A Glove Compartment Full of Primate

Yes.  It's true.

I asked what it was, specifically, and he just shrugged and said, "primate" again.

I believe it may have been baboon.

We had gone to Nagero county, even more remote, further north from Tambura, to see more clinics, and the soldiers we were traveling with were thrilled to discover the women near one of the clinics we visited were selling bushmeat.  It's highly regarded taste-wise (I believe it may have been described to me as "just delicious") and a bit more difficult to find in Tambura.  It's very common in the rural areas, though, and an important source of protein.

In related news, I am now pushing a "No bushmeat in official vehicles or if you must please put it in a bag" policy for my organization.

I have to say that while the human nature part of me is fascinated, the public health part of me is absolutely horrified by bushmeat, aka "tropical wild game".  It's increasingly understood by scientists that the diseases bushmeat carries is capable of spreading disease not only to the people who hunt and butcher them but onto humans all over the world.  It is now widely believed that the AIDS virus was transmitted from chimpanzee blood that came in contact with humans when it was butchered or eaten, about a century ago.  As an awesome article in the New Yorker magazine recently put it, bushmeat's threat used to be limited to only the handful of people in isolated African villages who were exposed to viruses from bushmeat, or exposed to people who were exposed to the viruses.  But as the world has become increasingly connected, all of a sudden those diseases that once stayed put are spreading out into the world.  Last year in New York, for example, illegally imported bushmeat infected with the simian foamy virus was found.  The virus can be transmitted to humans, but the long-term effects aren't known--yet.  The concern is that another global viral pandemic like AIDS could be waiting in the wings, and the rush is on to stop that from happening. No wants ebola or monkeypox (like smallpox, though less deadly, usually).

But how do you say that to people who derive their only protein from bushmeat?  Or derive their only income from selling it?  Good ole' "risk minimization" is the favored approach right now.  Don't butcher bushmeat if you have cuts on your hands.  Don't eat primates you find dead in the forest.  But that can only get so far, and it's unclear if even these messages are permeating communities.  So for now, it's monitor carefully and wait and hope that the global public health community identifies anything before it gets out of control.

Grim, no?  If you're in the mood for a bit more grimness, I highly recommend Richard Preston's The Hot Zone, one of my favorite books of all time.

Dispatch from Tambura Part I

I haven't talked much about why I'm in Sudan, but I'll give the quick overview.  There has been a major management overhaul for a variety of reasons in the South Sudan office.  It's also a big office, with 20-22 expats at any given time and 450 national staff, running 10-11 programs worth more than $10 million dollars (this fluctuates a bit from month to month.  We have a couple of particularly large projects, three of which I am focusing on improving the monitoring and evaluation of while here--the people who gave us all that money (US Agency for International Development, the US Bureau of Population, Refugees and Migration, the European Commission Humanitarian Aid and Civil Protection, the UK Department for International Development, among others) want to know that we're achieving what we said we would and (more importantly, in my opinion) my organization wants to know how we're doing, what we can do better now and next time (this is a blog entry of its own someday). 

One of these big projects is called the Sudan Health Transformation Project (SHTP).

It's funded by USAID, in collaboration with the Government of South Sudan, through an agency called JSI Research, which in turn gave money to a number of different NGOs to implement different parts of it in different areas.  It's intended to increase access to health, water and sanitation services for women, children and families across South Sudan.  My organization is part of ensuring continued delivery and expansion of primary health care services in Tambura (red arrow) and Malakal (blue arrow).

I came to Tambura to visit some of the clinics we are working with.  We have a total of 21 clinics spread out over an area and given the state of the roads I'm obviously not going to get to all of them, but today I was able to visit 3 plus the Tambura Hospital, where we have an HIV program separate from SHTP.

Here are the three clinics.

 

These are all primary health care units (PHCUs), the smallest in Sudan's hierarchy of care.  They are staffed by two community health workers, a maternal/child health worker, a watchman and a cleaner.  The community health workers have had about 9 months of training on identifying and treating basic health conditions (including assisting with childbirth) and when to refer to a higher level facility.

The facilities are basic, without electricity or running water, but have most of the essential drugs and tools to identify and treat the more common health problems--malaria, diarrhea, child malnutrition (it's an infant scale hanging in the picture right below), respiratory infections, antenatal care, etc.

Because there's no electricity, vaccinations can't be stored at the clinics.  Instead, they are brought from Tambura once a month in coolers with ice packs.  It was a vaccination day at the second clinic we went to and women with their children were lined up out front waiting.

Whew, off to bed after a long day.  More tomorrow.  Until then, these two sweet faces...

This is maybe one of the cutest things I have ever seen. This kid means business with the water pump, boots and all.

And for my friends who love cats (you know who you are), I found this kitten while getting an ice-cold (well, for Africa it was ice-cold, elsewhere tepid might be a better word).  I don't like cats, but this is pretty freakin' cute.  And it didn't try to headbutt me, either.

Morning Rush Hour

When I landed at Juba International Airport a few weeks ago, it was calm, overtaken by that mid-afternoon African heat-induced lull.  Just another small airport serving a few flights a day from Nairobi and Addis Ababa. 

Au contraire.  I arrived at the airport at 8 am on Thursday morning and found quite a different scene.  Dozens of tiny planes, some unmarked but most bearing the logos of the humanitarian world (World Food Program, Médecins Sans Frontière, International Committee of the Red Cross) were being loaded, NGO SUVs pulled up to them, people in logo t-shirts wandering around.  One by one, they finished loading, taxied down the runway and took off for the many remote corners of South Sudan.  Just another Thursday morning rush hour at the Juba Airport.

My plane was no exception--a tiny United Nations Humanitarian Air Service plane bound for Yambio airstrip, on the South Sudan-Democratic Republic of Congo border.

It's not surprising to see this--South Sudan is fairly massive and has very few tarred roads of any kind.  A vehicle that was recently sent by road from the Juba office to the Tambura office with supplies took more than a week to arrive.  It's a similar situation for most places.  South Sudan is the size of France and has 50 kms of paved roads (mostly in Juba) and no paved highways. It gets even more complicated when you realize that many of these dirt roads become entirely impassable during the rainy season.  And obviously commercial airlines are not flying these routes--low demand to out of the way dirt airstrips. Logistics is a nightmare.

My window seat afforded excellent views of the crashed jet just off one side of the Juba runway.

After an hour and a half, we began descending towards Yambio.  It couldn't look more different from Juba.

We touched down on the dirt airstrip in Yambio.

Immediately after we landed, people reappeared on the runway and continued about their (walking) daily travels.  Also, a dog came to meet the plane. Hartsfield International this was not.

Yambio has one of the loveliest trees I have ever seen, a massive baobab.

Yambio wasn't my final destination, just the closest I could get on an airplane.  No, I was headed to Tambura, another 180 kms (103 miles) down an "improved" dirt road--a slightly more than 3 hour drive.  The UN is rehabbing about 2,000 kms of dirt roads, and fortunately this is one that's mostly done (though we did occasionally have to veer off to bumpy dirt tracks through the forest in areas where it hasn't been completed).  The UN is actually supposed to fly planes to Tambura twice a month but usually doesn't because the airstrip isn't maintained.  A driver from the Tambura office met me and we headed off with our military escort leading (a requirement for NGOs in this area, where the Lord's Resistance Army is still active).

More from Tambura.  I was supposed to leave on the Saturday morning flight but the travel department in our office forgot to book it (a complicated procedure involving dispatch of the flight list from Khartoum on Thursday midday as they are closed Fridays in the Arab north), so I'm here until the Tuesday morning flight!  If only I had packed for a 5-day trip and not a 2-day one...

Nigel.

This is Nigel.

 Nigel is a dik-dik, a tiny antelope that lives across East and Southern Africa.  He lives at Acacia Hotel in Juba with his life partner, Madeline (dik-diks form permanent mating pairs). Madeline wasn't feeling the camera, but Nigel let me follow him around for awhile with my camera while he went about his life's work, eating every bush ever planted at Acacia.

He was a little shy at first.

But then he decided he rather liked being the center of attention.

Unfortunately, some other people saw that Nigel was working the camera and decided they wanted a piece of it.  This included a 5-year-old little boy who stays at Acacia with his parents.  He began to taunt Nigel.  Nigel responded by using his horns to headbutt the kid in the knee, moderately gently but fairly authoritatively.  This was my cue to go get a bottle of water at the bar.  Little did I know that Nigel's reign of terror had only just begun.

I was sitting at the bar a few minutes later when I heard shrieking and looked up to see a woman who had started to take pictures as I was leaving hurling her shoes at poor Nigel, who was headbutting her over and over again--enough and hard enough to draw blood from a horn wound on her ankle.  The woman took refuge on the front porch of one of the huts and I watched as Nigel ran crazily around the field and then retreated to the shade of a tree to pout  Like all too many stars, life in the spotlight had tipped him over the edge. I drank my water from the safety of the restaurant. 

But eventually I had to venture back to my friends and belongings by the pool.  I looked carefully around and spotted Nigel still pouting under the tree.  He looked like he was maybe dozing a bit, so I decided to make a break for it.  Can we all see where this is going now?  I began to make my way carefully across the patch of grass between the restaurant and the pool.  Then, all of a sudden, out of the corner my eye, I spotted a very small and very angry dik-dik hurtling towards my lower calves with one thing on his mind:  headbutt her, the one who started it all.

Imagining how I was possibly going to explain that injury to anyone (calf muscle impaled by horn?), I screamed like a little girl and sprinted across the grass, veering at the last minute onto the porch where Nigel's previous victim was sitting.  Nigel was too enraged to catch the last minute direction change and hurtled off between the huts towards the tennis courts, leaving me at the mercy of a crowd of extremely amused bystanders.

He reappeared a few minutes later, about the same time my injured pride began to recover, and sulked around the grass for a bit, attempting to headbutt anybody who came near the grass.  Eventually the manager of Acacia appeared and after several tries and some headbutts, picked up a cranky and struggling Nigel and carted him off to the corner of the property, presumably for some down time and a stern talking to. 

Thus ended Nigel's reign of terror.  For now. 

North/Central Africa Politicial Excitment

When I applied to nursing school at NYU a couple of years ago, one of the mini-essays on the application involved picking a song that described you and why (because this is clearly something that will determine whether or not I'm going to be a competent nurse).  Last night I was working out in my awesome travel gym:

...and the Tears for Fears song "Everybody Wants to Rule the World" came on my Shuffle and I got to the verse about "I can't stand this indecision/married with this lack of vision/everybody wants to rule the world" and thought, hey, that pretty much sums up my little corner of north/central Africa right now.  And then the Cee-Lo Green song "What Part of Forever" came on--"what part of forever/don't you understand" and I thought, hey!  This is Mubarack's song! "I could stay stay stay..."  I'm pretty sure I could keep going for a lot of world leaders.

But in all seriousness, it's a big time for this part of the world.  Evidence of the recent referendum on whether South Sudan would seperate from Sudan is everywhere.

The middle picture is of the referendum countdown clock.  It now reads 0 days 0 hours 0 seconds.  Apparently it's been broken more or less since it was installed so all the zeros aren't as symbolic as it initially seemed.  This clock is notable also because it serves as the main directional landmark in town.  Almost every set of directions starts with, "Okay, so you go to the referendum clock roundabout and then..." 

The results of the referendum were released last week--almost 4 million people voted, 98.8% of them for separation from Northern Sudan.  There's excitement and optimism, but also a certain prevalent wariness, a certain reluctance to be too excited .  What next?  How will it play out?  Already a government minister has been shot at his desk.  It's been blamed on family conflict, but there are many who aren't sure.  Fighting in the Upper Nile and Jonglei states in the east, where we have several project sites, has broken out between the southern Sudanese army and rebel factions and hundreds have been killed and injured.  Plans to demobilize soldiers have, for the most part, not yet succeeded.  It's a classic example of a society united in pursuit of one goal--independence from Northern Sudan--and then the challenges of carrying that momentum into the peaceful and inclusive development of a new state.  There's lots that could go right and wrong in the next few weeks and months.

On an entirely different note, there are really awesome lizards in this country.  I can't get most of them to stay still long enough to get a picture, but this one cooperated while I was eating lunch the other day.

In other wildlife news, I was walking from the guesthouse to office the other morning and walked by two children standing there, each swinging a dead rat around by its tail.  Apparently rats are considered an extremely tasty treat in the Dinka cattle camps, but I'm not sure about it the city.  I can hear rats running around at night, which is not, in fact, a terribly comforting sound.

Here's what making pasta for dinner looks like in Juba (no rats, but some Parmesan and bacon imported straight from in Italy in the (wildly overweight, according to the airline) suitcase of a colleague from Italy. Also no electricity, thus the candles.

The pasta also involved a trip to the big market in town, Koni-Koni Market.

The pasta was delicious.

First Weekend in Juba

Juba has an unbelievable number of expats from all over the world working here.  And it turns out on weekends you can just follow those expats SUVs to the fun.

In this case, the fun's at the pool. Note the giant plume of smoke from the burning trash in the distance.

And what good's a day at the pool without a cheeseburger?

And a slushie, of course.  Though my tongue went numb after I drank it, probably because it seems that after the US banned Red Dye No. 2 in 1976 because it possibly caused all sorts of terrible things (it was coal-tar based), they shipped the surplus over to South Sudan to put in the slushies at Acacia Village.

I also had dinner on the Nile--literally, on the Nile, it was a floating dock.  It was probably just as well it was too dark to see the river, but the breeze off of the river was lovely, as were the tiny kittens looking for scraps.

I'm fairly certain these perks of living in Juba will offset the 80-hour workweeks, scalding heat, and yet somehow still freezing showers that smell like raw sewage and don't rinse the shampoo out of my hair, which makes me look like I've dipped my head in Crisco, handy for reflecting off the brilliant African sunshine and catching the dust.

So happy to be back in Africa :)

Welcome to Juba?

I followed this sign, and got from D.C. to Juba in no time flat. 

Well, maybe not no time. Just two 8 hour flights, a night in Nairobi and another 2 hour flight. Side note: it didn't get light in Amsterdam until after 8 am. I was really disoriented when we were landing because I was pretty sure it was about 8 am and yet...total darkness.  I kept checking my watch.  And then I realized, nope, that's just northern Europe in winter.  And then northern Europe gave me my last Starbucks coffee for the next month and a half, free internet, and a wander through an exhibit of the Dutch master's paintings of witner at the airport branch of the Rijksmuseum and I was happy again.

In Nairobi I spent most of my day sitting in the car while the poor HR person in the Nairobi office spent two hours trying to get a passport-sized picture stapled to a visa at the Sudanese embassy.  This will be predective of things to come.  The best part of this visa is definitely that it says I am 200 cm (6 and half feet) tall with brown eyes and black hair.  Me to a tee.

Landing in Juba was like landing in many other regionally signficant but otherwise small African cities.  Disintegrating carcas of crashed jet by runway?  Check.  Single runway you turn around at the end and head back to the terminal? Check.  Military jets and helicopters? Check. UN and World Food Program planes? Check.  Fingers crossed the livestock are off the runway?  Check.  "Welcome 193rd Country of the World" Banner?  Well, that was a new one. 

I went straight to the office. 

Then walked down the street...

...to the guesthouse where the expats stay.



This is the tukul, the common space where there is a tv and meals. 

Electricity is intermittent.  Good thing we've got generators, though the constant roar in the background and waves of diesal fumes are giving me a major Baghdad flashback, as are the moments of sudden darkness, a blissful silence and then it hits: the wave of 100+ degree dry heat the (generator dependent) air conditioner was just barely holding back.

Are you jealous yet?