We Are the World

A bunch of strangers showed up in Sri Lanka at the request of Medecins Sans Frontiers to help a population in need.  The Tamil people, nearly exterminated, are trying to scratch a life from the red clay.  They carry with them the wounds of the war.  They have limbs that are missing, or non-functional.  They have pieces of steel lodged in their muscles and sinews.  They have memories that they can't forget.  And yet somehow they are able to smile at us, we strangers.

There were a couple of Japanese, a Hong Kong Chinese, Western Europeans, and a couple of Americans and an occasional African.  I have wondered at what has bonded us together.  Why did our friendships blossom and grow?  We didn't know each other.  I'm not sure that I ever learned people's full names.  We didn't even speak each other's language well.  But we tried.  And we smiled at each other, and we created a bond between us that will be hard to break.  I'm sure that our reasons for being there were as different as the countries that we represented.  But I believe that there was a common thread.  Somehow, we felt driven to help people in need.  We felt that we could let go of our comforts of home, to become strangers in a harsh land, in order to make a positive difference to a people who were uncertain of their tomorrow.

In a way, we were the refugees, the strangers in the new land.  We shared the bond of exiles, the bond of the dispossessed.  Our belongings were shared, we didn't really own anything.  And we shared a hope for a future, not only for the Sri Lankan people, but for ourselves;  for the world that we live in, and for the friendships that have formed.  I hope that the bond between us never breaks.

The Risks of Helping People

The Singala people, the majority in Sri Lanka, refer to the Tamils as terrorists.  The rebel faction, called the LTTE, for the Liberation Tigers of Tamil Eelam, were rebels.  And I suppose at one time they did use some tactics that would be called terrorist.  But so did the SLA (Sri Lanka Army), although they deny it.  The Tamil people lost the war that started in the early eighties, and lasted until 2009.  Many Tamil people lost their lives, and near the end of the war, the few who remained, fled into the jungles around Mullaitivu.  The Tamil people were, and are defeated.  They have lost nearly everything except their pride.  The MSF project that I have been working on has concentrated on the Tamil people who are now being repatriated into the area.  They have nothing.

Sometime after 9/11, international law made aiding terrorist groups illegal.  This is referred to as the criminalization of humanitarian care.  There are groups who have been labelled 'terrorist', but have no access to medical care.  So MSF evaluates the needs, and if the need is there, helps to provide care to the people who need it. They don't care which side of the line people are on.  They want to help people who need help.  They help people on either side.  They help people of any religion, of any ethnicity, of any race.  They look at people as people.  Some people are in situations where they need help, and cannot get it.  And so MSF is there trying to help, and takes the risk of helping.

The Daniels

The whole time that I was in Sri Lanka, I was either referred to as 'the surgeon,' or as Dr. Daniel.  They didn't really use last names in the way that we do.  But that was fine.  In fact, it was refreshing for me.  But I was not the only Daniel.  There were two others, and I include them here.  Daniel with the glasses, was a translator, and a very excellent one at that.  His sense of humor was relentless, and he never stopped giving me a hard time.  Daniel, the other Tamil guy, worked with the mental health team, and was an excellent counselor.  I know of many people who requested him and him alone.  He had a special way with the people who were hurting, and didn't know where to turn.  His empathy for the Tamil people was so real, that many times we all shared their tears.

It is a huge honor to be sitting between them.  I don't think that Daniel was really their name, but I was sure proud that they had chosen that name to go by.

Lakshmi

She was always ready to break into a smile.  Our translator, Lakshmi.  Her eyes were dark pools, like looking into the deep waters in evening.  She flashed understanding with those eyes.  Speaking Tamil, and English, and Singala, she, at times was our voice -- our connection to another human being.  She never faltered, and I was jealous of Dr. Ben, who had her attention every day.  I was lucky once, when she came with me for an afternoon of surgery clinic.  She bridged the language gap with me.  She appreciated my efforts to say the days of the week in Tamil.  She always seemed happy, and I asked her about that.

She told me that her daughter had gotten a divorce after being treated badly by her husband.  Her sons were very ashamed of this, and actually tried to kill their own sister.  She helped her daughter to escape, and she is now safely out of the country.  One of her sons doesn't even speak to her.  I know from my own experience, that if one of my own children refused to acknowledge me or to speak with me, I would be devastated.  I cannot imagine what she has gone through, as a woman, as a mother, and as a family.  But she always was there, with her almost smile, and her irrepressible attitude, like the unsinkable Molly Brown.  She tells me that she wants to come to the states, and maybe take care of someone's children.  I have her contact information, and I hope that I can find a reason to call her.

The Hair of the Dog

One of the requirements, or strong suggestions from the CDC, is to have a series of rabies vaccinations prior to visiting Sri Lanka.  I overheard one lady wondering why she needed the vaccine.  She said that she was not planning on handling any wild animals.  After being there for only a couple of days, the answer became very clear to me.  It is not the handling of the wild animals that is the problem.  It is the presence of twenty million wild dogs.  They are everywhere.  They lay in the streets at night, and wander about all day.  One of the popular reasons to visit the Emergency Room is a dog bite.  The females are almost always either pregnant or nursing.  They have no owners, and are truly homeless, unless you call the streets their homes.

The dogs in Mullaitivu, as elsewhere, are missing much of their hair.  They appear to be in a constant state of mange.  Apparently the fleas and other biting things cause them to scratch so hard that they scratch their hair out.  And there are fights.  They always seems to be in the middle of the night, and sound like they are next door.  I'm never sure quite what to do, so I just lie there and listen, hoping for an early end.

Red Dust

I returned home on Wednesday.  The saga of getting home does not really need to be repeated, but I will say that it took about 5 days of travel, interrupted with debriefings in Paris and NYC.  Although I am glad to be home, my mind travels back to Sri Lanka regularly.  There were many more experiences than I have had the opportunity to share.  So I will continue to share, if you all are so kind enough to continue to read.

The soil in the Mullaitivu region was dry and red, clay and sand.  Very little loam.  It was very dusty, and the red dust permeated everything.  Nevertheless, the people of the region always wore very colorful clothes, especially the women.  They wore beautiful saris, and colorful punjabis.  They were adorned with gold bangles, and necklaces.  They wore silver anklets.  They didn't seem to be touched by the dust.

My little bicycle on the street

I have been unpacking, and have noticed that the red dust is throughout my clothes and belongings.  It colors my shirts and pants.  And I am glad for it.  Just seeing it brings back the sights, smells and sounds of a different country, living in a different time.  Memories of a people in need.  Memories of my colleagues and friends.  I hope that no one can shake the dust from my feet.

Broken

A man once asked that if you had the choice between a moment of happiness, knowing that sadness would follow, or the absence of happiness, knowing that there would be no sadness, which would you choose?  I know people who would choose the absence of sadness.  There are those who just cannot bear the thought of sadness at all.  I think it is why some of them like to sleep so much.  People can be happy, or scared, numb, or even angry in dreams.  You have to be awake to be sad.

There are those who would bravely choose the happiness, knowing that it is a risk.  It takes a certain amount of courage.  It is a risk of hurt and pain.  It is a risk of failure, and a risk of loss.  But it is also the risk of hope, for what is happiness really, but a belief in a future.  A belief that our heart will heal after it is broken in sadness.  A belief that happiness will follow.  And for every potential sadness, the potential happiness becomes greater.  This is what makes us human.  Earning that future by believing in happiness, despite the very personal knowledge of the sadness that is there.

It is not easy.  My friends in Sri Lanka, the people with whom I have lived with, laughed with, and cried with, have known more sadness than most of us can only imagine.  The depths of the sadness that they have experienced only makes the peaks of their happiness greater.  They are creating their future by making the hard choice.  The choice of a broken heart, and the hope that it will heal.

Freedom

This early morning, I have been reflecting on what I have seen and experienced.  While in Mullaitivu, I saw an incredible range of emotions.  There was a kind of resigned sadness at times, kind of the sadness of defeat.  But these times were rare.  I think that the sadness was understandable, the losses are incomprehensible.  But even more than the occasional feeling of sadness, there was a happy exuberance.  The smiles that we received were many, the thanks that we received were constant.  The hope that I saw in the eyes of my patients, and in the national staff that worked with our team, at times nearly broke my heart.  I felt that I couldn't fulfill the hope that they had for me.  I couldn't operate and remove the memories that haunted their nights, and shadowed their days.  But when they smiled, something else took over.  For a moment, it seemed like they were free, that they, just for a moment, would let the sadness go.

I wanted so badly to be able to bring that fleeting moment of freedom to these patients.  To fulfill their hope, and to remove their pain.  But all I had to offer was a smile and a kind touch.  It seems so little, but it means so much.

A Sarong Sung Blue

subtitle,  The Bare Chested Priest

We made our second visit to the temple, a different temple, just outside of Mullaitivu, on the road to Puttukuryruppu (PTK).  It is the temple of our cooks.  They dressed up the women in saris, and I got to wear my new 'sunday-go-to-meeting' sarong.  I include the pictures of me getting my feet washed before going into the temple.  The other picture is the priest.  Not your average Lutheran.

My Sunday Sarong

Not your average priest

The Team

Here we are, the OT team.  Ayumi, the OT Nurse, has poured her heart and soul into the creation of an operating room, that several months ago, was just a blank space.  Dr. Kim, the VOG (or ObGyn for you americans), has worked tirelessly against nearly every hurdle that has been thrown her way, and she has never stumbled.  She has created an ante-natal ward, post-natal ward, and delivery area despite bat droppings, minimal hygiene and a head nurse who has bucked every positive move that she has made.  I am the surgeon, the thorn between the two roses.

The Mango Tree

The yard at the MSF ex-pat house has no grass to mow.  There are scattered dieffenbachia and bougainvillae.  We have a number of coconut palms in the back.  But there was a big bare area on the southwest side of the front of the house.  Kim, the second VOG, who is on her way to Nigeria, and myself, the first surgeon at the project, wanted to leave something more than a memory.  So we planted a mango on the morning of our departure.  The guard helped dig the hole, and assured me that he would water it regularly. One of the other national staff made a sign with our names on it.  It is a stick, nailed to another stick, and placed in the ground.  It looks likes it marks a grave, but he was so proud of the work, that I couldn't bear to tell him.

A Gift from the Sea

I was trying to arrange my packing so that it made some sort of sense, and I came across a small bag that I had no recollection of.  I opened the bag, and in it was a sea shell, a special gift from someone who must realize that there is no way to give a gift that can contain the smell of the sea breeze, or the salty taste of the Indian Ocean.  The true gift is the memory.  The memory of the sun, and the heat, and the sand, and the curry.  The memory of Sri Lanka, Serendip, Tabropane and Ceylon.

The Train Home

It was Friday morning, and we had packed our lives into canvas bags, and stored memories onto flash drives, and burned those memories into the deep hidden parts of our hearts, hopefully for later retrieval.  We loaded the van for the movement to Vavuniya, where we would catch the train to Colombo.  The trip to Vavuniya takes over two hours over rough roads lined with banyan trees and teak.  The tone in the van is subdued.  I am leaving the project after nearly two months in the field.  Kim, the VOG, is leaving the project 2 weeks early, and is being sent to Nigeria to fill in a gap in VOG coverage.  Charlotte is getting a long overdue break in her work as acting FieldCo and Psychologist, and will be diving with friends in the Maldives.  Ayumi, our OT nurse, is taking a break to visit Kandy in the mountainous region of Sri Lanka.

We get to Vavuniya, and have lunch, before catching the train.  Our tickets, up until this morning, were third class.  However, we just found out that we got moved up to first class.  I'm not sure that there is much of a difference, really.  The train trip is over six hours of lurching, jerking and pitching back and forth.  It is difficult to rest, and is so loud that it is hard to even talk.

Arriving after nightfall in Colombo, we stand together at the station.  I think that we all realize that this is the end of this chapter.  But we also realize that the world has become smaller, and we hope, a little better.  Our efforts, at times, seemed to be so insignificant.  But the smiles of our friends in Mullaitivu, and the efforts by everyone to tell us 'good-bye' before leaving, makes me believe that in some small part, we have made a positive difference.

My Friend Paul

He goes by the name Paul, but that is not his real name.  He has an easy smile, and mischief in his eyes.  He is a playful spirit, who I connected with immediately.  We spent hours on the roads together, trying to get to different mobile clinic sites.  He was not only my driver, but acted as translator, since I had not been allotted one.  He taught me the history of the area, taught me about snake houses, and shared his precious coconut wine, which I couldn't bear to tell him, tasted more like goat urine.  He is off of work this week, taking the leave that he hasn't used.  Yesterday, he took the bus for a two hour ride from his home in Kilonochchi, to meet me at the hospital, just to goodbye.  Once we drove to where he had been living during the war.  The church that he attended was destroyed.  All of his belongings were stolen.  I asked if he played any instruments, and he lamented that he loved to play the guitar.  I have tried for nearly six weeks to find a guitar to give him, since his was destroyed.  But to no avail. I feel badly that I haven't come through for him, like he has for me.  But he doesn't see it that way.  He sees us friends, who can joke together, sing reggae together in the truck, and laugh together, despite the fact that pretty much everything that he has ever had, has been taken from him.  I love his spirit.

Envoys

Because of the recently released UN report on possible war crimes, the United States Envoy was sent to visit the area.   He ended up here in the Mullaitivu District.  Because of the sensitive nature of his visit, the few white people, me included, had to lay low.  We were not allowed to see or greet him, and a hand shake was out of the question. MSF works very hard at neutrality and impartiality.  This was a chance to see that out here in the real world.  Americans are not highly thought of everywhere.  Effigies of Obama were burned last week.  Some of us will revertto speaking Spanish or German.  Unfortunately for me, I am the only one who speaks German, so it is usually Spanish.

I was seeing a patient the other day, and was asking in Tamil if he had pain.  He showed no understanding of what I was saying, and I thought, boy, my accent and pronunciation must really be bad today.  However, I was immediately corrected, and told that this man was Singala, and didn't speak Tamil.  What a dilemma.  The Tamil women can be identified by how they dress and how they wear jewelry, but I guess that I'm not sure how to identify a Singala man, unless he has on an army uniform.

Guano

Over the only stair case that is accessible to patients, is a somewhat porous roof.  In fact, all of the roofs here are pretty flimsy.  The hospital roof, however, as become home to thousands of bats.  They produce enough guano, that the roof tiles started to leak it into the stairway, and into the area next to the maternity ward.  If guano smells bad in Iowa, think of what 90 degrees and 100 percent humidity does to the fragrance.  I will tell you.  It magnifies it.  To the point that going up the stairs would make your eyes water.  There is apparently a secondary problem, in that the monkeys like to catch the bats, and will climb on the roof at night.  So, as part of the deal to bring the hospital up to a better grade, the roof is being fixed.  I'm not sure that is the final answer to the bats, but I hope it will keep the smell down.  There are so many smells in Sri Lanka that are unusual to the western nose.  I'm not really sure how to catalog them.  I'm sure that they will evoke many memories if I ever smell them again.  Of bats, and monkeys, and cows walking down the middle of the road, and the ever present burning of trash and manure.  But there are good ones as well, like the smell of curry, the ocean salt breeze, fresh fish, and prawns on the grill.  I will try to remember the good ones.

Sunday, May Day

It is May Day here.  For some reason, that corresponds to a holiday.  Since May Day is on a Sunday, that means that most of the people get Monday off.  We don't get the day off on Monday, but there will be reduced staffing.  Several of the women in our groups have purchased saris.  These are basically eight to ten yards of material that is wrapped around a person in a very particular way.  Being that today is a holiday, the women wanted to dress up in their saris, and go to the temple.  The problem is that none of them know how to get into a sari. So our local staff who help with the cooking and cleaning came over for a lesson.  Ayumi, our OR nurse, and Dr. Kim, our VOG, were dressed in their new saris.  I wore my best sarong.  And we all went to the local temple.  The Hindu temple is really quite something.  We spent about two hours going through the temple grounds, and at the end, were fed some of the food that is prepared by the priests.  This includes a spiced fruit and rice dish served on banana leaves.  It is actually quite good.

When we returned to our house, we changed into more casual wear, and went to the local beach, where we watched the fisherman bring in their catch.  We bought a kilo of fresh fish, small, anchovy like fish, and brought them home.  We fried them up in hot oil and salt and pepper, and have been munching on a tasty snack, fresh from the sea.  Now to get ready for Monday.

Windows and Doors

One of the things that one finds in more tropical climates is the absence of windows or doors.  That is, if we think of windows as glass partitions between the inside of the building and the outside of the building.  And if we think of doors as something that closes once we are outside.  I guess that we have windows here, but they are merely holes in the walls.  We have doors, or should I say, doorways.  Mostly there is nothing to close or hit you in the butt on the way out.  These openings are very good for airflow, as long as the air moves.  It also means that other things have free and unrestricted access to your living quarters.  It is no longer a shock to me, but there are always things crawling around.  Primarily insect life, but others include gecko like things, toads, tree frogs, and other feral animals.  Of all of the shots that were required to come to Sri Lanka, the most valuable was probably rabies.  I have not been bitten, but there are many feral dogs, and fewer feral cats.  They are everywhere.  In our emergency department, many of the visits are for treatment of bites.  Ironically, these do include human bites.  And of course, those are probably the worst.