Sam

There was a big party put on by our national staff last night. It was to celebrate the work that Sam Depoeh has done as the project coordinator. He is from Liberia, and will leave this MSF posting next week. From what I can tell, he has done a great job and will be greatly missed. I know that I will miss him. He has extensive knowledge of the area, and the underlying politics that still affect us daily. My driver Paul, a local Tamil, sat next to me as we toasted to Sam. 'To Sam' and then a drink. 'To the snake house', then a drink. 'To Ganesh' we yelled, then a drink. 'To the monkey god' we'd yell, then a drink. 'To the dog god' then a drink. Luckily, we couldn't remember many other gods, but these were all gods that had local shrines that we have visited. We did eventually get back to Sam. He is a good man, and I wish him well.

The Finals

The Sri Lankan cricket team advanced through the semi-finals beating New Zealand to make it to the finals. The other semi-final game was India versus Pakistan. As you may be aware, there is some animosity between those two. India won, and will now face Sri Lanka in the finals to be held on Saturday in Mumbai. Not quite March Madness, but still fun to see all of the excitement.

Tsunami

We have been notified that there will be a practice tsunami warning today. I think that they told us so that we would not panic. I'm not sure what I'm supposed to do. There really isn't any high ground to go to. Maybe climb to the roof of the house. We are about 7 km from the water edge, so I think that we will be ok. During the tsunami in 2004, thirty thousand people in this part of the island were killed. When Japan had their recent tsunami, there was a warning here, but Sri Lanka did not receive any significant waves.

The Snake House

We were travelling around the countryside visiting some of the mobile clinic sites, spreading the word that we are increasing the surgical capacity of the area, when I noticed these piles of dirt, that reminded me of the large termite mounds seen in Africa. I asked my local driver if these were made from insects such as ants or termites, and he told me, no, they are where the snakes live. He called them snake houses. The larger ones will have a king cobra in them, or perhaps a couple. Smaller snake houses hold a family of vipers. I'm told that there are either one or the other, but they don't like to mix company. The cobra is considered a sacred snake, and I have seen a temple with a large cobra at the front. In fact I do have a picture of it, but unfortunately cannot upload it yet. Sri Lanka is a country with one of the largest number of snake bites in the world. Our emergency room averages about 2 snake bites per day. I am looking pretty carefully where I step.

The Food

I have had several people ask about the food, and what are we eating, and is it good, and what do you think. I ask myself that nearly every day. I have mentioned the buffalo curd, which continues to be present. Our cooks are trying to please most of the ex-pats, by limiting the spices put into the food. I think that this is a mistake. What has happened is that the food becomes somewhat tasteless, instead of spicy. We eat a lot of rice, and sometimes prawns caught in the local lake. There is often fish or crabs, also from the local lake. Cassava and potatoes of some sort, along with some vegetables rounds out the meal. Overall, it is pretty good. The local food is only fair, but in the south of the island, the food is excellent. There just aren't the same resources here in the war-torn north. But, is almost all very local.

Hot heat

It is probably ironic to those who know me that I would end up near the equator. I did go to Florida once but that was as close as I got. And it was in January. Now summer approaches in Sri Lanka. I think that Colombo is about 6 degrees north latitude. The sun is high in the sky. Not that low lying cool disc that we see for a few hours a day in Decorah. But up there, overhead, in the middle of the sky, bearing down on us. The heat is hot here.

The other irony is that I am in a place that is religiously conservative. I'm not sure what that means from the religious standpoint, but culturally, we are not allowed to wear shorts, and shirts must have at least short sleeves. Probably a good idea, actually. Or that hot flaming nuclear explosion above us would toast us like we were small ants under a magnifying glass. This way, we are at least more slowly poached.

Sin

The greatest sin is the unlived life.

I'm not sure that I remember who said this, but this quote is very powerful. If someone knows, please comment.

Humanitarian Principles

The humanitarian principles that guide MSF are as follows:

Independence

Impartiality

Neutrality

The mission of MSF is to:

Provide emergency medical care to populations in need. These needs may be secondary to war or natural disaster. They may also include neglected diseases (ie. those diseases that do not represent a profit for drug companies.)

Provide temoignage, or witnessing. This means having the ability to describe to the world the situations that these populations in need are experiencing.

In the case of Sri Lanka, the temoignage is reduced. The government will punish the organization and the people involved, by reducing access to the people in need. We have seen this already. Great care is taken with communications to reduce the risk of losing our access. This discussion has occurred at the highest levels of MSF. The decision to compromise one of our fundamental missions is not taken lightly. But in this case, it preserves the ability to provide for the first mission -- taking care of populations in need.

1983

In 1983 there were riots in Colombo. They were very violent and fierce. Ten thousand people were killed. And the most recent set of wars between the Tamil people and the Sri Lankan army began.

But there were things that led up to those riots. I would like to share some of that history with you. As most of you are aware, history tends to be written by the victors. So you can easily find that in your library. I will expound on the other history.

Leading up to 1983

In the years prior to 1983, the Tamil people were highly educated. Admission to college in Sri Lanka was based on test scores. At one point, about 80 percent of the people admitted to college were Tamil. But the Tamils only made up about 15 percent of the population. College education was done in English. Sri Lanka was, after all, a former British colony, only to get its freedom in 1948. The Sri Lankan government realized that college education was important, but felt that the Tamils had an unfair advantage, scoring so highly on those admission tests and all. So they changed the rules. They said that if a Sinhala person needed to score 150 on the admission test, that then a Tamil must score 200 to be admitted (just for example.)

Secondly, that colleges should no longer teach in the king's English, but that higher education would be taught in Sinhalese, the language of the Sinhala people. (The two major languages of the island are Sinhalese and Tamil. These are not dialects of each other, but completely different languages using completely different alphabets.)

That was a double whammy to the Tamils. The admission requirements were unfair, and the language requirements were changed to disadvantage them.

A third thing happened. The government settled, or resettled Sinhalese people into the Tamil lands to reduce the political power of the Tamils (only 15% of the population.) There are rumours of fixing local elections, but I'm not sure that has been verified. The political voice of the Tamils was effectively silenced.

As oppressed people will do, the Tamils struck out at the oppressors. They have been given a bad name, and have been called terrorists, but I feel it important to give a look at their side of the story.

The Radisson

You may be wondering where MSF doctors and staff stay when they are on a mission. I know that I wondered this quite a bit. And then I found out. Houses have been identified in the area as possibilities, and a logistics person basically arranges a rental of the area. We currently have two houses in Mullaitivu, one for the offices, and another down the road for the ex-pats (people like me, who are not locally grown) to live in. It is a small house that we live in, and extra rooms for bedrooms have been built in the backyard. We are really only there to eat and sleep, so we don't need much. My room is about 7 feet by 7 feet. There is a too-small bed, and a small desk. That doesn't leave a lot of extra room. And of course, a mosquito net. Mine is very manly in color. I apologize for the quality of the photo (hand-held at 1/20). Any decorating ideas are welcome, but please keep in mind, that the shopping here is quite limited.

Tuk Tuk

Sri Lanka, and other parts of Asia have many three wheeled vehicles called Tuk Tuks. We use them to get back and forth to the hospital. The hospital is about a mile from where we live and eat. It would normally be a good walk, although the temperatures are so hot during the day that I wouldn't recommend it. The other problem has been the military check point just outside the hospital grounds. If you are in a vehicle, they don't stop you. However, if you are walking, you get stopped and your papers are checked. So we take the Tuk Tuk. This is the MSF Tuk Tuk, and inside our driver is smiling and waving. The other thing that I should mention about these vehicles is that when they are in use, the road or path or whatever becomes the field of play for the largest game of chicken that I have ever seen. So far, we have been winning.

More Cricket

If I heard the news correctly, I think that Sri Lanka just won its quarter final against England. There were fireworks, and cars beeping horns (not that unusual.) It is a big deal to the people here. The only thing that I can compare it to is the Packers winning the Superbowl. I guess it is just plain fun to be where the action is.

Market

By the way, I lived through the buffalo yogurt, and had more today.

We went to the local market yesterday, and a couple of the other MSFers bought a couple of things. On our way back we were invited to what appeared to be a wedding. Not to miss a cultural experience, we went in to a small tent that was decorated elaborately. The man at the door was eager to get us in there. We were like special guests. He placed some white stuff on our forhead and put a colored dot between our eyes. If I wasn't so white, I would have felt like a native. The sign in the tent said "Special day to celebrate Puberty". I was a little confused over the celebration. The girl, who appeared quite young, but was elegantly attired in traditional garb, was without a groom. But we didn't know how it works. Maybe he shows up later. Or maybe we were celebrating her entrance into puberty. Either way, we were treated like royalty, and the photographer took our pictures, and the family gave us cookies and some pink stuff to drink.

I'm still waiting to celebrate puberty myself. It seems like we try to deny it in our culture, rather than have a party about it.

It is nice to see the world.

Cricket

Just an update on the International Cricket Council. Sri Lanka won its first group, and will proceed to the quarter finals. They play tonight against Pakistan. I thought that I would include this, as it is difficult to get the results in the local papers at home. It is fun to see the local children playing cricket in the street or the fields. Just like the old days when we used to play baseball in empty lots. Usually just an old broken board is used as the wicket, but most have some sort of bat. There is always alot of cheering and shouting.
The excitement of the game seems to be an adequate distraction for the difficulties faced on a daily basis just for survival. Which, as I am finding out, is not as easy as we tend to think.

Buffalo

There is so much to say and share with everyone, and so little time to do it. I will try to leave a few vignets to reduce the backlog of stories.
Yesterday, I had the chance to have buffalo curd for breakfast. I'm not sure of what it really was, but it is made from the milk of the local buffalo, kind of a water buffalo. It was somewhat yogurty, and with a little honey, was actually quite good. Although I had a healthy suspicion of it, I nevertheless tried a hefty dose. I thought that if it was to make me sick, it might as well make me real sick. I survived, and there were no untoward effects.
I have been working is setting up the operating room. Here they call it by its British term, the Operating Theater. It sure makes it sound elegant. It is actually quite nice, and will be a big asset to the community.

The hospital

The hospital that we are working at was built after the tsunami in 2004 washed the previous one away. This new one is further inland, and should not be in danger. It is a two story hospital, and is primarily run by the Ministry of Health (MOH). However, there has not been any surgical capacity (no ORs) until now. Apparently MSF was prepared to build the ORs but UNICEF was given a directed gift by a private donor to build the OR. So of course, they did. There were a few things that were not perfect, as they are not really in that business, but we are correcting some of the minor things. There is going to be a dedication, with the local governor, the brother of the Prime Minister, and other bigwigs this next Tuesday. They thought that it would be especially memorable if we could perform the first surgery in the new OR on that day, and could it please be a C-section, so that the bigwigs could have a photo op with the new baby. I sure hope that gets vetoed.

The head nurse of the OR is from Japan, and seems to be very good. She has been here for about 2 months getting the whole OR organized. The only major thing that we are currently missing is a bovie. I wish that I had taken the old broken one from Decorah. Although on second thought, it probably wouldn't have worked here either.

They just got the bullet holes in the hospital filled the other day. It amazing that it was strafed the way that it was.

There are several families of monkeys living at the hospital. I haven't had the chance to introduce myself yet.

To Mullaitivu

The taxi was given the wrong date to show up, so we were a little harried as we tried to get to the train. Luckily, the traffic was pretty quiet at 2145, and we made the train just minutes before it left at 2200. And it was spot on. We had a sleeper car, and I had been warned that the beds were pretty well infested with bedbugs. I was travelling with the Head of Mission for Sri Lanka, my ultimate boss for the operation. Although I don't think that I got bit by anything, the constant fear along with the shaking and jerking of the train didn't leave much time for sleep. We arrived in Vavuniya at 0530, and were picked up by some MSF drivers who took us to the local MSF house. A little later we were able to get on the road to Mullaitivu. I think that it is about 50 km, but it takes 2 to 2.5 hours to drive. The road is very rough and narrow. The military presence is very palpable. About every 200 meters was a bunker with 2 to 6 armed soldiers. Several checkpoints were crossed, and we make without difficulty. Finally, to Mullaitivu.
I would like to put up some photos, but will not be able to until later, as the internet situation is a bit limited.

Colombo

The sun was rising in the east after a full night and half a day of flying. We landed this morning in Colombo, the capital city of Sri Lanka. I see why this is called the jewel of the Indian Ocean. Things are green and lush, and very tropical. The cars drive on the other side of the road, and the drivers sit on the other side of the car. The motorcycles drive down the middle of the streets, kind of like in Paris.

I have just started to meet some of the people here. they seem very nice and sincere. The projects that they are managing from the capital city include the one that I am going to, as well as an older project in the far north, called Point Pedro.

The big news around the city is the Cricket World Cup. Sri Lanka plays New Zealand tonight in Mumbai, and the place is just buzzing. Billboards and giant cutouts of players line the airport as well as the streets. It is very exciting, and I hope to see some of it. I also hope that someone can explain it to me. Anyway, we are rooting for Sri Lanka. The atmosphere is like we saw in the movie Invictus, and it has just about as much importance to the people here.

Paris Day 2

It is the second day here in Paris. I stopped at the MSF office yesterday to deliver a package sent from the NYC office. I was told that there was another package for me to deliver to Sri Lanka. It is full of medicine and equipment. Unfortunately, some of the people who are supposed to brief me on my assignment, have had to leave, and are involved in some of the assessment of Japan. That will make my day shorter.

I have had some further information regarding the possibility of continuing this blog. I have been told that I may not be able to blog from Sri Lanka. There are apparently some security concerns. So if you do not hear from me for a while, that is the reason. I will continue to try my best.

Paris, Day One

Air France is a wonderful airline. We flew a large Airbus 380, a double decker, and one of the biggest planes I've ever been in. The Flight Attendants were multi-lingual, and the food was interesting (I had the salmon shepherds pie.) Wine was served, if not encouraged, and cognac was definitely encouraged. I sat next to two men from Budapest who were designing new software for the iPhone and iPad. There was a camera on the tail of the plane so that we could see what was in front of us, and actually watch the take-off and landing. When we landed, the passengers all clapped, as if they were surprised or expecting something else.

The train trip to Paris, however, was not as comfortable. The first train was late, so that there were more people available to fit into it. We filled it to the brim, with standing room only. At the next stop, at least a dozen more people squeezed in. There was a lot of closeness going on. At the next stop, about 6 more people got on, and no one left. A smaller person's feet may not even be touching the floor, as the human wedge pressure held them up. One more stop where no one left the train, and 4 more got in. We weren't sure that the doors could close. The Iowa hula hoop of personal space had been crushed at the first stop. Now the personal space seemed to be less than the thickness of denim, and that denim was being pressed to the thickness of silk. I would have taken a picture of this, but I couldn't move. Anyway, it reminded me of the Who concert. But we all survived. After over 2 hours, and one transfer, I made it to the Bastille. My hotel was only a 15 minute walk.

Starting Out

Today has been a day of good-byes and hellos. I said a goodbye to my family, who has supported this adventure from the very outset. From the first thoughts about MSF many years ago, to the reality that it has become. Some say that if you think about something hard enough, it becomes real. I guess that we have thought long and hard about this, and here we are, now making it real. I also said hello to New York City old friends Carl and Martin Refsal, who graciously spent their evening with me, sharing a meal and beers, and great conversation.

Tomorrow I am scheduled to meet at the MSF offices for my first briefings. I hope it is OK to wear boxers to briefings.

The next step is unknown. I will be going to Paris to meet at the MSF offices there, and be briefed more. Then off to Sri Lanka.

The adventure has just begun.

Sarong

Can you picture me in a sarong? I'm told that that is the proper attire when relaxing after a tough day in the operating theater.

(not me)

Don't forget the Spork

After talking with others who have travelled into the far reaches of the world, and asking them for advice on things to bring, or maybe more importantly, not to forget, there has been a recurring answer. Something to eat with. Items have ranged from a complete set of utensils to just a knife. So I would guess that these answers distill down to a spork. I think that I saw one of these at the Decorah Chick Hatchery. Maybe I will have to pick one up. They don't weigh much, and they don't take up any space. Perhaps in the future, I will be able to tell about what I find to eat with the spork.