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My Culture

February 17, 2013

My friend has tried to explain to me several times how important it is to him to preserve his culture, in his own life and especially in the lives of his children.  Culture, to him, is nearly inextricably linked to identity.  He believes that in order for his children to have a healthy sense of identity, they must be brought up understanding the culture of their people, and its importance, despite the location of their upbringing.

Another friend explained to me that her parents instilled in her a Texan culture in order to provide stability and identity to their children as they moved from country to country working for the US Foreign Service.  She is very grateful for her parents’ wisdom in this.

Living and working in a multi-national team causes constant confrontations with culture which cause offense or insult.  These confrontations include offending colleagues by sending emails without greetings and salutations, smelling the food before serving it to my plate, and making comments about the unsanitary living conditions in the town.  To me, none of these things are inappropriate, but I have been told not to do them again to avoid offending my colleagues.

I have made many changes to my lifestyle to live and work in South Sudan with an international team.  When I was asked to make more changes, it put me in a mental struggle.  The questions that have been rattling in my mind are, “How much should I change myself (or my culture) to please others?” and “How much should I expect others to have grace for me and respect for my culture?”  I can make compromises on my daily habits and interactions only so much before I begin changing the very essence of who I am.  This is something that I cannot do and do not think should be done or expected of me.

This prompted me to ponder, “What is my culture?  What are the components of culture? What is it that makes me, me?”  Language, religion, ethnicity, socioeconomic status, education, practices and behaviors, perception of social hierarchies, political views, nationality, work ethic, communication style, values, moral codes, worldview?  Let me reflect on my identity in each one.

My language is English.  I grew up speaking American English, but the more I spend time with English speakers from around the world, my English has become less and less unique.  A friend even remarked recently that my accent sounds British!  I have adopted unique phrases from other cultures (like saying “half seven” for 7:30), but I also have my own American English phrases and slang that differentiate my English from others’.  Nonetheless, speaking English seems to put me into a category of people with nearly infinite opportunities for “success” (in career, material possessions, and fulfillment), which is the effect that acquiring English has on many individuals in many developing nations.

Somewhat different to language, but related is communication style.  I seem to have a different communication style than many of my colleagues.  They find my text messages and emails to be abrupt with little room for feedback.  My communications are to the point and down to business, often lacking formalities of greetings and salutations.  At the same time, in my verbal communication, I was told by a national staff member that I talk too much and I should try to make my communications with him as concise as possible.  I think for him, the more I explained, the more insulted he got that I thought he couldn’t understand what I was saying or that I thought he was incompetent to do the work correctly.  For me, I felt that I needed to explain the task fully and in detail so that there was no misunderstanding or lack of clarity of my expectations of how to do the task.  This is especially because there is somewhat of a language barrier (I speak American English and for him, English is a second or third language, learned in Africa).  To me, I felt that I was doing us both a favor by taking the time and effort to fully explain, and he felt insulted and annoyed with me for the same thing.

My religion is Christianity.  I did not grow up in a particular religion, so in this aspect of culture, I created my own culture, apart from my family; or rather, I joined another aspect of culture apart from them.  I wouldn’t define Christianity as having a culture unto itself, but different cultures within Christianity can be found, within a denomination spreading across the globe, or down to a specific church’s community culture.  I don’t feel that I want to, or even should, belong to a specific culture within Christianity, as my religion is a relationship rather than a ritual, though it does influence my behavior.  Primarily, it influences me to act in compassion and mercy, and should enable me to love everyone that I encounter.

My ethnicity is Caucasian.  That hardly means anything in relation to describing my culture.  My ancestors are from the Netherlands, Sweden, Russia, and Palestine, but all of my grandparents spent their lives on the east coast of the U.S.  In my lifetime, I had the influence of my two grandmothers, neither of whom seemed to reflect any particular ethnic culture.

My nationality is American.  Since America is the melting pot, what does this add to the description of my culture?  That I have the tendency to be arrogant, loud, and ignorant of the world?  I don’t believe these things are true.  To many in the world, it means I was born into privilege, which is true, but there are many Americans who were not.  Does it mean that I am superficial and lack moral character?  I don’t believe so.  Does it mean I have courage to stand up for equal rights and for freedom?  Yes.  Being American also means that I relate to stereotypes of different regions of the US, particularly the south and New England.  It also means I love Mexican food.  For me, being American means I’ve been influenced by many cultures, I was born into privilege, I have courage to stand up for equal rights and for freedom, and I have an identity in the history of the development of my country (like the end of slavery and immigration of Latinos).

My highest education level is a Master’s degree in Public Health.  Throughout my life, I’ve had access to and attended high quality educational institutions.  This causes me to fit in and interact best with people who possess strong analytical skills, dream big and achieve their dreams, and focus on solving problems.

My perception of social hierarchies seems to be very relaxed in comparison to many of my friends.  I do respect my elders, those more experienced, more educated, and in higher positions, but I also feel that I have something to offer or teach everyone around me, as I also have something to gain and learn from them.  “God is no respecter of persons,” comes to mind.  We are all equal in that we are all uniquely created, wonderfully and fearfully made.   We are all in various stages of coming into our full potential, to be all that we are created to be.  I believe I should treat everyone according to that potential, rather than the current reality.

Politics…  My relationship with politics is not healthy.  I despise thinking about politics.  I don’t think I can make a good judgement of a person and his/her ability to run a country (a job which I have no idea what it entails) without having met the person.  I recognize the privilege of living under a democracy that gives me a voice in the matter, as well as the hard-earned right to vote as a woman.  It is not my interest, but I know that it is in my interest to pay attention.  I took a politics test once to assess where I fall on the spectrum, and like most of my family, I lean towards the liberal democratic party.  But I do not identify myself with this party because I don’t agree completely with all the essentials of the party.  Nor do I feel that American politics defines any part of who I am.  I call myself a-political (without politics).  My beliefs about how to live in community tend toward socialism, that we should share resources so that no one is in need.  But I fully believe that all should work according to his/her ability to contribute to the community’s collective and individual needs.  As far as how government should play a part in society?  I haven’t a clue.

My work ethic is rooted in doing the best I can do to complete the task effectively and efficiently.  I don’t like laziness and idleness, or goofing off too much on things that do not add value to one’s own or others’ lives.  My employer’s values are integrity, accountability, faith, hope, compassion, and dignity.  I whole-heartedly agree with this work ethic.

I value people more than things.  I try to treat everyone according to the way I want to be treated, with love.  I try not to do wrong or harm to anyone.  I believe that it is not my place to take revenge.  I believe in “fair” and loving treatment of all people, regardless of anything they have done or said or believe.

This is who I am and who I strive to be.  This is my identity.  And it is influenced by many cultures.



[kuhl-cher] noun, verb, cul·tured, cul·tur·ing.


1. the quality in a person or society that arises from a concern for what is regarded as excellent in arts, letters, manners, scholarly pursuits, etc.

2. that which is excellent in the arts, manners, etc.

3. a particular form or stage of civilization, as that of a certain nation or period: Greek culture.

4. development or improvement of the mind by education or training.

5. the behaviors and beliefs characteristic of a particular social, ethnic, or age group: the youth culture; the drug culture.


There are certain aspects of the components of my culture that I consider to be “excellent” but I can’t say that my culture is the most excellent way.  I value aspects of many cultures, though they are not my own, nor would I choose to make them my own.  But I can see the beauty and value in them.

If I strive to live the way God desires, to look to Jesus as my model, then I am moving towards forming my worldly culture to Kingdom culture.  I wish to live as a citizen of the Kingdom of God, as a member of His family, and thus will refine my culture to His.  What does that look like?  It looks like love and freedom from the influences of evil for all!  It is honor towards one another.  It is peace among all men and brotherly kindness.  It is patience and hope for good in everything and everyone. It is joy in all circumstances as I trust in a loving God.  It is faithfulness to God and to each other.  It is gentleness in all interactions.  It is exercising self-control to protect self and others.  It is the harvest of the fruit of the spirit (Galatians 5:22-23).  It is having no envy towards others and not boasting of self.  It is not being arrogant or rude.  It means rejoicing in truth. There is no injustice.  It is believing in one another to be good, always hoping for good, and enduring through all hardships in that hope.  It is endless love in the Kingdom of God (1 Corinthians 13).  This is what I want my culture to be.


Crazy Logistics

October 20, 2012

I recently heard someone say that having a job in South Sudan on your resume means you can work in any context. I have also heard that South Sudan is one of the most difficult places to work because the logistics and transport is so difficult. I certainly have experienced that in my 9 months. Two horrendous stories: 1. trying to get latrine construction materials from Juba in the south to the refugee camps in Maban county in the northeast, and 2. trying to get construction materials from Juba in the south to Renk in the north of Upper Nile State.

For the first scenario, there were literally tons of cargo to ship along with 2 land cruisers – too much for the little caravan planes we usually use. We decided to hire a large plane called a Buffalo, which is large enough. The plane got loaded up, but on the day it was supposed to leave, the pilots were arrested for not submitting the proper take-off forms to the airport. Then the authorities discovered that the plane wasn’t properly registered, so the plane was confiscated (how, I do not know…). Our team unloaded all the cargo again and found a different plane for hire. It made it to Palioch, a town with a large airstrip about 2 hours away from the refugee camps where the cargo needed to go. To get the cargo from the airstrip to our base, we hired two lorries, unloaded the cargo from the plane and onto the trucks, which would leave the next morning. Our team headed back to the base from Palioch to get back by sunset. The next day, one of the trucks made it to the base, but the other one had been stopped at a checkpoint and the driver arrested because he didn’t have a waybill for the cargo he was transporting! Our field logistician drove to where the driver was and got him out by showing the paperwork. Finally, all the cargo arrived at the base in Maban from Juba.

In the second scenario, there were, again, literally tons of construction materials, including cement, wood, metal pipes, and plastic pipes, and a few huge water tanks. After these materials were procured over a few months, a barge was hired to take the cargo up the Nile from Juba to Renk. It would take about a week. Apparently, the barge looked like a huge canoe, rather than the typical industrial barge. We were assured that the boat could carry 3.5 tons of materials. However, someone forgot to consider the volume of the materials, and less than half of it actually fit on the boat. Nonetheless, it set off from the port in Juba headed for Renk. Somewhere along the way, the boat hit a hippo and sank. The hippo died. The crew survived, unharmed by crocodiles. The cement sank. The metal pipes sank. The wood and plastic pipes floated down the river and are being recovered. What a waste! We lost a lot of money in that endeavor.

By the way, when I say “we” in these stories, I mean Medair, because I didn’t have a hand in them, but they affect me since I’m part of the team and work in the same projects.

2nd Quarterly Summary

July 2, 2012

I’m sorry that it’s been way too long since the last blog entry!  Since the last one, I’ve finished a rotation, had an R&R with my family in Kenya (great!!!), and now I’m 2 weeks away from the third R&R to Nigeria to attend a friend’s wedding!  Below are a few significant events and descriptions of my experiences in the last few months.  Photos are posted here, if the links don’t work.

A previous project I worked on in May was hygiene promotion in cattle camps.  The people of the cattle camps live in very remote areas, far from the main road, and thus live mostly off of the land and their cows.  This cow is growing horns to be a warrior cow – its right horn is the sword held high and the left horn is the shield ready to protect from an attack.  The man is showing that this is his cow, which gives him high status and makes him a desirable bachelor.  His pose is used in dance to show his wealth by the kind of cow he has.  The right side shows strength whereas the left side is weakness.  The people wear a length of fabric wrapped under one arm and tied in a knot over the shoulder.  The men wear the knot on the right shoulder because he is strong.  The women wear the knot on the left shoulder because they are weak.  Young girls wear this fabric with nothing underneath until they are married or promised to marriage, around the age of puberty.  The prized cow wears a huge bell on its neck and leads the herd.  Most young men are seen carrying a weapon – a large wide knife or a spear, which is to protect their cattle from raids by other tribes or wild animals.

In the morning, cows are taken to the river to drink and fields to graze.  On hands and knees, younger boys and sometimes girls spread out the dung made in the night, to dry in the sun.  They walk around with dried cow feces caked on their skin.  Around mid day, the female cows come back to the camp for milking.  In the evening, the dried dung is gathered into a pile by hand and smoulders all night.  The cows are all roped to pegs in a circle around the fire.  The smoke keeps the cows calm throughout the night.

Oddly enough, many of the cow’s “products” are used in daily life, but they do not slaughter the cow to eat.  The only time they eat the cow meat is when the cow dies naturally.  Cow urine is stored and used to clean containers.  Internet research shows that it is a natural disinfectant.  It is sometimes added to the milk for consumption of essential salts.  Boys can often be seen wearing a plastic bag on his head to keep cow urine on his hair in the sun in order to bleach his hair.  A colleague reported seeing children rushing to the cow when it was urinating so they could wash their faces in it.  I saw a boy with severe cleft palate drinking the milk directly from the cow teat.  This image of a perversion of life is burned into my mind.  “This isn’t how the world was meant to be,” is all I can think.  Risks of drinking raw milk are tetanus, tuberculosis, and brucellosis infections.  The teat can also be contaminated by diarrhea-causing bacteria.  I had the privilege to try milking a cow – it was a disaster!  No one told me the teat had to be aimed!  And I was only able to squeeze out a little piddle at a time.  We brought fresh milk back to the base and boiled it to drink.  I didn’t like it at all.  It tasted like dirty cow…not surprisingly.  The ash of the dung is spread over the arms, legs, and face to protect them from mosquitoes and flies.

The people of the cattle camps are artisans and craftspeople, making their own tools, weapons, and materials, such as leather rope, knives, spears, smoking pipes, chairs, and games.  They play mancala in cups made in the ground and with seeds/nuts.  The boys also play a fighting game using sticks lodged into limes to make a V shape.  They throw the soldiers at each other trying to get the two Vs to catch each other.

Scarification is a common ritual among the people of the cattle camps. They have the scarring on their foreheads to distinguish their tribe.  The females scar other parts of the body such as the chest, abdomen, and back with beautiful patterns to make her more attractive.  Scarring is also used by the traditional healers.  The traditional healers also use the cupping technique.  These methods seem to be related to the body humours practice of medicine.

Can you understand what a challenge it was to share hygiene messages and what a challenge it would be to see significant behaviour change?

Our faithful driver and I have developed a very good relationship.  He teaches me about the culture in a very insightful way.  He speaks English well and seems to have the insider and outsider perspective.  I really appreciate his work, his company, and our conversations.  I asked him, “What makes a woman attractive in the Dinka culture?”  He told me that it is attractive for a woman to be tall and thick, with black gums, small, perky breasts, and straight teeth.  I asked further about the teeth issue, because most people have teeth that stick out, making it difficult for them to annunciate.  He said that those are the attractive teeth – straight ones.  I laughed so hard because he meant that they should stick “straight” OUT, not as we think of straight teeth being straight DOWN and aligned.  The way the teeth get that way supposedly has to do with the cultural practice of pulling teeth.  The front 4 bottom teeth are pulled as adult teeth, so most of them do not have bottom teeth.  The top front four teeth are pulled as baby teeth.  The way they do it is by sticking a tool between the gum and the tooth and leveraging it out!  Painful!  This apparently damages the tooth socket so that when the adult teeth grow in, they stick out.  The Dinka brush their teeth very well with a local plant twig and most of them have very white teeth.  In this conversation about what makes a female attractive and as I’ve been told otherwise, I have thick calves and small, perky breasts, BUT I’m too short, and my gums are so pink! and my skin is weird and pink, and I have too many teeth and they are the wrong angle, and my hair looks like sheep hair, and I like raw vegetable like a wild animal.  I am quite the ugly oddity in this culture.  It doesn’t do well for my dignity.

In June, I have been working on Hygiene Promotion in Primary Schools. This has involved reading a lot of material, putting together a manual for the CLOs to follow, providing a 2-day training for teachers in 2 of our 1-year project sites, and hygiene campaigns with the students.  In one state, we trained 19 teachers from 7 primary schools; and in the other state, we trained 15 teachers from 7 primary schools.  Topics of the training include the hygiene messages and how to teach them using teaching aids (cloth flipchart and laminated illustrations), the life skills-based teaching methodology for practical topics (such as hygiene), how to create a lesson plan about hygiene using the life skills-based approach, incorporating handwashing, good defecation habits, and drinking clean water into the school’s daily activities, and making an action plan for improving the hygiene status of their school.  The training in the first location went beautifully!  The teachers were engaged, interested, respectful, dedicated, and a good mix of male and female teachers.  Being in the north part of South Sudan, many of the teachers were trained in north Sudan.  The training in the second location last week was rough.  The teachers, all male, seemed to be unmotivated, have low capacity and analytical skills, mostly interested in trying to get more incentives from us and/or finishing the training as soon as possible, don’t seem to care for the students, and quite disrespectful.  The culture here is rather disrespectful to women, who are seen more as a household resource than as people.  I was really feeling the effects of this as I was putting myself in a trainer position over these men who must have felt threatened and several times put me down, criticized the training activities as I was teaching, taunted me as a group, and many other more discreet things.  I was co-training with the CLO, a male, who picked up on this as well.  I think he didn’t know how to intervene, and probably saw me trying to fight for myself well enough.  I told them directly at the end of the first day that I felt disrespected.  They denied it, and continued.  I really wanted to respect them, but when it came down to doing some of the activities like make the lesson plan, they were incapable of applying the information we had shared.  In the action planning, they were incapable of creating action points, listing materials needed, making one person in the group responsible to ensure its completion, and setting a due date.  For example, after suggesting an action point to one group, I asked them when did they expect to have it finished, pointing to the “due date” column on the paper.  The scribe wrote down “May 10”.  I reminded him that this is June 29, today so did he mean July 10?  He said, “No, May 10; we are just assuming.”  After trying to figure out what he meant, I reminded him that these are REAL action points that I expect them to share with the school headmaster and actually complete.  He didn’t get it.  He kept saying, “We are assuming.”  Incredibly frustrating.  There was, of course a language difficulty, but their comprehension of the activity itself was poor and inexplicable.

Throughout the 2 days, I had many ugly thoughts.  As I was cut down, I held my tongue to tell them things like how many places in the world I’d been to, and that I have a master’s degree, and that I have a better understanding of the universe than they do, and that I’ve had more diverse experiences, etc.  Shame on me!  What right do I have to exalt myself over them?  These things don’t make me better or worse, or more meaningful, or more valuable, or more of an authority than they are.   Are these things even at the essence of my being?  These are the world’s standards of exultation.  My identity is in Christ, and so is theirs.  Each one is a beautifully created image of Christ, with a high calling and important purpose to serve on this earth.  Each one is more valuable than pearls and gems or education level, or experiences, or travel.  They carry something special, somehow reflecting the Kingdom of God, no matter how distorted.  I am just as fallen as they.  I am just as saved by Christ.  Coincidentally, the devotion shared the morning of the second day was on humility.  And the next chapter of the book I’m reading (which I picked up the evening of the second day) is on humility.  I got the message and I thank God for His correction and guidance on how to bring the kingdom of God to earth, how to truly love and to love truly.  I am still learning to love.

Also in June, Medair South Sudan had our annual WASH conference, strategy conference, and our second quarterly meetings, all in a row.  It was intense and difficult!!!  There was a guest lecturer who shared a lot of daunting and depressing information about where the UN thinks South Sudan economy is headed.  The government is running out of money.  One of the things that he shared was that due to the economy, essential items, like bread, are getting very expensive for the majority.  The government’s response is to make rules and regulations for standardizing the size and ingredients of all bread made for sale.  I’ll leave it at that.

Last time I was at one of our 1-year project sites, in upper Upper Nile State, the team’s security was compromised in a laughable situation (retrospectively).  Sudan is across the river where there is an army base.  On either side of our base are army barracks for the south.  One fine Sunday when I was in the office planning to have a picnic lunch outside, we heard gunshots.  Actually, I was oblivious, but luckily my colleague heard it and knew what it was.  He walked outside to find out what was going on and I stayed inside the concrete building thinking, “He’s crazy to go out there.  I will just stay right here and keep working in the protection of these lovely concrete walls.”  After what seemed like a long time, I walked towards the door and peeked outside to see our ENTIRE team in a line along the fence at the back of the compound, facing Sudan across the river.  Apparently, they weren’t concerned, or they were completely oblivious to how dangerous they were being.  I went into the kitchen (still very protected) to get my food, lamenting that I would not get to have my picnic outside in the nice weather.  The others trickled in and also got their lunch.  Then POP POP POP from the other side of the compound and much closer than the first ones.  I quickly took my food into the storage room, which is our safe room and hunkered down, continuing to eat my lunch.  Others on the team loaded our evacuation supplies into a vehicle.  Soon enough, the news came that soldiers from our side had crossed the river into ANOTHER COUNTRY WITH WHICH THEY ARE NEARLY AT WAR, stolen some goats to eat and brought them back while being shot at.  The second round was our side shooting back as they were increasing their numbers on the shore of the Nile for intimidation.  All this movement, action, and stress was over a few soldiers having the audacity to steal goats from the enemy because they were HUNGRY.  Again, “This isn’t how the world was meant to be!”  Still, we had to remain alert in case of escalation, so we each got our own essential personal belongings together (including our quick run bag) and continued working.  After a few hours, we sent 2 of our team to communicate with the local authorities for advice on the situation and if we should evacuate or not.  In the end, we didn’t.  A very eventful day!

Lastly, I will tell you The Phone Saga.  While in Kenya, my phone was lost/stolen at one of the lodges that my family and I were staying in.  After my family left for the states and I was in Nairobi, I considered purchasing a phone at the Nakumatt (the Kenyan Wal-Mart), but I didn’t feel like going to the mall.  And I asked one of our logisticians in Juba how much a simple phone costs there.  He said it was 30 South Sudanese Pounds (SSP), which is about 10 bucks – a good deal.  Once I arrived in Juba and gave him the money with a description of what I needed, he shared that he thought I meant a phone battery, not a new phone (even though I didn’t say anything about a battery).  A phone would actually cost 100SSP (about 30 bucks).  Fine. I gave him the money.  The next day, I was happy to receive a new phone and charger.  I charged it until it said it was full and then went out with a driver and Medair vehicle to get a visa for Nigeria for my next R&R.  After we finally found the place, the driver had another errand to run and left me standing in front of the gate on the street.  I quickly found out that no one was in the office, even though it was 10am.  The guard said he couldn’t do anything about it, but I should wait because the person I need to see is “coming” and “on his way”.  I decided that wasn’t good enough and took out my phone to call the driver to come back, but somehow, the battery was already dead!!! Now I was stranded somewhere in Juba without a working phone!  (We all carry a printed contact list.)  I asked the guard if there was a phone charging station nearby, and he walked me to the closest one, around the corner.  These are small kiosks with lots of electrical plugs and they charge a nominal amount to charge the phone.  I waited ‘til it had a decent charge and called the driver.  The driver came just as someone appeared from inside the gate, somewhat surprisingly…why hadn’t the guard told me there was someone inside to attend to me???  This person said he would call “the big guy”, who was supposed to be on his way.  My driver is now impatiently waiting for me.  The big guy was around the corner and came quickly.  We did our greetings and then I found out that the man I had spoken to on my previous visit did not give me a complete list of the required documents, so I would have to return yet a third time…

Back to The Phone Saga:  I brought the phone to the logs guy, who informed me that it is common practice for the phone seller to remove the original battery and replace it with a short-life battery before selling it.  It is apparently normal.  I asked how much a better battery would cost? 30SSP.  I shelled out the money to finish this off, just to have a working phone!  I went to the field with my short life battery, new phone, and charger.  In a freak accident, a laptop fell off of a desk and severed the cord of my new charger.  I borrowed a charger from a colleague and sent a request for a new charger.  I would send the money back to Juba with a colleague.  The reply informed me that the new battery would actually be 40SSP, not 30, and the new charger is 10 more SSP.  I sent the money.  Before I returned to Juba, the phone stopped charging and stopped turning on.  “Maybe its just the crap battery.  It will be fine with the new one.”

Upon return to Juba, I very happily got the new battery and charger.  It still wasn’t turning on.  The logs guy I had been communicating with went on leave for 3 weeks, so I had to bring all this drama to another guy who said this was a personal matter that he didn’t want to deal with.  Apparently, he still gave it all to a driver/logs guy to sort out and the conclusion is that the phone is mysteriously broken.  My manager is kindly lending me a phone right now, but the phone saga continues.  And continues to annoy and frustrate me.

After returning…

March 31, 2012

After returning to Juba from Addis Ababa, I attended the Medair South Sudan Quarterly Meeting over 3 days.  All management on the programs and program support side were in attendance, and that includes me!  As I looked around the room, I felt distinctly young and inexperienced in comparison to the roughly 20 others in attendance.  I felt unworthy to attend these meetings, wondering what can I contribute the management of Medair’s work in this country?  I know it is a significant privilege to sit among these movers and shakers of humanitarian aid, to hear their dialogues, ideas, solutions, and strategies.  I do not take this for granted.  At the same time, I must recognize that I attended this event because I am in a management position!  Somehow, Medair sees me as belonging in this group!  This amazes me!  I know I must live up to the expectations of a leader, and I know that I have what it takes.  I will learn as much as I can from here, knowing that it is all in God’s plan to prepare me to do greater things!

As I was feeling all of this humility, I had to give a presentation.  I am proud to report that after years and years of practice classroom presentations, I have successfully given my first professional presentation to colleagues at the Medair South Sudan First Quarterly Meeting of 2012!  I presented on Medair’s approaches to health and hygiene promotion (HHP), my team members (the Community Liaison Officers [CLOs]), the funding proposal requirements for HHP (which forms the field activities workplan), my objectives and tasks as HHP Manager, challenges of HHP, and support requested to accomplish the work.  My line manager (the Deputy Country Director [DCD] of Programs), the DCD of Programme Support, and the Country Director each told me that my presentation was great!  This meant a lot to me because I struggled with public speaking for a long time, and I feel that this is a major stepping stone in my lifelong journey.

After the quarterly meetings, I planned to go to Awerial, the first field location that I visited.  I rode in the land cruiser for 1.5 hours to a town in between Juba and Awerial, called Terakeka.  There, we met up with another team member to exchange staff between vehicles.  Here, I was also informed that the CLO would be returning to Juba because his family had just arrived by barge from Upper Nile State to Juba, and they were all sick.  This is undoubtedly a good reason for him to leave the field, but it made me wonder what I would be doing while he was away, since we are partners in our HHP work.  We continued by car to Awerial, but on the way, I was informed that I would not be going to Awerial, but rather, I would be mobiling in Caltok with the health team to fill in for Alfred.  “Mobiling” is a term used here to refer to camping in the bush.  Though it may seem that being in Awerial is in the bush, in fact, it gets bushier.  We sleep in tents, bring jerry cans to collect water from the borehole, bring toilet paper in expectation of no latrine, and sometimes bring our dry food supplies with us to have a local woman cook for us, not because we are lazy, but so that we don’t have to bring pots, pans, charcoal, etc.  So I found myself dropped off in Caltok to assist with a measles vaccination campaign.  My roles at various times included: crowd control (which I hated!), rolling cotton balls, tallying ages of children vaccinated, washing the upper arm to prep for the injection, and unwrapping syringes.  We had 2 teams of 4 people and a driver to set up for a few hours in several locations in the area of Caltok over 4 days.  I stayed for 2 nights before we finished.  We received fresh, frozen vaccine each day from the base and kept them in coolers with freezer packs.  In some of the areas, we also distributed Vitamin A supplements to prevent blindness from deficiency of this essential vitamin.  It was very interesting to be a part of this campaign because I gained hands-on understanding of the program and its challenges such as quality control, maintaining integrity, treating each person with dignity, and reporting. It was easy for the team to make the injections a priority over the people.  This seems to be a common struggle in humanitarian aid where donors have expectations and helping is a job.

I try to imagine what it must be like for these people (especially the children) when 4 people, one being an odd color, come in a big machine with all sorts of odd things, telling them to come prevent a disease for children 6 months to 15 years old, refusing to give to anyone else.  Then the people come to the foreigners because they are curious about us, and they see us with sharp needles, injecting some kind of magic liquid that does who knows what, and making children cry and scream in pain.  Would you let your child come into our hands?  I would be skeptical.  However, it seems that many of these people are aware of the disease of measles, they know that it kills (aided by the fact that 7 children have died recently of measles in the area, which is considered an outbreak), and they are aware that there is such a thing as vaccines to prevent disease.  Many are skeptical and afraid.  Many children scream and cry.  Many of the older ones walk away with a smile, happy that the injection wasn’t as painful or horrible as they thought it would be.  Some of the reactions are funny, and some have made me very sad.  One that made us all laugh was a 6 year old boy who was apparently clueless about why he was standing in line.  When the injection was given, he was overwhelmingly shocked that the injection caused pain, and that shock quickly turned to fear.  The moment the needle was out, he turned and ran away as fast as he could.  He didn’t cry, because the pain was minimal, but the surprise had scared him and he knew he just needed to get away!  Some other children feared the injection so much that they fought and kicked and screamed, despite being yelled at, whipped, or slapped by the adults.  These cases made me very sad.  I know this is how I reacted as a child when I had to get an injection.  My mom has told me a story that 3 nurses had to hold me down because of my fear!  Now I know how difficult it was for my mom in that situation, knowing the injection was necessary but dying inside to relieve my fears and calm me down.

Yesterday, we first drove 30 minutes further from the main road to a village.  We sent one of our team out to mobilize the community to send/bring their children aged 6 months to 15 years to the church to receive the measles vaccine.  Everyone knows where the church is, and it is usually central to the community, but I wonder if anyone was excluded because they are not welcome at the church, they do not attend the church, or for any other reason.  Though Medair strives to serve all people without discrimination, on the field, some decisions are made out of convenience and first glance at the community, which may compromise our integrity.  While we were waiting for more children to come, there were three mothers with their children in the church.  We took this opportunity to teach them a hygiene lesson on washing hands.  I made the point that many children die of diarrhea and related to them what causes diarrhea, because they said they didn’t know.  The mothers said, “So give us the medicine to prevent this”, so I told them that as mothers, they have the power and the responsibility to be the preventive medicine to their children, and this medicine is to wash their own and their children’s hands with ash or soap after defecation, after cleaning their child’s bottom, and before eating.  During the lesson, one of the mothers commented that I must be sharing this message with them because one of her children died after having diarrhea.  I was sad to hear this, but very glad that she brought this up because it helped make the issue real to them.  I felt that this lesson was a success!

Next, one of the mothers told us that there is another village a 30 minute walk away, so we decided to go, in the heat of the day, carrying the small cooler, cotton balls, water, syringes, sharps container, and rubbish bin.  Usually when an African wants you to go somewhere, the place is “very near” and when they do not want you to go somewhere, it is “very far”.  We wondered how far this village really was, since she wanted us to go there instead of her going to tell them to come to where we were set up.  Sure enough, it was exactly a 30 minute walk.  I find this quite impressive since she didn’t have a watch and they don’t pay much attention to the time or passing of time in the bush.  In this village, we vaccinated more children under a tree, and then called the base manager to find out where the vehicles are and when we can be picked up.  He had some bad news: the vehicle that dropped us off got a flat tire, the driver changed it to the spare, and then got a second flat with no more spare.  The second vehicle came to its rescue, but on the way, developed a leak in the brake fluid, so it, too was unsafe.  He rushed off the phone to find a solution.  Medair actually employs a mechanic to maintain the vehicles, but these things still happen… So there we were, in the middle of nowhere, about 45 minutes drive through the bush with no road, away from the main road, running out of water, tired, hungry (we hadn’t eaten lunch yet and it was almost 330pm!), and wondering if we needed to return to the church and find some suitable sleeping arrangements and food.  This was contingency planning, but in the end, we walked back to the church, immunized a few more children, and a vehicle came to bring us back to our tents.  When we returned to where we left our tents, they were no where to be found!  The tents had disappeared and no one on our team had moved them.  After talking to several people in the community, we found out that the wind had picked up sometime throughout the day, the tent poles were removed and the tents were carried with mattresses and travel bags inside and piled into the tiny 2 room clinic nearby.  Still the day was not over…  When the people saw that we had returned, several children from that area came to us wanting to receive the vaccination because they hadn’t attended the previous day when we mobilized in that area.  We set up again and were able to use up the rest of the mixed vials of vaccine so that they wouldn’t be wasted.

That night, we were all happy to bathe (bucket bath inside an unfinished building) and eat a chicken stew and kisra meal together.  Kisra, also known as paper food, also known as injura, is a sorghum pancake, typical of Ethiopian food and common in east Africa.  It was an excellent meal!  After dinner, the driver informed me that my name is too difficult to pronounce, so I need a Dinka name.  My Dinka name is Akur (pronounced Ah-koo-r), which means a black and white cow.  When they explained the meaning, for the very first second, I was a bit offended to be named after a cow, but I quickly realized what an honor it is in this culture because they love the cow so much!  Their whole culture revolves around their cows: how many they have, their health, payment for marriage, renewable asset, etc.  I wondered, since the Eskimos have so many words for ice, do the cattle herders have so many words for their cattle?  In fact, the Dinka language has about 20 different words for various types of cows, mainly by its gender and color.  I admit, I think this is much more understandable than having so many words for ice, since there really can’t be much variation in frozen water…  Arising from the conversation about words for cow and names that come from them, I learned some other names.  The name “Machut” is given to a male child who comes after a child that was born and died already.  There is another name for a child whose father dies while the child is in the womb.  I would really like to learn more about these naming schemes because I think it will be very insightful to the culture, what they find important, and what they think identifies a person.

After this conversation, I fell asleep, happy to be somewhere known, comfortable and with a full tummy.  Around 11pm, the faithful driver woke me up to ask me to hand him the rain fly inside my tent because the rains were coming soon.  He happily put the rain fly onto my tent, for which I am so grateful!  The rains came loudly and I feel asleep again.

Carroll Behrhorst International Health Award!

March 19, 2012

Surprising and happy news!  I have been selected to receive the Carroll Behrhorst International Health Award at the May 2012 Tulane Graduation Ceremony.  I am honored!  “This award recognizes a student who demonstrates academic excellence and dedication to primary health care in lesser developed countries.  It is named for physician Carroll Behrhorst, who established a medical program to serve rural Kaqchikel Indians of the Guatemala highlands in Chimaltenango. The clinic served as a community health care training program as well. Behrhorst’s approach of combining health care and community development was selected in 1974 by the World Health Organization as a model for all developing countries.”  Of course, I will not be able to attend the graduation ceremony in May (the official ceremony for students who completed the MPH program in the previous summer, fall and current spring semester), but they will share a small blurb about what I am doing now in South Sudan!  I’m amazed at what God does to honor His children and bring favor to all situations!

Vignettes II

March 12, 2012


I attended a meeting with the county Health Officer, the chief of the town, and one of Medair’s Community Liaison Officers (CLOs), Oyay.  The purpose of the meeting was to plan for a Hygiene Promoter Training.  We asked them to mobilize the community, inviting all town residents to attend the community meeting the next evening.  I asked if different community meetings needed to be held for the different people groups residing there: black Christians, black Muslims, and Arab Muslims.  The chief responded that the people in this town live harmoniously, sharing all experiences.  If an Arab Muslim dies, everyone attends the funeral.  If a black Christian dies, everyone attends the funeral. Everyone will come to the community meetings, he assured me.  The Health Officer also added that they need more time to mobilize the community because, though the men are easy to find out in town at the bar or tea shops just sitting around, the woman are much harder to mobilize.  This is because the women take more time to find, as they are always working in their houses, and because they are always working, it is just so hard to bring them away from their work and the children.  The women make community mobilization very difficult; it is a problem.  I laughed at this, but didn’t share my views about this “problem”.


I mentioned to Oyay, that on the way back to the Medair house, I would like to stop at someone’s house.  The previous day, I had spent some time by the river where a kind mother invited me to her home, where I met her family and some friends.  The majority of our communication failed and ended in a lot of laughing.  She walked me half way home and made sure that I wrote down her name, Suzanne Daniel.  One thing that was communicated to me very clearly was that I was invited to return to her home the next day, which is why I told Oyay that he was free to return to the Medair house but I was on a mission to honor my invitation.  Oyay graciously decided to help me find the house and translate for us.  I thought I knew the way back to the house, but it took about 20 minutes of walking, looking, and asking, until finally I saw Suzanne waving at me from a few “blocks” away, elated to see me searching for her.

In her house, she served us both a cup of local coffee, brewed dark, sweet, and simmered with ginger and cardamom.  I love this stuff!  It has the same qualities as my favourite chocolate, which is the Lindt excellence cherry chilli dark chocolate bar.  Both have the sweetness of sugar and cardamom, the spicy taste of ginger and chilli, and the bitter, deep taste of the chocolate and coffee.  As we sat in the house, Suzanne’s friends came to greet us.  Since we had an audience of about 8 women, all no doubt with children at home, I suggested that Oyay share a message on nutrition, we he did happily.  When it was time to leave, through Oyay, I was able to tell Suzanne that I would be leaving the next day, but I would definitely come to visit her when I returned to Geigar.

I returned to Juba and then went to Pibor for a week.  When I returned from Pibor, I was given an anklet that Suzanne made for me and brought to the Medair house the day I left.  I was already gone when she came, so a Medair team member transported it to Juba for me.  Isn’t that such a sweet gift?!  It makes me so happy!

In the bush.

Right now, I am sitting on a plastic chair in front of my canvas hut in Pibor overlooking a small river.  On the other side, there are 7 Maribou Storks standing very still.  They are HUGE!  Every time I see one, I am baffled!  There are also some white Ibis.  Last night, I heard a lot of grunting and pig-like noises, which indicates that there’s a hippo nearby.  The town is down river a bit from here and I can see it along the bend.  The other side of the river where the storks are standing, isn’t developed, so it feels like I am looking out over a nature preserve.  The other day, a colleague bought the legs and hind quarters of a freshly caught gazelle.  She cooked it up and it was actually really delicious!  Of course, it is illegal for the gazelle to be hunted, but she didn’t care about that when she bought it – it was already dead after all.  There are lots of lizards around.  And this place has the most flies I have ever seen.  They are attracted to any moisture since it is very dry here, which means they like skin. They are soooo annoying!  But not as annoying as the mosquitoes in Awerial.  At least the mosquitos only came out for a few evening hours, though, whereas the flies are annoying all day long.  Tonight, we will go into town for an Ethiopian dinner.  Most of the shops are owned by Ethiopians.  We are pretty close to Ethiopia here, actually.  All the ladies wear beaded necklaces, bracelets, and headpieces.  The headpieces are like an engagement ring, worn by the young girls who are promised to a man who is paying the dowry price, usually in cows.  The colors of the beads are chosen based on the girl’s birth year, the birth year of her female ancentors, and the birth year of her fiancé.  My birth year colors are blue and green, so I’m having a necklace and bracelet made in these colors to be transported back to Juba for me by a Medair team member.  Yay!


February 20, 2012

They will meet.
Six of us drove around all day to have meetings with various community elders, chiefs, and to visit the clinics that Medair is helping to rehabilitate and capacity build.  I came along to attend meetings with the boma (village) chiefs to request that they mobilize their people for a community meeting at which Medair’s Community Liaison Officer will attempt to get the community to realize how much improving their hygiene practices will help their lives, and then present them with an offer of a Hygiene Promoter Training.  The community then selects those to be trained.  We drove north from Geigar on the highway, then headed into the bush on dirt roads that only exist during the dry season.  Because they are destoyed each year, the roads are never constant, and a new path is forged each year, sometimes several new ones.  We tried to find our way on these roads making decisions of direction at dozens of forks in the roads.  Each time, someone in the car predicted, “They will meet!”  Sometimes, this was the case that the path diverged and converged after a row of bushes, but sometimes they did not meet.  None the less, we made it to our destination by following the tiny white fleck on the horizon that signified a building, which meant a town, which meant it could be the town that we are seeking.  Some of those in the vehicle had been to this town, but never from the direction we came.  We didn’t have a GPS or the coordinates of the destination.  Once in the town, we went to the clinic, but it was closed.  Where is the nurse?  As we drove through town, we saw familiar faces of projects past, who each tried to help us accomplish what we wanted.  One chief was notified we’d arrived and came to meet us under a tree.  We were told the other chiefs were coming.  We waited and waited.  And so we met with the first, as we waited to meet the others.  They never arrived and were reported to be unavailable and far away.  But alas, “they will meet”.  My path will diverge and converge with that of so many, but in the end, “they will meet”.  All paths lead to the same place, and from every path, you can get to where you are going.  They will meet.

The nurse, as it turns out, was delivering a baby.  We saw him at the clinic later, drunk as a skunk.  He was proud to show us a series of rabies vaccine that he’d purchased in his pharmacy side business and was keeping it in the vaccination cold chain fridge.  My 3 rabies vaccination shots cost over $700 in the US.  I wonder how much he paid for his.  And did his stay in the cold chain, or were they in fact useless now?  Also at the clinic was a pile of boxes of expired medications and some loose, uncapped needles, provided by the Ministry of Health.  They weren’t used because 1. they were kept in boxes, not unpacked so that it could be known what was in stock, 2. the clinic staff aren’t trained to prescribe some of the medications, not knowing what they are for, and 3. there is no feedback system between the clinic and the Ministry of Health, so whatever is sent is a guess of what is needed at the clinic.  I also spotted a lab room, all equipment covered in dust, obviously unused.  A centrifuge, a microscope.  While we were at the clinic, a young girl came to tell this nurse that the woman who delivered the baby was feeling light-headed when she walked.  At the same time, a midwife came to the clinic, so the girl also told the midwife of the problem.  The nurse barked at the girl saying, “Who are you to come tell me what is happening?  It is up to me to go check on the patient to know what is happening!”  One of our staff asked the midwife to please visit the patient, and explained to the girl that the mother had lost a lot of blood and needed to take some iron supplements.  The midwife said, “Why should I go now?  Was I called to attend the birth?”  She hadn’t been notified.  The nurse insisted that he would go.  Our staff member wanted to keep this drunk nurse away from the patient, so she pleaded with the midwife that it was her responsibility to go.  The midwife agreed to go, but only for the sake of our staff member, but otherwise she wouldn’t because of the drunk nurse.  This is apparently how the clinic is functioning currently.

We drove into the returnee camp in Renk to a particular hut with walls and roof of straw and wooden supports.  Hardly a building.  This was the administrative office of the returnee camp.  Thousands of people fled from southern Sudan into many places, including the north of Sudan, many settling in Khartoum.  Now that they have a country to return to after decades of building a life in a foreign place, they loaded up as much of their household as they could onto trucks and barges heading south into South Sudan.  Now, they are in the northern most tip of South Sudan, waiting for transport further south, back to their homes or to better cities.  This is a temporary camp where thousands of people have set up dwellings using the furniture from their home in the north, and various materials provided by NGOs offering aid.  Their roofs are bedframes and chairs.  Their walls are blankets and the back of cupboards or wardrobes.  Their tables are trunks of belongings.  They largely rely on the aid provided – food provisions, dwelling materials of sheets of plastic and cord, soap, etc.  The land is not their own, and so no care is taken to keep the environment clean.  This contributes to poor health throughout the camp.  On this day, our goal was to plan for a community clean up day – one day where each and every member would clean the area around his/her dwelling, gathering up the trash and bringing it to a nearby burning pit, and sweeping the dirt for debris.  The camp is divided into sections 1-8, each with its own chief and Medair-trained hygiene promoters, all of whom were present at the meeting.  We discussed how the clean up day should be, pay, voluntary work, where the rubbish pits should be, how the rubbish should be transported, who will clean up the open areas that no one will claim, how we can motivate the community, and the responsibilities of the involved parties: Medair, the chiefs, the HPs, and the community.  After the plan is set, one of the chiefs begins to argue that this job is not a 1-day job, it is, in fact a 5-day job, requiring 5 days of pay, but also one full day of cleaning the environment is too tiring.  Here is Obstacle 1.  We try to explain that this is a short campaign to begin the cleaning of the camp, which is an ongoing process.  The community is responsible for keeping their area clean and Medair wants to facilitate a 1-day campaign to get the bulk of the work done so that maintenance of cleanliness is easier.  They see this project as Medair’s project and Medair’s goal that they are helping us to achieve.  They don’t need the camp cleaned for themselves, but Medair needs it clean for the donor’s approval, to show the progress that made with the loads of money that we apparently have been given to provide for the people everything that they need (and apparently more that they don’t, like a clean environment).  Obstacle 2: The chiefs want more pay.  The HPs want more pay.  We try to explain that the money promised to them for their participation is an incentive, not a salary.  They are volunteers, responsible to the community, and Medair wants to help make their hard work appreciated.  This is not understood, for they are losing a whole day to this project, when they could be…doing what?  Most of them don’t have another income-producing activity to be sacrificing time away from.  Obstacle 3: They need rakes, 2 per section.  Agreed.  Obstacle 4: This is not spoken directly, but the biggest obstacle of all is that Medair is trying to help the inhabitants of this camp to live under a set of minimum standards (“Sphere”) of dignity, health, and life, but they are refusing to participate in this achievement, and even deny a desire to meet these minimum standards, such as living in a clean environment.  These standards are those that should be attempted to be achieved even in the most grim emergent circumstances.  And they reject even that.  What is Medair to do?  All plans for the clean up day were put on hold until it could be presented at an aid coordination meeting to see which other NGOs can contribute.  But no matter how much is poured into such a campaign, if the community refuses to follow up with keeping the environment clean, then the camp will be in the same state as it is in today in about a month.  If they don’t want it, why should we do anything?  It can’t be forced.

By the way, some of the families living in this camp actually have vehicles!  The question that comes to mind is, if they want to go south, why don’t they just drive?  But why would you do that when IOM is offering a free barge ride?  Some of the dwellings in the camp are not occupied, or have one occupant and loads of household items.  The family brought all their things to Renk and left one person to guard it while they returned to Khartoum to live their lives, waiting for the free barge ride.  When the barge is near to Renk, they will pay for transport to return to Renk to load their things onto the barge from there.  These are the things that are happening, the ways people are surviving and taking advantage of the systems.  I don’t think its wrong, just ironic.  If you wanted a new life in your new country, wouldn’t you sell all your things, travel light and hope to get you and your family all the way back “home” safe and sound?  Why hold on to all the “stuff”?

Mobilization is a frequently used and heard word among my colleagues.  To move.  The first step to any project is mobilization, of the community.  We want the community to become active in what we want them to do.  Sometime we try to let them discover that what we want to do is also what they want to do, but this is difficult and often not achieved.  Community ownership, of a movement, of an idea, of a project is essential to the project’s success, but very difficult to achieve.  We think, “If we could just get everyone to pitch in just a little time, effort, money, then this problem could easily be solved!”  But when the ownership is lacking, so is the will to move.  In Awerial, DE and I were driving to a clinic that Medair is rehabilitating.  On the way into the town, there were hundreds of people migrating towards one point in town.  At that point were hundreds more in colorful garb, singing, shouting, and dancing, while many of them were carrying bundles of dry grasses used for roofs and fences.  A large group of them danced and sang their way to the market in town and stopped at each shop to request a donation.  What was happening, here?  Mobilization!  For what?  Rebuilding the church.  Not just the church, their church.  The community’s church that everyone attends and cares about.  I saw the beauty of community mobilization under community ownership!  Wonderful!  But how do we get them to mobilize for a clean up day or a hygiene lesson?  In Geigar, with Medair’s Community Liaison Officer (CLO), the payam (county) Public Health Officer, and the Geigar chief, we planned a community meeting for today, Monday late afternoon at the 4 large trees by the river, a nice shady spot where the sun sets somewhere into Sudan (the border of which is marked by the river).  The CLO and I were out all day where “they will meet”, and upon our return to Geigar, started to walk to the 4 trees.  We heard horns tooting and many people shouting, and again, all people seemed be walking through town to one point.  Could it be?  The community is so mobilized for the community meeting about hygiene promotion?  Were they calling all the people to come, follow the horns, for something powerful is happening among us!?  I was excited but the CLO was skeptical.  We asked a couple boys what was happening.  “Someone has died.”  We asked an older man and the report was that 3 people were found floating in the river, dead.  We got to the place from where many people had recently scattered and again asked what happened, if there was violence involved, if they had been shot?  We always have to be aware of the current events to keep track of our security level.  The real story was that an elderly woman left her home while everyone was sleeping and apparently drowned in the shallows.  Her body was found this morning and they had just buried her by the river.  The mobilization was for the loss of the grandmother of this community.  Their grandmother.  Thus, the community meeting could not possibly take place, as it was said that this was her day and they celebrate her life, for this was her time to go.  Mobilization is possible.  Not even just possible, but they are better at it than any community I’ve seen in the US.  Start singing and dancing and everyone comes to help and celebrate.  Blow the horn and all come to mourn.  Beat the drum and they will all come to share in a dance.  As long as its their own.