Marge in the Field

Preventing History From Repeating Itself

2011-09-08T03:30:00.000-07:00

In the humanitarian world, there are the disasters you see coming, and the ones you don’t.

We didn’t foresee the massive 2010 earthquake in Haiti … the devastating floods in Pakistan… the earthquake and tsunami in Japan…or the conflicts sweeping the Arab world.

But the current drought and famine in East Africa? We saw that coming. The only question was how bad would it be?

The answer: very bad and getting worse.

This crisis has now affected a staggering 12.4 million people – it has killed tens of thousands, and put 400,000 children at risk of starvation. Think about those numbers. Roll them around in your head.

We saw this emergency unfolding 9 months ago when the rains began to fail, the harvests were poor, and food and fuel prices shot up. Families already facing scarce food resources suddenly had to make do with much less. Throw in more than 20 years of violent conflict in Somalia and you have approximately a million refugees crossing the borders into Kenya, Ethiopia, Djibouti, seeking some sort of escape.

Make no mistake, this is the worst humanitarian crisis in the world today.

But that’s the macro.

Here’s the micro: a nine-month pregnant Somali woman, her two-year-old son, her husband, and his brother, journey many treacherous miles by foot across arid, forbidding desert to the Ethiopia border. There they wait to be processed. They wait outside for days in 100-degree heat and high winds that whip sand across their faces. Eventually they are bused to a refugee camp about 20 miles north, inside Ethiopia, where they are given a tent and a bit of food.

They come to International Medical Corps’ nutrition center in the camp, by which time the mother is so weak from severe malnutrition that she can barely keep her eyes open or speak. She cannot hold her own son in her rail-thin arms, and childbirth may very likely kill her. Her husband has been too ill to come to the center. Her brother-in-law holds her child for her, but he too is so weak that when he stands his legs and arms shake from the strain and he is forced to sit down again. The child cradled in his arms is so severely malnourished that he is non-responsive, not uttering a sound.

People should not be suffering like this. I keep saying the same phrase over and over in my head: “This is not right.”

Sadly, a crisis such as this has struck the region before: the famine in Ethiopia in 1984, famine and civil war in Somalia in 1991. These are horrific cycles that plague East Africa. While the government and communities have made great strides in mitigating the impact of these cycles, this past year has seen a perfect storm of factors that are especially pernicious and tough to combat.

I was in Ethiopia during the “global food crisis” in 2008, and witnessed a tremendous amount of starvation, pain and suffering. And yet, that crisis technically was not as severe as what’s happening today. It did not constitute what the humanitarian community defines as “famine” – the malnutrition and mortality rates were not at the levels they are now. When 1 in 1,000 people dies of malnutrition, that is considered a humanitarian emergency; right now, in the refugee camps where International Medical Corps and other NGOs are working, the mortality rates have hovered around 14 percent. Rates of severe malnutrition have been as high as 45 percent.

In the face of these grim statistics, what are our solutions?

I ask my colleague, Daniel, who runs our nutrition programs in the camps. A native of eastern Ethiopia, he has seen famine unfold here before. As he meets with new arrivals at the nutrition center, he is compassionate, but no-nonsense. One teenaged mother has brought in her 3-year-old severely malnourished son. His chest and ribcage protrude sharply over his distended belly, his limbs are twigs, he lets out a persistent, desperate hunger-wail. Daniel explains to the child’s mother that if he is not admitted to a stabilization center he will not survive - that milk is not enough, he needs therapeutic feedings.

As Daniel reflects on the great suffering he has witnessed recently and in years past, he also vividly remembers the victories. He recalls when he first began doing nutrition work in the early ‘90s, and himself was learning how to care for people and pass on skills. One woman in particular he remembers brought in two malnourished children for treatment – along with a third who she said was disabled, his arms and legs completely rigid and unmovable. All three children underwent therapeutic feedings. Suddenly one day, the disabled child straightened his arms and legs, and stood up. Daniel realized this child was not disabled; he was severely malnourished and needed proper nutrients to reverse the paralysis in his limbs. Witnessing and learning from this recovery proved a seminal moment for him – and to this day provides him with the hope that education can and will save lives.

Fighting back tears, Daniel says simply: “That was a day when I felt really good about my work. I will never forget it. Never.”

First Disaster - Then Luck, Perseverance, and New Beginnings

2011-01-21T17:25:00.000-08:00

Alex and I are sitting at the kitchen table, having some eggs before we and the rest of the team head out to one of our health clinics in Jacmel, a coastal town in southern Haiti.

Up to that point I knew very little about Alex. On the way down from Port-au-Prince, he was driving; I was in the back seat mostly talking with our logistics coordinator, Dave.

But sitting at the table on this morning, I offered a typical icebreaker, “How long have you been working with us?” It’s a simple enough question. Still, I have found - whether in Haiti or Lebanon or Congo – that out of that question, a surprising, fascinating yarn always unfurls.

Alex’s yarn was no different.

He told me he started working for International Medical Corps on January 16^thof 2010, just days after the earthquake that killed 316,000 people and left millions of others homeless.

When the quake hit, Alex and his wife, Gerda, were inside their home in Port-au-Prince. As their surroundings began to shake violently, they raced outside, only to watch their concrete home collapse seconds later.

Alex also lost his retail soda business in the disaster. With no home and no livelihood, he and Gerda sought temporary shelter in the Delmas district of Port-au-Prince.

Hearing that help was needed at the general hospital downtown, Alex went there to lend a hand, perhaps get some sort of work. “I speak Creole, French and Spanish so I thought I might be able to be a translator.”

He arrived to a chaotic scene; several hundred injured lay on the pavement outside, the hospital’s buildings too damaged for use. “The doctors and nurses were amazing. God bless them.”

Here, I interrupt Alex. “So you were at the hospital right after the earthquake? So was I.”

He stares at me, a sudden recognition crossing his face.

“I remember you! You gave me a job. You grabbed me and said, ‘I need a translator, can you help me?’”

The scene rushed back to me. I remembered him too. I remembered the stocky guy with a big smile and an eagerness to help. He did help immeasurably. In addition to translating, he moved patients, loaded and unloaded boxes, helped keep watch over pharmaceuticals and supplies in our command post.

I remembered near the middle of his first day at the hospital, taking the roll of tape with “International Medical Corps” printed on it and wrapping it around his t-shirt – the quickest way, in the sea of patients, family members, medical personnel, military, and media, to identify who was working with us.

So many people, so many Haitians, had come to the hospital to help. Alex was one of them, and he stood out. Each morning he returned first thing, asking what he could do.

As our emergency response continued to ramp up to meet the need, we began instituting systems for employing local staff and putting them on the payroll. Our head of logistics saw how valuable Alex was and hired him. He’s been with us ever since.

Today, Alex and Gerda still live in that temporary shelter, hoping soon to get a permanent home. Four months ago, they had a daughter, Chrislex.

Alex admits theirs are difficult living conditions, but he remains grateful that out of the ashes of the earthquake he is building a future with a job and family that make him happy.

And then he flashes that smile.

Genesis of Haiti’s 2nd Humanitarian Disaster

2011-01-09T19:09:00.000-08:00

When a massive earthquake struck Haiti a year ago, it was immediately apparent to the world that the loss of life and the suffering would be enormous, and that humanitarian intervention would be significant and long-term.

Such a natural calamity was relatively easy to identify and “diagnose”. Deaths and injuries – and their cause - were large and quickly apparent. An estimated 230,000 died and more than a million are still displaced from their homes.

But what about the slow-moving, quiet, less-noticed disaster that struck Haiti three months ago?

When cases of cholera began to emerge in the Artibonite district in late October, it would prove much more difficult to sound the alarm that a new catastrophe was in our midst and demanded our attention.

On the front lines, recognizing a burgeoning humanitarian crisis required experience and the willingness to push hard for a large-scale mobilization when many others were reluctant to believe.

Recently I received an email from our Country Director in Haiti, Mike Dockrey, that succinctly spelled out what it took to yell “fire!”:

Though the "outbreak" and first cases did occur around the 15th-20th of October, in fact, those were originally reported by officials as "intense food poisoning" and "acute diarrhea" from "bad fish" caught in the Artibonite River.

The first two victims were young schoolchildren who had indeed eaten some fish caught in the river. But I watched as our experienced medical staff, led by (Deputy Country Director) Jason Erb and especially (Medical Director) Jojo Cangao, listened to those earliest reports (that really didn't garner much attention that I could see) and argued to me for an assessment visit to the sites up there. Frankly, Dr. Jojo "smelled" cholera, and suspected that due to the absence of experience with it here, local authorities simply didn't know what they were dealing with.

We all sat in a room one evening, after Jason, Nurse Heather Lorenzen and Jojo returned from their two-day site visit to Artibonite and listened as Jojo confirmed that his suspicions were likely, and tragically, true. We organized our first real medical response to the impacted area for the next day - taking up medical staff, medicines, and other supplies (cots, buckets, chlorine, etc.).

I was just the guy in the room listening to their expertise, and agreeing to the consensus opinion that International Medical Corps had to move - regardless of current programming, budgets, or staffing considerations.

Our ability to recognize a national medical emergency in its infancy, and mobilize so quickly, and appropriately, saved lives. Simple as that.

Despite the large-scale response from International Medical Corps, other NGOs and U.N. agencies, in the days and weeks to come, there have been about 170,000 cases of cholera since late October, a number that is expected to triple in the next 10 months. The disease has claimed more than 3,000 lives. As bad as this is, it could have been far worse if we had diagnosed this looming crisis later than we did.

As we reflect on the one-year anniversary of the earthquake here, it is important to remember that this was a country with an extremely compromised health infrastructure even before the earthquake. Cholera broke out in areas that were unaffected by the quake – and it was a disease that hadn’t been seen here in perhaps a century; local health workers were completely unfamiliar with it. Had there not been a large presence of relief workers in Haiti to respond when cholera emerged, the death toll could have been significantly higher.

Sadly, the World Health Organization and CDC believe cholera will now be a recurrent disease in Haiti, appearing annually with the rains, spiking, and decreasing incrementally each year as the populace develops natural immunities.

Over the long term, we will continue to treat cholera patients. But it is clear that focusing on prevention and education campaigns in local communities regarding clean water and sanitation – and training local health workers to address cholera and other communicable diseases - will save exponentially more Haitian lives.

The international community must help Haitians recover and rebuild, but most importantly must provide them with the skills and know-how to care for themselves, if and when disaster strikes again.

One Remote Village, 4 Days, 250 Rapes

2010-09-15T14:00:00.000-07:00

I remember the sick feeling in my stomach as I read the email from our medical coordinator in the Democratic Republic of Congo:

“We are facing a massive case of community rape in Walikale Health Zone. …We expect that in total the number is about 250 women raped in 4 days – a major catastrophe.”

I stared at the screen in bewilderment.

I had been to the DRC a number of times, met many, many women and children who had been raped and whom we were treating. Indeed, the phrase, “Rape as a weapon of war” has become a tragic cliché to describe what has been happening in the eastern part of the country the last several years.

But how do you wrap your brain around such numbers – the scale of the onslaught, the systematic, diabolical nature of an attack in which women, girls, boys are raped by multiple armed men at once, often in front of husbands and children.

The attacks by hundreds of soldiers began July 30 in the village of Luvungi, located near mines rich in gold, cassiterite, and coltan. When our teams were able to reach the village days later and began treating the survivors, they first thought there might be 24, then 56. As more and more victims came forward and the scale of the catastrophe became evident, word spread quickly and the wider international community took notice. Secretary of State Hillary Clinton condemned the attack. U.N. Secretary-General Ban Ki-Moon dispatched a special representative to investigate.

As a humanitarian organization that has been operating in DRC since 1999, our focus is healing wounds and helping people to recover and rebuild their lives: providing medical treatment to a woman who has been raped, psychological assistance, and livelihoods assistance so she can get back on her feet and care for herself and her family.

But our mission also focuses on prevention and education - raising awareness about issues like sexual and gender-based violence, whether it is in a remote community in eastern DRC, or here in Los Angeles, where International Medical Corps is based.

During her visit to our programs in DRC last year, Hilary Clinton declared, “We believe there should be no impunity for the sexual and gender-based violence committed by so many.” The U.N. recently echoed her sentiments.

International Medical Corps stands with them in sounding a call to action for eastern DRC. We are very fortunate to have a powerful ally in educating the wider public about what is happening there. This month, the Geffen Playhouse is staging a production of the astounding Pulitzer Prize-winning play, “Ruined” about the triumph of the human spirit in DRC. International Medical Corps serves as an educational sponsor for the production, and all proceeds from the September 28th show, underwritten by The Edgerton Foundation, will go to International Medical Corps’ humanitarian work. Following the performance, Nancy A. Aossey, our President and CEO will join the cast on stage for a conversation with the audience about the play, our work in DRC, and the struggles of its people.

For tickets, go to: http://www.internationalmedicalcorps.org/ruined

It is hard for me to imagine the epidemic of rape in eastern DRC getting worse, and yet is has. All of us must do more to help bring an end to the violence there. How many mass rapes have to occur before the world says enough?

2010-06-07T11:26:00.001-07:00

The Ghosts of Haiti

2010-03-22T18:54:00.000-07:00

I walked the grounds of the main hospital in downtown Port-au-Prince today, surrounded by ghosts – images and sounds rushing back of the early days right after the 7.0 earthquake here nine weeks ago.

I was here with our Emergency Response Team from International Medical Corps the day after the January 12 disaster. In the area we dubbed the “forest,” about 500 patients had lain on the grass or on hospital beds, many with infected crush injuries teeming with maggots, their blank stares reflecting how numb they had become from the pain – or their faces contorted in pain. Moans, screams, praying, chanting, sometimes just eery silence.

Today, the forest was quiet. No live patients lying next to dead ones, bloody bandages and IV bags strewn about. No doctors and nurses frantically wedging themselves into tight corners to dress and disinfect, transport, or declare dead. Today all I saw were tidy tents with a few post-operative cases inside. Sturdy chairs outside the tents provided a comfortable waiting area for loved ones. The place looked small, simple, organized. All I could hear was the breeze in the trees.

I stood there, awed by the transformation, and wept for those who lived here and went home, those who lived here and had no home to return here, and those who died here.

I exited the forest and walked toward the pediatric ward. How many times had I walked this path – to the pediatric and maternity wards, the supply warehouse, the blood bank, the U.S. military’s hospital headquarters? I looked to my right, waiting to come upon the nursing college, where as many as a hundred nurses had perished that day, where every day the powerful smell of their decomposing bodies hung in the air. As I passed an empty lot, covered in a neat layer of rocks and crumbled cinderblock, cordoned off by concertina wire, I yelled out to my colleagues, “Where is the nursing college?! It was right here!” This was the former nursing college… razed… gone… the bodies and bones of Haiti’s future interred underneath.

Time marches on.

We then walked to the two ICU tents, where a group of doctors and nurses rotating through from Chicago-Rush Hospital, the University of Connecticut, and other institutions were tackling about 30 urgent cases, from typhoid fever to congestive heart failure. Suddenly, as I stood next to one woman’s bed I saw her begin seizing. She had gone into renal failure. A team of about 8 docs and nurses responded quickly. Amid the commotion, her husband and son moved outside the ICU tent, where they gazed inside watching in terror, praying she would live. The medical team administered CPR, gave the woman epinephrine injections, and after about 15 minutes of vigorous, sweat-inducing pumping on her chest they were able to revive her. She was dead, then she was alive.

I think back to the early days at the hospital - we didn’t have any of the equipment I see before me today: dialysis machines, portable ultrasounds. Amputations were done without anesthesia. Antibiotics and powerful painkillers were precious and ran out quickly.

In the bed across from her was a beautiful, young woman who had suffered massive complications in childbirth and lay limp as her mother and grandmother together washed her face, massaged her limbs, mixed a little food for her that she tried to eat without choking. It was a striking contrast between medical advances hard at work on one side of the room, and simple, loving care on the other.

The fact is countless patients who’ve come through University hospital would not be alive today if International Medical Corps weren’t there. We’re treating anywhere from 500-800 patients a day there – plus another 1,200 or so at our mobile clinics in 18 sites in earthquake-affected areas across Haiti.

It is astonishing to see how far we’ve come. And yet I am surrounded by tremendous degradation, pain and suffering. Areas like downtown Port-au-Prince and Leogane (the epicenter of the quake) are still complete disaster zones, awash in rubble. In many ways, they look no different than they did nine weeks ago.

So many people ask me about all the money that’s been raised in the U.S. and other countries for Haiti relief - is it getting to those who need it most? The answer is resoundingly yes – but millions were affected by the earthquake, in a place already buckled under by poverty and disease. They need health care, shelter, food, clean water. It will require herculean efforts, over the long-term.

We knew when we first arrived here on January 13 that we would need to stay for the long haul, doing the training of local health workers that is the hallmark of our work around the world and that will help Haitians rebuild and take care of themselves.

We have a responsibility to those ghosts – that we learn from what happened in those early days and move forward, caring for those they left behind and helping Haitians to carry on.

2010-02-07T13:11:00.000-08:00

http://www.huffingtonpost.com/margaret-aguirre/what-took-seconds-to-dest_b_439557.html

Margaret Aguirre

Global Media Strategist for International Medical Corps

Posted: January 27, 2010 08:39 PM

BIOBecome a Fan

Get Email Alerts Bloggers' Index

What Took Seconds to Destroy Will Take Years to Rebuild

What's Your Reaction:

Inspiring Motivating Moving Scary Outrageous Amazing Innovative Helpful

vote
nowBuzz up!

Get Breaking News Alerts

Here in Port-au-Prince, it is hard to imagine what it will take to rebuild what was wiped out in seconds.  The once-bustling port city is a shadow of its former self. The National Palace, which once sat expansive and regal amid its tropical gardens, is collapsed at its center. Chapels that once housed worshipers and art are in ruins. Home after home has been flattened. Businesses are buried. Concrete debris blankets the streets and tent cities housing tens of thousands each have sprouted throughout the region.

Margaret Aguirre in Port-au-Prince, Haiti.

When we first arrived in Port-au-Prince, just 22 hours after the 7.0-earthquake struck, the devastation was all-consuming. Dead bodies lined the streets. Thousands upon thousands needed emergency medical care, which our team immediately began providing at a makeshift clinic outside the Villa Creole Hotel in Port-au-Prince. The area was -- and still is -- a massive disaster zone.

In the first hours and days of emergency response, it was immediately evident that the earthquake had nearly obliterated what little medical system Haiti had. Few doctors and nurses reported to work after the earthquake, an indication that many of them were probably killed. Hospitals and clinics were completely destroyed, with medicines and medical supplies crushed beneath them.

That meant that the hundreds of thousands of injured had few places to turn for help.  Our first morning in Port-au-Prince, International Medical Corps started providing medical care at the Hopital De l'Universite d'etat d'Haiti -- the General Hospital as it's called -- a 700-bed facility in the city center that was badly damaged by the earthquake. An estimated 1,500 injured were sprawled on the hospital grounds, waiting for care. Many were in critical condition, hundreds needed amputations, and there was nowhere else for them to go. With no surgical capabilities, the only choice was to treat and stabilize as many people as we could with what little we had until more proper supplies arrived -- which they did within two days.

While there is a long road ahead to restore Haiti, noticeable progress has been made in just two weeks.  At the request of the hospital administration, International Medical Corps is now leading patient care and operations at the General Hospital, organizing triage and acute treatment of patients and coordinating all of the NGOs that have responded. We helped create an emergency surgical facility able to perform 30 to 50 surgeries a day. We also recruited a group of Haitian medical students who are working side by side with our doctors and nurses and learning to provide emergency medical care.

Outside Port-au-Prince, a dozen International Medical Corps mobile medical units are now working in Petit-Goave, Grande Goave, Petionville, Boloise, Carrefour, Jacmal, Gressier, and Miragoane to reach those who have little access to medical care.

International Medical Corps team

We estimate that our teams are now treating roughly 1,000 people every day. In the thousands we've treated, I have encountered story after story of survival and perseverance.

I met a miraculous five-year-old boy, Monley, who survived eight days buried beneath his home. One of our doctors intercepted Monley on the roadside, just after his uncle rescued him from the rubble, and rushed him to the General Hospital. He was severely dehydrated and emaciated, but amazingly unscathed. Our team gave him an IV, water, juice, and a bit of rice and soon Monley was able to leave the hospital, alive to share his story.

I met a mother, Marie, who thought her daughter, Megine, was crushed when their home came down around her. Two days later, they found Megine and brought her right to our clinic at the General Hospital where Marie had received care herself just days earlier.

I met a dancer with the National Ballet of Haiti. Sadly, her leg needed to be amputated below the knee, but she swears that she will dance again.

These people are Haiti's future. And we are committed to working with them to rebuild Haiti, to make their health care system stronger and better than what it was before. Our mission from relief to self-reliance has never been more clear or important to me after my time in Port-au-Prince. There is a long way to go, but we will continue to make progress, little by little, toward Haiti's self-reliance.

Text HAITI to 85944 to donate $10 to help International Medical Corps' efforts in Haiti or visitwww.imcworldwide.org.

From the Rubble, a Tale of Survival

2010-01-22T13:21:00.000-08:00

From the Rubble, a Tale of Survival

While in Haiti, I have seen hundreds dead, piled up on the sides of the streets or mass graves, often covered in a sheet as a modest form of respect. But in the death and rubble, I have witnessed remarkable stories of survival, one of which was a little five-year-old girl, Megine.

I met Megine at the General Hospital where our team has worked around the clock to save as many lives as we can. She was carried in by her father, her right hand hanging on by a thread.

She and her mother were in their home when the earthquake hit and did not get out in time before the building collapsed around them. Her mother, Marie, made it out from under the rubble and to the General Hospital, but they could not find Megine. “I was sick to my stomach the whole time,” says Marie.

Two days went by before Megine was pulled from the rubble. Her uncle discovered her and managed to get her out alive.

“I was so happy to see my daughter alive,” says Marie.

Marie and her husband brought Megine to the General Hospital. Sadly, her right hand needed to be amputated, but she made it through surgery, united with her parents, and alive to share her story.

Text HAITI to 85944 to donate $10 to our lifesaving work on Haiti.

Front-page LA Times piece about International Medical Corps

2010-01-05T12:59:00.000-08:00

Pioneering LA-based Non-Profit Saving Lives

Photo in NY Times "Documenting the Decade" feature

2009-12-30T21:26:00.000-08:00

Outside International Medical Corps clinic in eastern Congo

My piece on Huffington Post: Oprah and the Power of 10

2009-12-04T17:13:00.000-08:00

http://www.huffingtonpost.com/margaret-aguirre/oprah-and-the-power-of-10_b_380813.html

CNN on International Medical Corps book, "A Thousand Words: Photos from the Field"

2009-10-28T21:19:00.000-07:00

CNN on International Medical Corps book, "A Thousand Words: Photo from the Field"

Sienna Miller documentary about rape in eastern Congo

2009-10-13T14:45:00.000-07:00

Watch the movie here: http://www.imcworldwide.org/Page.aspx?pid=779

Oprah Partners with International Medical Corps

2009-10-02T10:42:00.000-07:00

International Medical Corps has partnered with The Oprah Winfrey Show in a campaign to raise awareness and support for women around the world. Oprah announced October 1 her campaign, “For All Women,” encouraging her viewers to go to oprah.com/forallwomen to learn what they can do to support women.

Update on GE donation and training in Chad

2009-08-17T11:30:00.000-07:00

Sienna Miller Visit to DRC

2009-08-12T15:40:00.001-07:00

Delivering Relief in Syria

2009-08-03T12:00:00.000-07:00

I spend most of my time in the field listening to people’s stories, trying to understand what they’ve been through, how we’re helping, and what more we could be doing.

I work pretty hard not to let my emotional reactions to the stories I hear get in the way of what I and our teams are trying to do. But at the same time I need to maintain my compassion for those sharing their ordeals with me. I hear stories of tremendous suffering, and stories of tremendous affirmation – often within minutes of each other. Loss/reunion, despair/hope, pain/healing. Many of the stories I hear have happy endings – many do not.

My visit to Syria was no different. I spent a few days photographing, interviewing and videotaping primarily Iraqi refugees who had fled for safety to Damascus and its suburbs. The numbers of refugees are disputed, but estimates range from several hundred thousand, to 1.3 million.

International Medical Corps was the first American NGO allowed to operate in Syria, providing comprehensive primary and secondary health care, mental health services, maternal/child care, even dental services. It is not easy gaining the trust of officials and the local population in Syria. But our partnership with the Syrian Arab Red Crescent has been critical to getting help to those who need it most.

Damascus, like any large city, has noticeable wealth – as well as deep pockets of poverty and need.

The large population influx has put a huge strain on the country’s health infrastructure. And many Iraqis have arrived with little or no money, and little or no support system. Their medical and mental health needs are enormous.

I spoke with children who witnessed first-hand the killing of mothers, fathers, and siblings. I remember meeting “Fatma”, who is 11. I had walked into an activities center for mothers and children at one of our health clinics and immediately noticed her. She was very pretty but pale, her hair pulled back in a barrette, her eyes downcast, she lifted her head slightly a few times to look at me as I spoke with her mother. Her expressions revealed only profound sadness.
As her mother recounted their story to me, Fatma’s 5-year-old sister hung on her lovingly, or vied for my camera’s attention, showing off the bright red-haired doll she had made with our staff.

Fatma’s mother explained that when they lived in Baghdad, her husband received repeated sectarian death threats. At one point Fatma was abducted, though she managed to escape. Then their house was bombed and Fatma suffered shrapnel wounds to the back of her head. That’s when the family fled to Syria, about nine months ago. She says Fatma is traumatized. She rarely speaks, she missed two years of school and cannot focus in class, her grades have plummeted from what they once were. She showed me Fatma’s report card, taped back together after Fatma had ripped it in anger and shame.

Our psychosocial coordinator at the center is working with Fatma, her family and others like them to address their issues comprehensively and get them more intensive medical and psychiatric treatment. Fatma is already showing some improvement, though she will take a very long time to heal.

But I am amazed to see the enormous impact we can have through the most simple, innovative measures.

At another center, situated in a run-down neighborhood on the outskirts of Damascus, we are focusing on early childhood development for Iraqis, as well as local children. Our staff and the kids together painted the walls of the center vibrant colors and planted a beautiful garden. We provide computer classes, plenty of children’s books and a mini-jungle gym, all in a bright, lively setting.

Nadia, our program coordinator, is the creative force behind the center. She placed colorful “wish boxes” in one room, where children can submit a simple request for us to fulfill on “Fun Fridays”. Some of their wishes: to ride a horse, to eat a salad, to receive a pair of shoes. For these children – many of whom have lost parents – this center is a little oasis they helped create.

All of the kids I met have witnessed unimaginable horrors, yet they are able to laugh and play like they haven’t a care in the world. Nadia tells me one of the children’s mothers remarked with astonishment: “What did you do? My child had stopped laughing. Now he is happy and smiling again.”

Update on GE Equipment Arriving in Chad

2009-07-13T13:57:00.000-07:00

Here's a follow-up to an earlier post, as we were awaiting the arrival of critical medical equipment from GE to our programs in Chad.

In this video, ,International Medical Corps Logistics Officer in Chad, Ibrahim Mansaray, talks about the challenges of getting the equipment where it's needed most.

http://www.youtube.com/watch?v=cvhT4w8SiEE\

In Their Own Words

2009-06-25T01:06:00.000-07:00

We’ve just finished our final workshop with 62 extraordinary Iraqi, Palestinian and Jordanian children.

Jim Webb and the folks at National Geographic had the genius idea to give the kids simple writing exercises during the course of the workshops – to help us better understand their lives, experiences and thought processes.

The exercises included answering questions like: “I remember…” and “I dream of…” We also had the children write an imaginary letter to someone they love or admire.

Below is a sampling of what they wrote.

On Friday we’ll be exhibiting the kids’ photos at the Children’s Museum – Jordan, under the patronage of Her Majesty Queen Rania Al-Abdullah.

=======
-Bassme: “I remember when the war started. My mother and I were sitting on the porch, I had final exams, and a man got killed in front of me.”

-Aya: “I dream of becoming an active person in society, and to be able to help others. My hope is to become a successful architect, and to travel to Venice. I remember once I had one friend, but now I have a lot.”

-Saber: “My life's dream is to help people. I would love to make a study about the percentage of homeless people, and to open a project for the people to be able to donate for the poor families. Since I was a little kid I dreamed that I would have a magazine to write in with my friends and the people I love about the common issues, Palestine and general opinion. We are now the generation of revenge. Everyone wants to fight with each other. Why aren't we like brothers? Like the Quran says: ‘We are all brothers in Islam’. So why can we not live like that?”

-Fatima: “I remember that my happiest days were with my father before he died, and I remember that when I was little my father used to play with me and my sisters. I remember the war in Iraq, and I see something burning in my eyes, the cars, and the homes. I also remember my cats and my sisters in Iraq. I hope that things will get better in Iraq.”

-Noora: “I remember the first day I came to Jordan we didn't know anyone, and I didn't know the language that this country was speaking. But after living here for many years, I mastered the language, and I got used to my life in Jordan and now I am very happy.”

-Mohamad: “My cousin's car impresses me a lot, because, it is very fast, and it has a turbo engine and it has big speakers, an amplifier and two screens and a system.”

-Hawa: “To my father and mother. They are the most valuable people to my heart. I love them with all my heart. I live in their shade (in a good way) and I love them. They made me. They taught me how to love and respect others. I hope for them health and peace, and to stay in a nest. I hope that Allah dear will keep them and to keep them for me forever. Thank you.

-Fatema: “To my dear sisters who are in Iraq now, I'm sending this letter to them and wish they could come with their husbands and kids here. I love mom very much and respect her, I wish she could stay with me forever. And this letter is also for my dear father who is dead but I still feel him with me. I hope he is in heaven now. I also wish that all Muslims will be in heaven with him.”

-Rashad: “I love you dad, because, you helped me and you taught me how to think about my life, my career. I know that you get tired every day so that we can stay alive, so when I grow up I am going to take good care of you.”

-And this from 11-year-old Sandian, whom we called “The Philosopher” because of her astonishing analysis of photos during the workshops:
“I remember the war, and the screams I used to hear at night, they were from a child who lost his parents or from a mother who lost her children, or from a wife who lost her husband. Yes, all of this is tied to the war. From it I saw eyes filled with tears, but from this pain I found support, for hope was my title, and the light of love and forgiveness I held in my arms, so that I may finish my journey. The sentence I love and always say is: ‘From the young of the future; the little ones of the nation; the heroes of tomorrow.’”

National Geographic Photo Camp in Jordan

2009-06-16T09:52:00.000-07:00

Jordan Photo Camp - Day 1

We just finished the first day of our Photo Camp in Jordan with National Geographic.
International Medical Corps conducted one of these two years ago with NatGeo for refugee kids from Rwanda, Sudan and the Democratic Republic of Congo, who were living in Uganda.

This time, we’re working with Iraqi and Palestinian kids living in Jordan, along with vulnerable Jordanian youth.

There are about a million Palestinian refugees and hundreds of thousands of Iraqis living in Jordan, so the strain of this population influx is profound. And for these kids, who have all witnessed violence, many having lost one or both parents, an art therapy project like this provides a much-needed window into their world – for them and for us.

Having previously done the same project in Africa, I am struck by the contrast between the cultures of kids there and the kids here in Irbid, a populous town in northern Jordan with a distant glimpse of the West Bank. The 20 children we worked with today, ages 12-19, are urbanites. All had experience with cameras; they’ve either used one or own one. So they were relatively quick to grasp the technology. They’re also not as shy and reticent about taking photos as the kids were in Uganda.

Then there are the young girls. As a woman and a semi-professional photographer, it is difficult for me to watch a young girl whose cultural mores make her reluctant to push the physical envelope required from photography – crouching down to get a great angle, sticking the lens close into the face of a male shopkeeper, maneuvering herself aggressively around someone to get the shot. For one girl named Ayat, I hesitate to push, knowing I need to respect the way she’s been raised as a female in Muslim society. And yet, something interesting happened when I, the pushy instructor, left Ayat alone to do her thing. Away from my gazing, judgmental eye, she started maneuvering around others, taking more shots, finding interesting angles. I can’t wait to see the images she captures as the 3-day workshop unfolds.

Tomorrow, we will go out into their home environments again to shoot more photos. Then, we’ll come back to the Child Protection Society center to sit with the children, the photographers and a team of mental health experts and let the children tell us the stories behind the photos they took.

This is always the most powerful part for me: sitting with the kids to review their photos – stunning, heartbreaking, joyous portraits of their lives – and hearing the stories of behind the images.

Over the next 10 days we’ll be working with 60 kids in Irbid and in East Amman at the Queen Rania Center. When the workshops are over, we’ll have sorted through probably around 20,000 images. Each student will help us choose their two favorites for a closing-day exhibit in Amman, with subsequent exhibits around the world. The students also will receive a few prints of their photos and a CD with all of them.

But just as important, one of our partners on the project, VisionWorkshops, has donated cameras for us to keep at the centers so the kids will be able to continue their photography and storytelling after the workshops end.

I often think back to the kids in Uganda who participated in Photo Camp there. Kids like Theo, Joyce, Andre, Mapendo and Ester. I wonder where they are and how they’re doing. One corresponds with me quite often. She is now 18, still struggling to survive in the refugee settlement where she has now lived for many years. She tells me she still takes photos with our cameras and that it’s still important to her that others know her story. We have shown the Photo Camp Uganda exhibit at schools around L.A., and have sent books of photos and letters from the L.A. students to the Uganda students so they can share their lives with each other.

I am very aware that once I leave – whether it’s Uganda or Jordan - these kids’ stories will continue to unfold and they will continue to need an outlet for expressing themselves and sharing their experiences.

Sienna's Final Post from Dem. Rep. of Congo

2009-05-05T05:00:00.000-07:00

Final post from actress Sienna Miller, who's been visiting International Medical Corps programs in DRC:

=====

It has been a whirlwind three days and so much has happened that I don’t even know where to begin. Twenty four hours of the last seventy two have been spent in a car so we’re all feeling weary. I’m not sure if I even have the energy to attempt eloquence but I’ll give it a shot.

We left Bukavu for Chambucha on Wednesday morning at six. The journey was everything we had been warned about and more: muddy roads that could swallow a truck, flat tires, makeshift bridges, military checkpoints, very young men with very large weapons. It was a six-hour drive through Kahuzi Biega National Park and north to Chambucha. The scenery was breathtaking. Thick dense jungle, bamboo trees and wild orchids, monkeys, every shade of green you could possibly imagine. Enormous spider webs and their equally enormous creators, such a change from the urban feel of Bukavu. There were children swimming in the river that borders the forest where the FDLR (Rwandan rebel group) are in hiding, and where the FARDC (Congolese government troops) have taken positions along the road, weapons trained at their sides. And that’s what’s so confusing about this place..utter purity and beauty juxtaposed with brutal violence.

So where we are heading is an area engulfed by guerilla activity. As a result tens of thousands of people have had to flee their homes in neighboring villages and have been essentially herded into Chambucha. The road we are on stops there, and we are received like heroes. The people had been told beforehand of our arrival and hundreds turned up to clap and cheer and sing us into our camp. It was so moving and there is no way I can do it justice in words...David Serota has it all on film, so it will no doubt eventually speak for itself.

International Medical Corps’ hospital facility is set up next to the compound where we are staying and after dropping our bags we walk fifty meters into the fenced area for a tour. The care being provided, considering the extremely remote location, is again incredible. The stories I hear are again, harrowing. I met a mother who was running away from a group of militia three days earlier with her baby strapped to her back. They both got shot, but survived and thankfully made it into the facility in time. Her boy is so little and the huge bandages on his arms break my heart.

Everything about this place breaks my heart. These people all have stories which they share with me and there is just simply too much to try to grasp. Everyone has lost something, everyone has lost someone. I meet malnourished babies, mothers, fathers, widows and widowers, malaria sufferers, their eyes glazed, victims of rape and pillaging. They are all here in massive numbers, and their stories are agonizing.

I meet a group of about a hundred who have selected an old man to read out on behalf of them all, their list of grievances. They have no homes and no possessions and they need others to recognize they are in crisis.

I sat down with the Mai Mai, an armed community defense group that has been placed here by the government, but not paid for months. The general told me that he wants to go back to his old post but leaving this area would look like he was plotting to join another force and would essentially place a target on his head. He was surrounded by his men in green uniforms, holding their ammunition and AK 47s. It is intimidating for me to interview them and certainly against the norm for them to answer difficult questions posed by a woman. Even though their definition implies that they are allies of the government, I know that there is really no “good” armed group in this country.

I later asked a victim of rape if she felt protected by the Mai Mai or any of the military here. She simply said “I don’t trust any man wearing a uniform”. This woman had been raped on three separate occasions, each time requiring fistula repair. The last time she was held captive for three months and was consistently raped by eleven men. The reason she had had so many of these encounters was because she was disabled and therefore when the men came into the village and the women fled, she was always left behind. She simply could not run as fast as the others.

I sit with a fourteen year old girl who was raped nine days ago… and another and another. It is impossible to fathom the sheer number of women who have been violated here, and their stories are way beyond anything I can even begin to comprehend.

I was able to deliver one wonderful treat in Chambucha. Lysa Heslov and her terrific foundation, Children Mending Hearts, provided hundreds of t-shirts for the children who are in desperate need of clothes and it was uplifting and rewarding to later see them running around smiling in their new clothes.

We spend the night in bunk beds within the camps and eat a supper of cassava leaves with some river fish and rice. There is no electricity so everything is cooked on clay pots over coal and we wash before dinner with a bucket of cold water. I haven’t felt so present in a long time. There is something to be said for eliminating choice and the calm that comes with it. It dawns on me that I get so overwhelmed at home and life is often spent planning or organizing or making decisions in general. Here there is really not much choice at all and as a result I find myself stopping and actually having the time to process the experiences we have had.

The drive back on Thursday took about seven hours. We slept in Bukavu and then drove eight and a half hours to Rwanda.

I broke down twice on this trip. The first time after being in the displacement camp outside Goma, seeing the woman with the colostomy bag. I had to step into an empty tent and sob. I had consciously planned on keeping it together, but the visual and the look in her eyes broke me. After that, some form of defense mechanism kicks in. Of course you feel enormous empathy but there is no room for personal emotion in these places. Still, as we crossed the border into Rwanda, it all hit me, and I cried. It was a pretty silent journey to Kigali because we all leave a piece of our hearts in DRC. There is a lot to process, but I have never gone on such an incredible journey before and am inspired to come home and start the real work.

Please go to imcworldwide.org and if you have anything to spare, donate. Trust me the money you spend will be very well used and these people need and deserve all the help they can get.

Day 3 from Sienna Miller's Diary from Dem. Republic of Congo

2009-04-29T13:29:00.000-07:00

I’m sitting in the dark, due to a huge rainstorm as I write this, from the balcony of the International Medical Corps guesthouse in Bukavu, eastern DRC. We left Goma at the crack of dawn and sandwiched ourselves onto a boat that was full way beyond capacity. And we laughed the whole way because despite the immense darkness that exists here, this country is beautiful in so many ways. Bukavu feels far more city like and certainly more developed than Goma, and equal in beauty and charm. We came to visit Panzi Hospital, where IMC is training doctors and which has become world-renowned largely because of its incredible work with thousands of women who are in need of surgical repair for a condition called “fistula,” a severe gynecologic rupture. It’s a frighteningly common condition in eastern DRC – because of lack of obstetric care, and the epidemic of rape.

Read Sienna's entire blog here: http://www.takepart.com/blog/2009/04/28/sienna-millers-travelogue-from-dr-congo-day-3/

Day 2 of Sienna's Diary from Dem. Republic of Congo

2009-04-27T20:24:00.000-07:00

More reflections from actress Sienna Miller, who's in DRC visiting International Medical Corps' programs:

Day 2
I guess it’s important to clarify why I’m here. International Medical Corps is an incredible organization that is providing healthcare and support to people in dire need. I met with them in Los Angeles two months ago and they approached me to see if and how I could help in anyway. They desperately need funding and general awareness raised both for the organization, and for all the projects they are involved with. If my involvement in any way could contribute to either then I was more than happy to be involved. My one request was that if we were going to start working together, it was imperative, that I see and experience what is going on first hand… So here I am.

Read Sienna's entire blog here: http://www.takepart.com/blog/2009/04/27/sienna-millers-travelogue-from-dr-congo-day-2/

In Congo with Actress Sienna MIller

2009-04-27T07:00:00.000-07:00

These are reflections from actress Sienna Miller, who is visiting International Medical Corps programs in the Democratic Republic of Congo all this week. Quite an incredible woman...

======
Day 1

We boarded the flight to Rwanda having spent a night in a gorgeous old colonial hotel in Nairobi. Felt such anticipation as we flew over Lake Victoria and watched the landscape beneath us with its deep reds transforming into luscious green and mountainous peaks. Rwanda is so full of history and so far from home. A country that has been ravaged by war and yet once landing we were met by a sea of smiling faces and stunning landscape. The only reminder of genocide on our four-hour drive to the border of Congo was the banners stretching across the road as a memorial to those who were so brutally murdered.

Read Sienna's entire blog here: http://www.takepart.com/blog/2009/04/27/sienna-miller%E2%80%99s-travelogue-from-dr-congo-day-1/

Twin Struggles in Burundi

2009-04-24T12:00:00.000-07:00

I met two young girls in Burundi this week whose personal health crises lie at the core of the challenges International Medical Corps is facing in a country that is tiny in size, densely populated, and among the 10 poorest in the world.

One of these girls was at the beginning of her crisis; the other in recovery.

I first met “Jacqueline” inside her family’s small brick hut in eastern Burundi, where she was lying in her bed, a blanket pulled tightly over her head. When she was not wailing with pain she was hyperventilating from fear. She was frantic and inconsolable.

A week earlier, while visiting her sister, Jacqueline was raped by her sister’s husband.

In Burundi, the rate of violence against women and young girls is high – a result of decades of conflict that ended in an initial peace agreement in 2003. What’s more, perpetrators regularly escape prosecution and punishment.

Immediately following the incident, Jacqueline went into hiding near her sister’s home and her family could not find her for two days – a critical time period in the treatment of victims of sexual violence.

When Jacqueline finally was found and brought to the hospital IMC counselors were called in to assist. The counselors tell me the first time they met with Jacqueline she repeatedly broke down while trying to recount the ordeal. “As she tried to tell us what happened she was re-living it over and over again. She was terrified,” one of them explains to me.

Once Jacqueline returned home, outreach counselors continued to visit her - hiking down a steep hill, thick with banana trees and cassava bushes, to reach her house. Despite her horrific experience, Jacqueline is fortunate to be surrounded by her family and numerous neighbors who paid visits to check on her and lend their support. Frequently in such situations, victims are stigmatized and rarely seek or get the physical and emotional support they require.

IMC is providing Jacqueline and other survivors of sexual and gender-based violence with medical care, counseling and socio-economic support, as well as referrals for those who need additional assistance so that they are getting comprehensive care.

It is impossible to know how Jacqueline will fare. The pain and the memory are still too raw; her recovery, if you can call it that, has only just begun.

Then, there is the case of five-year-old Mary, a shy, beautiful child who was brought into IMC's Outpatient Treatment Program site by her grandmother, Esperanza. At this nutrition center in Bunyari, a village in the very northern part of Burundi and one of 37 centers IMC is supporting in the country, we are monitoring children and providing them with supplemental food, like Plumpy'nut, Corn Soy Blend, vegetable oil and bulgur. According to the World Food Program, 57 percent of children under age five in Burundi suffer from chronic malnutrition.

Esperanza tells me through a translator that Mary’s mother and father separated last year. The father married another woman and he no longer cares for Mary and her four siblings. Mary's mother also left and went to Tanzania, so the grandmother now cares for all of the children herself.

Mary quickly slid into severe malnutrition. By the time she arrived at the stabilization center she weighed about 20 pounds; the normal weight for a girl of her size and age should be closer to 40.

Today, after carefully calibrated therapeutic feedings, Mary is recovered and able to stay at home. She still must regularly come to the OTP for monitoring, where she is weighed and measured and where IMC provides food for the week - on this particular day that meant 25 packets of Plumpy'nut and 2.3 kilos of bulgur. IMC also educates Esperanza and the other parents about maintaining proper nutrition for their children and recognizing the early signs that something’s wrong.

IMC has just launched a multi-year program across Burundi to identify and manage acute malnutrition through the community and the local health ministry, as well as work toward changing behaviors so that we can get real traction in reversing chronic malnutrition.

Esperanza laments how difficult it is caring for all of her grandchildren and struggling to make sure they have enough to eat. But when I ask if IMC has gotten Mary the care she needs, Esperanza nods her head vigorously, takes both my hands and says over and over in the local language of Kirundi, “murakoze,” which is simply “thank you.”

The More Things Change...

2009-04-20T12:00:00.000-07:00

It is strange for me to return to the Democratic Republic of Congo after just a couple months away and witness what has changed and what remains the same.

Over more than a decade in DRC, an estimated 5.4 million people have died as a result of ongoing conflict and disease, and millions of others were forced to flee their homes. It is often dubbed the deadliest war in modern history. While much of the country stabilized following a peace accord and subsequent elections in 2006, hostilities among government forces and the numerous rebel groups in the eastern sliver of DRC have persisted. The situation worsened in late ’07, causing almost a million people to be newly displaced.

In recent months, violence in the most volatile areas in the north, like Masisi and Rutshuru, has eased slightly. But the displaced are still streaming southward into the camps outside Goma. These seven camps where International Medical Corps is operating are bursting at the seams.

The last time I was here was in January. As we drove down Sake road, about eight miles outside Goma, I had noticed a few dozen bright yellow tents dotting an open field, about a mile from three of the largest displacement camps, called Mugunga I, II and III. Today, those tents number about 500, which translates to around 2,000 people. It’s become a small, ``splinter” village, suddenly transforming the landscape.

One thing that does remain the same here is the spectacular, verdant land, filled with banana trees and tall grassy fields stretching toward Lake Kivu. But another is the suffering of the people who live on this land – people who have escaped unimaginable violence and arrived in crowded camps with few belongings and fewer options.

Yesterday we escorted a large group of U.S. congressmen and embassy officials into Mugunga I camp to see what’s happening there, the care IMC is providing, and how they might be able to help. They were shocked by what they saw and heard.

Inside Mugunga I, home to 28,600, life is brutally, consistently tough. Conditions are cramped and unsanitary, the daily rains turn the black lava rock that covers the ground from nearby Nyiragongo volcano into a thick mud. Clean, safe water and nutritious food are scarce. The camp president tells us that 70 percent of the women are widowed because of the conflict. Rape and sexual violence remain rampant in and around Mugunga. Because women and young girls are generally responsible for collecting food, water and firewood, they become targets when they travel outside the camp to do so.

And we continue to treat children who are severely malnourished. One six-month-old patient I saw this week weighed about three pounds, her jaw sunken and her skin melting off her teeny bones.

Still, In the face of all this tragedy, there is something else, something lovely, that remains the same at Mugunga I: people working, playing and trying to live their lives as best they can with dignity and a sense for the future. As I walk through the camp the scene is as it was last time and the time before that: young men getting their hair cut at the barbershop in the sprawling market; a checkers game with bottle caps as pieces; the booming sounds of the local ``cinema,’’ where a video plays to a packed tent of people; women singing as they peel vegetables; the four elderly tailors who hold court in the market, perched at their Singer sewing machines, sharing stories; children shouting and laughing as they play marbles or soccer or jump rope. These scenes have remained the same on every one of my visits. This is daily life for the residents of Mugunga I camp – their home for who knows how long.

Hollywood Fundraiser for IMC

2009-02-11T14:45:00.001-08:00

http://www.latimes.com/entertainment/news/la-et-cause11-2009feb11,0,3559752.story

Life & Death at Guereda Hospital

2009-02-04T13:52:00.000-08:00

Spend a day at a hospital in eastern Chad and you quickly will witness the life and death implications when doctors have sophisticated equipment available, and when they do not.

Take International Medical Corps' hospital in Guereda, which serves the local Chadian population, as well as refugees from Darfur living in nearby camps. Guereda Hospital is one of three IMC facilities in eastern Chad that soon will be receiving desperately needed equipment donated by the GE Foundation: x-ray machines, ultrasounds, electrocardiographs, fetal monitors, etc. But until the equipment arrives, patients must go without the diagnostic care they really need – and the consequences are dire.

Eastern Chad is one of the most difficult and dangerous places in the world for delivering health care. IMC's medical director at Guereda Hospital is a South Carolinian named Florence, who just arrived in mid-January and has been at a full sprint ever since, treating patients while training IMC's local staff of nurses and health care workers at the hospital. Her first day on the job she saw around 50 new patients – not counting another 30 or so children being screened for malnutrition and receiving feedings – and the numbers keep rising. In particular she's inundated by female patients; Muslim women customarily prefer not to be examined by a male doctor and many of the women had been tended primarily by IMC's female nurses and mid-wives til Florence arrived.

In her consultation room, one patient, a woman in her 20s, explains that she has suffered abdominal pain on her right side for four years. Florence tells me that doctors in developing countries like Chad, faced with this sort of complaint from women, and without an ultrasound or ECG available, perform an appendectomy, the most common cause of pain in the area. In the case of this patient, she had her appendix removed but the pain never subsided. Florence suspects the woman has either uterine fibroids or multiple ovarian cysts. But without an ultrasound or ECG there is nothing that can be done for her beyond some temporary pain relief. This patient simply will have to wait, and come back when the equipment arrives.

Another woman in her 20s suffered a compound fracture to her tibia and fibula in a fall. Doctors had tried to remove bone fragments, but after two months her leg has become dangerously infected and may have to be amputated. Florence needs to be able to view the damage, but without an x-ray, she must perform surgery under general anesthesia to explore the bones and see if there's any possibility of healing or if a bone graft is necessary.

Yet another woman, in her 40s, lifts her shirt to reveal her right breast, gnarled and bloody from a very advanced tumor. Her treatments have consisted primarily of seeing a traditional healer who, as is often done, rubbed mud and straw into the open wound. This, sadly, has made it much worse. No modern equipment or chemo can save her now. Florence says there is nothing she can do for her. Had the cancer been caught earlier, things might be different.

With each patient I ask myself, will we be able to help? And will we be able to help in time? Fortunately, most of the patients Florence examines she is able to provide at least the band-aid that will hold in the interim with a minimal amount of suffering.

For the woman with the infected leg, the bone graft was successful. Her leg will heal, but given the severity of the damage, it will take a long time. Time is exactly the luxury that some patients can afford, while others cannot.

Once a Teacher...

2009-01-23T00:00:00.000-08:00

I spent yesterday in a place called Gaga Camp, in eastern Chad, near the border with Sudan. For the 20,500 Darfurian refugees who live in this camp, International Medical Corps is the only health care available, providing primary and maternal/child care, mental health and nutrition services, and HIV and hygiene education.

I brought with me a special package for one of the camp’s residents, care of the Washington Post’s Nairobi bureau chief, Stephanie McCrummen.

About a year ago, Stephanie wrote a terrific profile of a man named Azhari Ali. Before fleeing Darfur and settling at Gaga three years ago, Azhari had been a professor with master’s degrees in economics and political science. He spoke with Stephanie eloquently about the difficulty of trying to find purpose and intellectual stimulation in a camp with few resources – much less books. His only reading materials were what he was able to carry with him, including “Macbeth” and two-year old copies of Time and The Economist, which he had re-read countless times.

You can see Stephanie’s story here:
http://www.washingtonpost.com/wp-dyn/content/article/2007/09/21/AR2007092102286_pf.html

Soon after that piece appeared about a year ago, IMC received calls from people wanting to send books to Azhari - the parents of one IMC staff member even paid to send them. Stephanie too heard from numerous readers moved by the story. Compelled herself to help him in some way, she put together a package of books, magazines, notebooks, pens, batteries for me to take to him.

Azhari had been working as a translator for IMC when Stephanie met him. As a way to keep his mind sharp, he was attending relief agency meetings and educating himself on various health campaigns. He is now a community educator for IMC, helping with HIV, nutrition and hygiene education campaigns in the camp.

When I first arrive at Gaga camp and step into the tent to meet him, he is finishing up a training of other community educators. He is a quiet, dignified, solicitous man of 45 – just a few years from the average life expectancy in Sudan. I explain that I have something for him. When I pull out the materials he seems a bit confused, perhaps surprised that anyone would do this for him.

We chat a bit – he is taciturn but his English is excellent. He expresses his gratitude for Stephanie’s gift, and says he is happy once again to be working and productive.

One of IMC’s doctors in the camp, Ibrahim Cisse, says to me: “IMC is lucky to have found someone with such a high level of education to help organize the health community. We cannot succeed here without strong community participation and without health workers like him.”

Refugee camps are filled with people like Azhari - people who had lives, loved ones, professions and aspirations before chaos ensued. All of them are trying to recover what they once had.

Azhari tells me it’s the education and training of others that is so crucial. “This is the most important thing, for our future, wherever we are.”

Arrival in Chad, and Other Musings

2009-01-19T07:36:00.000-08:00

I'm sitting in the living room of IMC's compound in N'Djamena, the capital of Chad, feeling blessed with a surprisingly strong internet connection, and a bottle of wine I brought from Nairobi.

I had been warned beforehand of the heat, sand and dust here - it's formidable. I arrived about 1am at the airport. An hour later, as I put my head down to finally sleep, I could feel and smell the dust surrounding me - like a car had just driven by on a deserted dirt road.

Our lovely cleaning staff here has left on the tv for me - I've got the Michael Douglas masterpiece, "The Game," to keep me company now that they've all left for the evening.

I am a jumble of emotions here. I have just come from the displacement camps in eastern DRC, which are swollen with a couple hundred thousand people, all desperately needing food, medical care, clean water. The poverty and suffering is immense.

I'm also feeling a deep sadness about a close friend battling cancer far away from here. The latest news is not good and so I treasure any updates I'm able to get on her condition. I fear the worst and fear it will come soon, and yet know there is absolutely nothing I can do.

Amid all this, it is hard not to notice the optimism in the air here about our new president. Traveling through Kenya, Rwanda, DRC, Chad, I continue to be struck by the impact Barack Obama is having on this continent. Everyone is atwitter with the pending inaugural. Nairobi radio promotes "Obama's iPod, all day, every day". The TV stations are promising non-stop coverage of the event. Cab drivers opine about Obama's style of leadership, how he will handle the economy, the war in Iraq, aid to Africa, Congress, and how America's position in the world might shift next.

An IMC finance officer here in Chad told me Obama becoming president has had a major impact on him. When I asked how, he replied: "He is a brother to me." This is a time of great possibility. I just hope Obama doesn't "screw the pooch," as Gus Grissom famously warns in "The Right Stuff."

Early tomorrow morning I fly to Guereda, on the other side of the country, where IMC is working in camps serving about 275,000 refugees from neighboring Darfur, Sudan and the Central African Republic, as well as about 180,000 displaced Chadians.

I am delivering a special package to someone in one of the camps, which I will write about next time.

Until then...

In Congo, A Life Reclaimed

2009-01-12T20:12:00.000-08:00

I’ve been thinking about the notion of having to start over in life. After some personal tragedy, or a dramatic fork in the road, you find yourself searching for a new path, new meaning, a new method of survival.

Today I met a woman named Esperanza. She is a nurse with International Medical Corps at a displacement camp called Bulengo, outside the town of Goma in the eastern part of the Democratic Republic of Congo. Throughout the morning, Esperanza showed me around the IMC clinic that delivers primary health care and nutrition services to a population of about 27,000, advising me on how many patients she was treating and what sorts of maladies they were experiencing.

At one point I gathered a group outside the clinic to find out how they came to Bulengo. I asked how many of them had lost a loved one in the violence that has plagued this northern axe of DRC. Esperanza called out, “mon mari” – my husband. Only then did I learn that Esperanza doesn’t just work in Bulengo Camp; she also lives there. In fact, she began working for IMC after receiving care from IMC.

Four years ago, Esperanza was living north of here - in an area called Massisi that has been decimated by fighting between rebel and government forces - when her husband was killed. In late 2007, as the conflict intensified, she and her three very young children fled to Bulengo. Six months later, she was working again as a nurse.

Esperanza tells me she is grateful for the chance to use her skills, and proud to be serving her own neighbors.

Her journey – in terms of geography and profession - took me just a few paragraphs to describe, but to her it has no doubt been a painful, circuitous and lengthy one, filled with fear and doubt.

Esperanza found herself dumped upside down into the rushing water, yet succeeded in finding her way to the top again. She managed not just to survive but to keep her children safe and find a new way to care for them.

With one million people displaced in and around Goma due to the latest violence, she is one of so many who are starting over, trying to write new and better chapters to their lives.

The Obama Effect in Congo

2009-01-10T11:35:00.000-08:00

An extraordinary slice-of-life moment here in Goma...

Sitting in the cafe of my hotel, working on the computer, I notice a small group of about 10 young men and women, gathered for a late lunch, laughing, talking animatedly.

I then hear the voice of Barack Obama. I look over and the group is gathered around a computer. They're all watching Obama's presidential acceptance speech - I suppose on YouTube.
Two of the women are reciting his words... along with him... by heart. Incredible!

The women are commenting in French (the second language of Congo) how much they love Michelle... and Sasha... and Malia. They're all absolutely enraptured by Obama's speech - two months after he delivered it.

I've had numerous conversations with people here and in Nairobi over the past week about Barack Obama. I knew that many in Africa were emotionally invested in him and his success -but there's nothing like seeing it first-hand.

Ethiopia photo I shot in NY Times

2008-07-02T14:48:00.000-07:00

http://www.nytimes.com/2008/07/02/world/02zoellick.html?partner=permalink&exprod=permalink

Ben Affleck Visits IMC Program in Congo

2008-06-24T15:50:00.000-07:00

Hi all,

Ben Affleck and a crew from Nightline recently visited one of International Medical Corps' primary health care and nutrition centers near Goma in eastern Congo (see my accompanying photo gallery).

He interviewed our phenomenal program coordinator, Woseh Gobeh , as well as some of our beneficiaries at the center.

Affleck is hoping to raise awareness about the ongoing conflict in DRC and its impact on civilians. His video diary of his journey through DRC aired June 26 on Nightline.
Here's a link to a portion of that show:

http://youtube.com/watch?v=PTkWTb2-Jyc

"The Green Famine"

2008-06-10T00:09:00.001-07:00

As you drive through southern Ethiopia and gaze out at miles and miles of fertile, lush valleys, it is difficult to imagine that so many people here and across Ethiopia are suffering from malnutrition. But they are.

The green grass and vegetable fields are deceiving. Look closer as you pass cows grazing by the side of the road and you see their ribs protruding, their weak legs shaking.

Here, they commonly call it “The Green Famine.”

Ethiopia, like the rest of Africa, goes through cycles of rainy and dry seasons; but the last two rainy seasons failed badly. That means crop yields were vastly lower than normal and there wasn’t enough food to last until the next harvest. Though the land may now be green - it is only approaching mid-harvest and the rainy season resumed in June - there’s not nearly enough food being produced to feed a population that is rapidly expanding (from 50 to 75 million in 15 years).

But cyclical drought is only part of the complicated equation. Droughts do occur, poor harvests do occur - after all, they call the period in between harvests the “hunger season”. Ethiopia is, unfortunately, accustomed to hunger. This year though, there are two new events buffeting the country. One is the cumulative effect of more frequent droughts; instead of once every 10 years they’re now once every 1-5 years. Global climate change is having a visible and severe impact on this region and its agriculture.

The other huge shock to Ethiopia’s system is food prices. Global price increases, coupled with a drop in the supply of food locally, have caused basic food items in Ethiopia to double, even quadruple in price. In the last year, a staple like teff, used to make the traditional bread called injera, has gone from 500 Birr per 100 kg bag (there are about 10 Birr to a dollar) to 1,200 Birr. Cooking oil has doubled in price, and lentils, also a staple here, have quadrupled from 4 Birr/kg to 17 Birr. That’s like your gallon of milk costing over $15.

Now most of us, faced with rising costs for the basics, try to cut back – drive less, cancel the HBO, charge to a credit card and hope to pay off the debt later. But when you’re already living at subsistence level there’s nowhere to cut back. So you’re forced to eat less. Eating less for a population that’s already vulnerable, that already lives on the edge of hunger, means many may fall over the edge into hunger, malnutrition and even death.

And as is often the case, it is kids who fall over the edge first.

I wrote recently about malnourished children in the Democratic Republic of Congo. There, it was a lack of food but more importantly of protein-rich food. So typically they suffered from kwashiorkor - their tummies were bloated with water and they didn’t want to eat.

Here in Ethiopia, the problem is there’s not enough food to be had. A woman I met said she fed her family one meal of cabbage that day and one meal of cabbage the day before. That was it. And cabbage has absolutely no protein.

Most of the kids here suffer from a lack of calories, what’s called marasmus: their limbs are practically just bones, they struggle to stand on their spindly legs, they’re irritable and cry inconsolably.

The scale of the malnutrition that has gripped parts of this country in just the last few months is alarming. UNICEF reports that 4.5 million Ethiopians are in need of emergency food relief, and that figure may even rise to 10 million in July. In International Medical Corps’ Outpatient Therapeutic Programs, where we care for the severely malnourished, the numbers of new admissions from January to April have almost tripled. The numbers also have nearly tripled at our Supplementary Feeding centers, where we treat the moderately malnourished.

While more and more kids don’t have enough basic food from farms and markets, IMC and other aid groups also don’t have enough of the therapeutic and blended food that we normally provide to the malnourished. The World Food Program likewise is running out of the rations it distributes in Ethiopia – their shortfall is around 180,000 metric tons, and the Ethiopian government’s emergency reserves are nearly depleted as well.

On one visit to an IMC feeding center, we arrived to find a crowd of about 500 parents and children. There wasn’t a single child who didn’t appear to be suffering. Some mothers silently held their children, resigned to the fact that there was little they could do; others pleaded for help. It was painful to see.

We’re facing a race against time. People need food now. At a meeting I attended here with USAID - the aid arm of the U.S. government – it was understood the relief groups need more money to be able to buy more food (whether it’s local or imported) and increase their staffs in response to the crisis.

As I write this, the skies have opened up, triggering a sudden downpour that lasts about 15 minutes. This has happened almost every day since I arrived here. The trouble is, while it makes the landscape green, it may be too late to bring the immediate relief that’s so desperately needed.

A New Emergency in Kenya

2008-05-26T03:35:00.000-07:00

I am in the northern Rift Valley of Kenya. This is where much of the violence broke out last December and January following disputed national elections that unleashed long-simmering ethnic tensions across the country.

Based on what I’ve seen here the past few days, this region has clearly begun the slide into a second and potentially deadlier emergency.

During the conflict, about 1,000 people were killed and hundreds of thousands of others – many in the Rift Valley - were forced to flee their homes into displacement camps. In the months since, the rival political factions have worked toward creating a coalition for sharing power, which has brought some stability to the country. Now, those living in camps are being told to clear out, go back to their homes and begin their harvests in this fertile valley that is so dependent on farming.

The problem is, some 150,000 people either have no homes to return to – whole areas were scorched to the ground, including homes, churches, schools – or are afraid to return to areas where tribal animosities and resentments have not gone away.

So they are packing up and moving to what the Kenyan Red Cross calls “minor centers” and “resettlement” areas. New sites are sprouting like mushrooms – many with zero basic services. That means no water, no shelter, no sanitation or latrines, little available food, and no health care services. It is utter squalor. Diarrheal diseases are becoming commonplace. At night, the temperature can drop to the low 40s. Without blankets or enough clothing, children are suffering from upper respiratory infections. I watched children run around without shoes, playing amid burned-out buildings littered with broken glass. Their arms are covered in chiggers. They haven’t bathed in weeks. The potential for outbreaks is enormous.

The “emergency phase” of this crisis was supposed to be over. Many of the aid groups, including International Medical Corps, are about to run out of their funding and will be forced to pull up stakes. But anyone who looks at these sites and talks to those living in them knows this emergency is far from over. If these people stay where they are, their health is at great risk. If they return home (if they even have homes), violence could re-ignite.

I spoke to a woman named Rosanne, in Eldoret’s largest displacement camp, dubbed Showground, where International Medical Corps is providing primary and mental health care services to about 13,000 people. Rosanne’s arm was in a cast, she had a huge scar along the left side of her head, and a gaping black hole where her left eye used to be. She was attacked during the violence and her husband was killed. She has three children with her in the camp, but she has not been able to locate her fourth, a 16-year-old boy.

Rosanne and her children are being told they have to leave Showground soon. She angrily exclaims: “We cannot go home. We have nothing and it is not secure. How can we leave?” I ask her where she is going to go next, she just looks away and sighs.

We visited a small settlement near Burnt Forest, which became infamous during the conflict after a church was burned to the ground and 30 of those inside were killed.
At this settlement, just a couple of days ago, a few hundred people arrived and began erecting tents. Their only available water for drinking, cooking and cleaning was what they could hoist up from a deep well – the water inside was the color of milk chocolate. A little boy we saw wandering around had large, fresh gashes on his knee and stomach that had yet to be treated.

Seeing how desperate the conditions were, our program coordinator got on his cell and had one of our medical teams diverted from another camp to this site for at least a couple of hours to provide treatment. But this was just one of about 100 such remote sites where the population had left a camp with some services and relocated to an area with none. International Medical Corps and other relief groups are doing their best to reach these people – or create some sort of central point where they can go and get the help they need. But it’s frustrating and disheartening.

I have been asked many times how I avoid getting overwhelmed by the scope of the need. This is one of those times that tests me. We’re always trying to make the biggest impact, multiply our efforts, reach as many people as possible. In just one month in Eldoret and Kitale we saw more than 11,000 patients. And yet, we can’t always solve all the problems or help everyone we want. I remind myself that this is significant and certainly better than no help at all.

Hidden Epidemic in Democratic Republic of Congo

2008-05-18T06:54:00.000-07:00

Hi, all.

It’s been a year since I was last here in eastern Democratic Republic of Congo. Anyone who’s heard me talk about DRC knows how much I love this place, the intensity of the landscape and the people, their generosity and strength.

They certainly need that strength.

The sad truth is that violent conflict is still raging, particularly in the North Kivu Province, where government forces (called the FARDC) and the various rebel groups (like the predominantly Rwandan FDLR, CNDP forces, and the Mai-Mai) are constantly going at each other. Civilians, as always, are caught in the middle.

Over the summer, the conflict intensified in North Kivu, forcing hundreds of thousands from their homes. And despite a ceasefire reached in January, the region remains chronically unstable. Since late 2006, an estimated 850,000 have been displaced in this province alone, and that number is expected to increase in the coming months as the FARDC attempts to retake areas held by the FDLR.

Much has been said and written about the epidemic of sexual violence perpetrated against women and children. Frankly, no amount of words is enough. But there is another epidemic here that has not captured the spotlight: during the 1998-2003 war, and the resulting humanitarian catastrophe, most of the estimated 5.4 million deaths have come from hunger and disease. The most vulnerable are the children.

That’s where an 18-month-old boy named Ivote (pronounced EE-vote), comes in. He was named in honor of DRC’s historic elections in late 2006. He very nearly didn’t make it to his first birthday.

Last October, Ivote’s parents and his three brothers fled from their village near Masisi, where some of the worst fighting has taken place. Already, two of his siblings had been killed.

For months, Ivote had been suffering from diarrhea and malnutrition. No doctor or traditional healer was able to help him. By the time he and his family had made the 40-mile journey south to Mugunga displacement camp, outside Goma, he was near death – a skeletal child who could not stand, could scarcely speak, and his limbs frozen stiff. At the age of 11 months, he weighed just over two pounds.

His mother, Sophia, tells me she had lost all hope that he would live.

International Medical Corps is running primary health care clinics and supplementary feeding centers in Mugunga and other nearby camps, serving more than 300,000 people. IMC immediately transferred Ivote to Virunga Hospital in Goma, where we treat about 100 new cases of severely malnourished children a month.

Ivote suffered from a type of severe malnutrition called marasmus. Most of us are familiar with what this looks like from the images that emerge during famine: shockingly skeletal children, who are weak and cry unconsolably. Children with marasmus are literally starving and can’t possibly be fulfilled by any amount of food; they finish and want more and more. But if they’re allowed to eat all they want, they can overdose and vomit from the excess food in their stomachs. So the amount of food they eat has to be calculated carefully and meted out in three-hour intervals.

Marasmus is actually relatively uncommon in North Kivu. Ninety percent of children here suffer from what’s called kwashiorkor (kwash for short). With kwash, the baby is bloated, with fat feet and cracked skin. In the most severe cases, the skin bursts and the child is covered in large swaths of bloody sores. Babies look like burn victims. It is wrenching. The difference with kwash is the children don’t want to eat; it’s difficult for them to eat. Here in North Kivu, families often must flee fighting and hide in the bush. They go many days without food or with only protein-deficient food like cassava that causes children’s bodies to bloat with water. By the time they reach the camps, they have stopped eating entirely.

The vast majority of the children we’re treating at Virunga Hospital have come from the camps, where they are identified by IMC for more intensive treatment. When they arrive, they often suffer from other complications, like diarrhea, anemia and respiratory infection, which must be treated immediately so that they can better recover from the malnutrition.

The children and moms – often the siblings as well, who can’t be left alone in the camps – move into the center, where they are clothed and fed a diverse diet, including maize flour, beans, oil and salt.

IMC’s recovery rate at Virunga Hospital is 95 percent. For most children, recovery time – if they suffer from no other maladies – takes around five weeks, after which they are discharged back to the camps and are monitored at IMC’s supplemental feeding centers.

For Ivote, recovery took two months. Today, his chubby cheeks and bright eyes make him unrecognizable as the same child in the photos when he arrived. He toddles around the hospital grounds like a typical 18-month-old. Upon recovery, he weighed 14 pounds.

As I’m leaving the center, the IMC van arrives with a new batch of severely malnourished children. A father, seeing me taking pictures, hoists his feeble daughter up to his shoulder and asks me to take hers. Her legs are covered in cracked, bloated skin. Her right eye is sealed shut from conjunctivitis. It is heartbreaking to look at her – and her father’s anguish at her condition.

The only consolation I can find is that in all likelihood, in a month’s time, she, like the scores of other children here, will be fully recovered and headed back to her home in the camp. That is my hope.

**Note: The photos of Ivote and some of the other severely malnourished children are graphic and difficult to look at. Many of you might not wish to see them pop up in my blog gallery so I chose not to include them. But I’m happy to email them to any of you who are interested.

Lebanese Hospitality

2007-11-06T09:00:00.000-08:00

Hi all.

I've noticed that as I've started widening the audience for my dispatches they've sometimes gotten more business-like. But so much happens beyond the work IMC is doing that I thought I'd send an email to a smaller group of you where I can more easily write about what I'm experiencing.

Yesterday we traveled to North Lebanon to visit one of IMC's field sites in a very poor village called Akkar.

The night before I had gone out with our Country Director and Finance Director to a bar in downtown Beirut. Some of you may already know Beirut, but it is new to me, so everything I heard about it being "The Paris of the Middle East" didn't really resonate. Let me just say it is a spectacular city - winding cobblestone streets filled with glittering restaurants and cafes, young women dressed in strapless dresses and stilettos, hair-gelled hotties puffing on Gauloises or Marlboros.

Needless to say, we stayed out til 2 in the morning, smoking way too much and drinking a ridiculous mix of alcohols throughout the night that left this aging chicky extremely green when she awoke at 7 the next morning to head north. Actually, not green; more like plaid. Right as we arrived in Akkar, following a two-hour journey with a classically kamikaze Lebanese driver at the wheel, I proceeded to exit the vehicle and vomit over the side of the road.

Always the consummate professional, I wiped my mouth, got out my cameras and started walking toward the school where IMC trains teachers on improving their child development programs. In addition to taking pictures/video, I'm also training a lovely young Lebanese woman who just joined IMC as a communications officer and whom I first met that morning on the drive to Akkar.

I'm especially pleased to be making such a wonderful first impression on my "student." Fortunately, she is an understanding and insightful woman. We talk at length about her fleeing the bombings here last summer, then returning to her home and undergoing another wave of bombings, which she rode out alone while nursing a bottle of vodka. She also talks about the difficulties of dating a Shi'a boy (she is Druse) for a year and keeping it a secret from her parents, with whom she still lives.

After a few hours of my taking pictures of the instructors and children, the school's director asked us to stay for lunch with the group of about 20 people. He and his wife prepared an enormous, delicious feast of grilled keftah and lamb kabobs, homemade tabouleh, hummus, yougurt and pitas. Nathalie tells me it is customary to honor your guests by making 5 times as much food as is necessary.

At one point during lunch one of the women asks me if I have children. I say, sadly, no. She asks me my mother's name. I tell her and she then says to me, "I will pray tonight that Margaret, daughter of Joan, will have a child."

I fight back tears and tell her "shukran" - thank you.

I am incredibly touched by the warmth and generosity of these people. The group is primarily Sunni Lebanese. I can't help but wonder, if they knew I was Jewish, would it make a difference? I don't know, and to be safe I am not telling anyone here during my stay that I am Jewish.

This is such a complicated region. One week in Jordan and one week in Lebanon will allow me to only scratch the surface. But I'm having a phenomenal time, learning so much about people and their cultures, learning (at least trying) to listen more and better, trying to stay focused (often failing), and missing you all terribly.

Sitting in IMC's office, looking out over the Mediterranean, I feel extremely lucky - about everything.

Thanks for indulging me and I'll see you soon!

Love,
m

"Post-war" Lebanon

2007-11-03T09:00:00.000-07:00

Greetings...

As an American visitor to Lebanon I can’t help but seek out the contrasts between our two countries. For one, as I have found across Africa, and now in two Middle East countries, hospitality and generosity are a ferocious badge of honor. NO ONE here will let me pay for a meal or a drink - EVER; I am their guest and they take that extremely seriously. It is far more pronounced than I have experienced in the States.

But another stark contrast is hard to escape: the United States is currently at war, albeit thousands of miles away. You certainly wouldn’t know this by roaming the streets of a typical American town. But in Lebanon , a country currently not at war, there are relentless reminders of it, and the potential for it, everywhere you look.

The impact of the war in July of 2006 between Israel and Hezbollah – and of the previous wars here throughout the 70’s and 80’s - is still being felt throughout this small country, which is boxed up against the Mediterranean by Israel, Syria and Jordan. In the Bekaa Valley in the east, one of Lebanon ’s largest bridges has yet to be repaired; a bomb ripped apart a section, leaving a tangle of steel cables and concrete rubble hundreds of feet below.

Across southern Lebanon there is heavy construction underway to rebuild houses and buildings that had been leveled during the July assault, Quite honestly, it is often difficult to discern which areas of devastation are the result of war, or of poverty and neglect.

Even in downtown Beirut - a breathtaking blend of old and new, pristine cobblestone streets, gleaming cafes, soaring glass structures, and centuries-old mosques – heavily armed government soldiers are posted at checkpoints every few blocks. And there are buildings damaged during earlier wars that are still abandoned today, their facades pockmarked from the shelling.

In the southern suburbs of Beirut , which is controlled by Hezbollah and suffered significant damage in the July war, the streets are lined with banners on every streetlamp commemorating the war dead, referred to here as martyrs. Each banner shows a picture of the dead soldier and is emblazoned with the Hezbollah flag. I am told by IMC staff as we drive through the streets that this is considered the very safest part of Lebanon : Hezbollah knows everything and has tight control over security and intelligence of all kinds. One person jokes that Hezbollah no doubt could access my photos the minute I plug my USB stick into my computer.

Driving through the southern Lebanon town of Sidon , near Tyre , we were reminded of the dangers of working in this region when we got a call informing us that a small bomb had gone off in the town. No one was injured, but we were a bit rattled - I, evidently more so than our staff, whose reaction was somewhat blase.

I remark to our local staff on the apparent “celebration” of guns – one of our drivers even has a cell phone whose ring is a machine gun’s rat-a-tat-tat. They explain that guns are a sign of power and independence from those who threaten to take it away. Ironically, the government has plastered the streets of Beirut with an advertising campaign promoting peace and unity. One foreboding sign shows a Hezbollah fighter holding a shoulder rocket; the words implore, “Don’t let terrorists come between us.” Another poster shows a young boy with a machine gun positioned next to his face, the text refers to the importance of nurturing him, and educating him now, before he is wooed away by violence.

So, how do you reach out to a population that is in great need of physical and psychological healing?

As a medical agency, International Medical Corps is providing primary health care services to clinics across Lebanon , vaccinations for children, maternal health care, screenings and referrals for secondary care, even helping with wheelchairs and hearing aids for the disabled. We’re also targeting the influx of Iraqi refugees (there are an estimated 40,000 of them), particularly in the suburbs of Beirut , with mobile medical units to provide basic care and let them know that services are available.

But in addition to the immediate needs, we are trying to address the underlying problems that hinder proper care. Several months ago, UNICEF provided us with a sizable grant to establish a psychosocial “Child Friendly Spaces” program at 27 schools across Lebanon . This means training instructors on more constructive ways to educate and care for children who have been repeatedly exposed to war and violence.

The needs here are enormous. It’s easy to feel overwhelmed. This has been true at every field site I’ve visited with IMC – from the Congo to Lebanon . But in talking to the people we are helping and training I am deeply moved by the impact we’re having. An Iraqi refugee who had brought his young daughter and son into a clinic in south Beirut told me that without this clinic he could not afford any care for his children – especially his young boy, Ali, who has a persistent upper respiratory infection. An elementary school instructor in the Bekaa Valley , east Lebanon , says she is learning that there are other means, beyond corporal punishment, for reaching her students and helping them learn.

It is difficult, as a non-political humanitarian organization, to work in these convoluted, political environments, yet stay focused solely on the humanitarian need. Whether our beneficiaries are Muslim or Christian or Jewish, need is need, suffering is suffering. We have to just do the work, navigate the politics without taking sides, and make lives better than they would be without us.

"Marhabah" from Amman, Jordan

2007-10-23T09:00:00.000-07:00

Hello, all.

I am in Jordan , where an estimated 600,000 Iraqis have fled the violence in their homeland, streaming across the border in hopes of finding a safer existence. Many of them have leveraged everything they have to secure visas and get their families onto flights out of Iraq .

By the time these refugees make their way to a major city like Amman , they have little money or economic prospects and limited access to health care. Most have also suffered the loss of a family member.

Yesterday I toured health clinics in a low-income area of East Amman , where large numbers of Iraqis have settled and where International Medical Corps is working to provide them with primary and mental health care services.

Their stories are heartbreaking. Repeatedly I heard the same phrase: “I have lost everything.”

One man morosely recounted the bombing that hit his home four months ago, killing one young daughter and paralyzing the other. His wife, who witnessed everything, has been so distraught she can scarcely leave the home. He has come to this particular clinic, which is funded by the UNHCR and run by the Jordan Red Crescent, to appeal for the expensive surgeries for his surviving daughter.

Injuries related to conflict are just part of the painful equation; these refugees have inadequate primary care and nutrition for their children, little or no reproductive or antenatal care, and many suffer from neglected chronic diseases like diabetes and high blood pressure for which they cannot afford care or medication.

At another clinic operated by the Jordan Red Crescent and French Red Cross, a little Iraqi girl was brought in by a father clearly fearful about her worsening condition. She was extremely frail, unresponsive and her pallor ashen. Her father described how hard life has been since fleeing Iraq . He is out of work and unable to afford care for his family. This clinic is literally their only lifeline.

But in addition to those seeking help at these facilities, there is an enormous population not being reached at all because they are simply unable to travel. IMC is targeting this population, planning to bring comprehensive primary and mental health services to them directly through mobile medical units.

IMC is just getting started here. The influx of refugees has been so vast and so rapid that we repeatedly discover whole new “gap” areas – suffering that is going either unnoticed or underserved. All of it is putting increasing strain on the local population, particularly among the poor who are in need of similar services.

Aside from the physical needs, these people have huge emotional needs that are largely being ignored. This is an oft-neglected area, and therefore one where IMC is taking the lead, integrating clinical mental health into primary care services.

The refugees we’re working with have been subjected to years of low-level warfare and large-scale regional conflicts, depriving them of basic life needs, and exposing them to trauma, depression and stress. This is to say nothing of those with pre-existing mental health disorders that aren’t being diagnosed or treated. For these refugees, the prospect of long-term recovery really hinges on their ability to recover emotionally as well.

One woman I met from Baghdad tearfully recounted how her brother was killed, forcing her to flee with her husband and four children. And yet she is effusively grateful for the care she is receiving at this clinic. On this day, she has brought in her young son, who has a bad cold – and she has discovered the happy news that she is pregnant.

I am astonished once again by the resilience of people who have endured relentless violence and crushing personal loss. For the man at the UNHCR clinic whose daughter was killed, and who faces losing his only other child, the outlook was grim. A Jordan Red Crescent representative explained to him that the hospital likely could not approve such expensive surgeries for one child, when so many others are in need. He gazed down, thought about this for a moment, then turned to me and offered a striking statement: “Maybe you tell people about the situation here - it might not save my daughter but it might save others.”

Coming Home

2007-04-02T09:00:00.000-07:00

Hi, all.

I’m on my way home. Not there yet but after 130 hours in cars, 30 hours on planes, and 10 hours on boats over the last five weeks, this hotel room in Kigali , Rwanda feels like a wonderful first step to my final destination.

Throughout this trip, it’s been hard not to apply what I’ve seen to my own personal life.
I’ve been missing home, missing family and friends, and all the thousands of familiarities and creature comforts that go with home.

So last Wednesday, as I stood on a dock in the town of Baraka, in eastern Democratic Republic of Congo, and watched hundreds of Congolese refugees returning to their homeland for the first time in many, many years, I fought back tears.

For one family I met, it has been seven long and painful years since they fled from their small village in remote South Kivu province into western Tanzania . Muzalio Chiba, his wife, Suzanne, and their two-year-old daughter, Anna, escaped, along with a wave of their neighbors, just as the country’s civil war began to sweep into their village of Tulonge .

For seven years, in the refugee camp where they lived in Tanzania , they tried to make some sort of life for themselves. And for seven years, they dreamed of returning to their homeland and their family.

On Wednesday, for the first time since 2000, Muzalio and Suzanne, along with their now four children, set foot once again on Congolese soil.

They are among the tens of thousands of Congolese who are finally making their way back home, after the official end of DRC’s decade-long civil war. Many of these returnees have been away as long as 10 years.

It wasn’t until about a year ago that it became safe again for them to come home. Since then, large ships, each carrying up to 600 Congolese, dock each week at the ports of Baraka and Uvira, near the northern tip of Lake Tanganyika .

On this particular day, I watched as IMC’s medical and logistics staff helped each of the returnees gingerly make their way down the steep gangplank onto the dock; babies, the elderly and the sick were physically carried or transported by stretcher.

There, I saw Muzalio and Suzanne, like the 300 or so other people on the ship, holding all that they possessed in the world: a bit of food, a makeshift cloth sack, filled with their clothes and other personal belongings, and their identification papers. Their entire lives were boiled down to this. I remember the looks on their faces – at turns joy, anticipation, and consternation. What would happen to them now?

Many Congolese have no other family left in the country – or if they do, they may be hundreds of miles away from the port. What will they do for food, medical care, a place to live, a job?

In July of 2006, as thousands began repatriating, IMC identified massive shortfalls in the care and services they were receiving. The 55 existing health centers in two of the health zones were unable to offer adequate medical support for the huge influx; shelter had been provided for fewer than 2,000 of an estimated 60,000 returnees; nearly 3,500 women had experienced some type of gender-based violence over the prior nine months, with virtually no follow-up care; there was extremely limited access to sanitation facilities or clean water (in one area, the only water available to a population of 37,000 was five miles away); and there were virtually no modes for people to earn an income and support their families.

So in January of ’07, with funding from the U.N. refugee agency, UNHCR, IMC began providing health care to returnees at every step of the process - from the boat to their villages of origin. This includes primary health care and follow-up care, screenings and referrals for those suffering from malnutrition, pre- and post-natal care, immunizations, as well as treatment and counseling for victims of sexual violence and assistance in reintegrating into society. In addition, IMC has begun improving access to safe water supplies and sanitation by rehabilitating existing water sources, constructing new ones, installing rainwater catchment systems, and building latrines.

In all, IMC is serving about 560,000 people, including those repatriated from Tanzania , those displaced within Congo because of the war, and a host population that already was underserved.

At the transit center, where returnees stay on average 48 hours, they are registered, receive medical examinations, are fed hot meals and are able to take showers, and given a three-month food ration. They then are driven in convoys – with IMC medical escorts on board - to their villages of origin.

Sitting outside the registration tent at the transit center in Baraka, Muzalio and Suzanne told me they’re thrilled to be back in their country, but uncertain about what lies ahead. They feel lucky to be healthy and to have family back in their village (about 200 miles away), whom they hope to see soon. Still, their needs will be enormous on this long journey home, as they try to pick up the pieces and rebuild their lives. I feel like we’re going far toward helping them do that. For those who have no support system at all and are most vulnerable I feel we’re giving them what they need as well.

My mind fixes on the image of IMC staff at the port in Baraka, holding these refugees’ hands, helping them grab onto the rails as they put one foot in front of the other, make their way down that slippery ramp, and finally reach firm ground.

That’s the goal; that’s the mission.

Wounds of War in Congo

2007-03-26T09:00:00.000-07:00

Hello again, this time from the town of Bukavu, on the far eastern side of the Democratic Republic of Congo, near the border with Rwanda.

It is staggeringly beautiful here - tropical forests, vibrant flowers and sparkling lakes. But this landscape is scarily deceptive.

The past week I’ve spent a lot of time listening to women and young girls - listening to stories, horrific stories, trying to fathom what they’ve experienced, and thinking about how we help them get what they need to rebuild their lives.

DRC is seething with the after-effects of a decade-long civil war - widely viewed as Africa ’s worst modern conflict - which claimed the lives of nearly four million people and displaced two million others.

In 2003, the country formed a transitional government, and just a few months ago, held its first democratic elections in 46 years. That was a big step, no doubt about it. But the outside world has generally viewed the elections as a much-awaited reason to turn away and move onto the long list of other pressing geopolitical concerns.

The fact is, in many ways the war here never ended. Violence is pervasive, and for the people of northern and eastern DRC in particular, elections and peace accords are largely window dressing. This area is overrun by rebel groups and militias who are terrorizing villagers and fighting for control of the country’s vast reserves of diamonds, gold and other resources.

If anything, the humanitarian crisis here is mounting. DRC’s health infrastructure has been destroyed, with more than a third of the population lacking access to even the most basic health care. What’s more, there is little electricity and few roads outside major cities. According to the Human Development Index, DRC, a country the size of Western Europe , ranks 167th out of 177 countries.

International Medical Corps began working in DRC’s most volatile region of North and South Kivu Province in 1999 and is the only international relief agency that has maintained a permanent presence here. We're supporting 59 health facilities and 19 nutrition centers, serving an overall population of about 330,000.

One of the biggest challenges is access; most routes consist of unpaved dirt roads covered in mud and boulders, and rife with enormous potholes. Navigating these roads at around 10 miles an hour means it takes a full day to reach any given village. We – and when I say “we”, I mean IMC’s Country Director, Birame Sarr , and his phenomenal staff - spent a good two hours a day digging ourselves and other trucks out of the mud, or trying to get our tires back on the planks of a hastily constructed bridge.

Security, obviously, is the other big problem. IMC’s local staff are in regular contact with the warring factions, who seem to appreciate the care we’re providing and have allowed us to continue without much incident. But things are unpredictable, to say the least.

To get a painfully vivid snapshot of what’s happening here, you need look no further than the women and young girls – girls as young as two. The Kivu provinces have produced some of the highest numbers of sexual violence victims in the world. You can literally see the trauma on their faces, and in their medical charts.

Their stories are appalling, and there is a sinister, sickening uniformity to the details of these stories, i.e. who the perpetrators are and the acts they’re committing.

Take one young woman named Bingi whom I met at a health facility IMC supports in the remote village of Chambucha . She told me she’s 17, although our staff members think she may actually be 15. This angelic-faced girl shyly described for me the night four months earlier when uniformed men with guns broke into her home. They beat her husband, took her to the woods, and raped her repeatedly over several days. She was eight months pregnant at the time. A month later, she delivered her child still-born.

Subsequent to the attack she has suffered a condition that has become a pernicious marker of the violence and absence of adequate pre- and post-natal health care in DRC: a severe gynecologic injury called fistula. Thousands upon thousands of Congolese women suffer from its devastating physical and emotional effects. There’s no polite way to describe fistula, a vaginal rupture that causes urine and feces to seep down the woman’s legs and that causes her to smell. As painful as it is and difficult to treat, women with fistulas doubly suffer from the stigma associated with it. They are often referred to with the pejorative “baqua,” Swahili for “rape”. They are frequently ostracized by their families and communities and many are forced to leave their homes. Even those who remain find it near impossible to perform the already back-breaking daily tasks of carrying 50- to 100-pound loads of water, food and supplies to their homes.

Bingi was comparatively fortunate: her husband has not cast her out, and she did not have to travel far for treatment. In fact, she is one of the first women to undergo fistula repair surgery at Chambucha, through an IMC-supported program that provides medical personnel and training on this complicated procedure, and then careful monitoring and follow-up. That was a huge step forward.

But most women in this sprawling region are forced to get themselves to Bukavu and a highly sophisticated facility called Panzi Hospital - the only one in the region with the ongoing surgical capacity to treat a condition as complex as fistula. The hospital is run by a heroic surgeon, Dr. Denis Mukwege, who recognized early that fistula cases in his homeland were skyrocketing, single-handedly took on the problem by training doctors around DRC to treat it, and has performed thousands of surgeries himself – including the one for Bingi in Chambucha.

Outside Panzi Hospital, I met legions of women and young girls, some from as far away as Rwanda and Burundi , who had come seeking medical help. Hundreds of them sit on long benches in an open-air “warehouse” and wait. And wait. And wait.

While the first 72 hours after a woman has been raped are critical toward treatment and prevention of sexually transmitted infection as well as fistula, many rape survivors are held captive for days, weeks, months. And those who are able to escape soon after their attacks either cannot access treatment quickly, or are too ashamed to do so. Most of the women I met outside Panzi Hospital were just such cases.

Thirty-year-old Jeanine told me that for two weeks she was held captive about 30 miles away, in South Kivu’s Kahuzi-Biega National Park , where rebel armies frequently hide. She was repeatedly raped by the four uniformed men who kidnapped her. She has a large gash on her forehead and cuts all over her arms from the beatings. Jeanine’s three children were also kidnapped. One has been found and is living with her sister; the others, she has no idea where they are. Jeanine arrived at Panzi two days ago and is now awaiting the results of an HIV test; she also has begun to experience crushing pain in her lower abdomen that may signal fistula.

She is hoping to see a doctor soon. Through a translator I ask if it’s at all helpful for her to be here with other women who’ve suffered similarly and be able to talk about their ordeals. She says, “No, we don’t talk about it.” That encapsulates much of the problem: stigma is so entrenched and it’s difficult to educate communities – men and women - on ending sexual and gender-based violence.

So in addition to treating these women’s physical wounds, IMC is helping to provide counseling, community education programs, as well as income-generating activities to help them get back on their feet, whether they return to their homes or not.

It’s impossible not to be overwhelmed by the medical and psychological needs across this region. And yet without us, it would be so much worse; those most vulnerable to the violence and lack of health care would have almost nowhere to turn. So we keep building medical facilities one brick at a time; providing food to malnourished children one cc at a time; delivering clean water one liter at a time; and helping plant vegetable gardens, one seed at a time.

There is no other way.

Water on the Brain

2007-03-19T09:00:00.000-07:00

Hi, all.

For the past three days I’ve been mulling over and over in my mind the question of how much water I use in a day.

As many of you know, I'm not much of a water drinker - maybe two glasses a day.

But figure the average amount people use for drinking, cooking, bathing, washing clothes and dishes, flushing the toilet. In the U.S. it's around 20 liters, or about 75 gallons a day per person.

I thought about this as our Landcruiser came upon a woman and her two young children on the side of a desolate road in Samburu District in central Kenya . In this area, populated almost entirely by the Masai tribe, women (they’re the ones who take on this task) walk an average of six miles every day to find water. They walk in sandals along dirt roads covered in canyons of scalding hot rocks and boulders. Some climb miles into the hillsides, searching for a fresh spring. Then, they walk all those miles back, carrying up to 20-liter containers of water for their families.

On this particular day, I was traveling with IMC’s country director for Kenya , Peter McOdida, as well as a Samburu District water official. The woman and her children whom we met were nowhere near a water source and had to resort to begging by the side of the road for whatever we or any other passersby might be able to provide. As we poured water into their containers, the two young girls playfully fought over them.

In this remote region of Kenya , water and the pursuit of it is everything.

Many Samburus go days without a drop. In the dry season, which constitutes a total of eight months of the year, they consume an average of about half a liter a day. Sometimes, they go with none. And whatever amount they are able to find goes immediately to drinking, sharing with farm animals, and cooking. Washing and general hygiene are a luxury. In the end, unsafe and insufficient water means sick children, unhealthy food, and malnutrition because animals don’t have enough to drink and fruits and vegetables are unable to thrive.

But there is another troubling result to the hours women and girls spend every day searching for water: these are hours that could’ve been spent getting an education or generating income. And for women with infants, this is time not spent breastfeeding. The lack of access to water compromises the health of the entire family.

So, what to do.

As in many of the crisis zones where IMC operates, a big part of the solution already exists within the community and it’s a matter of engaging the local population in fixing problems in a sustainable way. Samburu has numerous water points throughout the region but they are often far apart and/or are in disrepair, and they’re not being managed properly.

This month, Starbucks announced it was awarding $1 million to IMC over the next two years to train villagers and water officials in building and maintaining water supply systems in Samburu, as well as building latrines and providing hygiene and sanitation education programs.

We visited one of those water points slated for construction - in a village called Waso Rongai. There, we met a woman and her young daughter who had traveled about two miles to collect water from what amounted to a small bore hole in the middle of the sand. I peered into the hole at the dirty brown water as she scooped out cupfuls and poured them into a jerry can. For her, dirty water was better than no water at all. I dreaded to think what sorts of water-borne diseases she and her family might contract by drinking this.

She said what many other Samburus told me during this trip: “There is no water where we live and we have to travel great distances to find any. We need help.”

To get a sense of how IMC has already started helping, we went south to a village called Seren, where IMC helped residents construct a system of pipelines that extend to a freshwater spring about three miles up the mountainside. Before those water pipelines were there, women were forced to climb the mountain every day to reach the water source.

As I slowly – very slowly - made my way up this mountainside laden with boulders and dry sand, I imagined what it must be like for a woman to undertake this same trek day in and day out. I had a one liter bottle of water with me, which was empty by the time I reached the top, drenched in sweat and thoroughly out of breath. But she would have gone on that journey without water, then carried her heavy container back down the mountain.

Imagine what her life would be if the daily search for water were no longer a concern? As Peter said to me, “You fix the water problem and everything else falls into place.” A simple statement and I suspect a right one.

==============================
p.s. this coming Saturday at 10am, Starbucks is holding a "Walk for Water" from Santa Monica Pier to Venice Beach. The walk, which includes music and dance performances, is inspired by the three- to- six-miles journey women and children make every day in "water stressed" countries. The event marks World Water Day (which is officially this Thursday) and Starbucks will announce at that time the grant it's awarding to IMC.

Next week, I'm in Democratic Republic of Congo. I just hope my muscles can hold out.

"Jambo" from Kenya

2007-03-11T09:00:00.000-07:00

Hi everyone.

I’m sitting on the back porch of my room, looking through the palm trees and brilliant yellow African rose bushes down to the banks of Lake Victoria - the largest in Africa .

I rolled a lucky seven here, given other places I’ve stayed. We are in a town in Suba District called Mbita, in far southwestern Kenya , near the border with Uganda . Our housing is at an educational facility that includes primary and secondary schools for local kids. It is truly idyllic – and we’ve got running water, which is a real luxury in Suba. But I’ll get to that in a bit.

In Suba, HIV and AIDS are having a catastrophic impact on every single person in the region; someone either has the disease, is helping care for someone with it, or a child whose parents died of it.

Here’s a staggering set of statistics for you: while the rate of HIV among the adult population of Kenya is around six percent, it is 38 percent in Suba. What’s worse, many of those with HIV also contract tuberculosis because of their compromised immune systems. Throw in the heightened incidence of malaria and you’ve got a population that’s literally being decimated.

In gathering places and markets everywhere, you see posters, signs, people wearing t-shirts with messages advocating AIDS and TB awareness, prevention, testing, and counseling. The word is slowly getting out. Four years ago, when IMC began working here with funding from PEPFAR (President’s Emergency Plan for AIDS Relief) and the CDC, rates of HIV were even higher – 44 percent.

But there are deep pockets where generations of behavior are damn difficult to reverse and where people are living in such remote areas that information doesn’t easily get to them. These are the areas most often ignored by the rest of the world, so they are where IMC is focusing its activities.

That means hours by boat across the lake, or in a Landcruiser, traveling along dusty, rocky, unpaved roads to reach people who have close to nothing except the mud huts where they live, their family members, and a disease that is destroying all of them.

DAY ONE - POSITIVE OR NEGATIVE
Our first day here, we set out with a handful of IMC community mobilizers from Suba to a remote “cul de sac” of mud huts where a large extended family lived. Our guide was a phenomenal woman with IMC named Grace Muthumbi, a nurse who is our HIV/AIDS Program Coordinator based in Nairobi . Grace’s face was badly burned in a fire in 1991; she has had to confront issue of stigma ever since. She came to work for IMC in 2000, hoping to help others stigmatized by society because of diseases like AIDS.

When Grace and the rest of our small group walked into the mud hut we found waiting for us the patriarch of the family, his brother (both in their 60’s), his daughter and his two wives. Polygamy is practiced by about a quarter of the population of 165,000 in Suba, making the spread of HIV and people’s (especially women’s) ability to protect themselves from it that much more difficult.

This family was receptive to our visit and gave their consent for me to videotape. They knew the basics about the disease and that it can be spread through sex. The community mobilizers had a relaxed conversation with them, dispelled some of their misconceptions, stressed the need for taking personal responsibility and using condoms, and talked about the importance of taking medications properly in the event any of them tested positive.

The family then agreed to give blood and receive their test results immediately, right there, right in front of us and my camera.

I wasn’t fully prepared for this.

After taking their blood, the counselor examined all five test stick-results. I watched him and again pondered the statistics for Suba: 38 percent. There are five people in this room. I was suddenly very troubled by the odds.

One by one, the counselor showed the two older men and the wives their results, holding the test stick before them, and the chart displaying two columns of results: positive and negative. Each of their results was negative.

Then he took the 26-year-old daughter to the other side of the room, away from the others. He showed her the stick and how it compared it to the chart. He looked at her and whispered, “positive.” She stared at the stick, without expression. Her whole life was changing.

I shut off my camera and walked outside.

A different counselor took the young woman to another hut to talk with her about the results and the drug regimen she now should follow. She agreed to take medications.

I know that without IMC this woman (who has no children) likely wouldn’t have found out she had HIV ‘til much later - perhaps when HIV turned into full-blown AIDS; wouldn’t have started taking drugs that could save her life; wouldn’t have informed her husband, from whom she was already separated, that he was at risk. I know it is good that we’re here. This is what it’s all about. People get AIDS and we have to do our best to strangle its impact.

But it was crushing to watch this unfold for her.

DAY TWO – MEETING A COUPLE OF HEROES
The next day Grace and I traveled two hours in the opposite direction to some remote villages and to a clinic that IMC built primarily for the treatment and prevention of HIV/AIDS, TB and malaria.

With us was IMC’s Country Director, Peter McOdida, who is a native of Suba. Peter is fantastic – big, toothy smile and a great laugh. He’s loved by his staff and has a warm, fatherly way with the beneficiaries as he offers guidance and encouragement.

At the clinic I was introduced to Risper and her husband, Sebastian, a vibrant, gregarious couple in their 30’s. In 2004, Risper met with an IMC mobilizer who urged her to get an HIV test. She tested positive. At the time, she was pregnant with her third child. She tells me that when she first learned of her status, she was afraid for her life and that of her unborn child – and afraid to confront her husband with the news. But an IMC counselor convinced her how important it was to have Sebastian tested as well. He did, and he was positive.

IMC worked with Risper and Sebastian to counsel them, get them treatment, and try to prevent transmission of the virus to their child with the help of prophylactic anti-retroviral drugs and more effective feeding practices once the child was born.

Today, that child is a gorgeous three-year-old named Salome, who regularly tests negative for HIV. She very likely would not have been so lucky had her parents given in to the widespread fear and denial of the disease.

Risper and Sebastian are currently healthy and are now employed by IMC as community mobilizers, raising awareness about HIV. Risper says she feels strong and loves knowing that despite the adversity she faces, she is helping to save the lives of the people in her community.

DAY 3 – A FLOATING SLUM
The next morning, I was up at 5:30 to meet the boat that would take us across Lake Victoria to a series of islands where the primary engines of economy are fishing and prostitution. HIV is rampant here; it’s difficult to mobilize and educate villagers because of the transient nature of the population, the intractable stigma surrounding the disease, and the fact that the commerce of sex is essentially sanctioned by beach community leaders.

There is a massive need for robust HIV/AIDS programs – not to mention water and sanitation systems.

As we approach our first destination, Mfangano Island , I see a shoreline crowded with hundreds of long, colorful fishing boats. But once we dock, the conditions we find are appalling. Garbage is strewn everywhere - mounds of it. And packed in tightly across the island are tiny corrugated tin dwellings. This is for all intents and purposes a slum.

There are about 6,000 people on each island, and only one or maybe two latrines for all of them. When it rains, the refuse washes down to shore, where people bathe, clean their clothes and dishes, and collect water for drinking. It’s completely unacceptable but it’s all they have.

On these islands, nearly all the men fish for a living, then travel from beach to beach, selling their catch. You find that many of the women have children but no husband or partner (many have died of AIDS and other diseases), so they must find ways to buy food for themselves and their kids. But the only financial opportunity available to them is selling fish. To do that, a woman is required to first go to the chairman of the beach community. He then assigns her to a man, who will give her fish to sell. The understanding of course is that the man will demand sex from her in exchange for the fish.

The women tell Grace and me they desperately want other options, perhaps building more latrines for pay, or opening a cafe. IMC is working to persuade the various beach committee chairmen to work with the women in devising different income-generating opportunities, but ritual is difficult to undo. And let’s be honest, the men like getting sex.

IMC has enlisted hundreds of women and men with HIV living on these islands to form groups and become community mobilizers. On this day, we’ve brought a big box of t-shirts branded with IMC and Kenyan Ministry of Health logos, promoting HIV awareness and the prevention of mother-to-child transmission – what we call PMTCT. After discussing strategies with these groups for fighting HIV and creating new economic livelihood opportunities, we hand out the t-shirts. They proudly slip these on and then beam for my camera.

I think about the small steps you have to take. I think about the man on Remba Island who walked away dismissively when we tried to talk to him about HIV, but who later was engaged in that very discussion with one of the community mobilizers wearing his new IMC t-shirt. It’s tough to chip away at taboos, and getting buy-in from men is generally so much harder than from women.

But in just this three-day period I witnessed dozens and dozens of people being reached for the first time. Maybe in another four years the HIV rate will be down another six percent. How many lives is that? By my calculation, just over 10,000.

Next week I'm headed to the north, where Starbucks just gave IMC a $1 million grant to build a water and sanitation system serving about 180,000 people.

I love you all...

m

Teaching Photography to Refugees in Uganda

2006-11-20T18:54:00.000-08:00

I’m in the car, on the four-hour drive back to
Kampala. It’s rainy season but for the first time in
11 days, it hasn’t rained. As far as the eye can see
the landscape is lush, tropical and stunningly
beautiful. Everywhere you look your eye takes in a
rich, intense hue of green.

We’re in southwestern Uganda, in a refugee settlement
near the border with Congo where IMC is conducting a
photo camp/art therapy project with National
Geographic and some of the best photographers in the
world - who also happen to be hilarious and absolute
sweethearts.

The goal of the project is essentially two-fold: teach
a group of 60 kids, ages 12-20, a new skill; and use
their photos as a therapeutic tool for them to tell
their stories that we can then pass onto the rest of
the world.

Today was difficult for me: joyous to watch the kids
“graduate’ from the workshop, but heart-wrenching to
say goodbye and know that their struggles will
continue long after I leave.

These refugees of war – some orphans - have come here
primarily from Congo and Rwanda. For many, this is
just the most recent stop after years of forced
migration from one camp to another, one country to
another. I met children – now young adults – who have
been here since the genocide in Rwanda in 1994. Camp
life is all they’ve ever really known. But whether
they're recent or long-term refugees, the refrain is
the same: they miss their real homes and lives before
arriving here and hold tight to the hope that someday
they will return.

Chris Rainier, who photographed IMC programs in
Bosnia, Somalia and Indonesia, said to me that as a
photojournalist, he often goes into a disaster zone
and sees doctors, nurses and supplies brought in, “but
we tend to forget the emotional stability of the
people who’ve been affected. So this program is
focusing on bringing some joy and happiness and the
ability for people to talk about the experiences of
coming from a war or famine zone. Photography is the
perfect catalyst for that.”

For the kids taking part in our photo camp, their
situation is particularly burdensome. For myriad
reasons, none of them is in school – although they all
desperately want to be, and they see their futures as
bleak. One 12-year-old girl dropped out after her
teachers caned her – she was too poor to buy soap to
stay clean, or to buy the proper clothes. She now
cares for her ill grandmother.

Many of the kids said they don’t attend school because
they must care for siblings or a sick relative, or are
responsible for tending the home, which usually
involves walking long distances to fetch firewood and
water, or cultivating their families’ gardens (when
asked why they’re not in school, they frequently say
simply, “because I dig.”)

We heard stories of young girls who had been raped.
There are girls in the settlement who said they sold
their bodies for clothes or transportation. For this
very reason IMC began working here, under the auspices
of the U.N. High Commissioner for Refugees, three
years ago, educating men, women and young people on
HIV/AIDS and sexual and gender-based violence.

All of the children spoke to us about the horrible
conditions in which they live: mud-dirty drinking
water; families of ten cramped into one-room homes;
and a subsistence diet of rice, beans, cassava (a bit
like a potato) and rarely any meat.

As one 16-year-old Congolese boy who came here almost
a year ago, told me: “It’s not right, living like
this. You should see it. When you come to my house you
see how my mother looks. It was not like this in
Congo. It is hard here.”

This was reflected repeatedly in their photos.
Powerful photos.

We all were astounded that children, most of whom had
never held a camera, could absorb instruction so
quickly, then go out and produce such compelling and
technically proficient shots of their lives and the
people and things that matter to them: smiling
sisters, despondent brothers, plates of food, a field
of corn, a child’s hand.

When we arrived on the first morning of photo camp,
the children were gathered at the community center,
quiet, unsure of why they were there, polite, timid.
It proved a stark contrast to their reaction once we
began explaining the workshop, shooting photos of
them, and then handing them each an Olympus E-330
digital camera that they would be borrowing. Their
eyes lit up. They handled the cameras gingerly at
first. Then as they became comfortable, they began
exploring their surroundings, snapping everything,
snapping each other, searching for the new,
interesting angle. They relished taking a photo and
then examining it, perfecting it, showing it to anyone
nearby. My heart burst to see the huge smiles on their
faces.

On the following day, we sat with the children to
discuss and “critique” their work. When we heard the
narratives behind these photos, they immediately took
on added power. One 14-year-old student took a
phenomenal shot of a baby in his mother’s lap, her
hands gently resting over his loins. We viewed it as
symbolic of love. But he told us the mother had
covered up her baby, ashamed that she was too poor to
clothe him and thus wanting to hide his sex.

Another 17-year-old girl took a fantastic photo of two
little boys sleeping side-by-side amid some sticks. We
thought it was sweet; she said it reminded her of how
children hid during the genocide in Rwanda.

We all felt a heavy burden to hear out these stories
and help these kids. Lynne Jones, IMC’s mental health
technical advisor, worked closely with the
photographers, community educators and translators (in
Swahili and Buganda) as they talked through the
painful events these children had witnessed and
experienced – and continue to experience.

Lynne says she’s found that what makes photography
such an effective tool is it’s often easier for a
child to talk about a picture than answer a
straightforward question. “They have much more to say.
The picture shows things that they might have found
hard to articulate. Plus, for these children who are
not in school and don’t necessarily have a skill, they
are mastering something and showing that their lives
have meaning. That’s very important.”

In all, we pored over approximately 24,000 photos
taken over the past week.

Today, we returned to the community center and held a
ceremony for the 60 kids and their friends and family.
On display were 8x10 glossies of two photos each
student chose as his or her favorite. They also each
received a few other smaller prints, a CD of all the
photos they shot, and a certificate of achievement.

When they were in the audience and were shown a sample
packet of what they would be receiving, they broke
into cheers. Later, they proudly held up their packets
and “diplomas” (they loved that word) for our cameras.

It all was fabulous. But it’s not nearly enough. Every
single child, in addition to their deep desire to go
back to school, has now caught the photography bug and
wants to continue taking photos, honing their craft.
They want to keep learning, perhaps become
professional photographers. One boy had offers from
people in his village to take pictures for money. As
the staffs at IMC and National Geographic watched this
program unfold, we became keenly aware that we must –
must - implement a permanent, sustainable art therapy
program here and in future locations. You cannot teach
these children to fish and then take away the fishing
pole. There is simply too much creative brilliance,
livelihood potential, and psychological relief not to
leverage the opportunity.

Photographer Ed Kashi told me: “I feel a tremendous
responsibility to leave a lasting impression here and
in other photo camps we do around the world so that,
for those who have the desire and the talent, they can
continue and become photographers.”

I adore every one of these kids and hated saying
goodbye. I will never forget Theo’s contemplative,
downcast face, which would transform into a huge grin
when you’d compliment one of his many beautiful
photos. Or Joyce, with the angelic singing voice,
radiant smile and great eye for detail. I have
promised to write both of them and I will keep that
promise. It is one of many I made here that I am
determined to keep.

Malnutrition in Ethiopia

2006-11-10T09:00:00.001-08:00

Hi, everyone.

I’m sitting in IMC’s office in Kampala, Uganda,
finally getting a chance to answer emails and give you
all an update. I feel like I’ve just emerged from the
ionization period – virtually no cell phone or email
access for a week. For those of you familiar with my
complex relationship with the Blackberry, this is no
mean feat.

I arrived in Addis Ababa, Ethiopia, last Saturday
morning and spent the weekend meeting IMC’s staff and
getting to know the city before heading to the field.

The people are truly incredible. The women, stunningly
beautiful – if I owned a modeling agency, I’d set up
an office in Ethiopia. Everyone is extremely generous,
warm. People are very communal in the way they eat
(everyone digging into one dish with their hands) and
the way they walk down the street arm-in-arm. They
greet each other (acquaintance or close friend) with
respect and enthusiasm.

Cabbies here drive with the same suicidal fervor that
they do in every other cosmopolitan city I’ve visited.
Addis is a big, polluted mélange of very old and new.
It’s thriving and decrepit all at once. Pedestrians,
sheep, camels, cattle, buggies, all travel the city’s
streets together, cars honking and swerving around
them.

We visited the mercato – considered the largest
open-air market in Africa. It was a Sunday, so most of
the stores were closed, but still it was bustling with
street vendors and people buying and selling chat,
which essentially is like cocaine in an herb and is
sold and chewed legally here. Not planning to try
that.

The food I love. Unfortunately, my stomach didn’t – at
least not goat in large quantities. At dinner outside
a town called Asebe Terefe, about 300 miles east of
Addis, I devoured some “enjera tibs” – goat meat
roasted in a clay pot with rosemary and garlic and
eaten with pancakes. For the next three days my gut
was in a vice. Not fun.

Outside Asebe Terefe, in what’s called the West
Hararghe zone, IMC supports hospitals; runs clinics
that provide medical and nutrition programs for
severely and moderately malnourished kids and mothers;
and “livelihoods” programs centered around helping
people plant gardens with vegetables they can eat and
sell.

The first day we visited about five different sites.
It was exhilarating, painful, heartwarming,
heart-wrenching – and in the end, exhausting.

One of the first sites was a hospital IMC helped build
where very seriously ill children are treated. It was
difficult seeing their little bodies covered with
sores, their eyes swollen nearly shut. They all are
malnourished but have other medical complications and
opportunistic infections, - TB, malaria, pneumonia.
And yet, IMC has a terrific record here – about 92%
recovery. Hard as it is to see these kids suffer, it’s
consoling to know that most of them eventually will be
ok and return home.

On a personal level, I felt like I was able to do my
teensy part – when I took the digital pics and then
showed them to the moms, their eyes lit up and they
burst into smiles, touching the little screen and
pointing to the image for the babies to see – they
clearly weren’t expecting to see an immediate shot of
themselves. They’d ask me to take more pictures, this
time giving me big grins. What a great feeling. I have
dozens and dozens of these.

I struggle with the need to take photos that represent
what people here are truly experiencing, yet I know
that the general public doesn’t want to see awful
photos of wailing babies with deep wounds and
protruding bellies – in the humanitarian world we call
them “flies in their eyes” pictures. We don’t want to
exploit these images. But I also don’t want to snap
only smiley, happy faces as well – although there’s
lots of that, to be sure. In the end, I have some of
everything. In just a few days I took 500 photos, and
there are still two weeks to go.

(I’m unable to attach any high-resolution pics with
this internet connection, but will try to photo-shop
some down and send along at some point) :-(

The other highlight for me so far was visiting an area
high in the mountains near Gola where IMC has given
people seeds and know-how to plant gardens – or
supplement, say, sorghum and corn with beets, carrots,
cabbage and tomatoes so that they have a more diverse
diet and can sell what’s left over.

One mother of six was so happy with what IMC had done
for her that she insisted on giving me a bunch of
enormous carrots, a head of cabbage and beetroot – as
if I were responsible for her good fortune. I
literally had to fight back the tears.

The “motels” where we stayed in this region were
around $7/night (about 60 Ethiopian birr) and you get
what you pay for: teeming with roaches, no hot water
or toilet paper, constant noise through the night
(religious chants, roosters, dogs barking). So I was
relieved to fly back to the nice guest house in Addis,
across from the British Embassy. That night, the staff
threw a dinner at a local restaurant with tons of
dancing to traditional songs. Total thrill.

So I arrived in Kampala last night in preparation for
meeting with the National Geographic crew that’s going
to do a Photo Camp/Art Therapy project with IMC
starting Monday in one of our refugee camps in the
south, on the Congo border.

I hope I’m ready for the field again, since the hotel
here – the Kabira Country Club – is literally like a
resort, with balcony, pool, squash courts, outdoor
restaurant and bar. I’m going to rest up and gird for
battle.

I miss you all.

Love, love,
Marge