26 July 2013

Ango: Zen and the art of health clinic maintenance

Let me begin by saying: Holy Cats. I know that I am often blasé about this whole aid worker gig and all (I have to preserve my worldly street cred), but sweet glorious goodness, was this field trip ever amazing. I spent only four days in Ango territory, which is roughly (very roughly) 500 km from Bunia and I’m still processing everything that happened.

It all began fairly normally. My supervisor and I awoke nice and early on a Saturday morning (our Friday flight had been canceled) to head out to the airport. The sun was barely up, and already there were children singing (raucously and enthusiastically out of tune. A dulcet choir of cherubs this was not). Otherwise, the morning was more or less unremarkable. At six am, waiting in airports is pretty much the same everywhere.

On our way to Ango, we stopped briefly in Dungu at a beautiful airport run by Bangladeshi peacekeepers in jaunty hats. Though the runway was dirt, it was hard pack and meticulously maintained. We were the only plane on the runway had no less than three peacekeepers directing us. It was dramatically different from my own destination, which was essentially nothing more than a dirt strip hard-won from the forest (and the forest wanted it back). As I was unloading our bags, the pilot sauntered off to the edge of the runway to relieve himself.
The PAX terminal at Ango
The base manager took us on a perfunctory tour through the town and showed us around the airy compound. When I imagined moving to Congo, this is much more what I had in mind than the stately house in Bunia. The kitchen and dining area were both in detached payotes (peyote? pailot? They’re grass huts with half walls, and I have yet to find two people who spell the word the same way), and you had to draw your own water for showers from the cistern. I live in the lap of luxury comparatively and promise (well, will try) not to complain again either the cold showers or occasionally having to fill the toilet from the bucket. I will, however, still whine about the rats. We strongly considered pilfering one of their seven(!) cats. Technically, the base here did have a toilet seat for the latrines. Unfortunately it had detached long ago and you now had place it on the raised concrete pit if you felt inclined to use it.

Once there, however, we had time only to ditch our luggage and repack the necessities (rain gear, water, notebook, and camera, of course) because we were on a tight schedule. Off we were whisked on the back of motorbikes for the next five hours. My first-ever motorbike experience was, in a word, liberating (and thrilling, exhausting, and painful, if I can take a few more). Aside from the tremendous discomfort in my hips (seriously, though – this was a thigh and ab workout like none other), the bikes were infinitely preferable to the Land Cruisers. I will take some lower back pain over nausea any day. Our drivers were amazing – I have no idea how they navigated the dips and rocks and mud. I just tried to squirm as little as possible and enjoy the ride. In those stretches where the road was simply too bad for passengers, it was often a great relief to have to opportunity to walk a bit, bow-legged and unbalanced though we were.

Indeed, this trip was full of firsts – the first time I have ever been in a (nearly empty) refugee camp, the first time I’ve seen a black mamba (at least that’s what the guards thought it was. But it was a baby mamba, so I guess that’s okay?), the first time I’ve ever been grateful for a pit latrine, the first time I realized that good dentistry is the ultimate status symbol, the first time I’ve ever seen a WFP distribution center…

The only one of these on that first Saturday, however, was the visit to the refugee camp. Much to my surprise, it was beautiful. It reminded me of the transient camps at KAIA and is the most well-branded place I’ve been outside of an A&F (yikes. How dated does that reference make me?). The camp boasted a cook stove for each tent and latrines and a school and plots for gardens. The refugees that were already ensconced were probably living better than most of the people in the surrounding villages. To complete their perfect camp, the UN now just needs to convince the rest of the refugees to trek all the way (a little over 100km, I think) from the border. It was hard not to compare the orderliness of this ghost town – it was at less than ten per cent capacity - with the almost certain disarray in Uganda right now, where tens of thousands (I’ve heard anywhere from 45,ooo – 70,000) of Congolese have fled in a matter of days.

Far from busloads of refugees – of even streams of people on foot – the only traffic with which we had to contend with children riding in pairs and sets of three on bikes more wood than metal at this point. All of it – wood, tires, metal, kids – had turned the same rust brown as the mud. We must have been impossibly rude as we blew past women with bundles of sticks on their heads and men in fedoras carrying machetes, but they all stepped smoothly back into the foliage to let us streak by (we never actually went all that fast. The road was simply too bad. But it felt like we were jet-powered). One man, who was using his machete to both peel some kind of yellow fruit unknown to me and at the same time herd a gaggle of children (with the flat of the blade, but still!), goggled at us in our helmets and high-performance rain gear like we were the crazy ones. You’re shepherding children with a sword dripping juice, sir! Given the context, though…fair enough. One of the little girls gave chase after us, waving and screaming greetings in Lingala. When we waved back, she beamed so broadly the flowers chalked on the mud hut behind her bloomed.

I suppose this also should have been on my list of firsts, but this was without question the first time I have ever been this close to absolute poverty. Real poverty. The people in the tin-roofed houses in Bunia are not why the life span in this country is 53 for men and 56 for women. It is because of the girl with the dead eyes dressed in rags, a single button holding what was once a dress to her body. Because of the man with no teeth and a withered leg who clung to my hands for support when he wished me a good morning. Because of the women who paused from their work in the muddy creek waters to watch us motor by impassively; they were washing cloathes and children in the same source from which they would later gather water to prepare their meal of rice and banana leaves.

Realizing the extent of the destitution in this area made it all the more moving, not to mention deeply uncomfortable, when you simultaneously experience outbursts of profound generosity. The staff at the first clinic we visited, in Mbibili gifted us with pineapples and eggs that I’m reasonably sure someone had used in lieu of payment for treatment. Our little party inspected birthing rooms, latrines (one of only two in the surrounding 50 km! Let that sink in for a moment), the pharmacy and drug depot, even the pit where they burn placentas, and 15-20 people dogged our every step. The entire staff and several patients tramped past a girl who had given birth only two days before. She was unfazed.

To me, though, the most amazing thing about this clinic might have been that it was solar powered. My NGO had apparently designed a system where the solar panel fed a motorbike battery (so that it could be reasonably easily replaced) that powered the lights and kept the fridge running to preserve vaccines. I’m not sure I’ve ever had more pride for an organization I worked for than in that moment.

The tour did not stop with the clinic. The head nurse also led us to the church and market, showing off the highlights of his village with pride. The large (Catholic) church had unexpectedly delicate stone work and simple cut logs for benches. Meanwhile, the market offered a large array of plastic shoes, cigarettes stacked in artful towers, and monkey meat, cooked or fresh. The recently deceased monkey had its tail tied around its neck so you could carry it like a furry, creepy purse. We threaded our way to the back of the market where, selling knock-off Crocs and kola, we found the nurse’s wife. She invited us to stay for dinner. When we demurred, she pressed us to at least take some bananas back. They…mostly survived the trip. And my bag still smells pleasantly fruity today!

By the time we arrived back at the base, the team had begun to make dinner. In the 15 kilos we were allowed on the flight, we had been sure to pack flour, fresh vegetables, cheese, even wine, all of which are difficult if not impossible to get in the local markets. The team repaid us by making pizza in an oven crafted from an old oil drum. In a burst of my own generosity, I shared my emergency ration of brownies. I packed them at the behest of head of country programs, who warned me that I would have very little to eat during my stay (meat and rice are the regional staples). It was possibly a bad move and I was a bit nervous for the next few days. Motorbikes and fasting do not make for an ideal combination.
Would I survive? Well, yes, clearly I did, so there’s not much dramatic tension there. At any rate, I’ll have more on the rest of the trip soon. Stay tuned!