Let me introduce you...

Let me introduce you…

With much anticipation and I’m not going to lie, some fear and uncertainty, I journeyed to Juba, South Sudan. While I’ve traveled to (only) about 7 or 8 other African countries, I wasn’t entirely sure what to expect when I arrived in Juba. I had been given some pretty clear instructions on which line up to get into, what to write on the entry forms, and who would be waiting, but one never knows what will really confront them on arrival.

And sitting in the airport in Nairobi, sipping my decaf, soy, caramel machiatto at the famed Java House was not helping me mentally prepare for all that Juba has to offer…

I finally made my way over to the waiting area at Gate 15 for the departure. As I sat, I played a little game in my head of trying to guess the travel reason for all the other passengers in the lounge. It is pretty easy to determine the reason for travel of other passengers when you board a flight to Cuba or Mexico. But going to South Sudan is not quite as straight forward as my vaccination nurse in Vancouver would have led you to believe when she asked me, “Are you going for business or pleasure?”

While I am sure I will find much pleasure in South Sudan, the passengers waiting in the lounge were not likely embarking on a relaxing vacation. Still, guessing people’s purpose for travel was not as straight-forward as one might think. Yes, there is the older man with the UN lanyard or the ones like me with their NGO acronym splayed across their t-shirts. But then there were the 3 teenage boys in baggy jeans and backward caps bopping to hip hop on their ipods, or the young woman with striking makeup and 2 inch long fake finger nails furiously tapping between her Samsung Galaxy and her iphone 6. Returning home from a holiday? Visiting their parents on a school break? The guessing game made the waiting time go faster.

Boarding commenced as it has in most African airports I’ve been to (and European as well). You first all cram onto a bus to be driven far down a tarmac, sometimes in seemingly random locations. I’m standing on the bus when an older guy comes up to me and says “You must be Alida” – I was suspicious at “You must be….” because it is not uncommon for unfamiliar men in foreign countries to pretend to know me, so I immediately had a guard up (scam artists fish around for information which they get you to unwittingly disclose and then use the info to convince you that you know them and while your guard is down, they are eyeing or stealing your phone, wallet etc). I guess I shouldn’t have been so suspicious – I was on a bus in a secure location. How far could a devious thief get?

No, it was a fellow colleague from Medair, who had heard there was someone else on the same flight to Juba. And my “Medair” branded t-shirt (which I was instructed to wear) gave me away… It turned out to be handy and reassuring to have someone who was familiar with the airport procedures guide me, rather than me trying to incognito read my tip sheet as I passed through the steps.

As we circled for landing, I took in the landscape. The familiar red soil, green trees and shrubs stretched for miles with small rocky hills pocking the landscape. The Nile, meandering its way north (yes, the Nile flows up to Egypt), and then the sprawling city of Juba.

On landing, you again realize you are not in an ordinary African city. The only other commercial airplane was one from Egypt Air. Otherwise, there are rows and rows of UN, WFP (World Food Program), and Red Cross airplanes and helicopters. Our plane parked between a huge WFP plane waiting for clearance, and some smaller UN planes. I bid goodbye to my beautifully coiffed cabin crew on Kenyan Airways and welcomed the reality of South Sudan. Or at least my sweat glands certainly did. I had been mentally preparing for 50 degree celcius heat and my first thought was “Oh, it’s not that bad, I can handle this” but within a few short minutes (or seconds) I felt rivulets of sweat streaming down my cheekbones and draining down my neck, meeting in the middle as if they were tributaries. And I hadn’t even walked to the arrivals building yet!

Before Arrivals, you have to walk through the Ebola screening tent. I followed my colleague on a short-cut through some grass towards a WHO (World Health Organization) tent, where for some reason I expected a thorough and high tech environment. After all, how many times have I quoted WHO in an academic paper I’ve written? I imagined anything inside a WHO tent must be state of the art. Alas, there was a plastic white table at the far end of the tent, a few tired and hot looking people lounging on the side, and one older gentleman scanning everyone’s foreheads with an infrared thermometer. Fortunately, the shock of heat did not raise my internal temperature and he waved me through with a nod.

Next step was customs where I tried to absorb the mild chaos of what was going on around me. I noticed the woman at the desk being asked for multiple ID’s even though she had a visa, so when my colleague said “get out your ID”, I had already mentally remembered where I packed it in my bag. Fortunately the immigration official was satisfied with my visa and smiling face, so we moved 15 feet to another official who then checked to make sure we had actually received a stamp in our passport. A mere 5 feet away from this check-point was a single luggage x-ray scanner. Once you find your luggage in a big stack, you have it checked by yet some more officials. Most were men in army fatigues but there was one woman, who was so exquisitely dressed in a satin bodice dress with frilly sleeves made from traditional African fabric, I thought she must have just come from a wedding. But then I remembered, African women are always dressed this well and it is I who looks like an under dressed, slovenly mess. I wonder what they must think of my faded linen pants, sweat stained tshirt, and running shoes?

She was kind enough to take my word that there were only clothes (no satin dresses!) in my bag and didn’t require me to open everything up and spread it out.

A mere 5 feet from the baggage inspecting area, was another gentleman who checked our baggage tags with our luggage before allowing us to proceed. In a space of a couple hundred square feet, I had been checked 5 times. They certainly are serious about passengers passing through their airport!

We finally we lurched out of the tiny airport with all our bags and walked to the Medair vehicle. Again, I thought “Well, the heat isn’t so bad” and then I caught a reflection of my face in the truck window – it was 100% glistening with sweat. To the point it looked like I just got out of a swimming pool. I may need those ORS (Oral rehydration salts) sooner than later.

A short drive took us to the Medair compound where I promptly met the base manager. She immediately took me round for a tour and many friendly introductions. I’m the new one on the base and Juba is brand new to me. Let me introduce you….

*** please note - these are NOT photos that I took! I found them on the internet ***

One Day

A colleague just said to me, "I'm sorry about the tough day you had at work."

To which I replied, "Which day was that?"

Quite honestly, there are so many challenges in the hospital I am at, that there has not been One Day where I, or the Tanzanian nurses, have not faced massive challenges.

So, let me describe a snapshot of One Day for you.

Last week, I came into the labour ward from the Administrative morning meeting, to see an infant born, covered in meconium (this is baby poop). When the baby has pooped inside the womb, there is a good chance they have breathed some of that poop into their lungs. I saw the baby lying lifeless on the delivery table, so dropped my bag on the floor near the nursing table, grabbed the baby, and brought her over to the infant warmer (the warmer part doesn't work - but that is a whole other blog).

I grab one of the electric suction machines to find that there is a convuluted mess of suction tubes, none of which seem to be connected to anything that actually sucks. And the insides of all the tubes are moldy. As I am making my way through these giant, non-working machines, tripping on the cords of the mostly non-functioning equipment, my colleague Macha, motions to the extremely moldy foot operated suction pump that I had tucked behind all the mess yesterday.

You see, I was desperate to help this baby, because yesterday, as I was trying to clean the dusty, non-functioning equipment, a newborn brought in from their home, had gasped their last breath just a few feet from me, but we were all too busy to notice. Other babies were coming, women were begging for a place to lay down their weary bodies, I was trying to organize and understand this plethora of useless equipment. I was too busy to notice an infant dying, just a few feet away from me. And so, on that day, I decided that life takes precedence over cleaning. And then I started to understand why the maternity department is dirty. Life comes first.

Returning to my clumsy, now-swearing-under-my-breath antics, I finally managed to wrangle this antiquated piece of machinery out and attach a too large suction tube and push it down the tiny throat of the lifeless infant. I started pumping with my right foot and holy crap, this thing worked! The mucous had been too thick to bring up with a bulb syringe, the standard piece of equipment, but I managed to bring up what was blocking the airway and the baby gasped. But not safe yet.

With totally irregular breathing, the baby needed help and so I started using an ambubag to try to get more air and oxygen into the lungs (we call it "bagging"). But I will tell you, those CPR classes make it seem a lot easier than it is. Tilting the head back, keeping the tiny, slack-jawed mouth open, making a seal around the mask on the face - extremely difficult, especially when you are internally panicing.

I see the stomach rise and fall - that means the airway is still blocked. Either by mucous or because I haven't positioned the head correctly. Re-position the head, try again. Stomach is still moving.

Get the suction out again - clear the nostrils - they were full of gunk. Trying to bag again. It looks like both the chest and the stomach are moving. Stop bagging. The baby is breathing, but very irregularly.
Another nurse is trying to assist and has some "interesting" approaches, which I have never learned (but maybe they work?). She presses on the stomach and tells me to bag the baby - indicating that if the stomach is pressed, the air will be forced to go into the lungs. I try to explain that is not what I learned in CPR! I bring out my dormant CPR knowledge, and try some back thrusts on the baby while holding their head low, attempting to physically move the mucous up the airway so I can get it out easier. Put the baby back on the bed and  I suction some more, putting the suction tube further down the throat. I am convinced the airway is still blocked with mucous and blood.

I give the foot pump suction another rigorous go (I guess I am getting a work out) and I see the tube fill with yellow and blood tinged mucous. The smell from the moldy water and tubing is pungent and I get briefly nauseous. I get a lot out but realize that I have probably caused some superficial trauma to the tender throat area with the "too big" suction catheter. But the baby is breathing more now and doing it independently. Still irregular, but enough that I think bagging her will interfere with her efforts to breath. I put on some nasal prongs (there is no oxygen mask of the right size) and miraculously, the oxygen concentrator is working.

I wrap her up tightly with the Kanga's (Tanzanian cloth) to try to keep her warm, switch on the exam light and point it at her, hoping the radiant heat will warm up her body temperature. I sit on a stool near her and keep a close eye on her. I can't let cleaning get in the way again.

She is breathing enough times per minute and her heart rate is strong, but she is quite slow to respond and seems to have poor reflexes. The mother and grandmother come in to check on her and I explain in my childlike swahili that she has "water in her lungs" and had a hard time breathing at birth, but that we are doing everything we can to help her breathe. The nod silently and go to the post-natal ward to wait.

She seems stable enough that I can help with a few other things in the labour ward and feel like I am not abandoning her. I work on sorting out the mess of machines. Just as I am plugging in and unplugging machines, I see a tide of water coming towards the 5 electric outlets on the floor. I quickly throw them up on a stool, envisioning death by electrocution, just after I got the baby breathing! I tried to gently explain to the cleaning staff that water and electrical plugs don't like each other very much. Crisis averted and I continue on.

I tell my colleague that I refuse to go home until I am confident that there is a functioning suction machine. I separate out all the tubes and try to see what is working. Two of the electric suction machines have a very weak suction and I can't tell if they are working. The connector to attach the actual suction tube is missing, so essentially they are non-fuctional. I go find the biomedical repair man and tell him that I won't go home until they are working. He jumps right on it and rolls them away for repair. I take the foot pump to the dirty utility room, grab the bucket of bleach, and try to scrub some of the mold out of the pump. I can get the glass bottles clean but the tubes are another story.

I head over to the Medical supply "store" (It is just referred to as "The Store") and explain that a baby almost died today because I didn't have the right supplies on hand and I want some *now*. They let me into the big room and I start going through boxes I had seen on my "tour" a few days ago, and pulling out some much needed oxygen prongs. Unfortunately, there are no suction tubes to be had. Anywhere. The ones for the machine, or the ones to actually suck mucous out. They are "finished" and little interest in finding out when they might come across some others. I reiterate that babies lives depend on this equipment and hope the message spurns them into action.

So, I return to the ward to check on the baby and find she is still breathing on her own and occasionally opening her eyes. I put the suction machine tubing in a big bowl of bleach and just hope it removes some of it, because it is either moldy tubes or no suction. And no suction could mean a life lost.

I get the mother from the ward and bring her to the baby and explain how she is doing and that she might need to drink. I have the mother express some milk into a tiny cup (we use the tops off the IV bottles) and did something I never thought I would do - teach a mother how to fully express breastmilk. I was right in there, expressing it. Oh geez, we never did this in neuro...

I show her how to cup feed and the baby feebly laps her tongue on the milk and we encourage her to swallow. We manage to get a few ml of milk into her, hoping that it will boost her sugar levels. After about half an hour, I try taking her off the oxygen to see if she can tolerate breathing on room air.

The challenge is - keeping the baby in the labour ward on oxygen but having no nurse really available to monitor her and she goes into distress without anyone noticing. Or hoping she will cope on room air and be with her mother and grandmother and they can alert a nurse if her breathing becomes laboured. I opted for the latter.

We go to the post-natal area and I check the oxygen - it's 95% on room air and her breathing is the same it has been all day. I explain in my terrible swahili (and a lot of actions) that if her breathing becomes slow or laboured or she gasps, they have to bring her to the labour ward right away to be put on oxygen and have the nurse look at her. (There is no nurse stationed in the post-natal ward on evenings or nights as there is only 2 nurses for up to 50 patients, and their babies). They seem to understand and agree.

As I step back, I notice that although I had thought the mother had been a bit reluctant and disconnected from everything, she is very gently and tenderly holding her new daughter. As I walk by an hour later, I see her expressing milk again for another attempt at feeding.

It is now almost 5pm and I am exhausted. In between all of the above, I went and did complex dressing changes on several patients with very limited supplies, answered queries from curious families, and was constantly fetching supplies.

I promised the mother and grandmother that I will come on Saturday to check on them. I hoped for the best. I had a nagging feeling that the baby had been without oxygen for just a bit too long - but given that African girls and women are incredibly strong, was secretly hoping and praying that she would pull through.

I headed in on Saturday without a doubt in my mind but found a different mother in the bed. I was so confused. I had tried so hard to keep the baby alive yesterday. They couldn't have been discharged. The baby still needed antibiotics. Maybe they switched beds. Yes, that had to be.

I sought out a nurse in labour ward and asked where the mother of the baby was. She casually replied that the baby had passed away overnight. When she saw my crestfallen face, she quickly apologized for the loss, not realizing how much work had gone into keeping her alive.

I wandered out of the maternity ward and back to my bicycle not sure what to make of this. Is this what Tanzanian nurses do every day? Is this why they seem less shocked when a baby dies, because they are so used to it? Will I get used to it too? Will I stop getting angry at the injustice of it all?

This is but One Day in the life of a nurse midwife in Tanzania.

One Day.

Every day has a heart breaking challenge of its own.

This is but One Day.

I look forward to the One Day in the future when these kinds of stories are in days of the past.

Humans of Tabora

So, a few people have allowed me to take their photo - several of the guards at the hospital insisted on posing and I told them they would be on my website. I truly appreciate when people allow me to capture their beauty, personality, humour, and grace.

Check out Humans of Tabora (HoT) here

Tour of Tabora

Well, in some respects, Lonely Planet and Trip Advisor are correct in that there are not a lot of tourist attractions in Tabora. I biked by the "Game Park" which was locked and the children's swings looked like there was a layer of cobwebs on them.

But there is no shortage of things to see. I bike around town, trying to get to know the area and just see how people live. People are very reluctant to have their photo taken, so it is going to take awhile to build trust in the town so that I can take people photos. So, I'll keep riding my bike around town with my camera slung around my shoulder and hopefully people will see that I am really quite a nice person :-)

Click here to check out the Picasa album

A fine balance

I haven't known how to write this blog post.
How to share what is joy for many mothers, but an incredible loss for a few.
Why is it that the pain can feel so much heavier than the joy? Even when joy is all around you?

I hope I can describe the joy but acknowledge the pain.

There are 6 beds in the labour and delivery ward. They are not the fancy beds you might picture when thinking about your own birth experience. They are very simple, very well used metal beds with a thin, vinyl covered mattresses. They are always full. The rotation of women giving birth does not stop. It may give a reprieve for 20 or so odd minutes, but babies do not yet tell time or know the importance of a tea break, and so the bed is soon occupied. At times, even a mattress has to be pulled from the antenatal section and placed somewhere in the middle of the room for a 7th mother to be monitored. Or for a woman in severe eclampsia to be under the watchful eye of the nurses.

One young mother did not even make it to the bench. After taking herbal medicines in the village that induce labour, she gave birth on the floor under the sink before a nurse could even usher her further into the room.

I am often overwhelmed by the number of urgent situations that never cease. I told the nurses that in Canada, each one of these situations would require what is called a "Code team" and there would be masses of people surrounding each "emergency". But the nurses are so calm and cool and take it all in stride. This is what they do. Every day. All day.

Once the baby is wrapped and the mother is stable, she quickly moves to the post-natal ward. Along with the antenatal (before giving birth), it is the most congested part of the hospital. Two women share a bed, along with their babies, carefully curled like 2 question marks at each end of the bed. They take a bit of time to recover but as soon as it is evident that the baby is breastfeeding and the mother has no complications, she is discharged home after about 6 hours.

The women who have undergone C-sections after prolonged or obstructed labour are in a separate section and the positive unintended consequence of having major surgery is that they get their own bed! They stay for 3 days, barring no infections or further complications with instructions to return in a week to have their sutures removed.

And then the "Kangaroo room". Aside from 2 incubators that are never turned on (I'm not sure they even work), premature babies are cared for in this heated room, utilizing the best "technology" out there - skin-to-skin contact with their mothers. They receive extra education about nutrition and caring for their tiny infant. Some of the babies are born weighing less than 1kg. I weighed all the preemies one day. The mothers eagerly anticipating some weight gain, eyeing the mechanical scale carefully, and squealing for joy when the scale was tipped higher than last week.

Each day brings so much joy to so many families. The healthy triplets born to a mother of 9 children.  The baby that cried heartily after a painful birth. The mother that makes it to the operating room to stop the excessive bleeding to save her life. I should be walking on a cloud with all the new life around me!

But there, too, is pain. On a particularly difficult day, I walked into the labour and delivery ward to see a full-term infant lying lifeless at the end of the delivery table. Suffocated by the cord that had given him life for 9 months. Then the surgical delivery of a 7 month old lifeless fetus that had suffered placenta previa. The placenta had become detached from the mothers uterus, and the flow of blood to nourish the baby had stopped. And another baby born stillborn. And yet another mother referred in from another health centre with no fetal activity. Everyone around me looking so stoic and continuing on with the day. I wanted to stop the world from revolving and shout "this isn't supposed to happen!! Why aren't people crying?" I wanted to shout against the injustice of this! But I too, had to continue on with my day. My whispered "pole sana Mama" (I'm very sorry Mama) quietly acknowledged by the mother who likely knows this grief all too well.

It is a fine balance to give time and voice to the pain and loss but not to detract from the joy of new life that otherwise surrounds me.

It would be very easy to allow anger at the injustice and inequities of maternal health in Tanzania take over and outweigh the joy. In fact, that would be the easy way out. But I don't like taking the easy way out. I try to tip the balance towards joy, towards strength, towards resilience, towards progress.

And so my approach, against all the odds, is one of a strengths-based perspective.

When I asked "What are your strengths here in the maternity ward?" the answer was,

"We come to work every day because of what we call "huduma ya moyo" or "caring from the heart".

The scale is tipping already.

Tabora homestead

It's always nice to have a visual understanding of where someone lives when they go on to tell a story. So, if you see on Facebook that I've posted that the power is out or that I want the lizards to eat more insects, feast your eyes on my humble abode.

Although sometimes I feel like a pioneer (baking my own gluten free bread, warming up bath water in a pail in order to bathe), I actually have it pretty good. I have running water, a toilet, a bedroom with a closet, a shelf, a kitchen equipped with a stove, fridge, and freezer, a front yard, and about 100 pet lizards that feed themselves. What more can one ask for!

Here is a link to the facebook album
https://www.facebook.com/media/set/?set=a.10152822770850295.1073741849.528770294&type=1&l=af76fca830

I've added photos below, but not sure why it won't let me rearrange them... however, they are self explanatory.

you're welcome to stop by any time!
Karibu sana!

iCare

Care? Care what? Who Cares? You Care? What's Care? i Care?

These are some of the responses I've fielded when explaining that I was going overseas with CARE.

When they thought I was saying an acronym, then I would said, "Care, you know like 'I care'" and one would say "You care what?" I almost started calling the organization "iCare". I've started just saying "CARE Canada" or "CARE International" because somehow the second word makes it sound more official.

So, what is CARE anyway?

Well, as per their website, CARE started as an effort to deliver "care" packages to people in Europe after World War II. Over the past several decades, their work as evolved into focusing on emergency relief, economic development, food security, and maternal health. What attracted me to look more closely at the organization was that in their mission and vision statement, they reference wanting to work with the poorest communities that are not well served by other organizations.

          We seek a world of hope, tolerance and social justice, 

where poverty has been overcome and people live in  dignity and security.

So, I applied and was accepted as a "Volunteer Nurse Advisor" under the umbrella of a maternal health program already well underway in the Tabora region of Tanzania. 

In 2010, the G8 leaders committed to financially supporting initiatives to improve maternal, newborn, and child health and  called it the Muskoka initiative.  (Every time I hear a Tanzanian say it, I think of some woods in Ontario, and momentarily wonder why we are discussing the Canadian wilderness....)

With funding from the Canadian government, CARE proposed and has implemented the TABASAM project - or the Tabora Adolescent and Safe Motherhood - project. (Don't worry, there won't be quiz on acronyms!)

To start, Tabora is not an easy place to get to. It is a 17 hour drive from the coastal capital of Tanzania (Dar es Salaam) and the only airplane that used to fly here is now totally broken (the engine failed and had to do an emergency landing). It is a mere 6 hour drive from Mwanza, on Lake Victoria on dusty, bumpy roads. Thus, it is also not a very popular place to do development work. Unlike many other easily accessible African towns and cities, you don't see NGO signs and landrovers of NGOs dotting the landscape every where you go. According to the last unofficial head count, there were only 42 foreigners in this town of at least 150,000, and most of those people are in the tobacco industry. 

There is not much around other than farms; no beaches to lay on, no mountains to climb, and no lions to watch. The wikipedia page and Lonely planet say this about the town of Tabora:

Tabora does not have many tourist attractions. 

It is well off the beaten track, with few tourists.

In my ancedotal experience, it is the places the hardest to get to and are least "interesting" that are the least served and have some of the worst statistics for health, education, and development. So, I am actually pretty pleased with the fact that CARE chose this area for their work - because it is so under-served. 

Working in close cooperation with the Tanzania government at all levels, CARE has implemented advanced training for Community Health Workers (CHW) focusing on maternal and reproductive health. Nearly 1,000 workers have been trained and equipped with a bicycle, t-shirt and small monthly stipend to work in their communities to educate and monitor pregnant women, promote family planning, and facilitate referrals to appropriate health centres if concerns or complications present. The CHWs with this advanced training are present in 176 clinics/dispensaries and 56% of government facilities across all of the districts in the Tabora region (kind of like a province).

An area that the project has not focused on is the hospitals as it has been assumed that they were equipped with the necessary infrastructure and support to handle the complex maternal cases.  The hospital administrator is very appreciative of the work of CARE in the community and so asked if they could receive some support in the hospital. And this is how my position came about.

While my career experience has not been in maternal health, my interests lie in helping people assess and improve their workplace and health practices. And while the Tanzania health staff told me I'd be delivering babies "by next week", I have only gone as far as rubbing a labouring woman's back or weighing some preemies :-) and I think I should keep it that way! The staff are fully capable and are experts at their jobs - I am certainly not there to teach them how to deliver babies! Rather, I will work alongside them to try to improve the workplace in which they deliver the babies. 

In upcoming blog posts, I will describe "a day in the life of the maternity ward" - and it will guarantee to shock and surprise - in both postive and heart breaking ways. 

(p.s. you are under no obligation, but if you are interested in giving a "CAREing" gift for friends and family at Christmas, giving one of these presents instead of another sweater or tie is a great idea!)

Ottawa re-imagined

In preparations to go to Tanzania for 6 months, most of the questions I fielded consisted of
"Is there Ebola there?" and
"Are you sure it's really safe to go to Africa right now?"

I usually put on a smile (or smirk for some) and reassured them that everything would be fine and that I was more likely to get Ebola in Vancouver or Texas than in East Africa.

Little did I know that the safety issues would present themselves in Ottawa!

I have to admit, when I imagined Ottawa I thought that everyone would be very formal and speak kindly of Stephen Harper. Fortunately I was wrong, on both counts.

My visit to Ottawa was interesting starting right out of the gate. I walked up to the taxi stand at 9:30pm and my imagination had told me that perhaps the taxi drivers would all be wearing tails and speak in British accents (I don't know why - just humour me). What I got was more like a movie scene of a "drive-by". All the airport taxi's in Ottawa are black Ford Taurus and mine swayed so much on the road that I am certain it was equipped with hydraulics. At one point it bounced to and fro so much that I was re-living the choppy seas of the Hong Kong ferries between Lamma Island and Central. I prayed that my inner ear problems would not kick in and cause unrelenting dizziness for the weeks to follow. To add mystery to this low-rider swaying Taurus, the taxi driver wore a black hooded sweatshirt and he never once pushed the hood down so that I could see even the side of his face.
We raced through the streets of Ottawa and I kept glancing out the window, expecting either movie cameras or a high speed chase. We screeched up to the hotel in downtown Ottawa and the driver quickly and silently got all my bags out of the car. I hadn't heard him utter a word and hadn't actually yet seen his face, but just as he dropped the last bag in front of the door, he turned to me and gave me a very friendly welcome to Ottawa. Turned out he was just a big teddy bear of a man who wears hoodies and drives a crappy car...

Then, just getting into the hotel with my bags turned into an obstacle course. I retrieved one of those fancy looking baggage carts that one sees in movies (we went camping when I was a kid, none of this hotel stuff) and loaded my bags outside the doors. Getting in the door was a challenge. The baggage cart had worse steering capacity than a hospital stretcher so moving it towards the door felt like I was wrangling a bull. I found the handicap button dangling from its wires on the doorpost and prayed I wouldn't get electrocuted! I managed to manoeuvre the cart inside of the first door, but much to my surprise, the handicap button doesn't open both doors; no that would be too simple. I find the second handicap button and the second (inner) door starts opening, but the luggage cart is in the way. So, I start backing it up through the first (outer) door, but by that time, that door had started shutting. So, I'm being hit in the behind by the first door and the second door is slamming my luggage around while I am desperately trying to steer the cart *anywhere* but through the doors!  The hotel staff were just watching blankly - they didn't even crack a smile! At least get a laugh out of it! I felt like I was on "Just for laughs"!

Fortunately, my humorous calamities ended there, for the day.

Ottawa re-imagined.

I spent a few days at the Care office, learning the ins & outs of what they do and what I would need to know before departing for Tanzania. On Wednesday morning, I had a Safety & Security briefing about living and working in East Africa. We talked about using safety measures, being aware of surroundings, vehicles to use and not to use, and the general reassurance that Tanzania was a welcoming and safe country to live and work in.

I was then in a presentation on some recent work done at the UN regarding refugee rights when my back pocket started buzzing. Since I rarely get texts during the day, I discreetly checked my phone under the table. My brother had texted "There's been a shooting at the Parliament. Are you okay?"
I texted back that I was fine and would check in later. When the meeting ended 10 minutes later, I broke the news to my new colleagues and the TV was quickly turned on to check the news.

Not having to actually enact security measures in Canada, the staff quickly went to work contacting all the colleagues who were in meetings in downtown buildings. Afternoon meetings were cancelled as the police asked people to not come downtown and news of additional possible shootings were reported. While there was a palpable buzz in the office, people still continued to work on their projects and deadlines.

Realizing that my hotel was just a few blocks from the first shooting, the staff quickly found me an alternate hotel room since it was not known if I would be safe or allowed to get back there on Wednesday evening.

Then, just as things were settling down, the lights went out and all the power shut down. A backup generator kept the Internet connection going for another 30 minutes or so, but it was a bit eerie that whilst watching play by plays of a possible terrorist attack downtown, we lose all power to the building. It turns out it was a coincidental loss of power from the provincial power grid, but added a level of eerie stress to the day. Since the NGO world runs off emails, no one could really continue their work for the day. One of my colleagues drove me to my new hotel. Which is where the humour comes back to my trip.

We approached the hotel from one side but the building said "Embassy Senior Living" on the side of the building. We looped around the block and approached it from the other side where it said "Embassy Hotel and Suites". Google maps was telling us that this *was* the place. I went inside and found the lobby filled with 80 year olds leaning on their walkers, watching the news unfolding. I inquisitively asked the front desk staff, "Is this a hotel or a seniors home?" and he sheepishly answered "Both."  I let my colleague know that all was clear and I checked myself in to this curious hotel. Turns out they are transitioning it from a hotel to a Seniors home and that only one floor was left of hotel rooms.

I used the elevator to go up to my room and found a daily schedule of activities for bingo and crafts. I had missed all the good stuff! My room was newly renovated; with grab bars, shower seats, and call bells next to the toilet. I guess if I ran out of toilet paper, I had a direct line to the hotel lobby - all from the porcelain throne. The TV didn't work and they didn't provide any knitting needles, so I headed over to the mall across the street, which my colleague had described as the "Seniors mall."

And indeed it was. Among the stores tailored to "comfortable clothing", orthopedic shoes, and cheap coffee, there were the daily stalls set up by retired couples selling their homemade terry cloth baby bibs and jams. One woman was sewing away at her table while her husband waited expectantly for customers. Another woman didn't even look up from knitting dishcloths to notice me walk by. (Maybe she waits for the squeak of supportive shoes). I did manage to find a cheap charger for my phone as all "Seniors malls" come equipped with dollar stores!

The only place I could see to eat was named "Monkey" something and I just really hoped it was not a strip club or a Hooters copycat. I was relieved to find fully clothed people and some regulars sitting at the bar. And of course the news was on and we all stared and sipped our drinks while wondering how such a thing could have happened in Canada.

I finally returned to my new seniors home and checked the latest police updates. They had determined that there were not multiple people involved and they had decreased the lock down zone to a small perimeter. I called the Security contact and asked permission to go back to my downtown hotel. Who would think that I would have to follow security protocol in Canada?

Ottawa, re-imagined.

My visit to Thursday's Question Period was cancelled and my MP sent an email apologizing for Parliament being closed (that is so Canadian!). So,  I didn't get to witness politicians shouting at each other, but I believe I was able to witness something so much better.

I have told friends that I don't always want to be with them only when things go well. I want to be with them in their pain and their heartache so that I might know the fullness of their life and share in their suffering.

While I was only able to see Parliament from a distance, I truly believe that I was in Ottawa for a much more powerful time. I was able to be here with people in their pain, I was in the capital when Canada was mourning for its loss of innocence, I was present for the fullness of a heartfelt response by thousands of Canadians.

I walked by the War Memorial each day - while it was still a crime scene and when it turned into a *true* memorial site. Seeing soldiers standing guard not only for the unnamed soldier, but for the innocent man who lost his life, was incredibly moving. I saw hundreds of people bringing flowers, mementos, letters, but also themeselves, to honour the life one someone they had never met.

I saw Canadians offering to buy police officers coffee and lunch. I saw Canadians having respectful interviews with Imams who came, too, to offer their condolences. I saw news reporters, standing for hours in the same spot, never take a break so that Canadians might stay up to date.

Fortunately, this is a part of Canada that I didn't have to "re-imagine" because it felt like I was home.

Long haul

It's been a long haul of getting a Masters degree, a diploma in Tropical Nursing, Wilderness first aid certification, courses in International development, volunteering, and endless wondering if I am pursuing the right course of working overseas in the Global South once again.


Rejections and silence from numerous applications for the past year. In some cases, my 3 degrees and year in Kenya noted as "not enough" or my lack of french skills disqualifying from working in non-french speaking countries.


I've been confused more often than not. Has all this work and effort been in vain? Have I been following my own singular and selfish path?


Recently though, a glimmer of hope. After emails back and forth and communication delays, I have finally received an offer! Someone is nuts enough to take me on!


I have been offered a 6 month opportunity in Tabora, Tanzania with CARE Canada. They have been working to improve access to maternal health in the community and rural areas for some time and recently had a request from the director of the Regional hospital in Tabora for some help to assess and plan for their maternal and reproductive health in the hospital. They were seeking someone who could come along side people at the hospital to:

•    assess the Tabora Regional Referral Hospital maternal and child health services and practices   including management, administrative practices, quality and health information; 

•    Develop plan in conjunction with CARE and Kitete Hospital staff to strengthen the maternity ward, outreach program, referral system, and, 

•    To build management, administrative and patient-care capacity in the maternity ward of the Kitete Hospital

And as per Murphy's law, as soon as I accepted the position, I had 2 more interview requests for jobs I had applied for months ago! But I trust that this experience will be a great opportunity to build my experience for more future work overseas.

I am simultaneously really excited and really terrified! While I know it has been a 6 year journey to get to this point, I will always have some nervous anxiety about what I am doing! I know when I get there I'll have some private breakdowns of crying and wondering why I have put myself in a position of knowing nothing and no one! But after a week or two, I'll start settling in, once again getting used to people yelling "mzungu" at me, or trying to touch my hair or skin.

Thanks to everyone who has listened to me endlessly talk about my desire of moving overseas (okay, it's always about sanitation). 

So, if you know anyone who wants to sublet my place (just blocks from Kits beach!) for 6 months, let me know! I’ll be leaving about mid-October!

a career in crap

I sometimes wonder if I have set myself in the wrong direction. If getting this Master in Public Health and hoping to go overseas again is just a daydream and I will wake up to reality soon. Having lived in Vancouver for three years now (!), I have had fleeting thoughts of saving for a condo, trying to get a second date (never get past the first!), carving out a space for myself here, seeing my family more, getting more involved in life in Canada. It is getting harder to remind myself what the end goal is as memories of what has been are fading. But then I'll hear something inspiring or have a vivid recollection of an important moment and it all comes back to me.

The weekend started with class - I spend one full weekend per month at the university being overloaded with enough information to cause brain damage. In "Social Determinants of Health", I introduced myself - "My name is Alida and I love sanitation. I will probably use every and any opportunity to talk about crap. Just to warn you." The professor looked slightly uncomfortable but amused and dryly said, "I can't wait to read your final paper." Over the course of the weekend my conversations inevitably make some reference to sanitation and I secretly question whether I like the attention of the shock value that it brings or that I still actually have a love for sanitation.

And when I start to harbour those secret doubts and the gnawing feeling of "but life could be so uncomplicated if you stay in Vancouver", i am delightfully reminded that my passion for all things sanitation is indeed genuine and not a fabrication to generate some laughs. I listened to Shane Claibourne speak this evening and he reminded of one of my favourite author's writings on vocation. Frederick Buechner wrote "Vocation is where our greatest passion meets the world’s greatest need." It was such an affirmation that I am not only called, but blessed, to have discovered a passion for what is truly the world's greatest need. We take our porcelain thrones for granted, but sanitation is the single greatest successful public health intervention known to mankind. Adequate disposal of crap is the biggest life saver on the face of the planet. And yet 2.6 billion people still have no toilet, latrine, outhouse, crapper, or even a hole in the ground. It's the world's greatest need.

I have to ask in wonderment, Who am I that I should be so blessed to pursue a vocation and a passion for the world's greatest need!!

Yes, professors raise their eyebrows at me, people politely laugh at me, classmates likely tire of me (and my crap stories), but I count myself so amazingly fortunate to be one of the few who can disregard (most of the time), "the great blaring, boring, banal voice of our mass culture, which threatens to deafen us by blasting forth that the only thing that really matters is.... salary and status" but instead listen to "the voice that we might think we should listen to least, and that is the voice of our own gladness." (Frederick Buechner, The Hungering Dark)

I am glad when I talk about crap.
I look forward to making a career out of crap.

joy unspeakable

in a christmas program i attended this past sunday evening, these words, sandwiched in a longer sentence, struck me.

joy unspeakable

perhaps because the words seemed reversed that they particularily stood out. i think more because in the past two years i have experienced joy in my life in ways i have never experienced before.

some people close to me have reflected that i am a different person when i speak of, or when i am in, africa. my conversation becomes more animated, my eyes change, excitement starts building from somewhere deep in my chest cavity. i literally do not control it.

this is joy. it is much more than being happy. it is total and utter contentment, no matter the circumstances. it is understanding that i have been so incredibly blessed to having discovered my calling in life. i am learning to allow that joy seep into my canadian life as well. i felt it when danny, a man who sells a street paper in my neighbourhood, gave me a bear hug yesterday.

joy unspeakable

joyful moments caught in megapixels

i met Hannah, a 12 year old girl in the IDP camp. a week earlier a colleague and i had taken her to emergency to have her broken arm set. my colleague helped the mother navigate the system while i helped the xray tech set multiple fractures.

we were delighted to meet again.

in maasai land while on a safari.

just joyful. just because.

joy x 6

visiting the home of little kenyan alida (the baby)

the adoptive aunt is a kind, caring, and generous woman

who has her hands full with 3 daughters and 2 adopted nieces.

swing and jump.

skipping rope.

pretty simple game.

nothing more than a piece of rope and the ability to swing and jump.

i had been walking through a camp for internally displaced people (idp) in kenya in february 2008. 20,000 kenyans living in a space called the showgrounds, no larger than a couple of football fields; or something the size of the stampede grounds in calgary. actually, probably smaller.

i had sat in the dirt and talked to mama's cooking over their three stone fires, chatted with a 98 year old man whose maize and farm was burned by his neighbour of 50 years, i was nearly stampeded by a few hundred people who heard that dried fish was being distributed.

i retreated to the bleachers that are usually for patrons who are showing off their cows for market. i needed space from the growing crowd of children who were clinging to me. i needed to digest the fact that this overflowing campground was one of hundreds that had rapidly become a "safe" place after a stunted genocide.

i sat there hating the hatred that sent these people here.

i sat there wondering what on earth one does with 300,000 displaced people.

i sat there feeling defeated and deflated.

i sat there feeling sorry for myself.

and then i saw her. this little girl skipping rope. amidst supper cooking, laundry drying, men drinking, tents sagging. this little girl skipping rope. so simple. so natural. so normal.

i saw hope.

not in the politicians negotiating power. not in the ambassadors urging peace. not in the ngo's giving food. not even in my little arrogant self with little to give.

the tilt of her head and the light on the rope and the swing of her skirt.

hope.

swing and jump.

hope.

swing and jump.

hope.

swing and jump.

watu wakenya

stunning

strong

courageous

determined

selfless

this grandmother lost all of her children to HIV/AIDs

and is raising all her grandchildren.

when she should be retired and resting

she is gathering firewood

and hauling water

and changing nappies.

and she is still grateful

and lives with joy

humbling me

everyday grace

i want to begin sharing the stories of my year in kenya that had a profound impact on me.

the people of kenya often saved me from myself.

enjoy the coming blog posts as a celebration of a life changed in kenya.

mine.

love them in the moment.

BBC radio became one of my best friends while living in Kenya. I spent my evenings listening to world report and even relied on their reporters to find out what was going on in town during the post election crisis.

here is a story about the street boys (mostly, there are some girls as well) that live on the streets of eldoret, passing their days by sniffing glue and trying to help you park your car for a few shillings. one tried to sell me a cell phone he had just stolen out of a car. they were mostly good kids, but from poor homes, gone to the city to find food or make money and end up hooked on glue.

it is likely that i have encountered the children in these photos. i was at a loss as what to do with the strung out 8 year old boy or the pair of 9 year old girl prostitutes. they told me the rescue centre was horrible, if they were fed, and they could get more food on the street from well wishers. they "work" by helping stop traffic when you want to park your car or they will

"protect" your car in the evenings while you are at the grocery store. their future looks grim - their brains are fried, they miss all their developmental milestones, they don't go to school.

all i could do was try to love them in the moment.

Orphans continue a tough struggle on the streets

By Will Ross BBC News, Eldoret, Kenya A report by Save the Children says that four out of five children in orphanages still have a living parent. Orphanage life means that millions of children are unnecessarily at risk of the widespread dangers of living in institutions, including rape, exploitation, trafficking and beatings. Many orphaned children in Kenya prefer life on the streets In Kenya a combination of a lack of money, physical abuse, the effects of HIV/AIDS and last year's inter-tribal violence are taking their toll. Many children forced onto the streets are pushed into a life of crime. 'The Barracks' Just off the main street running through the centre of Eldoret you will find an army of glue-sniffing street kids. Almost all the children have a small bottle of glue hanging from their mouths and with glazed eyes they appear semi tranquilised. "It makes me sleepy and I have less stress," says 15-year-old Jimmy, who after years on the streets looks younger than 10. "I live on the verandas in a box," he tells me. "Life here is very hard with no food, nowhere to sleep and no-one to care for you," says Evans Kariuki. "It is not safe. You can die here. People fight. There is a lot of violence. The police come sometimes and take you and beat you." Broken families In another part of Eldoret I meet Mary, her husband James and their six-year-old daughter Grace. Neither of them have regular employment and their single-room home smells of an illegal alcoholic brew - one way of raising a few coins to buy food. Mary and her daughter Grace struggle through poverty on a daily basis They were a family of four, but at the age of seven Juma ran away for a life on the streets. "I tried to look for him but it was difficult because his friends on the streets kept hiding him," said James. Mary is sure Grace will not follow in her brother's footsteps. "I can take care of her because she is a girl," said Mary before adding that Grace had been going to nursery school, but she is now at home because they cannot afford the fees of less than $20 (£12) a term. New hope I later meet Juma at a centre for former street children. Now 13, he is getting food and goes to a primary school thanks to ECCO - Ex Street Children Community Organisation. Many children have been rehabilitated, but problems still remain "I ran away because I was beaten at home. Life used to be good at home but whenever I made a mistake my mother beat me. Once my finger was even cut with a knife, "said Juma who now dreams of becoming a pilot. For the staff at ECCO discipline is a challenge. "The hardest thing is keeping them in line - asking them to follow rules which they are not used to and most of them have been sniffing glue for years so stopping that is hard," said Mercy Rotich, the programme officer for social work and education at ECCO. Hard struggle As I leave the centre there is news of another crisis. A 13-year-old street boy has been raped and after being discharged from hospital urgently needs a home. Institutions have sprung up in Eldoret to take in some of the street children but there are many complaints of inhumane treatment and concerns that they do not have the children's interest at heart. "You talk to a child who has been in a home for a few months and they do not want to go back. You talk to a child who has been in a home and they do not want to go back Mercy Rotich "They tell you about the problems of being beaten or denied food. These homes are getting money but the money is not reaching the beneficiaries," said Mercy Rotich. "Some of them are not going to school and yet there is money for them to be taken to school. They are not being taken back home yet they have funds to trace these homes." The government agrees that there are problems with some of the homes and knows some organisations are formed not to help the children but to make money. "Briefcase NGOs - I know they are there and they are possibly swindling money from the donors and funders and well-wishers. It is now our role to ensure that what is given to the child is not going to the dogs," said Philip Nzenge, the children's officer in charge of the district. 'Damning indictment' Back at The Barracks several street children told me they had run away from Eldoret Rescue Centre and preferred life on the streets. The Rescue Centre is a series of metal shacks perched on a hillside on the outskirts of town. The staff denied that children were beaten but admitted that some of them struggled to cope with order and discipline after a life on the streets. Although this is a step up from life on the streets, conditions for the 233 children are grim and bunk beds are crammed into the metal shacks. Staff said there was a plan to build permanent structures. I found a month-old girl there - born on the streets but perhaps destined to spend her next 18 years in this centre. It is no wonder then that Save The Children is calling for stricter monitoring of children's institutions. It also wants funds to be channelled into helping families support their children describing it as outrageous that children are separated from their families when they have parents who, given a bit of help, could look after them.