she said it she was smiling all the way through. When parents see a child turn back from death they are very happy- it is a remarkable thing that she said.”

“Without proper care,  and if you are in a place where treatment is not  available, you would not be looking at a three year old child- you would be looking at another statistic.”

“There is no better way to thank the strangers who help MSF  here than to show them a child  that is still alive. People have hope not only for living but for living useful lives- going to school, farming, raising families, working. As doctors we have  a way toward happiness- we can properly treat  our patients and help our colleagues” Eric Aghan added.

The work continues. In Henry’s old bed there are two new patients with feeding tubes in.

In the maternity ward Azel was sleeping in the incubator. She was born 17 days ago to Dorothy, 26 years old, HIV positive.

Azel, sleeping in the incubator.

When she was born she weighed 1.92 kg.Now She is eating and gaining weight.

Dorothy found out that she was HIV positive when she was  3 months pregnant.
She told her husband after a few days. “He accepted the news. He told me it was normal. I told him to go and get tested. He didn’t bother.”

When a mother is HIV positive the child  will not necessarily contract the virus.
All protocols have been followed to help prevent the transmission of the virus to Azel. But  Dorothy won’t know for sure wether the baby has the virus for another 18 months.

In the lead up to World AIDS Day, 2008, on December 1, photographer Brendan Bannon is in Kenya and will be providing images every day of his travels with MSF throughout the region.

Day 4 - INVISIBLE CHILDREN

Walter is 12 and Charles is 10. They are alone and they are invisible.

“Nobody comes from the community to visit us here. They just look at us from the outside,” Walter said looking out the door of the house he shares with his younger brother.
They never knew their father. Their mother died in 2002 and  this April thier grandmother died.

“We dig the earth and plant and we go to school. No one is telling is to go. We go because we need more knowledge. I want to be a doctor- that’s why I go,” said Walter.

“Doctors help people and  I want to help people” he continued.

“Do you know any doctors?” I asked him.

“I heard of doctor Chula but he died 3 years ago. People were always talking good about him” he said.

Walter is 12 and Charles is 10. “Nobody comes from the community to visit us here.

I wondered if  during the time his two closest relatives were dying if they  received any medical treatment.

There is a cost recovery system at the public hospitals so people in Kenya who  are sick and poor often go without care believing it to be out of reach.

The boys  told me that when they get sick they wait for it to finish because they can’t afford to go to the hospital.

The brothers live in a 2 room mud and stick house on their grandmothers  200×200 meter plot.

Scattered around the land are signs of industry and initiative. There are the rows of maize, smaller plots for green vegetables and next to the house Charles has made a small nursery for tree seedlings. “this is my experiment,” he told me.

Walter is 2nd of 49 in his class  at school. Charles the younger brother is 5th out  of thirty.
In the face of an incredible tragedy these kids have and incredible resolve. And they have each other.

Charles said “My older brother is always  giving me advice. He tells me ‘We should love each other and not destroy the things we have.”

Walter added “ we still have a few problems- Sometimes  there is not enough food so we go to sleep hungry; The other problem is clothes- we don’t have clothes to wear to church.. or shoes. And sometimes we can’t afford the fees for our exams at school.”

After we face all of these problems and if we are able to succeed I hope the community  will see that we are people too.”