Nathalie, psychologue

On bulletin boards in several MSF compounds I saw the above notice, a simple handwritten sign with the name and number of a psychologist [I've changed the number because hey, this is the Internet.] Obviously, dealing every day not only with extreme poverty and its health-related consequences of disease and malnutrition, but also conflict-related injuries such as gunshot and machete wounds and burns, can take its toll psychologically.

I didn't speak on this subject with anyone I met while I was in the D.R. Congo, but I read about it in Dan Bortolotti's "Hope in Hell", a good book I quoted from yesterday. Bortolotti interviewed a number of people about the psychological effects of their experiences in conflict zones, and one story stayed with me.

He writes about a nurse who served in Africa who on her return to the tiny community in northern Canada where she worked and lived, had trouble adjusting. Substance abuse was a major problem in the community, and the nurse was frustrated not only that many health problems were to a great extent "self-inflicted", but also that people had little understanding of their relatively privileged circumstances.

She said, "I really had a problem with the drinking-related stuff – people calling me inn the middle of the night, getting yelled at, cursed at. I remember having no sympathy for my patients and really having to cover that up, because that could have got me in trouble ... I just wanted to take them by the shirt and shake them and say, 'You're so damn lucky. You have a life, you're relatively healthy, you don't risk being shot every day, you can be vaccinated for meningitis.'"

Bortolotti then goes on to quote from an e-mail the nurse sent to a colleague who had been in Burundi with her: "We had a murder here last Tuesday. First one in five years – not too bad for a community of 850. As I performed CPR on this man's lifeless body, I was surprised to note how detached I felt. He'd attached someone and then got stabbed in the chest – both of them were screaming drunk. Later, when we pronounced him dead, I felt no empathy for the man, nor for the family. No sadness. The two nurses I worked with that night were quite freaked out. When they offered us 'debriefing and counseling' the next day, I almost laughed ... It is snowing and dark now at 3 p.m. Nothing to do but walk the dog and visit friends. It is true, nobody really wants to hear about Burundi. I am talking on the local radio this Tuesday. I will keep it very simple. I would love to tell them how fortunate they are to live in a country with such great access to health care, even if it sucks by Canadian standards."

For the most part, it's true. "... nobody really wants to hear about Burundi ..."

Panga

I snapped this photo of a panga, or machete, lying on the ground at a health clinic in the village of Tongo in North Kivu province. I snapped it because although the panga is a commonly used tool in Central and East Africa (and by other names, in many other places around the world), it has also been used (and is being used today, as I write these words) a great deal as a weapon.

It was one of the main instruments of death (and maiming) during the Rwandan genocide of 1994, and I can't look at one without thinking of that, rather than its utility for cutting brush or dismembering a chicken. I recently read a good book about MSF called "Hope in Hell", by Dan Bortolotti, who recounts the experience of a Belgian doctor in the Rwandan town of Butare during the early days of the genocide.

The doctor recalls that on April 22 and 23, 1994, Hutu soldiers hacked to death in front of the MSF medical staff 150 Tutsi hospital patients, and then grabbed a nurse who was a close friend and seven months pregnant: "They came to take Sabine and I intervened physically and said, 'Leave Sabine alone. Sabine has nothing to do with this ... and besides, she is a Hutu.' The captain who was responsible for the different [killing] teams looked at me very carefully, and then he opened his pocket and took out a piece of paper, and on this paper there was a list of names, typed. And Sabine's name was on it. He looked at the paper and he looked at me and said, 'Yes, you are right. Sabine is a Hutu. But her husband is a Tutsi. And his baby is going to be a Tutsi.' I suddenly realized the cruel reality that in Rwanda the baby follows the paternal line. So Sabine was killed and so was the baby."

So I took a photo of the panga.