Friday, August 12, 2016

[Yemen] Jumuah Mubarakah! :)

the mosque is just over there!

Jumuah mubarakah is what they say here (at least between men) after offering friday prayer. It's basically saying have a bless friday to the people they meet or even they talk to on the phone.
Being able to offer friday prayer in the mission, for me, is a bless. On my prevous mission in South Sudan, the project was located in the middle of nowhere. I heard adzan few times only, so vague that up to now I still think that I was probably hallucinating because I didn't hear adzan for so long.
And now, here in Yemen, even though I still have to wear my MSF vest when I'm on the street--although the mosque is 20 meters away from the house--I feel so much grateful.
Like most buildings in Yemen, the mosque is a modest square-one-floor building with minaret on one of the corner. On July, the weather was so hot that I sweat just by sitting there listening to the khatib yang sedang berkhutbah. Of course there were few wall and ceiling fans but they don't really make any difference.
Men and boys came with their sunday friday best complete with their jambia (and sometimes with guns well)

One thing that amazed me is that how quiet it was. No voices of people mumbling or chatting, no sounds of children running around and screaming. People, old and young, came to the mosque to offer prayer. And that's what they did. I'm amazed how people listen to the sermon seriously, how school-age children came in 2 or 3, few without adults, offer sunnah prayer and then sit quietly listening to the sermon.

jumuah mubarakah from Abs! :) 

Tuesday, August 2, 2016

Talking about Wrong Thing in the Wrong Hand

Disclaimer: Despite the fact that the following story was based on actual event, I will deny any allegation or presumption on when or where it actually took place.

I am writing this because it is too horrible to be forgotten. I am writing this because a man's life, whoever it is, is precious. I am writing this because the mind is a dense jungle where everything could be lost upon entering.

One afternoon we received a young boy with a GSW to the head. When I examined the head, brain matter coming out of the back of the head through a small hole.

I am mad. So mad when I found out that it was accidental. The boy was playing with his friend who happened to carry a Kalashnikov casually as if it was something a teenage boy would bring when hanging out with his friends, when that friend accidentally pulled the trigger and shot him at the back of his head.

Didn't see any exit wound, so the bullet is most likely still lodged inside the cranium.

I am furious to be exact. I just can't believe that some people consider a gun, a rifle is a toy, something to play with. Especially in this place where was is raging and gun is easily found. I thought they are supposed to be more careful and wiser with this thing, since they're seen what a weapon can do, how war changes their lives and their country and how a gun in the wrong hand can be vvery dangerous.

Read other entry about GSW in here.

GSW = Gun Shot Wound

Friday, July 29, 2016

[Yemen] The Much Needed Snake Antivenom

One day, we received  Adel, a 12 year old boy, who was bitten by a snake few hours earlier. He came in a state of severe envenomation. He's barely conscious. Blood was coming out of his mouth and his ear. His eyelids were dropped. His right foot was swollen up to his ankle.

He had all the signs of severe envenomation. We thought he was going to die.

He didn't.

In this desert country where venomous snake is not hard to find, number of snake bite cases is quite constant. Each week we receive 10-15 cases. This means that in one year we receive more than 500 cases.

People live in houses where they keep the doors and windows open almost all the time due to the heat. This makes them prone to the bite of this slithering creature. The more fortunate ones have their houses tightly closed to keep the air-conditioned room cool. But it doesn't mean they are snake-bite free. The threat is still there: when they go to the market, when children go to school, when people are outside of their houses, snakes can still bite.

So, unlike Malaria or Dengue that we can prevent by trying to prevent mosquito bite, it's not quite the same with snake.

When snake bite is not easily preventable, what we can do in managing case of snake bite is by giving anti venom as soon as possible to the patient. Since different place has different types of snakes, it is better to use locally-produced antivenom, the one that is specifically made against the snakes that are found in that area. But the availability of antivenom is a challenge itself. In the project we have been using antivenom that is produced by a company in Saudi Arabia. Since we receive it from Sanaa, it takes time from when we order to the time the antivenom arrives in our hospital. The problem is some patients may need more antivenom compare to other patients and use almost all of the supply. When this thing happens, we have to purchase it locally which quality is questionable. The good thing is, the one that we buy here in Abs seems to work quite well even though it was manufactured in India.

One thing for sure, as MSF is the only one providing free-of-charge the expensive snake antivenom, people from different districts, even the ones from far places like near the border to Saudi Arabia, come to our hospital to seek antivenom that is needed so much.

Even so, the majority of snake bite patients are still unable to access the treatment that can save their lives. So the path to provide people living with high risk of snake bite is still far from reach.

Tuesday, July 5, 2016

[Yemen] Ramadhan Kareem in the Project

It's been more than a week since I've arrived at the project in Yemen. I am assigned in Abs Rural Hospital in Abs District in Hajja Governorate which is in northwest part of Yemen. Before arriving here, people in the capital have warned me of how hot it is in here.

It damn is.

Hot and dry. And dusty. With occasional sand storm in the afternoon. Typical desert weather.

 occasional sand storm in the afternoon

And so, besides adapting to the project--how things work, working with expats, working with national staffs, seeing patients at the hospital, speaking arabic or trying to, eating different things here--I have to do fasting in this situation.
Especially due to the hot and dry weather where the wind almost doesn't blow and dust everywhere. It's so hot, that during the day, even the local people like to splash water on their face, head and neck.

And so my typical day during ramadhan would be get up around 3 am to do sahuur, offer fajr pray, go back to sleep, get up at 7.30 and go to the office at around 8 am. Doing some paper work and reporting before going to the hospital at around 9.30 am.
At the hospital, I put my bag at the ER, doing rounds with the doctors and nursing supervisor at the ER and observation rooms which can take from 30 minutes to 1 hours depending on how busy it is. At 11 am, continue with doing rounds in surgical ward with the surgeon, nursing supervisor and IPD doctors, then crossing the hospital compound to maternity ward. You know, it´s already hot in the morning, so you can imagine how hot it is going back and forth between wards in the hospital at noon. 

Yes! It is that hot!
At around 1 pm, we usually do rounds in the pediatric ward with nursing supervisor and the doctor and finish around 2-2.30 pm. Then I usually go back to the house to offer dzuhur pray because it´s quite rempong when you´re wearing shoes with the wudhu and everything. Go back to the hospital after offering ashar pray, I stay and supervise the doctors in ER and IPD until around 5 or 6 pm. Sometimes it is so hot and I get so lemes that I go back early or even don´t come back to the hospital after ashar, instead I go to the office to do some paper work.
Being a moslem in a moslem country in the Arabian peninsula, you would guess that it would not be so difficult for me to do my obligations as a moslem here. Well, not quite right. Since, this province is under the occupation of the Houthi which is shiite, I can´t really go out and pray at a mosque before knowing which sect does the mosque belongs to: shiite or sunni. Also, you can´t differentiate whether a person is a shiite or a sunni from their outer appearance, so I can´t really ask someone to offer pray together with me since that person might be a shiite.

Alhamdulillah, there are 2 other person that are fasting as well at the expat house. They are both relocated national staffs. We usually have iftar together continued with dinner with the rest of the expats and sahuur together with the watchmen and the drivers. The menu for iftar is usually shafoot which is pita bread which is soaked in yoghurt that I don't really like. And then there are dates, fresh juices, and of course sambosas. For sahuur usually we have fresh khubz bread with fatta (or is it fahsa?) which is minced meat with onions, okra, potatoes and few other things that I can´t recognize.

 plain shafoot (picture taken from here)

 khubz and fatta (i guess) (picture taken from here)

Don't ask me about ngabuburit. Around that time I would still be either at the hospital or at the office. Saving lives or Saving files.


Rempong: complicated
Lemes: sluggish, weary

Saturday, July 2, 2016

facing a huge problem

 taken from

Watching some part of the match between Serena Williams vs Christina McHale in second round of Wimbledon, I can't help thinking how McHale felt at that moment. The tv showed while they were both waiting in a the lounge before entering the court. Serena was wearing her beats headphones while Christina stood slightly behind her. And when they were called, Serena came out first followed by Christina--looking a bit intimidated not only by Serena's fame, experience and achievement but also Serena's muscled physique. Christina who never got more than 3rd round in Wimbledon seemed a bit depressed and definitely under pressure.

Serena, however, with her 17 wimbledon record appearance, has different pressure. She must win over this girl and maintain her dignity and power in the eyes of the international tennis community.

In the end, Serena won the match but Christina put up a pretty good fight.

I don't have a moral of the story thingie about this. I just want to say--and remind myself--that even though you are facing a huge problem in front of you, a big wall that separates you from your goal, all you have to do is deal with it. Face it. Jump over that wall. Climb it. Break it. Whatever the result, in the end, you can tell yourself that you've done what you could do.

Friday, July 1, 2016

[Yemen] New Mission New Country New Position

In Kung Fu Panda 3, Master Shifu told Po to teach his friends. Po refused because he didn't know how to teach. Then Shifu said to Po,"If you only do what you can do, you will never be more than what you are now."

And that what happens to me now. Coming to Yemen knowing that I'll be a Medical Activity Manager instead of "only" as ER Doctor scares me and excites me at the same time. Medical activity manager is basically an administrator. that person runs some part of the hospital. yup. running the hospital. responsible not only for medical-clinical stuffs, but also HR stuffs, referrals and training. big deal. I am not sure if I can do it, but as Shifu said above i will never be more than I am now if I only choose to do what I am capable of doing.
Actually, this is what I did when I was in Karachi, Pakistan on my first ever mission with MSF. I was supervising the national doctors, conducted training and made sure that protocols are respected and followed. The difference is: that was a clinic, this is a hospital.

I actually learned about this new position when I received the contract from HQ while I was waiting for my connecting flight to Djibouti. I was surprised of course but nonetheless excited at the possibility doing something new and different.

I was already suspicious when I read end of mission report from my predecessor. Because she was doing a lot more than an ER Doctor supposed to do. And that email just clarify my suspicion. I asked though, the HR in HQ to clarify this to the pool manager that offered me the position the first time. no answer yet.

It is a completely different challenge from what was offered before.

Well, I'm already on the field. So even if the contract remains the same, I am not coming back before I do What I've come for.

It takes a lot of efforts of course, but I'm up for the challenge.
Note: The reply came from HQ. They changed the position from Medical Activity Manager into ER MD. But the job description remains the same. -__-

Monday, June 27, 2016

"If you only do what you can do, you will never be more than what you are now." Master Shifu in Kung Fu Panda 3