One Month of War!!!!!!!!!

Can you imagine?
November 18th the war broke out in Ezo.
I was a blessed one evacuated by the United Nations.
But.......
My parish priest, my parish community, my beautiful pregnant women, my wonderful Gynecology patients, my local staff have been in the bush for one month now.
They are very low on food and water.
There have been 3 Maternal deaths in the past month since I left!!!!
Of course 3 babies as well.
The County Health Director sent me a copy of the "War" update report.
2 of the Maternal deaths were for simple malposition of the baby. (baby not in correct position)
Easily fixed with a less than 30 minute Cesarean Delivery.
1 death was for Post-partum hemorrhage.
Usually fixed with some basic steps and medicines.
If needed last resort (and I mean very last resort) to save the mother's life a hysterectomy.
So I feel like I want to know which one of my BEAUTIFUL pregnant patients that I love and make laugh attempting to speak Zande died?
Which 3?
I see all their smiling faces.
Please pray for them all.
I am here SAFE in Nzara with the Comboni nuns working at their hospital. So many interesting cases here.
A lot of severely dehydrated and malnourished women because no food or water in the bush and some manage to escape and make the 5 hour ride on the VERY DANGEROUS rode to Nzara from the various war zones.
Hoping that Ezo "cools" down so I can go back.
The United Nations does a "security" assessment.
I am so needed there.
Please pray for my parish priest Father Jacinto.

SAFE!!!!!!!

Thank you to all my friends, family, colleagues and prayer warriors!!!!!
I felt the prayers, thoughts and well wishes!!!
Since Tuesday afternoon, I have felt peace and security in my heart!!!!!
Today Thursday, I am in Juba the capitol city of South Sudan.
CMMB my organization is so wonderful!!!
They wanted me to have a week rest so I am at a hotel here in Juba and resting.
Of course there are some ground rules.
Do not leave the hotel alone.
Do not walk alone.
Agreed!!!!!!!
Of course I continue to pray for my beautiful Ezo and it's people. Who are STILL living in the bush in fear.
No food, no water.
Now it has been 2 full weeks since the conflict/insecurity/war started.
A person in Yambio told me yesterday that the pregnant women and children are sick. Living like that now for 2 weeks. Malaria, Typhoid, hunger, stress.
Many have left South Sudan to go to the Congo as refugees. Which is ironic considering we have a huge refugee camp in Ezo for the Congolese refugees. I am told it is completely empty.
Here I am enjoying running water, electricity, a soft bed and food.
I feel guilty. But I feel happy to have such things.
My mind is in conflict.
Should a missionary volunteer enjoy such luxuries?
But I am grateful to CMMB for being so caring to me.
When my week is up, I will maybe go to Nzara, with the Comboni Nuns who have a hospital there to work until Ezo is ready for me to come back.
Unfortunately in Nzara there is no Operating Room (Theater). But they DO have an ultrasound machine.
So this is sad to send patients to another referral hospital (Yambio) where they will NOT receive excellent surgical care.
But such is life in the Mission.
Like one of the CMMB staff said to me when I was saying to just send me back to Ezo.
"Dr Rachael, life has no spare. We need you, secure and alive."
Thank you Moses and thanks to all of YOU who pray for me and care about me.
God bless you abundantly!!!
Please pray I may go back to my Ezo to help all my beautiful pregnant mothers and lovely women!!!! They need me but I need them more.
They are my family and in my heart.
Please pray for those in Ezo.
Please pray for Peace in South Sudan.

KIDNAPPED!!!! I WAS TAKEN!!!!!!!

Yes.

Just when you think you are safe after being evacuated from the war zone, the conflict area. Just when you think things are better, they can become much worse very fast.

Yesterday, Sunday after Mass, at 10:30 AM I decided to exercise. Take a vigorous long walk (3-4 hours) for the first time since I left Ezo. In Ezo about 3 times per week I do so. Every day I take about a 1 hour walk. This helps me to meditate, clean my mind, and think better.

The streets were actually full with mostly women and children walking to and from church. At no point was I alone on the road.

After I crossed a small stream that had some wood covering it as a primitive bridge, a young man of about 18 asks me “Where are you going?” Now please understand that here every day, hundreds of people ask me any place I am walking this question. This is common practice. Even little children every day ask me this. So as per usual I told him, “I am walking.”

“Where?” he asked

“Just for exercise or sport” Funny how since no one except some soccer players do exercise, this is a difficult concept to grasp. But I felt this young man was a little more aggressive as he stood up and walked out into the road to ask me.

I continued walking. Then when I reached this little church, I just felt I should turn around.

But too late….

When I walked past that boy again, another boy who was drunk came out into the road and told me to stop right there. Since he was drunk I kept walking as I was talking telling them that I was going home and was just out walking for ‘sport’.

The first boy runs out into the road and tell me to STOP right there. Or he will arrest me. I asked how he could arrest me if he is not a police. He ran and from behind a tree grabbed a huge army rifle and cocked it pointed at me. 

I tried to get one of the 30 or so women and children walking on the road to help me but NO ONE defended me or told him to let me go. 

Maybe they were all scared. 

Very sad and scary situation when everyone looks away pretending not to see you, when NO ONE defends you, but I understand they are scared of them also.  

So I stopped walking.

He then told me to go and sit down. That I was walking on his territory and he does not know me. I could be a spy.

Oh… so I understood, he is a rebel or Arrow Boy or SSNLM (South Sudanese New Liberation Movement) person.

I explained I am a volunteer doctor working for free in Ezo helping HIS people, his wife, his mother, his daughter, and his sisters. I am with an organization called CMMB. I am a friend to all people and in Ezo have cared for hundreds of Arrow Boy women.

Of course this means nothing to him. He tells me I need to explain all this to his boss. I said fine. 

After 20 minutes his ‘boss’ arrives who also is intoxicated and again same questions, same accusations, then same explanation from me.

He states that I need to go and see his boss in the bush.

I asked him to please have mercy. I am sorry I was on his territory. Call the Arrow Boys in Ezo. I have cared for many of their women. Please let me go, I will never come here again. 

No, get on the motorbike and let us go to the bush to his boss.

So we drove into the bush for at least 45 minutes. 

Very scary as we go deeper and deeper in the bush, 

I started to quietly cry and then he yelled at me not to cry because someone on the road could think he hurt me. So I had to force myself not to cry. 

Not as easy as you would think.

Then we arrive to an area or compound where there were at least 50-75 men each with at least 2-3 rifles around their shoulders.

OH MY GOD!!!!!

In the back hiding in their Tukulos (huts) are some women and children. But they are ignoring me.

I am told to sit down.

I am told that this man in the middle is the Commander.

OK…..

He asks me what he should do with me.

I told him to please forgive me. I did not know it was his territory. Have mercy. I am a volunteer Doctor. I receive no pay. I help all his people in Ezo. I asked him to call his fellow rebels in Ezo to ask them about me. I explained that they all know me and love me.

He asked me why I was walking. I tried to explain for exercise. He does not get the concept. His younger men try to explain for sport, just to exercise. I explain, I am fat and want to reduce. He also does not get this concept and wants to know why I want to reduce. I try to explain for health. I find it so ironic that being fat and NOT doing exercise it more understandable to these people than trying to do exercise and reducing weight.

He states that he does not know who I am and someone needs to verify my identity. I told him let us call CMMB in Yambio. He states he does not know CMMB.  He will not call anyone from CMMB. He does not know or trust them. Who else?

I asked him if he trusts his own Arrow Boys or SSNLM people in Ezo. He said he does. I told him to call them. He apparently has someone do it and they tell him I was in the bush hiding with the Priest, that the priest is my friend.

He asks me if the Priest can verify my identity. Yes he can.

OK call him.

My FREAKING Network is not functioning. Also I have a new phone since my other one was not working and now was stolen from the CMMB compound in Ezo, that has all the phone numbers. On this phone I have 2 Priests number and the Deacon.

He tells me to give him the number. He goes to make the call. As the network is very crappy there in the FREAKING bush, it was difficult to call out.

Meanwhile the spokesperson of their group, the SSNLM (Arrow Boys/rebels) arrives and he is more educated and realizes they need to return me before they have trouble. He tells them from what I can gather that I can NOT go to the Congo with them. Thank God.

Finally the Commander finishes the call and tells me the priest identifies me and confirms all that I have said is true. OK. So let me go, right? NO…

Now he states that if the other tribe or the government sees me leaving they will kill me and blame it on them. So what can we do? Call the priest back and have him send someone to get me.

He states, “When a shirt falls into the river in the water what happens?”

I state, “It becomes wet.”

He states, “Exactly.”

I absolutely do not understand what he is trying to tell me. But later on someone explained that this means I need to help him.

He asks me what I can do for him.

I explain as a Doctor, if there is anyone sick, I can take care of them. I can help any woman here who is pregnant.

He says No, that he wants money and medicine.

I explain that I am from Ezo and had to be evacuated and all my things have been looted (stolen) in Ezo, that even to eat CMMB is the one to feed me.  That even the clothes I have on were donated by one of the midwives in CMMB.

Also for the medicines, if he wants we can go to Ezo and I can get medicines but here in Yambio I do not know even where they keep the medicines at the hospital. I explain I am a missionary. I have NO pay. No money. No medicine here.

Then he asks if I can connect him to the U.S. Embassy so they can help them. He tells me that God allowed me to come here to help them connect to the USA for help.

So I told him that when he releases me and I go back I can try and see what I can do for him. He likes that answer.

Then three hours later at 3:00pm still no one has come to get me. 2 journalists arrive, to interview the SSNLM and hear their demands. The journalist is very curious about me there. I can’t understand anything but he is asking about me.  The Commander explains something to him and starts to laugh. I see that the journalist is not convinced. When the journalist shakes my hand, I do NOT smile and I shake my head NO.

Apparently the Journalist goes back to the town and asks at the Curia (the Bishop’s house) if anyone knows me. They explain that yes and they are trying to come and rescue me. But they are having problems. So they send the motorbike driver (an Arrow Boy) who brought the journalists in the first place out to the bush to get me.

Meanwhile I am still in the bush. It is 4:00 pm and they are getting very anxious about me still being there after 4 hours. They keep saying that if the priests were serious they would have come and get me. They also say that they must leave and go to the Congo and to other places and I am delaying them. Now is the first time I get really anxious because I realize this is how people get shot and killed when the captors get nervous and want to get rid of this “problem” which by the way they created!

Then God had mercy on me and it started to rain. So they were distracted. We waited until the rain stopped. They could not leave either in the rain on motorbikes.

So I suggest we call CMMB. They will send a truck for me. They agree. I call CMMB. They of course immediately answer and say they will come.

Meanwhile the Arrow Boy motorbike guy comes and puts the priest on the phone who tells me to get on the motorbike and leave immediately and not to wait for CMMB to arrive because these people are now wanting to leave the area and wanting to get rid of me.

So I get on the bike and back we come. We go to the Curia. I called CMMB who immediately arrives to get me. But the Arrow Boy motorbike guy wants to take me to the National Security office to verify that I have not been physically harmed by the SSNLM/rebels.

CMMB people tell him, they will take me in the truck. So we go to the National Security Office. The director explained to me, in his opinion, who these SSNLM people are, their etiology, and their goals. He tells me do not make the same mistake again walking, crossing into their territory. That if the peace agreement had not been signed a few days ago I would probably be taken to the Congo, raped, hurt, killed and God only knows what else.

I assure him that I will not make that mistake again.

He says, “You leave now.”

Shakes my hand, and that is it. 

5 hours of my abduction, kidnapping is over. 

One hour of interrogation is over.

Conflict and war means no rest, no security ever. It is always present. 

This morning I called the CMMB program manager to ask if I could come walking to the office from the hotel. He said it was safe to do so. But I felt for the first time ever as a missionary, volunteer, world traveler real anxiety to walk the streets. 

But I made myself do so. 

I must NOT let fear continue to eat at my heart.

It is not over. 

The conflict continues. 

My parish priest in Ezo, Fr. Jacinto is sick, he is STILL in the bush after almost 13 days. The Deacon is still there as well. They are not eating properly. The CHD (County Health Director) of Ezo is bringing him medicine for malaria.

The Rebels are still seeking monetary compensation for me. This morning they came to the CMMB compound asking for money. 

So now I have been told I am NOT to walk anywhere alone. I must take the CMMB vehicle even for the short distance between the compound and the hotel. 

The National Security Office now has me as a possible threat to National Security. Because they can't understand what I was doing out walking. 

All I can say is DAMN exercise!!!!!!

I really do not feel safe here in Yambio. I know this feeling will pass but everyone I see is a possible spy for one side or the other checking up on me. 

I know this is NOT real but after everyone has been telling me this to scare me, I am starting to believe this. 

Thank God I am going to Juba on Wednesday for R&R and then going to Nzara Hospital to be with the Comboni nuns until things “cool down” in Ezo.

CMMB administration here has been so wonderful to me, so supportive and understanding.

Conflict like this between tribes is horrible. It never ends because the hatred never ends.

God please send your peace to South Sudan.

Pray for my Parish priest and the Deacon still in the bush.

Pray for me that my heart becomes peaceful and secure again. 

I miss walking. I miss exercise. 

I never thought I would say that. 

I am ALIVE!!!!! I SURVIVED!!!!!

 Last Wednesday I was at work, calmly finishing the blood pressures and weights of our pregnant mothers at the ANC (antenatal clinic).
I had just gone into the room where we measure fundal heights and fetal heart rates when I received a call from a friend who is a teacher who is not from Ezo, "Doctor, just so you do not become alarmed, all the children ran away from the school. We are expecting trouble this morning. If you can't get home go to the church."
Boy was that an understatement!!!!!
When I walked out of that office the hospital was deserted. How can 50 pregnant women run away so fast??
Then a midwife came to me and told me we need to go immediately to the CMMB compound because there is going to be trouble today between the soldiers who are from one tribe and the "rebels" who are from another tribe.
As we were walking away from the hospital, gunfire started.
We could not get home as our CMMB compound is past the Army Barracks.
So I suggested we run to the church. In the opposite direction.
The roads are deserted and the 6 of us CMMB staff went to the church.
The Catholic Priest and Deacon welcomed us and then the gunfire and RPGs (huge guns that make alot of noise) started to go off so we went to the bush to hide.
Among the ants, mosquitos and insects laying on the ground. Covered in the leaves, branches and trees.
Then after a few hours of war, the noise stopped and we were able to go back to the Parish Home.
A old woman was brought with a gunshot wound in her hip. They wanted me to help her. She had an entrance and exit wound and "only" soft tissue was injured.
She was in the right place (hiding in the bush) at the wrong time, a soldier was shooting and she was hit with a stray bullet.
So I cleaned the wound and dressed it and bathed her dirty body and we hid her in the priest's veranda.
The Catholic priest Fr. Jacinto and the Deacon Vairi were so kind. They gave us tea, hot chocolate, milk (great treat here) and food. The also had the altar boys boil hot water for us to bath.
Then the war started again.
Back to the bush.
That is where we stayed for 2 nights and 3 days. Then a guard from the abandoned U.N. compound came to get us to bring us to the UN compound in Ezo (abandoned because there was never trouble in Ezo).
That was a tension filled walk as the rebels were every where but left us alone and we were fearing meeting any of the soldiers who would be angry that the guard was walking us to the compound. At least that was what I was told.
We arrived at the ABANDONED UN compound and we had no water or food but shelter. So some little woman from another NGO (non-governmental organization) called World Vision left the compound alone and went to her home and retrieved food!!! How freaking brave!!!!
Then the next day Friday, a UN convoy with tanks and soldiers with huge guns came to rescue us.
They were surprised we did not have our passports or luggage. We tried to explain that we were at work when this started. They were very understanding and helped us so much.
God bless the U.N. people who rescued us.
The streets in Ezo were abandoned.
Except for the soldiers who were all out with guns. The rebels were all out with guns.
They were kind enough to allow the entire convoy to pass by our different NGO compounds.
Then.......
We left Ezo.
All the humanitarian workers in the area.
So now Ezo has NO ONE to help any one.
Then in the UN convoy from Ezo to Yambio (a 4-5 hour drive) they felt it was dangerous to continue so we stopped for the night and slept in the bush again.
Finally on the weekend we arrived in Yambio.
Our luggage was confiscated by the Security Police in Yambio thinking that we were helping the rebels.
How ridiculous!!!
Of course the soldiers and the rebels are our patients. All their wives, sisters, mothers, daughters are my patients.
I know them all.
I love them and serve them all.
War is so senseless.
Everyone in Ezo is hiding in the bush.
The 2 pregnant women who have transverse babies that had scheduled Cesarean Sections this week will eventually go into labor and eventually their babies will die and then they will die.
All the HIV patients who CMMB gives advanced treatment to will get sick.
The many women who suffer from Gynecologic illness and who were scheduled for surgery will bleed until very anemic and eventually die.
The many women who we follow for possible ectopic pregnancy and need surgery will die.
War is costly.
War is horrible.
Today Wednesday a week later, I finally received my laptop from the jail. They realized we did not help the rebels. Whatever....
This morning I called my friend the Deacon and he is still with Father Jacinto hiding in the bush. This morning many bombs and RP Gs went off.
A delegation from the government and leaders was going to Ezo to discuss peace and cease fire but with the intense fighting they turned back and did not reach Ezo.
My beautiful Ezo is destroyed.
My beautiful patients are hiding in the bush.
My beautiful mothers are suffering.
My heart is broken.
The only positive learning experience is now I know which leaves to use to wipe for number one and which to use to wipe for number two.
Also I know the perfect distance to squat; not to low as to have sticks and leaves poke you as you relieve yourself and not to high as to then soil yourself.
Please pray for my Ezo and my patients.

GET UNDER YOUR BED!! GUNSHOTS!!!

Last night around 11:30 PM. gun shots started very close to my house. For about 2 full minutes there was shooting continuously.
Then after that a few more.
I was still awake as I had been speaking on the phone until 11:00 PM and was reading my book.
I slowly got up and went to the window.
The owner of the compound where I live was quietly but quickly collecting all his belongings from outside and he and his 3 wives were still chatting but working to "close" the compound.
The midwife from Uganda happened to be sleeping at my house instead of her usual place at the CMMB compound because we had been told that there were insecurity issues this week. She did not feel safe at the CMMB compound so she came to my house.
We have been told that the local "Arrow Boys" who are the Zande rebels against the soldiers, are in the bush and are looting and stealing from people to survive in the "bush".
She came to my bedroom door and informed me that I should get under my bed and close all the windows.
Also I had just dialed a friend to inquire if that friend had also heard the gunshots. My friend had not. But also told me to close all my windows and get under the bed.
Annet the midwife called the CMMB administration in Yambio and they told her to not go outside the house. (Thanks for stating the obvious)
A few more gunshots were heard.
That was it.
This morning as usual I got up at 6:00 AM and went walking to Mass. Everyone greeted me as if nothing happened but I knew they were all talking about the gunshots.
I found out when I went to work that the "Arrow Boys" had been in the "bush" and had demanded supplies from the local Commissioner and he did not comply.
So they went to the solar panels of our ENTIRE WATER SUPPLY in Ezo and stole them. Now we will soon have absolutely no water.
They do not realize that they are hurting the people. Their people, whom they claim to be protecting. Not the Commissioner, what does he care. He has people to bring him water.
I am so saddened that we will have no water because of this reason.
Because of this "insecurity" the hospital is so different today and the past 2 weeks.
We did have office patients today in our Obstetrics and Gynecology Surgery department. But very few.
Of course still NO Gynecology Surgery patients at the hospital. They ran to the "bush" to wait for the insecurity to finish.
The entire week only 2 women delivered at the hospital, the rest are delivering at home or worse in the "bush" then come after delivery for complications only.
This makes me sad because my favorite patients are all the pregnant ones. I love these wonderful, funny, joyful loving mothers and mothers to be.
How conflict is so cruel to women and children. More so than to the men who start it.
By the way one complication was a 16 year old who delivered her first baby in the "bush" and came to our facility because of bleeding. Well the little patient had a fourth (4th) degree tear. Which in non-medical language is she tore herself all the way to her rectum.
Thank God in my residency, one of my senior residents, Dr. Creighton Likes III who is now a Fertility specialist in South Carolina taught me how to repair a 4th degree, it is not common. Since residency I have only had to repair about 25 and all have been during my Mission trips and volunteer experiences.
So since this girl was only 16, and this will affect her the rest of her life,  I was very glad that the CMMB midwife from Uganda had the prudence to call me.
Can you imagine if this girl had come to deliver in the hospital? She would have probably not had this complication.
No wonder why people speak of stress in war time. Even though I do not really fear and feel safe, still the constant rumors and talk have even taken their toll on me. I now understand in a very limited and small way the reason for Post traumatic stress syndrome.
Funny Story:
My friend that I told you about that I was speaking to on the phone, when I told that friend that Annet told me to close the windows and I feel that I will die of the heat.
My friend who I had woken up from sleep did not understand that I said from the heat and said to me, "You will not die!!" in a very serious manner.
At least that caused me to laugh the rest of the night.
Thank God for humor and laughter and great friends!!!!
Please keep me in your prayers.
But MORE importantly pray for the people of South Sudan and for the Arrow Boys.
That we will soon have true and lasting PEACE!!!
God bless beautiful South Sudan. This is a beautiful country and the people are even more beautiful!!!
I want to live here forever..........

Loosing weight

Very funny how other cultures view weight issues.
Because most people here do not over eat and do not have any processed food, and work physically so hard every day.
Most people are a healthy weight.
BUT.....
People here take "medicine" to gain weight.
Men here feel they are successful if they have a very large abdomen.
Women all want to be "thick".
So since I arrived here I have lost some weight.
People are now telling me to stop loosing weight.
That my family will not recognize me when I get back and they will be angry with me for loosing weight in Africa and my family will think that I was suffering here.
I try to explain that in my country to be overweight is something that is seen as negative.
That in my father's home country of Italy to be overweight is seen as very negative.
Believe me people, I am still overweight. Still obese.
Even the people I work with from Uganda are saying that women look better in clothes when they are fat. That I should not loose any more weight or I will look bad.
HAHAHAHAHAHAHA!!!!!!!!
Every culture is so interesting. As humans though we are so much the same. Our DNA as humans is so similar in such a large percentage.
Not to sound cheesy but we are ONE race the HUMAN race.
We always desire the opposite of what we have. We want what we cannot have.
So I will continue to eat the local food and walk everywhere as I have been doing.
The women and men here will continue to take "supplements" to gain weight.
The women in Italy will continue to have the lowest BMIs in Europe and American women will continue to be obsessed with weight loss.
My family will be happy for me that I lost weight.
Human beings......

GUN SHOTS!!!

So we are in a state of "insecurity".
We are told that 2 soldiers have been shot and a civilian was injured. Also the Commissioner of the neighboring county was shot. The chief of the "Payam" or village was shot.
In a neighboring village there is fighting for these reasons.
Last night in peaceful Ezo, there was gunshots.
3 of them.
I heard them very clearly.
We are told that a former commissioner is causing this trouble here.
Then this morning there was gun shots as well.
People are running from Ezo to the "bush". There is complete chaos.
People are running in all directions. So who knows where it is safe?
We were told last night that we would evacuate.
Last night I was told when I was going to my house to make sure I did not turn on my flashlight or torch as they call it here. To not open the door to anyone. To close all my windows (the only request I did NOT comply with).
Also to prepare a bag for emergency evacuation.
I really dislike all this fear and all these rumors.
For some reason I am not scared. I feel secure. I feel like I want to stay with "my" people here.
One of my very good friends reassured me that most of the trouble are the rumors and unfounded fear. This friend texted me updates during the night so I felt safe. What a wonderful friend!!
This morning when I woke up I decided to refuse to let fear enter my heart.
GOD gave me this gift.
I walked to Mass as I always do everyday.
I greeted people along the way. People were actually so happy to see me. They felt reassured that I was not evacuated or hiding at home.
After Mass I went to the hospital.
Thank God I did because a woman was there crying. She was having an Abortion or Miscarriage. So I took care of her.
She needed a D&C. Only I can perform this so thank God I was there to do this.
Then as today is Wednesday, the pregnant women were at the hospital waiting our ANC (antenatal clinic).
I was told by some of the staff to send them home.
ABSOLUTELY NOT!!!
If these women walked here I am going to respect that and see every last one of them.
Which we did!!!
We also saw our surgical patients.
Although the theater attendant told me that today we will NOT operate. I did not push the issue because if they are all against it I do not want to force the surgeries.
The hospital staff that was there was so happy that I came to work.
We were laughing and really feeling like we can make a peaceful situation here.
I realize all our bravado does not stop the shooting all around us.
I realize that me going to Mass and the Hospital and seeing patients does not automatically cause peace in South Sudan but guess what?
Everyone that we encountered today felt so happy that I was there. That I was brave and came walking to Mass and walking to the Hospital.
Human beings desire peace.
I saw that today so clearly. there is no doubt in my mind that we are the vehicles of peace in this world.
As the song states so clearly:
"Let there be peace on earth and let it begin with me."
All my blog readers: pray for peace in South Sudan. Please pray for my safety and the safety of all the wonderful people of South Sudan.
By the way for those of you who are worried. CMMB is still discussing if we should be evacuated or not so I will keep you posted. I do NOT want to leave.
What a blessing to have peace in your country!!!

Less than 6 months to go!!!

So sorry to everyone that I have not posted photos in a while. I lent my camera to a local person who asked me for it.
I have my camera back and will start taking photos as soon as it is charged.
My promise here as a Volunteer with CMMB ends April 2016. So please pray for me that my next step is whatever God calls me to do.
Many of you know that I love to travel and do volunteer work. As a Lay Missionary with the Propagation of the Faith it is my vocation and pleasure to do so.
I do not want to arrive at the end of my life and not have done as much as I can for my fellow human beings especially the "least" among us.
When I was 15 my father gave me a photocopy with a beautiful poem. It stated that any good we can do, DO IT NOW because we only pass this way but once.
Sometimes the good is staying where we are. Sometimes it is going someplace else. Sometimes it is opening our hearts, sometimes it is giving up our hearts for the greater good and for GOD.
In the 6 months I have been here we have done so much. Saved so many Mother's and Women's and Infant's lives.
We (The CMMB Safe Motherhood Team which consists of me and a nurse/ midwife who is sometimes called away) have heroically operated in an Operating Room or Theater as it is called here that has NO electricity, NO lights, NO water, NO operating table, NO anesthetist, NO general anesthesia, we perform all our surgeries with Ketamine. The theater attendants from the government do not know the names of the instruments so we have to point and I have tried to teach them some names. There is no NG tubes or OG to deflate the stomach while we operate. The sutures are not the correct type. The instruments are very old and rusty.
But we forge ahead.
So much can be accomplished with so little.
The other day my parish priest Fr. Jacinto helped me so much. During confession I was telling him that my greatest sin is pride. I feel so angered sometimes when I say something and a person with an 8th grade education or worse someone who does not know how to read or write tries to correct me or questions me.
He made the solution so easy. "Rachael, we follow Jesus Christ who was the Son of God and was sent to this earth and had to put up with Pharisees and High Priests and His fellow country people who were such critics. Remember this."
Wow!!!
What a way to remind me!!
Please pray for me and my next 6 months here.

Trust me I really am a Doctor!!

So remember the woman who had cervical cancer that I operated on?
Well, she was doing so well postoperatively. She met all her post-op goals (urinating, passing gas, eating and walking) by post-op day number 2. Wonderful!!!
Her wound on post-op day number 7 had a little purulent discharge and had a small seroma under neath it so I opened the skin which easily opened. Then for the next 3 days I personally packed and dressed the wound and it was looking so very good.
Then, the husband (who is a nurse by the way) on the third day of dressing changes decided that the wound should be closed and asked the Theater Attendant (O.R. Tech) to close the wound. So this man with an 8th grade education who did a 6 month Theater Attendant class with MSF (Doctors without Borders) waited until I was at Mass early in the morning and took the woman to the Theater (O.R.) and closed the wound with very close and very tight and very deep sutures!!!!
When I arrived after Mass at 8:30 am, one of the clinical officers (like a Nurse Practitioner) informed me that did I know that the Theater attendant had done this?
Of course I was furious!!! I went to see the patient, she was moaning in pain.
To make a LONG and CRAZY story short, the 8th grader/theater attendant felt that I did not know that to make wounds heal you need to close them!!! The husband also felt that  I was wrong and should have re-closed the wound.
I patiently explained to EVERY ONE  involved that when a wound is infected we must open it and then dress it every day and let it heal by secondary intention.
Of course in this case it is difficult to be humble, and kind and compassionate. I felt like screaming did they not know I AM A BOARD CERTIFIED OBSTETRICIAN AND GYNECOLOGIST!!! But I swallowed my pride and calmly tried to convince them to re-open the wound. They refused.  I called the nun Doctor who referred the patient to me as the husband works in her hospital. She stated what can we do? I know what can I do?
The CMMB staff supported me and the government staff also to try to convince them to re-open the wound.
We had a meeting with the Theater attendant and he thanked me for all I that I do to teach him but that I should have not abruptly gone in his "office" and corrected him.
Again I swallowed my pride and hoping to help the patient I explained the science behind wound healing and packing wounds.
He stated next time take him aside because that is not professional to correct him in public, so I explained that I was shocked that he had touched my patient because professional courtesy is to NOT touch another surgeon's patient!!!
So that was Friday.
They refused to let me re-open the wound all weekend.
Today on my walk, a man stopped me to tell me that that woman is NOT doing well, her wound is red and swollen. That she is very sick.
I explained that they refused to follow my advice and went to the 8th grade/OR tech for care. The man said to me, "Why, you are the REAL Doctor?".
I know my friend, I know.
How sad, after working so hard during the surgery and she did so well after for her to die for a STUPID wound infection!!!
I was thinking, maybe I should have screamed and yelled and thrown things, and been rude and maybe this woman will live. At the time, I felt being kind, compassionate and calm would be better, but now I do not know, maybe being rude, loud and uncaring to the 8th grade/theater attendant maybe would have saved the woman.....
I do not know......
Please pray that the Lord gives me patience.
Today is my 6 month anniversary here.
6 more months to go.
We give you thanks Almighty God for this and all your benefits, you who lives and reigns forever and ever, AMEN.

Healing Hands of a Child!

I wanted to share with you something so beautiful that happened to me the other day. I was walking home from church and I was feeling a little sad for a personal reason.
Of course as usual many children run from their homes and yards or compounds as they are called here just to greet me and shake my hand. Some of the children hug me.
This of course makes me as it would anyone feel like a million dollars and like a very special person. One little girl who normally hugs me, grabbed my face in between her hands and caressed my face and then rubbed my hair.
Everyone that knows me knows I LOVE IT when people caress my face and my hair. I think I love this because when I was little if I got a chance to lay down beside my Mother, which was not often because she was busy or breastfeeding babies, she would caress my face and my hair. Also even when I was in Residency, I would come home and lay in the bed in between my Mother and Father and my Dad would caress my face and hair.
Who am I kidding, even before I left Boston, I would sometimes lay on my parents bed and they would caress my face and hair. What a gift!!!!!
I felt like God gave me a special gift. He allowed this little girl to allow me to feel the caring and love of my parents.
Truly the Kingdom of God is like these little ones.
Thank you God and beautiful little Girl...

So inadequate!!!!

I am so inadequate!!!!!
I am NOT a Urologist or an Oncologist nor is there ANY in this entire country.
This week I had a patient sent to me from Nzara, which is the city 4 hours away where I was evacuated to when there was the insecurity. The Comboni nun Dr Sara sent her to me. She suspected the woman had cervical cancer as she had a fungating mass from her cervix in her vagina.
When I examined the women this was the case indeed. So I am here alone. I am the ONLY Gynecology Surgeon in this city, in this county, in this state and in this region!!!! So I felt I should operate and debulk (take away) as much of the cancer as we can. So with the brilliant Gynecology Oncology Attending's voices of my training in my mind, I went ahead and removed as much as we could. We removed her uterus, her Fallopian tubes, her ovaries, and the top portion of the vagina where the mass was attached.
The patient did very well. Sadly of course there was a piece of cancer stuck over an important artery and I did not remove it as it would cause her to bleed to death.
Thank you Dr Larry Puls, Dr Richard Boulay, Dr. Martin Martino for your amazing training and guidance during my residency.
You really helped this woman through me.
Although of course her 5 year survival rate is not good. We have no chemo or radiation therapy in this entire country!!!
These are very poor people who can't afford to go to neighboring Uganda for medical treatment.
Then I was sent a 20 year old woman from a closer neighboring village who has a very disturbing story. She was "given" by her older sister at the age of 14 to an old man who got her pregnant and she had a baby. I am told because she was very young and very small the baby got "stuck" inside her and died. Then the person at the health facility proceeded to pull the baby out and DISLOCATED HER HIP AND BROKE IT.  As a result this poor woman literally walks bent over and can NEVER straighten her leg. She was so traumatized by this experience that she would not allow an exam. She now pours urine from her vagina.
When I performed an exam under anesthesia, I could NOT believe what I was seeing. Her urethra is completely scarred closed. Her bladder is wide open into the very scarred vagina. Her introitus is open to the rectum only the rectal mucosa  is intact. Her vagina is scarred closed at about 3 cm into the vagina!!!
What a mess!!!!
I could not even get the smallest dilator into the urethra. It is scarred completely closed.
The SAD part is everyone thinks I can work miracles and were so happy when we were leaving the Operating Theater and I had to explain that I did nothing ABSOLUTELY NOTHING to help her.
How disappointed I was. Although her family was not because they think that I will some how be able to help her!!!!
This young woman makes me want to cry, as every day when I see her she is beaming smiling as though I am the greatest person ever. Little does she know that I am so inadequate. I greet her and hug her which is a big deal because NO ONE touches her as her fistula causes her to constantly leak urine. She smells of urine as well. But I DO NOT CARE. I want her to feel the love of a human being for once in her little sad life. I sit on her bed and hold her hand and tell her how today she looks "smart" which is their way of saying beautiful. I tell her I LOVE her.
How can good things happen to "bad" people and bad things happen to good people? Dr Martin Martino once said this to a patient with Ovarian cancer who after adopting 3 child from Korea found out she had metastasis to her brain. Thank you for that lesson Dr Martino.
Please God help me, help these beautiful women of South Sudan whom I love through my inadequacies.
Pray for me and please pray for these women who are dismissed by the world, by society, by their own families. The "unseen" people. The "invisible" people.
I SEE them, they are NOT invisible to me. I love them dearly and fiercely.

I found it!!!!!

I have found the kindest person EVER!!!
I have found the most Christ like person EVER!!!!
So my entire life I always considered the nicest people in the world to be my family.
And Father Manny a Redemptorist missionary priest from New York in the Dominican Republic.
But now they have competition.
This person is consistently and with all people the kindest, most generous person I have ever met.
He treats the Bishop and the naked little boy that comes to daily mass with the same respect, kindness and compassion. No pretension, so humble. It is so difficult as human beings to treat "important" people and the "untouchables" the same. Usually we are impressed with the first and treat them better.
He is what Jesus must have been like in the human form.
This young man makes sure every day I have eaten lunch and supper. He also makes sure every one in the parish eats as well.
He serves people as if they were Jesus.
He is constantly laughing, smiling. Always joyful. But serious when he needs to be.
I have seen people mistreat him and he stays quiet and accepts it.
Wow!!!!
I think more people would desire to be Catholic/ Christian if he was around. More young men would want to become priests if he was their example.
He has had to suffer greatly to become a priest. Because of the war here in Sudan/ South Sudan he has had to flee to Central Africa to study in the seminary. He walked from South Sudan to Central Africa back and forth every year. He had to be undercover studying in Khartoum (the capitol of Sudan). He had to leave his homeland and study in Uganda theology.
This man is amazing. I am in AWE of him.
He really makes me feel like I need to be a better, more consistent, more generous, more giving person.
He is the new Deacon at my Parish awaiting ordination to the Priesthood, Deacon Natale Vairi III. His name in Natale (Christmas) because he was born on December 25th. Truly Jesus was reborn in this young man.
Please help me to pray for him, for his vocation, for his precious life.
You are all welcome to South Sudan to meet the most compassionate person I have EVER met!!!! He will certainly feed you!!!
I praise the Lord for these Brothers and Sisters through out the world that live and die giving testimony of the Good News of Jesus Christ.
Who came as we were reminded in today's gospel the feast of St. Matthew for the sick and sinners.
Thank you God for Deacon Vairi III!!!!!

People die on my ONLY Day off!!

So since I left Boston on April 4th, I have not had a day off. I have been working every day and on call 24 hours a day, 7 days a week.
Loving EVERY MINUTE OF IT!!!
Since I arrived there have been ZERO maternal deaths. Thank God. Praise be Jesus!!!!!
Last week I was invited by the Parish Priest of the largest parish in the Capital city (Yambio) of this state (Western Equatorial) to come for the First Anniversary of the Late Bishop Gasi to give a day of reflection/talk/preaching for the people.
He said he would send a truck to come and pick me up and I would be staying at the new Bishop's house and taking meals with the Bishop!!! (Bishop Eduardo Hiiboro Kussala of the Tombura-Yambio diocese)
So I said, "YES!!" Of course after asking permission from my CMMB person. Who said I could have Friday and Monday off.
I had a wonderful time. My talks were on Friday. I spoke about Faith, Sacraments specifically Eucharist then the last talk was on Marriage and Family.
What a great day!!! One of the priests was my interpreter. He did a fantastic job.
The weekend was amazing!!!! Adoration all night long, Praise singing, dancing, Healing prayers.
Meeting the Bishop was an honor. He is a champion in this region of Africa for peace. He has written a very interesting book (which he gave me a copy and I read) on Peace and Reconciliation. He travels all over the region to promote peace in South Sudan and in Africa in General.
What an amazing, interesting, humble man!! Who by the way is walking the walk, not just talking the talk. He has lived in Refugee camps and Internal Displaced Persons Camps to help with Peace and Reconciliation.
He is brilliant, fascinating and I thank God I had the opportunity to meet him.
So on Monday, the Bishop assigned one of the Deacons to take me around Yambio. This Deacon is the one assigned to my parish in Ezo and he is a wonderful friend and brother to me. He is the subject of my next blog.
As we are going around, I receive a call from the Hospital in Ezo that there is a woman at the hospital who needs a Cesarean Section but has a dead baby.
So I am 5 hours drive away. (on a good day)
To make a LONG and complicated story short, the Theater attendant performed the surgery and when I arrived back on Tuesday, she died.
So I was DEVASTATED!!! I wanted to cry for taking time off.
If I had stayed in Ezo, she would probably be alive. Why did I leave for a long weekend?
The Maternal Mortality rate was ZERO the 5 months I have been here. Now for me one maternal death is 100%.
The worse part is that most people do not feel bad. Because they said that her Father placed a curse on her with Witch Craft and that is why she died.
What the heck??!!!!!
But I also must walk the walk after talking the talk. So forgiveness and reconciliation From God are in my heart. I want to live in peace in my soul.

IN ALL THINGS WE GIVE YOU THANKS ALMIGHTY GOD, YOU WHO LIVE AND REIGN FOREVER AND EVER. AMEN.

Twins and Women

Twins Galore!!!! Appreciate Women please!!!

Everyone that knows me knows that I absolutely love twins. They are my favorite!!! Twins are so cool. The genetics, the physiology, the science, behind twinning is fascinating to me.

Well we were blessed last month to have not one, not two, not three but FOUR sets of twins here in Ezo. What fun!!! 3 were delivered vaginally and one via C-section.  2 sets were both head down. One set was head down and breech and one set was breech and transverse presentation!!! How cool is that?!!!

The mothers laugh every time they see me because I get so excited to see ALL the twins!!! All during pregnancy these women were troopers. No complaints.  The babies are all so beautiful.

The one mother we performed a Cesarean Section on was because she had just had gone to the “city” of Yambio 10 months ago and delivered a baby via C-section and had a midline skin incision and I was worried because of uterine rupture. She also had the breech/transverse combination. Such close births. She was also 4 feet tall!!!!! She was at the end of her pregnancy wider that she was tall!!!! So cute though. No complaints from her even though I kept her in the hospital for almost 2 weeks before we did the surgery.

In Ezo, as in all of South Sudan and most countries, I feel that women are so underappreciated. These women do all the domestic work (which by the way is 10 times the work women do in USA at home), they harvest in the field, they take care of their families, find money for schooling for the children, they fetch water, they take care of their sick neighbors, they go to church and pray, they feed the homeless and beggars. They discipline their children. They teach their children to pray. They help the children with school work. Then they have to share their husbands with other wives. The husbands do not always give them money. A lot of husbands spend their money on themselves. I sincerely do not know why some of these women get married except for societal pressure. Most men’s contribution to their “family” is the donation of genetic material. It is surprising that the women do not revolt.

The interesting part about this is that ALL the men address me as “Doctor”. Most of the women though call me by my first name even though I always introduce myself as Doctor.  Or they call me “Sister” or my awesome Zande name “Zia Zia Toro” which means “Holy Spirit”. So that part I do not get. But I think the men know I am a foreigner and maybe the women accept me more?

Well, any way I appreciate and really have such love in my heart for these women. They can call me anything. I know they love me so much. They care for me; they feed me (a big deal in my book).

GOD BLESS THE WOMEN OF EZO AND THE WORLD……

Walking Fetus!!!

The Baby is trying to walk outside!!!!!

Today as I was walking to the hospital after morning Mass, a young man on a motorcycle pulled up beside me. “Doctor, there is an emergency at the hospital. The baby is trying to walk outside.” I jumped on the motorcycle and without trying to even have this 16 year old boy explain to me what the heck he was talking about I went.

When I arrived at the hospital, I knew there was an emergency because tons of people are standing around. So I went inside and as per usual the volunteer community health worker is there ALONE with the mother who has both of her baby’s feet coming out of her vagina. The feet were swollen and blue. Not a good sign.

I ran to grab the ultrasound machine. The baby was still alive with a great heartbeat. Wonderful!!!! I am alone with this young community health worker. But this baby needs to come now!!! So I said, “Joseph, you are going to do surgery with me. Go to the Operating Theater and prepare for a Cesarean Section. Do not speak to anyone on the way and be quick. This baby is still alive.” (the reason why I said do not speak to anyone is that in this culture greeting others is very important and he would take 40 minutes to normally cross the yard to the Theater from the Delivery Room because of stopping and greeting people) He ran off.

I grabbed the gurney and commanded to young strong appearing men, “You come.” They came. They carried the woman to the Operating Theater. We grabbed a visitor who happens to be a nursing assistant in another village and he came as well.  Of course our Operating Theater with no electricity, no running water, no operating table (only an examining bed) only the grace of God to accompany us.

The baby was delivered via Cesarean section successfully but with great difficulty I might add. I remembered the words of one of my chief residents during residency. “You shred a uterus but you get that baby out. “ We did not shred the uterus but almost. Praise the Lord we got the baby out and mom and baby are Thank God doing well in Postpartum.

When I think about the situation, so dangerous but at the moment we do what needs to be done with the people and equipment we have. How can anyone in a Developed country ever complain? I am ashamed of all the times I complained about stupid little things in the hospital in the USA. We are so blessed in the USA. What an amazing country. What amazing people Americans are!!!

I also meditate that if I had not been here in Ezo, Western Equatorial, South Sudan today that baby would surely have died and later Mom would have also. What a privilege!!!! 

EVACUATE!!! WAR!!!

Yes.
It was that dramatic.
I was at church on Saturday August 1st. The CMMB truck pulls up at the church. Thank God I had finished my talk on of all topics, "Peace and Reconciliation".
The driver tells me that I need to come with him right now because there is an emergency. I thought he meant at the hospital so I jumped in the truck and off we went.
When we passed the Hospital, I asked why did he not stop. He told me that the CMMB Program manager came to Ezo and told him to come and get me.
Now I knew there was fighting between 2 tribes in Yambio which is a 5-6 hour car drive from where we are. Because Friday night when I slept at the church because we had an all night prayer vigil a friend who was in Yambio texted me to pray for him because there was "War in Yambio".
But this happens all the time here in South Sudan.
Ezo is always peaceful thank God.
The Program Manager told me to pack my bags because he was evacuating me to Nzara which is the closest town with an Air Strip. But it is a 4-5 hour car drive in the direction towards Yambio. But they felt it was safer to have me near an airplane that could take me to safety..
Now Ezo is quiet. There is NO trouble in Ezo. In fact it is known for being peaceful.
So I said NO. I would not be evacuated. There is not trouble here.
But he said that the 2 tribes that are fighting in Yambio are the 2 tribes here and the insecurity is so great and so many shootings in Yambio between the tribes that trouble could erupt at any time.
So 3 people asked me to please go without a fight or discussion. So not to make a huge production and also remembering the words of my family members (do not try to be a hero, be safe) I left my beautiful Ezo to go to Nzara.
It was actually a great experience although I missed Ezo and felt badly to leave my 3 Hysterectomies waiting for me on Monday.
The Comboni Missionary Nuns are in Nzara. They run the hospital and the school. They are a group of Missionaries from Verona Italy and work all over the world but were founded for and work specifically in Sudan.
They were very welcoming to me. I stayed in their guest house for Volunteer Doctors. Which has indoor showers with HOT WATER!!!!!. And indoor toilets.
They have a very organized hospital compared to any other one here in this area. Unfortunately they do not have a Operating Theater (Operating Room)
I worked every day from Monday to Saturday all day long as the Nun Dr Sister Sara does.
It was fun and the people there were most kind. One of the CMMB midwives made lunch and supper for us every day.
Then after 10 days of being an IDP (Internally Displaced Person) I was driven back to Ezo. I am just kidding because I lived a "high life" compared to the real IDPs.
The welcome that I received back in Ezo was humbling. People were running to see me, to hug me and kiss me and were crying telling me how they missed me.
At church I was told to stand up and every one clapped to 5 minutes straight which is actually a long time to stand in front of 900 people clapping for you.
Sorry I did not send this sooner. But actually our INTERNET was NOT working since the day I was evacuated. It was just fixed today or paid for today. I am not sure.
Funny ending to this story. CMMB in New York was not aware that I was evacuated and when my family called to find out they were not able to give information. But my Mother who is like an undercover CIA agent remembered that I had said as I was being evacuated that I was going to the Comboni Nuns in Nzara. She contacted the Headquaters or Motherhouse as Catholics call it in Verona Italy and my little Mother was put immediately in contact with the Nuns in South Sudan!!! They sent here an email stating "We have your daughter here. She is joyful." So my Mom said she then knew that they must know me. They also said "She is sleeping here for some time" Meaning that I was there for 10 days. But of course my brother Edward said he knew they were talking about me because I love to sleep. Hahahahaha!!!!!!!

1 Thessalonians 5:18." Give thanks to God in All things for this is HIS will for you"

112 years of Chrisitanity

Greetings!!!!!
I am so sorry I have not written sooner. The internet is inconsistent and I really dislike just sitting around waiting for the internet.
I have had an exciting past 2 weeks!! The Church is celebrating the anniversary of the Cross of Evangelization. Let me explain. One hundred and 12 years ago Christianity was brought to South Sudan by Italian missionaries. Later specifically Comboni Missionaries.
So the original Cross brought by the missionaries travels the country to each parish. So our Parish of Regina Mundi has the privilege to have the Cross now.
We have many outpost remote Chapels and our Parish Priest Fr. Jacinto wants everyone to have the opportunity to celebrate our evangelization and Christianity.
So I have been going to all these remote chapels in the "bush".
I have walked 12 miles to one chapel, 6 miles to other ones. Then I sleep there. With all the parishioners and the parish priest.
I almost started to cry last week because when I went to this one very remote jungle "bush" chapel. They prepared for me under a tarp an actual brand new bed with brand new sheets. So every one else slept on the ground on mats (as I had planned) but I was treated like a special person.
They were so happy to serve me and treat me so well. So much hospitality!!!!
I would hope if any of them ever came to the USA we would treat them as well as I have been treated.
We start on Friday afternoon walking to the place. Then on Friday evening we have talks on the Cross of Jesus, Faith, Forgiveness and Peace. Then we have supper all together. Then we have the Rosary, then we have singing for 3 hours. Clapping, dancing and moving to the songs. I am the only one sweating.
Then we have 2 preaching sessions. Then we have spontaneous prayers. We go to sleep at midnight. Then we wake up at 6 AM to prayers being sung by some women. Beautiful!!!!!
Then we have the most exciting and joyful Mass at 10:30 AM. Then after mass which ends at 3 PM, we eat together and then we walk home (the 6 or 12 miles).
These people are so humble, so holy, so hard working. The women work, hard manual labor for 14 hours every day then come to the church and pray and dance. Amazing!!!
I love these people. They are so kind to me. I do not deserve the treatment and kindness and hospitality and generosity.
The church here has been the best thing to happen to me!!! I love the parish priest Fr Jacinto, he always invites me to eat in his tent with him and the seminarians and Deacon. They serve him special food. So I get the best food!!! He always says to me, "Feel at home, you are welcome. This is your home."
He always gives me excellent advice. He is a true priest. He lives very humbly. He works 7 days a week and all day. When they call him at night to give Last Rites to the sick and dying he goes.
I am so grateful to God and to these beautiful people for all these wonderful experiences.
Praise be Jesus Christ!!! Now and forever.

1 Peter 4: 8-10
8Above all, keep fervent in your love for one another, because love covers a multitude of sins. 9Be hospitable to one another without complaint. 10As each one has received a special gift, employ it in serving one another as good stewards of the manifold grace of God.…

AMEN!!!!!!

Excuse me, are you Chinese?

So everyday I wake up at 6 AM and walk the almost 2 miles to daily morning Mass at my parish Regina Mundi, on the way there, I am greeted by many people.
Almost every day, I see a man who drives by on a bike. He greets me and I great him in the local language Azande or Pazande like the local say.
" Senoooo" (Hello)
Response: " OOOOOO"
"Guinea Pai" (how are you)(literal translation: are you there)
"Pai Te" (I am fine) (literal translation; I am here)

The other day, he said to me in English, " So Madame Doctor are your Chinese or something?" So with all the self control not to BURST out laughing I said, "No I am not."
He said, "What are you then? Because you are friendly like Americans and you are Christian like the Italians, and eat our food like the Bangladeshi".
Wow!!!!!! hahahahahaha!!!!!!
So I explained, " I am from Italian people but I am American."
Isn't that funny, that I must be Chinese?
Even though I do not feel like I look Chinese, when I was in China in Beijing, I was asked at least 5 times things in Chinese because the locals thought I was Chinese.
My brother Edward is my witness that this is really true.
My goal is to be confused for a South Sudanese, Azande.

HIV: the Disease of the "Beautiful" People.

As I have shared previously HIV is quite prevalent here.
The WHO and the CDC estimate about 80%. This is here in Ezo County in the Western Equatorial State. The tribe here is Azande and because of polygamy and promiscuity the rate is so high.
The rest of South Sudan is mostly Dinka tribe and they are usually monogamous and proud of NOT being promiscuous and their HIV rate is less than 0.5%.
So at our Antenatal Clinic on Wednesday, which is one of my favorite activities by the way because I love these pregnant women and girls. A lot of our new Obstetric patients were tested for HIV and were positive.
What surprised me was their reaction. No sadness, no regret, no tears. Some smiles. Some holding their heads proudly.
What??????
So I asked the interpreter to ask them what they felt about this new diagnosis.
ALL of them stated, "I am fine because HIV is the disease of the beautiful people."
What do you mean?
"Well, it means handsome men have had sex with you and now you have HIV and the government and NGOs give you free medicine, free extra food, free programs for help."
Then I realized that most of these young people have not seen anyone suffering with AIDS.
Because they are started on medicines soon after diagnosis and we achieve a low to non existent viral load. thank God. Their children receive prophylaxis after birth and usually are negative.
When I shared this with some of our compound working staff, they agreed that beautiful people get this disease. One of the guards said, "My mother has HIV and I know I will eventually get HIV." I explained that actually this is not necessarily true. But he is convinced.
The HIV nurse, who runs the clinic for the HIV medicines told me that on Friday, they saw 229 patients. They are seeing more and more. They average 100 patients daily. This is out of about 100,000 population.
How to convince a culture that what they feel makes them part of the "beautiful" people is actually NOT a positive of healthy trait.
We also have that problem in our culture with anorexic women feeling that being so underweight is beautiful, also women who have many plastic surgeries and feel that a very "plastified" face is beautiful.
I just think, why can't we feel beautiful because we are so loved. God our Father, our Abba loves us so much. He gave His only Son to us, who dies on a Cross for each and every one of us to feel beautiful.
Abba, I belong to you.
Abba, I feel beautiful because I am your beloved daughter.

Romans 8:38-39King James Version (KJV)

38 For I am persuaded, that neither death, nor life, nor angels, nor principalities, nor powers, nor things present, nor things to come,

39 Nor height, nor depth, nor any other creature, shall be able to separate us from the love of God, which is in Christ Jesus our Lord.

Amen....

20 minutes to live....

The day before yesterday as I was seeing Gynecology patients in the "office", the Midwife Bernadette called me. Shes states that a patient was brought in, carried by her relatives. She stated that a patient that I had seen earlier today was sick.
This patient came to the office earlier that day with a + pregnancy test. Here we do not have the capacity for a Quantified HCG. But on ultrasound there are no POC (products of conception) in the uterus. I was worried about an ectopic pregnancy, but the Fallopian tubes were normal appearing the ovaries appeared normal. The pt had no pain and was stable. No vaginal bleeding. the uterus appeared a little enlarged but not anything that at that time appeared worrisome. So I recommended close follow up and for her to return the next day and THANK GOD I put on the paper, return sooner if sick. (not that there is any legal ramifications here from any documentation, but for my peace of mind)
Well, when I go to see the patient she is hypotensive, tachycardic, pale and has severe abdominal pain. So when I placed the ultrasound machine on her pelvis, there is an abdomen full of blood!!!!
I explained to everyone present that we need to go to the Operating Theater right NOW. But typical response, no fast movements, so I said in a loud and deep voice.
" If this patient is not in the Operating Theater in the next few minutes she will die! She has 20 minutes to live!".
So I got a fast response and everyone amazingly worked super fast and hard, and she really was in the O.R. quickly.
When I made my incision, mid-line I could see purple under the peritoneum. The abdomen was full of blood. The blood was just pouring!!! The ectopic pregnancy had ruptured!.
It was an ectopic in the cornual region of the uterus which is so bad because it is difficult to detect, difficult to remove and to fix.
I grabbed packing and quickly packed her abdomen. I could not see anything because of the literal fountain pouring out of her. So I used my hands to grasp the uterus and followed down the tubes and felt the rupture on the right side.
I squeezed it closed and the blood stopped!! Thank God!!! Then I placed the clamps, no bleeding!
Then I performed the surgery to fix it. Of course this place is part of the uterus so unlike the tube we can't remove it.
The patient today is doing well postoperatively.
Today Saturday I was called back to the hospital, a mother had been brought in bleeding after a spontaneous abortion this morning. She was at home bleeding for 12 hours. On ultrasound she had a piece of placenta in her uterus still. By the way I am the one performing all the ultrasounds. With my hand held ultrasound. Thank you CMMB. We performed a STAT D&C and now she is doing well. This was her 11th pregnancy.
Because of the polygamy the older wives are trying to keep up with the younger wives, so they keep getting pregnant when the younger newer wives get pregnant. Not really an ideal situation.
Life here is so fun!!!!
The people are very friendly,
The food is great.
The Church is exciting, vivacious and ALIVE!!!!
Praise to you Lord Jesus Christ!!!

PHOTOS....

 Pentecost Sunday, I read the First Reading in English as there is a large Ugandan, Congolese community that does not speak Azande.

 Using the Amazing ultrasound CMMB gave me to bring to Ezo. The women of Ezo love it.

 In the Operating "Theater" doing a Cesarean Delivery. Notice no electricity so we use a flashlight or "torch" as they call it here.

In the OR after delivering the Conjoined twins. The Theater Attendant or OR Tech is using a head lamp so we can see as it weighs a lot and kills my neck if I use it.

Before we send her to jail......... let's save her.....

On Friday, I am in my office seeing our daily 30-40 patients, Mostly Gynecology. Mostly enormous fibroids. (Yeah!!! myomectomies and hysterectomies).
This is not counting pregnant patients. Patients that are already in the hospital. Patients that  I am called to see on other services.
In come 2 staff, "Dr Consoli, this lady is trying to commit a "criminal" (their words, not mine) abortion. This is the second time she has come. She has a positive pregnancy test, she has some vaginal bleeding." "Should we prepare to call the police?"
I see the patient. She appears ill. She is diaphoretic (sweaty), tachycardic, tachypneic, she appears in pain.
I perform a pregnancy test myself. It is positive.
On ultrasound (thank you CMMB and Safe Motherhood for the ultrasound) she has as if from a textbook, a molar pregnancy. Anechoic spaces, snowstorm or granular appearance.
I explain that she has no fetus in her uterus.
She has a molar pregnancy which is dangerous.
They ask me if she already "got rid of the baby". I explain that this is a A molar pregnancy — also known as hydatidiform mole — is a noncancerous (benign) tumor that develops in the uterus. A molar pregnancy starts when an egg is fertilized, but instead of a normal, viable pregnancy resulting, the placenta develops into an abnormal mass of cysts.
There is no baby. There is no termination.

We took her immediately to the Operating "Theater" and evacuated her uterus.
She stabilized.
I finished seeing my patients.
The police are not bothered.
The next day, on Saturday, early in the morning I stopped by the hospital to check on her. She was doing very well.
She told the interpreter to tell me that even if this Doctor calls the dead, they will rise.
Thank you but....... no, in scientific terms we evacuated the molar pregnancy and all is well.
Only Jesus raises people from the dead.

Another interesting story is.....
Every night I gather with 20 of the neighborhood children from 3-17 years old. Mostly teenage girls. We say the rosary/pray then we talk.
We talk about different topics. Mostly about my life. They want to know every detail about me.
They can't believe I have no children and HORROR... I am not married!!! Hahahaha......
So one of the girl's mother, wanted me to help the baby. She was saying that the baby has anemia. So she was giving her watered down tomato paste!!!
I explained that the baby looks healthy. Has pink mucous membranes. Is well hydrated. Probably the watered down tomato paste is not needed.
She looked at me like I was an idiot. "Doctor, do you not see the tomato paste is the color and looks like blood. So we are helping her. ".
OK.....
Continue.
What a silly person I am. Of course this is the way to go.........
I now know how movies stars and celebrities feel.
Every where you go EVERYONE stares at you. Everyone wants to shake your hand.
Every one wants to know everything about you.
Every one stops doing what they are doing when you walk in a room.
Wow!!!!!
What a privileged person I am.....
I am really enjoying it here in Ezo, South Sudan.
Saint Catherine of Siena (a Doctor of the Catholic Church) said, "If you are doing what you are supposed to be doing, you will set the world on fire!".
I really feel like I am doing what I am supposed to be doing.
Praise be Jesus Christ now and Forever!!!

You put hot water where??????

So recently I have noticed a lot of children screaming at the hospital. I was first thinking maybe because of IVs or Injections but no.......
Last week I heard the screaming and since it was a Sunday and I had just finished a delivery and did not have a million patients waiting to see me, I went to see what the commotion was about.
Well..........
There is a mother squatting on the ground with her child trapped between her legs and abdomen she is pulling her child's butt cheeks apart. Then HORROR....
She pours steaming hot water in her child's anus!!!!!!!
I screamed, "What is she doing? Please someone come and help."
The nurse came running she states, " Doctor this is a tradition in our culture when children are sick we pour hot water into their anus to clean them."
I told her, "That is not a tradition, that is child abuse"
Then I asked the midwife from Uganda about this. She states she gave up 2 years ago (she has been here 3). She states it is a Zande/ Azande custom and she used to scream at them but they never stop.
Also she told me that some families when they are wiping their children's butt they notice the pink of the anal tissue and get afraid and pour steaming hot water in it then also!!!
Every time now I hear a child screaming I try to go and save their anus. I do not make it all the time, in time.

Also speaking about culture, today a minister from Uganda who is working here asked me where were my husband and children?
I answered, I do not have a husband and children but I am very close with my own siblings and parents and extended family.
He asked me, "What happened to you?"
I answered, " Everything, I became a physician, completed 2 residencies, a Fellowship, have traveled to every continent except Antarctica as a tourist or a Medical Volunteer or Medical Missionary. I have saved many people's lives through God grace, and helped thousands. (I was trying hyperbole to get my point across).
I expected him to say, " Wow!!! Good for you."
But NO.....
He says, "That is all very nice but you are forgetting the most important mission, to have a husband and children. I hope you do that soon, before it is too late."
I asked him, "What if my mission is to be single or become a Religious, a nun?"
He said, "Impossible God wants us to reproduce. "
I said, " OK, God bless,"
Him, I can not change but I can try to save the children's anal canals.
God save us. God graciously save us.

On the other hand, last week was Pentecost and I had the BEST Pentecost ever!!!!! In my life!!!!
The mass was............
wait for it.....
4 hours long!!!!!!!
I felt like I was at a party, singing and dancing for 4 hours.
Not ONE second was I bored.
If you ever think religion, mass, church, God is boring, come to Ezo, South Sudan.
You will never think that again.
I love church here!!!!!
God is good, all the time. All the time God is good!!!!!

Doctor come, the baby's head is stuck...

Today is Wednesday.
We have Antenatal Clinic or ANC. People love acronyms here.
We had just finished seeing 40(!!!!!!!!!!!!!!) pregnant women when the nursing assistant from the Labor and Delivery came and very calmly states, "Doctor you come, Berna the midwife said you come. " So I ask, is it an emergency?
She answers very calmly, "A patient arrived from Nandi (a neighboring town) her baby's head is in the vagina."
What???
Is the shoulder stuck?
No. They can't get out the baby since yesterday.
What the HECK??????!!!!!!!!!
This conversation is happening while we are walking rapidly to the Maternity Ward.
A very dehydrated, lady is laying on a regular bed in Postpartum. Indeed a baby's head is coming out of her vagina.
So I immediately get the lady to the Delivery Room.
OK, the shoulders are not "stuck".
They are actually being pulled back if anything.
No fetal heart tones. (Dead baby of course).
But the women has severe abdominal pain., I can feel a leg very high up like right against the abdominal wall.
She must have a  Uterine rupture.
I say loudly and firmly, We need to go to the Operating Theater.
When we open the lady up, OMG!!!!!!
She has a huge uterine rupture. The uterus is exploded open.
Then WHAT????
CONJOINED TWINS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Thoracopegus. Joined at the chest.
This poor woman was trying to push out for 12 hours or more the impossible. They would have NEVER come out from below.
She would have eventually died.
Thank God she came. We can try to save her.
The infants delivered easily actually once we grabbed all 4 legs and arms.
Then we repaired the uterus.
I am shocked this lady did not die when she ruptured considering that her uterus exploded open through the side.
She just missed the vessels of the right side of her uterus.
We were able to save the uterus.
Now the strange part is that when the nurse brought the babies outside, the father ran off because he was scared. (So I am told, as I was still in the OR)
Then the aunt took the babies and placed them on a mat. Then everyone proceeded to call everyone they know and by the time I came out of the OR there were at least 150 people all around the babies. Looking, taking pictures. Calling more people.
I asked the "Theater Attendant" if we should bring the babies inside, and not let them be a "display". He said, No the family and the people want to see.
OK.
Then one of the Local midwives asked me if we have this type of "birth" in my "village". I told her that conjoined twins happen everywhere and in my "city" they also happen unfortunately. But usually we know about it early on because of early ultrasound.
So she asked me, "It is not satanic then?"
I responded, " NO of course not!!!! NEVER!!!!! It is just a simple issue of when the embryo separates. Pure science." "No Satan".
In fact we should thank God that this mother is alive.
PRAISE BE JESUS CHRIST NOW AND FOREVER!!!!!!!!!!!!!!!!!!!
What a day!!!!!

Butt rubs at Mass

Today I went to the Azande/ Zande mass.
Usually I go to the English mass early in the morning. But today I wanted to see all the excitement and what everyone is talking about.
It was spectacular!!!!!!!
Preteen girls in the middle aisle, dancing with every song. A full choir of about 50 singing with enthusiasm, swaying and clapping with each song.
All of us packed like sardines in this small church.
It was cooler today about 90 degrees Fahrenheit.
Everyone paying attention even the children. It is amazing.
I was sitting in the middle bench as I usually do for English mass and one of the Attendants (every one has a job) came up to me and told me to follow him. OK.
So I did and he had me sit up front near the altar. Which was fine because the big door is up front so more breeze.
Then the church became really full a few minutes before it started.
A little old lady about 90, bent over walking with a stick, weighing about 70 pounds wanted to sit behind me. She brought her own little chair which was maybe 12 inches off the ground. She sat right behind me.
When it was time to sit down for the first reading I feel something rubbing my buttocks. I thought could it be a bug?
No, it was not.
It was the old lady rubbing my behind. So I kind of pretended that it was a bug and brushed her hands away.
Nope. That did not do the trick. She continued to rub my butt.
Then when I stood up, I tried to move the 3 inches to the left that was empty space between me and the person standing next to me.
Nope. She keeps rubbing and now squeezing.
Nobody thinks this is strange.
Everyone is ignoring this.
OK.
I turn and smile at her and try hold her hands.
Why did I do that?
She then squeezes my breasts one at a time.
So when I ask the younger lady beside me what is the old lady saying?
She says, She is asking you how you became to big and beautiful?
OK So thanks for the beautiful part......
I think........
The rest of the mass I would feel an occasional buttock rub.
I guess when you are 90, you can rub someone's butt during mass.
It was an amazing mass and not just because someone was rubbing my butt the whole time.
These people really know how to celebrate the mystery of Christ.
Real community.
Real worship.
Real butt rubs.

Auto impregnation

Very interesting....

Today was the third time that a young patient comes to me asking to become pregnant.
The three of them are in their late twenties.
They come in, and ask can I help them become pregnant.
So naturally I say, well let us see what we can do.
Then I ask a full medical, surgical, obstetrical, gynecological history. Social history.
Every thing is normal.
Then I ask, how about your partner? Is he healthy? Does he have previous children?
They calmly tell me, I do not have a husband.
OK....
Do you have a boyfriend, male neighbor or someone to help you out with the other half of the genetic material?
Of course I do not say it like that but you get the point.
No, they thought maybe I had some medicine that could help women become pregnant on their own.
I think to myself, if I did then I would have received a Noble prize in medicine.
So then I explain that to have a baby, even in today's modern world. Even in the most modern medical situation. We need male genetic material (sperm) to create life.
Ohhh...... they say sadly.
Then I joke and ask them if they would like us to find them a husband.
They laugh and say No.

Sorry......

Eating Bugs

So now we are in rainy season. More or less every day it rains. At night after the rain on certain days that the local people know, but can't explain to me how they know, millions of "white ants" or termites gather under the light.
So we turn off all lamps and leave only one outside light. The neighborhood children gather and eat the flying white ants/termites alive.
I can't bring myself to do this.
But they dry them, remove the wings and cook them with onion and salt. Then the Azande people eat them by the handfuls.
Everyone who knows me, knows that I will eat anything and try anything. But I was able to take only a few bugs.
I could not do the fistfuls. And I absolutely could not eat them alive. Like the neighborhood kids eating them by the handfuls.
I do not know, Is it the little legs on my tongue, or the crunch when I chew?  I do not know. I have eaten in my life,  many things.
In Belize when I lived there for 2 months in the rain-forest with the Mayan people, I ate rat and armadillo.
I have eaten cow and sheep testicles.
I have eaten pig eyes, cow tongue, intestines, stomach, brain. Scorpion.
Not to offend anyone I ate a few of the bugs.
The people here say they are "sweet" I do not taste sweet but like a grass taste. Now maybe they do not know what sweet is.
They have no dessert here.
Can you stand it?
No cake, no pudding, no ice cream. NO DESSERT.
No brownies, no chocolate.
All of you already know there is NO ICE here. So water is lukewarm. Soda is lukewarm.
 No cold Coke. They have Juba Coke (named after the capitol city) which tastes like watered down fountain soda.
Any way I eat well every day.
BUT.......
I pass on the BUGS!!!!!!!!!!

Deaf Deliveries....... and miracles.......

Can I just say I have a soft spot in my heart for Deaf mothers who are delivering?
Last night we had a young lady who is deaf deliver a beautiful baby.
She was so focused on directions. She was strong and brave.
She immediately put the baby to breast and is a champion breast-feeder!
She already knew me because she came to look at her baby prior to delivery via the ultrasound.
God is so good to me.
I have had the privilege of delivering various deaf women in my career.
Actually at the North Shore Community Health Center, we were located next door to Deaf Inc. and we had quite a few of their clients. The beautiful midwife I had the honor of working with in Salem, Mary MT Collari CNM had a great relationship with them and shared this relationship with me.
So this was all preparation for last night, knowing what works and does not work with the Deaf Mothers.
What a miracle!
A mother, a beautiful woman who is sharing her body, her nutrients, her blood and oxygen with this little creature of God, has these contractions or "rushes" as Ina May Gaskin calls them. She uses all her energy to literally push out a 10 cm head through a barely more than 10 cm passage.
There is so much waiting during delivery usually.
Wait to be in active labor.
Wait to dilate.
Wait to push.
Then all of a sudden, after sooooooo much waiting there is an absolute and complete miracle happening so very quickly before your eyes.
There is another precious, complete human being with the potential for so much.
This new child could be the next Peace maker of this earth, then next scientist, teacher, physician, engineer that could change the world.
Wow!!
Am I lucky or what?
I get to witness this all day long.
It NEVER get old. NEVER get boring. NEVER is the same.
Women are so amazing.
Our bodies are so amazing.
God is Good. All the time.
All the time God is Good.

Promised Pictures.....

 I have the privilege of living on the richest man in town compound. He owns the local general store. He has 3 wives and 11 children. Two of the children are away at school.  I am the only one with an indoor toilet and shower in town. Also the only one with running water and a water tank. Above is my bathroom

 My living room. It is empty.

 The front of my house.

 My little neighbor Baquita. She is one of the owner's daughters

 This is Angelica the owner's wife's sister. She is peeling peanuts. A very common food ground in greens and cooked on top of rice with garlic and palm oil. And fried with salt also. Very good.

 This is the picture of my compound. My house is on your right.

 This is my back yard with 3 graves of family who died of HIV. All the adults in our compound have HIV.

 The community (Ezo) only public water supply. People come all day and fill buckets and jars and containers. People from 3 years old to 93 years old come. My tank is filled from this source. Sometimes it is stopped by the government. So we have no water.

 Our neighbor's compound.

 This is a "tukulo" on the CMMB compound. My house is on your right.

 My bathroom with the buckets of water in case of emergency.

My bed with my mosquito net. The bed came with the house.