Old Articles

I am posting something which I have written for MSF-HK some years back -- after I finished my first mission in Ethiopia.It's not for the lack of things to write that I am putting this here, but due to some requests from people who have been following my blog. These (articles) have been printed in Hong Kong and distributed to high school students, and published in the msf-Hong Kong website some years back. These articles have also been used for fund raising. I hope you will like them!


Saying a prayer

Dear Friends,

Hi! Salam no (that means peace in Amharic)! It's been quite a while since I have written you all. I have here in Abdurafi, Ethiopia – the farthest and the most isolated part – for the past 4 weeks now. I am all alone in the -project: the PC had just been evacuated because of glandular fever and the ex-pat nurse has to go back to England because of family problems.

It has so far been okay, I mean, being the project coordinator and all. It's a new thing for me so there is a lot of room for mistakes and of course, improvements. I have had the opportunity to manage the hospital in Vanuatu, but here, it's a different ball game. Anyways, if there's one thing which would make me feel bad, it's the patients and not the "office work".

I think from this perspective I could say with much conviction that WE ARE VERY LUCKY. We worry about the trivial things everyday – what kind of food we want to eat, where shall we go after work, our mobile phone credits, what kind of outfit best needed for this occasion, so on and so forth. Here, I have seen a lot of young men and even children walking hundreds of kilometers to work in sesame, sorghum and cotton farms. Their average daily wage is approximately 3 US dollars, and they stay in these farms in the direst of conditions. No clean water to drink, not enough food, and no medicines for malaria and other diseases.

The other day, I had a referral from the local Bureau of Health because of a young man who had fever of more than 2 months, enlarged spleen and severe emaciation (his BMI was less than 13%). The only property he has is the clothes on his back – he doesn't even have anything on his feet.

I could never forget the look on his face when he died. There is that look of hopelessness – something which I could not describe, but something which I can truly feel. Something which you can taste. Here is someone in front of me who left his home and family to earn some money, dying without his family knowing. Dying, without someone saying a prayer for him.

He will be buried in an unmarked grave, along with hundreds of migrant workers from all over Ethiopia.

As a doctor, I try to separate myself from the harsh realities of my job. At medical school, we were told to keep the doctor-patient relationship strictly professional. It would be better to treat patients if you have little emotional baggage. Here, I can't help but empathize with every sick person who comes to the clinic. Why? These are people who bet on their lives to earn some money for themselves and their family. Sometimes, they loose their bet. That is one hard price they have to pay.

I am sorry if this letter is a bit depressing. I guess there is no other way to tell the story. I'll try to make it up beat next time, promise!

Miss you all!

Erwin




September 20, 2006

The value of money

Dear friends,

Hello! I would like relate my story in Amharic (just to brag – hahahaha!) but of course, no one could understand it. I have been here for 3 months now and I feel quite confident in speaking the language. In fact, when I go on rounds, I ask the nurse not to interpret for me. Anyways, it so much fun to look at the faces of the patients when I speak Amharic.

It had been a rough week for us – my national staff doctor has been away for the Somali explo and one of my nurses is sick. The number of patients we were taking care of was more than what the clinic can handle. On top of this, the cholera treatment center has been receiving more than 60 patients per day. Thank God I have another ex-pat helping me with CTC or else I would go crazy!

I know you probably are asking if I still get very interesting cases. Yes, I do. Kala Azar is quite an easy disease to treat if the patient comes early. However, when the parasite has devoured much of the patient, the course would be a short slide down hill. Worst, if the patient is co-infected with HIV.

The other day, I was informed by the nurse on duty at 2:00 am of a patient in status epilepticus. A migrant worker was admitted earlier that day because of severe emaciation, fever, spleenomegaly and epistaxis.

The patient was still having focal seizures when I arrived. A young male probably aged 20-22 years, BMI of less than 15%, lies on the bed. He was clinching his fist very tightly. His random blood sugar was very low, making me think that one of the probable causes of his seizures would be hypoglycemia. But then, he also has diarrhea, so it could be anything. After giving Phenobarbital, hydration and pushing glucose intravenously, the patient calmed down.

When he relaxed his hand, we found 800 birr (about 100 US dollars)! I told the nurse to keep the money so no one would take it from the patient while he is asleep. The next day, he was up but severely weak. I asked him why he is so thin when he had money to spend for food. Why is he wearing a torn shirt when he could buy himself decent clothes?

He gave me a wry smile and answered softly: "It is for my family".

I tried holding back my tears, because a lot of us would do everything for our family, or for the persons we valued. I have heard of countless of stories of people leaving their comfort zones to earn money somewhere else. A lot of Filipinos have sacrificed themselves so their families would have a scrap of luxury back home.

But what is the actual value of money in a place like Ethiopia? 800 birr would feed his family for the next three months. He would be able to buy seeds for the next planting season. He would be able to get on a bus and go home. 800 birr is probably worth two cows, or four goats, or three sheep. 800 birr is big money.

After two days of ups and down in the patient's condition, he died.

I asked the staff as to who shall I send the money the patient owns, but all I got was a shrug from every member of the staff. We don't know where he came from – all we have was a name.

What is really the value of money? For this young man, it was his life.

Every year for four to five months, thousands of migrant workers go these parts of Ethiopia to work in the farms. The population in Abdurafi which is about 50,000 during summer would go up as high as 180,000 during the planting season. Of these, hundreds of young men die from hunger and malnutrition, HIV/AIDS and Kala Azar, and other diseases. The sad reality is that for money, a lot of these people would be willing to risk life and limbs.

On the other side of the world, a lot of my friends have asked me why I am in this kind of work. I, along with thousands of volunteers risk also our life and limbs for a lot of different reasons. I used to respond with a very generic answer: "I want to make a difference". Recently, I have changed my answer to: "I can make a difference". Money has been an issue with a lot of my friends. Of course, I fully understand them. We were in school for almost 10 years of our lives and so, to "waste" it by not earning enough, is absolutely crazy. However, it is not always about the money. Sure, it is nice to have ready cash to spend on things you wanted, but at the end of the day, you ask: "Am I satisfied"? "Have I done my part and helped people"? How much more money do I want"?

So you see my friends, we all have different valuation of things. I don't question our quest for better financial status. The value of what we work for depends on whose perspective it falls into. A young man, barely out of his adolescence would at anytime give his life for a hundred dollars for his family. What would we give in exchange for what we do?

I hope have not touched any raw nerves. My work in this isolated place has taught me a lot of things. I am learning everyday – even though it is the hard way. I also hope that I have opened up some views, and made you all realized how important life is.

Keep in touch and please do give any response to this letter. Miss you all!

Erwin