End of mission…sort of

My mission in Bolivia started on Jan. 22, 2020, and was to be for 3 months. Next week I hit the 3 month mark but there is no end in sight for the mission due to borders being closed and all flights in or out cancelled.

Bolivia is a beautiful country with equally beautiful people. I love the mission project, which is basically facilitating training of doctors and nurses in maternal/infant health protocols as Bolivia has the dubious distinction of being the Latin American country with the highest maternal and infant mortality rates. Our project works with 2 community clinics and does health promotion, psychological support for victims of sexual and domestic violence and maternal/infant health. We encourage women to birth in our facilities rather than at home because they lack any kind of skilled care at home and the outcomes are often poor. So we offer culturally sensitive care and respect the birthing practices and rituals of the indigenous population, mostly Aymaran people. They birth vertically if they so choose and are offered only warm food and drink, which is their tradition during labor and postpartum. Nothing cold can be consumed.

For over 2 months I worked in the clinics and alongside the doctors – there are no recognized midwives in the Bolivian health care system so doctors attend all births in clinics and hospitals – and it was challenging and rewarding. Episiotomies are routine for first time mothers, a habit very difficult to break. There is however, not the routine obstetrical violence I have seen in clinics and hospitals in Africa, although I suspect this is only true in the facilities where I work because I have heard awful stories of hospital birth here. Still, I am glad to not have to be witness to that. The women who birth in our clinics are treated with kindness and respect.

COVID-19 has been hanging over the mission pretty much since I started. We all knew it was coming and as it got closer, we got more briefings and more information. Without knowing what the Bolivian government was going to do, all we could do was wait. When it was becoming obvious that borders would be closed and flights were likely to be stopped, we were given the choice to leave at that time since it was unknown when we would be able to go if we stayed. No one left.

MSF cannot make any moves or directives in the clinics we support without the full and express permission of the health ministry here in the country. These are not MSF clinics, they are Ministry of Health clinics that we provide support to. So one day we were all going about our lives and the next, everything was shut down, including borders, flights, all stores – everything. We were ordered to stay home 24/7 with exception being that from 8-noon M-F, based on the last digit of your ID, you could go out on your assigned day and shop for the week. No one under 18 allowed out at all – ever (I can’t tell you the last time I saw a child) and anyone out after noon or on a Saturday or Sunday is fined 1000bs for walking, 2000bs for driving and 8 hours in jail. Police and military patrol on foot and by vehicle and there are checkpoints everywhere.

All of this might sound extreme but this is a country of 12 million people. We have 500 ventilators in the entire country. As of this date, April 14th, we have 354 cases and 28 deaths. Whatever we are doing is working so far.

I understand that most people do know what it is like to be a humanitarian aid worker. There is a limited understanding that ranges from “that sounds so exciting!” to “that sounds really awful!”. And the reality is, it is both of those and everything in between. We are away from our homes, families, friends and pets for huge amounts of time. We live communally with people we don’t know but get to know but staff is ever-changing. Some are people we’d gladly live with if given the option and others are people we would barely give time of day to under normal circumstances. The food can be limiting, weight is lost or gained depending on the context. There may or may not be reliable internet so communication back home can be hampered. Sometimes security is high and movements are limited. In certain contexts it is hot, like 100 degrees hot and there is no AC. Sometimes we live in great accommodations and sometimes it’s a tent! Sometimes we have the supplies we need at the clinic and sometimes we do not. And by supplies I mean, things that could mean life or death for a patient. And then there is the work itself. On any given day, one might see a child die of malaria, a baby die because labor was just too long, a woman die because her AIDS was just too far advanced for any medication anymore or an infant starving to death because his mother died and he has no will to live. This is the work. Heartbreaking, frustrating, sad but always challenging. It motivates us to help the next person. You cannot dwell too long in the “what ifs” because there is always someone else who needs help.

How we get through missions is completely up to us. We have the support of each other, the other team members, we have our individual coping mechanisms (or lack thereof for some of us!), we have psychosocial support from HQ and we have people back home who love and support us and this is a huge help on mission – the connection back home.

This mission has been a dream. There are 6 expats including myself. We have hot running water, live in nice apartments and have no security restrictions. And then COVID-19 arrived. While all the restrictions are limited, we are able to go to the clinics on special movements at special times because we were granted permission by the ministry of health and are essential workers. So although our hours are limited, we continue to work. This was all manageable, even the huge amounts of time spent in the apartment longing to be outside where the weather has been gorgeous now that the rainy season is coming to an end. All manageable except that as the rest of the world is falling apart, those of us out here working far from home are all but forgotten. So when the tough stuff comes, abandoned newborn on the clinic doorstep, stillborn baby to first time mom, a 14 year old sexual violence victim, a baby with a cleft palate born to a single mother – oh yes, in the midst of COVID-19, life still happens and it is that much tougher due to the pandemic.

The frenzy of panic and self-absorption as seen from a distance by those of us who regularly work in a context of emergency or even semi-urgent, is quite striking. The whining over restrictions, the hoarding of toilet paper, indignation over not being able to go from home to cottage or not being able to purchase home improvement supplies because they are not an essential item and WHY are they not? – very eye-opening. This first-world entitled attitude that has always existed in the U.S. has been magnified by this pandemic. It is shameful to me. I am embarrassed by it. Watching the flagrant disregard of stay-at-home orders is very frustrating. All I can think when I see that is, the longer you all disregard this and think the rules don’t apply to you, the longer we are ALL stuck! This is so much more than about you!

There seems to be an inability of people to grasp the fact that, although we are all in this together, we are all having very different experiences. Same storm, different boat. There is a difference between someone being restricted from going to their cottage and someone who was living paycheck to paycheck and now doesn’t have enough to feed their family! I have friends and family in both positions. We probably ALL do! I know there are a lot of people a lot worse off than me and I am here working helping some of them. It helps to get outside myself. Didn’t we learn at some point in childhood to put ourselves in someone else’s shoes? When did we lose this lesson?

I have learned to focus on the people out there helping, being funny, being creative, finding ways to survive the stay-at-home orders and helping others. Friends in dog rescue, still rescuing dogs! I have a small handful of friends who have checked on me and for them, I am truly grateful. I cannot tell you how isolated I feel. Unlike most people, I am not quarantined at home, I am far from home. I have no friends or family here. This is not my country. This is not my language. This is not home. For me, the 24 hour a day order to be inside is manageable, especially since I can work a shift once a week and work from home on my computer. But there are still times when I get desperately lonely and feel very isolated and most of that is because of all the unknowns.

A normal mission might be 6 or 9 months but there is always, always an end date. My mission was 3 months and it was to end the 22nd of April – next week. I knew weeks ago this was not going to happen and I made a certain peace with it. But still, it hangs there, this unknown date which, once it does come, might come quickly, as in, “we got you a flight out tomorrow!”. There are no ‘goodbyes’ to staff or the people one has worked with for months, I just go. The uncertainty of what lies ahead at home – where will I go in a country that is in quarantine? No one wants a traveler on their doorstep.

Then sometimes fear creeps in. Waiting to learn a close friend or family member is critically ill. It could happen. It happened on my last mission. This time, there is no way home. Conversely, if I were to become critically ill on mission, normally I would be on a Medivac out and repatriated. This would not happen now, there is no way home. I make peace with those things on a daily basis. It is a process. These are my realities. This is my boat.

So here I am in Bolivia. I will continue to help the mothers and babies as long as I am here and in between I will hope the rest of the world finds a way to make peace with their circumstances. I see friends doing it on social media. There is despair, ranting, a grieving of things and events that have been lost, but then there is hope. There is working through the loss, because there has been loss – a LOT of loss and grief. Grief is good and healthy. Those are the posts that get me through. So be frustrated, be sad, grieve and then get out there and do something! Enjoy the small freedoms. Enjoy your yard in the springtime. Watch the birds. Help an elderly neighbor, foster a dog or cat, play a boardgame with your spouse, children or roommate, take an online class – the possibilities are endless, especially if you have a yard and can go outside! People are literally risking their lives on the frontlines every day while a large portion of the population is being asked simply to stay home. Although I know it is not simple. None of this is simple. Not for you, not for me. So be kind to each other. Ask for help if you need it. Cry if you have to. Be grateful for the small things. Soon the storm will pass. Let us be able to look back on it and say we were our best selves.