Days are long here in Bangladesh; hot, emotionally heavy and physically exhausting. All of this is compounded with a mysterious illness that has been taking out the team, one by one; sometimes two by two. During the first rotation, only 3 delegates were able to escape isolation; the second rotation seems to be following along nicely.
I’m determined to not get sick.
Isolation means a couple nights in a hotel, never further than a couple steps from the toilet. It’s not the sickness I fear though, it’s the quiet. Two days in a hotel room could sound like a dream in this exhaustion, but the quiet scares me because of the truth it often speaks.
In order to survive, truth is not an option.
Not now anyway.
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I’m a psychosocial support delegate working in the field hospital and in the refugee camps that currently house over 625,000 people.
625,000 people.
It’s one of the largest humanitarian crises’ in the world right now and there are few words to describe it. The sounds. The smells. The sights. The silence. The screams. Babies. Children. Youth. Women. Men. All things in between.
625,000 people.
Having fled a recent eruption of violence in their home country of Myanmar, many walked for days to cross into neighbouring Bangladesh. Carrying only what they could on their person, everything they once owned now left behind. Homes were burned to ash. Women and young girls gang raped. Men forced to watch. Shot. Killed. Babies thrown alive into raging fires, leaving nothing but the painful screams of the mothers whose arms they had been ripped from. Those who could walk, walked. Those who could be carried, were carried. Hours. Days. Weeks. Eventually, the relief of the border for those who survived to cross it.
With little to no food and illness spreading between groups, many were sent directly to the field hospital for treatment. Others were able to move from the Transit camp, where they could rest and get their basic needs met for a few days before moving into the larger camps.
625,000 people.
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It’s already been a long day. If the constant work doesn’t tire you, the hot sun over an open field will! Our fridge is full of water; nothing but water. Someone here is always around to remind you to stay hydrated, “did you drink water?” is almost like the new “hello, how are you?” The answer is always “yes, but probably not enough!” You drink every chance you get here, there is little relief from the heat and the humidity.
The hospital is a 24 hour operation and we’ve been operating mostly with ex-pats as we try to secure local staffing support. We are all tired, but we are one solid team.
I’m closing up the psychosocial tent for the evening when I get called into the outpatient department. I can already hear the screams as I get closer to the tent. I turn the corner to enter and stare into the eyes of a terrified mother. From the mother, I follow the screams coming from her 6-year-old daughter; whose leg and foot are covered in blood. After all the walking and surviving the border crossing, S was run over on the road by a passing tuk-tuk. The language barrier is always difficult, but many times in this deployment I have been grateful for it. “We are going to have to amputate, let’s get her to the Operating Theatre”, the mother knows nothing and this gives me a better opportunity to explain it to her in a much more sensitive way.
By the time dinner rolls around, I’m not hungry; but I have to eat. Being a vegan in the field isn’t ideal but I’ve found a couple options in the boxes of rations. Tonight, it’s tomato and pasta sauce with a soy ground “beef” – not horribly disgusting and it ends up being my favourite by the time my mission is complete.
I sit alone in an attempt to process the last few hours of my day, but solitude is rare here. I’m joined by a few other colleagues and I take a moment to appreciate the ability to laugh.
“Did you drink water?”
“Yes, but probably not enough!”
I drink some more, take my antimalarial and fill up my water bottle for the night. As hot as the sun can be in the field, it’s even hotter in the tents.
By 9pm, the wifi signal begins to strengthen and I’m able to connect with my loved ones at home. Unfortunately, the time difference doesn’t allow for much of that as the kids are in school when I’m going to bed. Some meaningless, and painfully slow, internet browsing works just as well to pass the time. My roommates are both still in surgery and I have the tent to myself for some much needed alone time, with music.
It’s a good half hour before my roommate returns and I can tell by her face that there is something wrong. She has just returned from a couple days in isolation, after only about a week in the field and I ask “Did you drink water?” She immediately begins to cry and I brace myself for what’s to come.
“How did the surgery go? Everything ok?”
“No, the baby died.”
We have yet to have one survive.
“Did the mother make it?”
“Yes, it’ll be a long night for her, but she survived.”
We spend the next couple hours talking about her experiences here; it’s her first mission. She tells me that her daughter lost a baby late in pregnancy the year before and that she is pregnant again; due to give birth in a couple weeks. There is nowhere else she would rather be, even though she knows she is needed here. I can almost feel the weight of her pain and I know, without her saying, that she won’t survive here another week.
I need to sleep.
The call to prayer begins at 4am and angrily wakes up the sleep deprived team daily. Most of the delegates sleep with earplugs to try to drown the sound but I find it helps me get back to sleep when I am having trouble. It’s now after 1am and I say goodnight to my roommate.
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An hour later, I hear my name being called. At first, it fits into the dream I’m having but I wake up anyway and realize that it’s not. As my eyes struggle to open towards the bright headlight shining on me, I start to make out the shape of our 6’7″ team leader over my cot. She is trying not to startle me and apologizes for having to come in to my tent. We have an emergency in the Operating Theatre. I look around the tent and see that my roommates have already gone to prepare. I get up and get dressed and head to the Operating room.
I pick up the on-call interpreter on the way and get briefed while walking. A man in his 20’s has been rushed to the hospital for emergency surgery, no one is expecting him to survive. He is local engineer who, while working on a build, fell onto a bamboo pole; puncturing his trachea and lung. The team worked REALLY HARD and managed to repair most of the damage but there is still a leak in his airway. He’s on a ventilator when I get there and will need to be transferred to a hospital 50kms away for more specialized surgery, if he survives the night.
I’m called for his wife, who has accompanied him to the hospital and did not handle the news well. She’s been crying for hours, alone. They came here together for his work from another city in Bangladesh and have no family and friends in the area, just each other. She tells me that she has never left his side and that she doesn’t know what life is without him.
She asks if she could see him.
The doctors have told her that she cannot, but I am not satisfied with that. I go into the Operating Theatre to speak with them and explain that she needs to see him in order to be able to get some rest. They are concerned with how she may react when she sees him connected to all the machines, I ask that they let that be my problem if it gets to it. They agree and we cover him as much as we can, leaving only his head and one arm exposed.
I go back and prepare her for what she is about to see. I explain what the machines are for and tell her the importance of being quiet while we are inside there. She takes my hand and allows me to lead the way. When we get inside, I can feel her hand tighten, and I remind her that he needs to sleep. She remains quiet and walks with me to him. She releases my hand and puts it on her husband’s exposed arm. Tears start to form and I tell her he’s just sleeping. She moves her hand to his head and starts to stroke his hair, telling him that she’s here and that she loves him. I know exactly what is coming next and I tell her we have to go. She looks at me and as she turns around to leave, releases the loudest, most painful scream.
Love.
A powerful emotion.
I take her outside and set up a bed for her in a tent nearby. She has to rest, they both do.
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Before I know it, it’s the morning call to prayer – signalling that I have another 2 hours to fit in a power nap before my next work day. I manage to fall asleep and wake up to my morning alarm for breakfast.
I’m such a mess right now.
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Breakfast is crackers, peanut butter and a Larabar from home – with coffee, of course.
Every experienced humanitarian aid worker has 1 (or a few) items that they wouldn’t dream of deploying without. For me, one of those is a couple boxes of Starbucks single serve instant coffee. We search for home in the strangest ways sometimes.
Our morning meeting begins, and we have good news and bad news. The good news is the man survived the night and they transported him and his wife this morning. The bad news, the mother who lost the baby yesterday, has also died.
Every day starts and ends with death here but I’m choosing to hold on to the good news today; our medical team is amazing.
Gratitude.
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Whatever fumes I have left in my tank will have to keep me running for the rest of the day. My partner and I open the psychosocial tent and meet with our team of volunteers.
The team is made up of 8; 4 men and 4 women. They range in age, but it’s almost impossible to get real ages here and I’ve never been very good at guessing. All 8 have made the journey to Bangladesh themselves, the most recent arriving just a couple months earlier. They are the true heroes of any mission, and this one is no different. Despite what they have been through, and their own living conditions and challenges, they choose to give back every single day (or 6 days a week because we force them to at least take a day off to rest). After our morning check in to make sure they are doing well, we break the teams up and send them off for their daily activities inside and outside the hospital.
Dedication.
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It’s 10am now and I’m called to the maternity tent. An 18-year-old girl, who doesn’t look older than 14, arrived to the camp alone; no family, no friends, no support. On her second night, she was assaulted by a group of men. She was brought to the hospital overnight, assessed and treated. The physical wounds were easily visible but it’s not until the morning that the invisible wounds really start to appear.
After being cleared medically, she refuses to leave the hospital. With nowhere to go, the terror in her eyes speaks louder than her silence. I meet with her to discuss some possible next steps, as staying in the hospital is not possible. I refer her another NGO’s medical clinic nearby, where she can stay to access some psychological support. The relationship between our sites has been a strong one. We have services they cannot offer, they have services we cannot offer – partnerships are the only way to survive in these environments. But even with strong partnerships, we watch individuals walk out of our hospital and hope they make it to the next location safely.
Barefoot and in pain, she makes her way out to door and I watch her walk away.
Hopelessness
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I return to the psychosocial tent, where there is a 13 year old boy whose younger sister is admitted to the hospital. He and his 4 other younger siblings have been playing in the children’s safe area for the last two days.
He’s bored of having to take care of them and I could use a distraction.
11 games of Snakes and Ladders later, I’m tired again and need a break from everyone.
Here, sometimes the only solitude you can find is while using the washroom and even then, there is no guarantee. I make my way to the porta potty and hang out for a couple minutes. It’s way too hot in there but I’m not ready to go back yet. I decide to sit in the kitchen area for a couple more minutes and I see about 50 bananas in our ration area. In this moment, there is no happiness like a fresh banana.
It’s delicious.
I drink some water and a few minutes later, its back to the tent.
Rejuvenation.
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I’m called into the pediatric ward where a 5-year-old girl is dying. Her father carried her several miles to the hospital, by foot. Her mother stayed in the camp with their 3 other children. He is frantic for support but cannot bring himself to tell his wife that he will be returning home alone. He is pacing back and forth, and I can hear the faint wheezing of her breaths, uncertain of how much time she has left. Everyone in the ward is watching and the other mothers are starting to angrily yell at the father to call his wife. I ask him if he wants to go into the psychosocial tent, where he can be with his daughter alone, and he says yes. He doesn’t want to touch her, too afraid that he will breakdown. I carry her nearly lifeless body across the field hospital and lay her on a cot in the tent. I wrap her up in a blanket and hold her hand as she takes her last breath because no child should have to die thinking they are alone.
He gathers the strength to call his wife and I hear her screams through the phone. They are both screaming now, and it takes every ounce of strength I have left in me not to scream too.
The smallest coffins, are the heaviest.
Strength.
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After the wife’s brother comes to take the father and his daughter’s body home for burial, I run as fast as I can back to my sleeping tent.
I must have watched the video my kids sent me that morning a hundred times. What I wouldn’t give to hold them right now.
Longing.
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My roommate comes in and begins to pack her belongings. I ask her if she’s ok and she says she is not feeling well again. She is going back to the hotel for isolation.
I say goodbye and thank her for all the amazing work she has done.
I know this will be the last time I see her here.
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The psychosocial tent has reopened after the death and I can hear the sweet sounds of children playing as I walk towards it. I go inside and see the beautiful smile on S’s face as she looks up at me. It’s the first time I’ve seen her since the amputation and she is the most perfect gift at this moment.
Her painful screams now replaced with the best giggles I’ve ever heard (after my own children, of course).
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It’s time for S to eat and I carry her back to her mother in the pediatric ward. While there, I check in with my favourite little 9-year-old boy.
Two weeks earlier, a group of wild elephants attacked one of the camps; killing 4 and injuring another 4. This little man had both his legs broken in the attack; he’s been bedridden with us ever since. His older brother never leaves his side, and up until yesterday, he believed he would be here forever. I’m glad to have helped clear that up for him and his spirits have definitely lifted since. I try to get him to do his upper body exercises using a creative contraption that one of our technicians put together for him, but he laughs, and I know that he’s not interested right now. I leave some toys with him and tell him I’ll come visit later as a call comes in asking me to go to the maternity ward.
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A young woman lays in silence on the bed. After being violently gang raped while pregnant before crossing the border, she has now suffered a miscarriage. She’s alive, on the outside. I can’t tell you how much more of her survived that.
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My partner and I are shutting down the tent for the day and getting ready for our daily debrief. It’s her first deployment, and it’s not an easy one! While our personalities are very different, they are also quite complimentary. No one else has a very strong understanding of the work we do and just how difficult it can be to provide support to EVERYONE, so I’m incredibly grateful to have her on this journey with me.
We’ve created a bit of an evening debriefing ritual, where we talk about the day (and life, in general) while playing background music and doing our stretches/yoga. It’s something I look forward to, and today is no different.
I’m not hungry again but I force myself to eat.
And drink water.
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I go to bed and start to cry.
Crying, for me, is a very good thing. A release. A cleansing of sort.
It’s the lack of feeling that scares me, and these tears remind me that I am still alive and well.
I don’t know when or how it happens but at some point, I fall into a deep sleep. For the first time since I arrived, I don’t need the call to prayer to lull me back to sleep. In fact, tonight, I sleep through it completely.
Exhaustion.
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A new delegate arrived the night before, one I’ve worked with in the past.
I am genuinely happy to see him; he looks well rested and excited to face the day. We eat breakfast together and do a quick life catch up before I start. Since he doesn’t have much on his schedule for today, he tells me he will connect with me later for a psychosocial operation overview.
I wish him luck and tell him to drink lots of water.
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It’s not long after breakfast that I’m called to the outpatient department to speak to a male patient. The gender dynamics here are interesting. It’s a predominately Muslim country, and normally, men and women are kept separate from one another. We’ve redesigned the hospital to respect the culture and religious practices, and everything we do is done in consultation with the affected population and community leaders. While men wouldn’t normally access support from women, at the hospital we have found that when it comes to psychological concerns, they are more likely to open up to a female. Still, I respect an individual’s right to choose and so, I pick a male translator to accompany me to the ward. The man doesn’t speak; not because he can’t but because he hasn’t in weeks. He is sitting cross-legged on the bed and I can see his genitals – he’s completely unaware of this as he stares blankly at the wall beside me. I ask my translator to discreetly adjust that for him, and he does. The man doesn’t move. He was brought to the hospital by a friend, who was growing increasingly concerned about this behaviour. Through the translator, I ask his friend when this started, and he begins to tell me in his language.
When his village was attacked, they captured his wife and children. After killing his sons, they forced him to watch the rape of his wife and daughter; before killing them too. He fled alone; crossing the border with nothing else to live for.
I look at him, two shiny streams of tears now running down both sides of his face.
The first signs of life his friend has seen in weeks.
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After an hour with him, I desperately need to hear S’s laugh again. Her and her younger brother are starting to spend more time in the child safe tent and even the doctor’s stop in regularly to see her smile.
The psychosocial tent has become a bit of an escape for those needing a short time-out from reality. It’s the only place where you can hear constant laughter, and we make sure we always have cold drinking water on hand.
Today, we are visited by one of the technicians.
Regardless of everything that is going on, he goes out of his way to smile. A genuine soul, he quickly became one of my favourite people to work with.
But something is different today.
He asks if he can come hang out with us for a bit, and both my partner and I ask him if he is ok at the same time. He sits down and immediately starts to cry. My partner gets up and gets him a glass of water.
“What happened?”
He got news from home that his uncle died. Far away and feeling helpless, he says he can’t think of a better place to go. He tries to apologize but we don’t accept apologies for feelings. He laughs and says, “that’s why I came here.”
We let him cry for as long as he needs. We speak when we need to. We watch children play. We drink water. We listen to laughter. We just are.
And then our radios go off and we spring back into action.
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Another emergency C-Section.
Another baby dead.
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Our isolation tent is now filled with children with measles. The crowded refugee camps are the perfect breeding ground for all things communicable and we are in desperate need of a vaccination campaign.
Watching any child die is awful, but there is something about measles that looks especially violent.
Another child dead.
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S is learning to walk with her crutches. They were able to save enough of her foot in surgery so that she will be able to put her weight on it.
That smile.
Hers and her mothers, as she takes her first steps.
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The new delegate returns after providing support for the child who died earlier. I can see that he is upset by it.
Of course, he is.
Although I’m just starting to process the events of my own day, I know he needs me to be there for him.
Present.
He sits down and looks me in the eye, fighting tears, his voice shaking. I can almost feel his heart breaking as he asks me, “Was that the first death?”
I take a breath, get up and pour him some water.
“Here, you’re going to need a drink.”
*names have been changed to protect the confidentiality of individuals.
And miles to go before I sleep 