Paul and I had to figure out how to get approximately 400 lbs into a cargo area the size of a large trunk, including medical equipment, donations, personal items and of course survival equipment (in case of emergency). We also had to calculate the center of gravity because we would be depending on this 1968 Sky master to safely carry us over oceans, jungles and mountains.

We stopped in Key West to refuel and then took off over the clear turquoise waters towards Cuba, with written permission from the Cuban officials to fly through their airspace. Cancun, our next stop, was only ninety minutes away. Because it was our first port of entry over Mexico we were required to land there and clear customs.

Once on the ground there was another 2.5 hours of logistics (refueling, paperwork, customs, etc...) to deal with before we could take off again. Paul met some folks who gave us the lowdown on which airports had fuel (a situation that changed daily, sometimes hourly). The cost of fuel for the 337 was approximately $3.60 per gallon and we used somewhere around 11 gallons an hour so finding out where to get this precious liquid was extremely important.

It was still too far for a direct flight to Villaflores, Chaipas so we had to overnight in several locations along our route. Wanting to avoid the big city confusion of Cancun we chose Playa Del Carmen as our resting spot for one evening. The landing strip was adequate, the airport staff extremely friendly and we could even walk from the plane to our hotel. What a great choice. OK it took an hour to walk because we couldn’t find the exact street and it was about 90 degrees with about the same percentage of humidity but we made it just in time to watch the sun set as a Mexican teenager played some mellow tunes for us in English and Spanish on his acoustic Guitar. We complimented his talents and tipped him handsomely (good thing too because were his only tipping customers).

Before we could continue onwards the weather quickly turned bad. The airport we had chosen as the only suitable place to land in Tuxula Gutierrez (GTZ) close to Villaflores was in the mountains and fogged in. Not only was landing there a bad idea, the airport was also closed due to weather so we had to make a choice. Finally we decided to land in Villahermosa where the weather was good but the distance from our final destination was considerable. We were at least 3.5 hours away from Villaflores by Daytona 500 standards. Oh by the way, it was good that we didn’t even try to land in GTZ because the official aviation maps we had purchased in America had the military airport and the civilian airports (in GTZ) transposed. We investigated in person later to get corrected details!!!

Dr. Jesus Farrera drove hours to pick us up in an Ambulance with two student nurses, Juan & Ivan. We were so happy to see them when they finally arrived in the dusky afternoon haze. Once the authorities got a good look at the Ambulance with lights flashing they became a bit curious and followed us back out to the plane to inspect everything we had. It took some time but we were cooperative and soon they were also helping us repack our things and secure the Skymaster in place.

To say the trip to Villaflores in an ambulance was eventful would be putting it mildly. First of all Dr Jesus proved to be as expert a driver as those in Daytona where we are from. I’m not sure that was a good thing considering the blind curves, mountains and lack of light once the sun fell but with a good grip on the door handles Paul and I managed to avoid being tossed around too much, even with seatbelts on! We were literally being tossed not only from the rapid rate of speed around the curves but the strange side to side movement the vehicle was making. Folks even passed us pointing at our tires but Dr Jesus just assured us it was faulty 4 wheel drive and it would be OK. We did stop once or twice to check the wheels; they were still there so we continued on.

FYI Chiapas is one of 28 states in Mexico. The town of Villaflores is located on the border with Guatemala about 1.5 hrs south west of the capital Tuxula Gutierrez.

As soon as we arrived in Villaflores, even before unloading the Ambulance, Jesus rushed us into his Red Cross clinic to assist with surgery. By this time it was around 10 PM. We did 3 operations lasting until 1:30 AM before we settled in with Jesus and his family. Back at his modest 3 story apartment his four yr old son, Leo gave up his room for us to use during our stay.

We had planned a little ceremony to present Dr J. Farrera and his clinic staff with a plaque & the donated medical supplies from a special friend, our own finds locally and Medical Bridges (www.medicalbridges.org) as well as the money sent by Rita Iverson, Jamie & Phillip Krmpotich and their colleagues from Casper, Wyoming but… the suction machine and other supplies we had brought were needed urgently so they had to unpack and start using the new supplies the following morning!! We were so pleased that our donations really made a difference.

I was amazed at how efficiently the clinic was run with so little in terms of supplies. Many things in the clinic were donated by the community in Villaflores. We were the first outsiders to bring a donation!! The clinic was a non functional broken down shack when Dr. Farrera took it over 2 yrs ago. He and the students completely refurbished it but they still need so much like OR lights, monitoring equipment and an infant incubator.

With only a table lamp for warmth, the baby we delivered by C- Section baby was so cold by the time we were finished weighing and measuring her. The light is not good in the operating room. Only common kitchen lights mounted on the ceiling are used to see for surgery!!

Dr. Farrera only uses spinal anesthesia on his patients, with the assistance of an Anesthesiologist.
If the patient is poor or turned away from the public hospital Dr Farrera will provide free surgery for the emergency cases. Those who can pay give a very small amount to cover the costs and to provide living expenses for the students who have no other source of income.

All post op patients go home after 24 hours (because they don’t use general anesthesia) but a man electrocuted by high voltage wires ten days prior showed up while we were there, he returns periodically for follow up and wound care. Dr Farrera will do reconstructive surgery and grafting in a few days. The patient is so thankful for his good medical care that he told us he will volunteer his services in the clinic when he is better!

Dr. Farrera also provides free Ambulance rescue service for the community of Villaflores. During our visit just before the donation ceremony an emergency call came in. A 48 yr old woman tried to commit suicide by drinking a pesticide and eating rat poison because her husband found another woman. So we rushed to her rescue. Later we learned that the major cause of suicide in this area is due to failed love relationships. In fact, death due to suicide is higher here (Villaflores area) than other unnatural cause approx 50 per 100, 00/yr

Dr J. Farrera has joined together with a local nursing school to provide technical training and practical education in his clinic. Student nurses, firemen and paramedics all learn emergency rescue, can deliver babies and provide patient care. They also learn how to assist in surgery and suture. His students have practical skills that will save lives and make them invaluable to the community when they are finished with their training.

Together Paul, Jesus and I discussed the community needs and how future volunteers can work together with the city of Villaflores towards future goals. Villaflores is still in need of a “sister city” in USA and they need an airport too! Are there any volunteers out there to work on these projects???

NEEDS: Medical, Water and sanitation, AG planning. The city has much to teach us and we much to share with them so if you are interested in making a volunteer (or other) contribution and learning in the process…contact me through this website or mlightfine@earthlink.net

Only two folks including Jesus speak English in Villaflores so it would be necessary if volunteers speak at least a few words of Spanish…Perhaps you’d like to come here to learn better Spanish!!

**We did learn later from the residents of Villaflores that Dr Farrera is also well known for his fast, efficient driving skills. Something we noticed during those hairpin curves, narrow overtakes on mountain roads and his constant reassurance that everything would be OK!!

After Villaflores, Chiapas we continued our journey on to Baja California Sur, Mexico. We had contacted LVM (The Flying Doctors) prior to our travels because they offered very short term volunteer services to Mexico and Central America. They even accept students along on their trips so we wanted to check out some of the locations to share with potential volunteer and to see if we could help out again in the near future. They were very helpful and willing to share information with us.
LVM gave us the names of several folks to contact upon landing in San Ignacio and Bahia Tortugas. We wanted visit their clinics and learn more about their medical and community needs so we could share that information with you.

San Ignacio did not have a functional landing strip (at this time) but Bahia San Ignacio did have a dirt runway with clean outside latrines available. We decided to stop there but were not able to reach our contact in the main town about 1.5 hrs away by auto. However we were offered the opportunity to see Grey Whales in the lagoon since we were already there and had a few hours to kill. We were amazed at their size and gentle demeanor. Dolphins act as midwives helping deliver the new baby whales. The salty lagoon is chosen by the mothers to be for its high salinity so that the newborns are more buoyant. We were told that they are very helpless at birth and need to be taught everything from breathing to swimming. Neither mother nor baby eat solid food for three months as the mother breastfeeds her baby 50 gallons of milk per day so that it will gain weight and grow an average of one inch per day until it is big and fat enough for the icy swim north.

There was yet one more location with a clinic we wanted to visit in Bahia Tortugas, a small non -touristy fishing Village.

Mary Lightfine

Last update: 15 January 2004 DAYTONA BEACH SHORES -- Imagine that you are a poor woman in labor and must walk miles to the nearest crowded public hospital to give birth. There you may not even receive medical assistance as you squat to deliver a child in squalid conditions. Now, imagine watching that baby die, simply from the cold.
Each year, low body temperatures will kill many newborns in developing subtropical nations, since underfunded state-run hospitals and private clinics often can't afford the luxury of incubators and other equipment needed to save premature and low-birthweight babies, according to registered nurse Mary Lightfine, of Daytona Beach Shores.

Watching Dr. Jesus Farrera Grajales of Chiapas, Mexico, struggle to save these babies at a Red Cross clinic has inspired her to seek donations of an incubator and other medical supplies for a trip to the region she and companion Paul Rooy will take at their own expense this month.

Since 1992, Lightfine, 47, has volunteered with the Nobel Peace Prize-winning relief organization Doctors Without Borders, an American affiliate of the French agency Medicine Without Borders, which provides emergency medical care in war- and disaster-stricken areas. Rooy, a local patent attorney, also has volunteered for several years with Angel Flight Inc., which provides free transportation to patients needing distant medical care.

" I think a little guy can make a larger impact. A lot of these relief organizations are big, and once they get really big they are controlled by others. When you're small and you do your own thing from the heart, you can do as you feel necessary, which is important," Lightfine said.

Lightfine said Grajales, who performs an average of 20 Caeserian births a month, has been her inspiration since he walked into the agency's New York office in 1998 to volunteer to serve abroad. The son of a poor Mayan Indian family, he operates his tiny clinic without government assistance, performing elective surgeries for paying clients to fund free health care for multitudes of poor Chiapans.

There's no end to the demand for his services, either, since health care in the region is scarce and poorly provided, leaving many to rely on curanderos and other traditional spiritual healers.

Much of the trip will be spent gathering detailed statistics on infant mortality rates, water and sanitation conditions and other environmental needs that Lightfine plans to address in future missions.

" When I lecture at colleges, a lot of students come up to me and want to know how they can help, so I'm trying to help set up a volunteer program so that students that I lecture to can go and help out in his clinic.

" By networking and sharing information, a lot of people who want to help in many ways are able to. It's also a nice way to help others help others."

A childhood spent in New Jersey and Ohio doesn't sound like backdrop for a life spent dodging bullets in Somalia and riding donkeys across land mine-filled terrain in Afghanistan, but it was perfect for Lightfine. She lived for more than a decade in Macedonia, Burundi and other places rocked by civil wars.

The former emergency medical technician and emergency room nurse financed her education selling eggs and milk from her Ohio farm. She taught herself to sew and live outdoors, skills she credits with preparing her to survive working in primitive conditions.

Those experiences also give her a deeper insight into the mindset of the rural communities comprising much of the developing nations, helping her to transcend language barriers, since English is not the first language of many volunteers.

" About 2,500 volunteer doctors and nurses go abroad each year and the organization has more than 11,000 native healthcare workers," she said.

Her years as an ER nurse in Georgia and Florida also helped her to develop the quick reflexes she needed to deliver babies in the Sri Lankan jungle and survive being shot at by Somalian militias. She even talked down a Somalian soldier who threatened to execute her for "stealing" his bomb when she removed it from a hospital bed he had claimed for his own.

" I told him, 'If you kill me who will care for your brother here in this bed?,' " Lightfine said. "I found out that if you give people a way out with dignity so they don't lose face in front of their people, they'll take it."

To contribute to the trip, call (386) 304-0533 or visit www.nursewithoutborders.com.

Hi everyone from Mary,

I’m writing from the International Medical Corps (IMC) office in Taloqan, located in the northern part of the country. I love it here, Afghanistan is wonderful.

I’m told that when you cross the border from Tajikistan you must set your watch back by 30 minutes and 5 Centuries. The people are great; they are friendly, accommodating, and hospitable.

Logistically getting here is a nightmare. After 5 hrs of Camel trophy driving from Dushambe, Tajikistan to the border we were turned back the first time due to lack of one paper. The second time we hitched a ride with Children’s crisis fund, known outside Afghanistan as Christian Children’s fund, but were not able to get out of the city so changed bags and vehicles. That was better because the new Vehicle from the Office of International migration had diplomatic status so we were not stopped at the 15 checkpoints. When we arrived at the border no one was there to unlock the gates so it took us one and a half hours to find the Russian military commander and to draw him away from his vodka party to get permission to cross. Once at the river barge (there is a big river separating Tajikistan from Afghanistan) we had to have our bags inspected by the Afghan authorities. They were looking for money, weapons, gold, and vodka. They found nothing of interest in our luggage. Good thing they didn’t pat me down because I was hiding valuables in my underthings. We were then permitted to walk through the muddy riverbanks on to the makeshift barge with our many supplies, sans vehicles. Once on the barge we were told to go back to Dushambe by an Afghan official due to lack of yet another new document. The Russian commander convinced him to forget it and let us go. We made it across the icy river in almost enough time to watch the sun set, as we covered our selves with the traditional chader for women, wondering where to sleep for the night. Finally by luck, as the sun began it’s dusky decent in the freezing temperatures we found a stranger who fed us a warm meal and let us sleep on his floor by a wood-burning stove for the night. The next day we had to engage men on horseback to wade through yet another river in order to find the shallowest point for a vehicle to cross (bridge was out). The water came up over the bumpers nearly to the door handles. Even some mud puddles were that deep. Nothing other than a high wheelbase four-wheel drive, low mileage vehicle would be useful here.

Several of us journeyed beyond Taloqan today in a rented vehicle. This was a big security risk we were taking, to drive in a rented old Russian jeep without radios or communication equipment in a war zone through mountains zig zagging mine fields and crossing rivers, an oversight on the part of IMC. In some places I had to cross near freezing bodies of water barefooted, in one village a man loaned me his Donkey. There were so many places to visit. We did learn a lot about several communities. For the most part they have semi-damaged homes to live in but were denied access to their fields for planting by the Taliban. They were also denied access to their irrigation water and chased away from their villages. They are starting over again in the winter with few seeds and even less livestock. The landmines affected many men and animals; women stayed inside so were not at risk as much. Children picked up the unexploded ordinances and suffered mutilation or death as a result. Our jeep passed several unexploded bombshells along the roadside. In one area they were built into the road itself!! We passed dozens of Afghanis working for Halo Trust to remove explosive devices. I asked one man, who’s job it was to de-mine dangerous areas, if he was "scared" to do this kind of work. His reply brought tears to my eyes. He said "if I have to step on a land mine and kill myself to save the life of another person, I will do it, it is a noble cause."

Speaking of dangers, an earthquake occurred the other day not far from here, six on the Richter scale, leaving a 1.2 KM crack in the earth, no casualties as far as I know but it did add to our security concerns.

People tell us that they have no food at all in their homes but are working their field with plows pulled by oxen. Only half of the village we visited had Oxen for plowing. Travel is done by Donkey. Some have horses; only the very rich have vehicles. One Tajik man pointed to a Donkey and said "Afghan jeep". Most people just travel by foot.

Regardless of which village you visit, no matter how destitute, they were, the people always offered us bread and tea. It is an Afghan rule to be hospitable, to offer your guests something even if you will go hungry as a result. It is considered rude not to accept such offerings. This left me feeling guilty but I ate and drank, even when the tea was laden with salty tasting debris.

To keep warm the men wear Army jackets or long traditional quilted or woolen coats. Most women still wear the burka and do not interact even with us on the street, but at least they are outside moving around and feeling freer. Although the Taliban are gone habits will not change overnight, especially since women wore this type of clothing for hundreds of years in certain villages. Only in major cities did women show their legs and faces prior to the Taliban. Now, if women or foreigners are seen on the street everyone stares just to see a new curiosity.

Most folks live like those from centuries past in large compounds surrounded by 10-foot high mud walls with a large medieval wooden door to the entrance. The homes are a collection of mud and straw shelters with log, mud and grass roofs. Each room has a tin wood-burning stove for heat. No one has or uses furniture, only cushions for sitting and sleeping. Much of the area has been deforested from the constant need of fuel and lack of replanting. Melted snow flows from the mountains into canals that traverse urban and rural areas. This is how the families find water for drinking and washing. I accidentally drank it from our water storage container for two days until I discovered its origin. I was the only person not to become ill. Must be my iron stomach!

There are tons of organizations here, all just getting started with their programs; a lot of displaced are in Taloquan city waiting to return to their villages. The main complaint was lack of food, and seeds for planting. Seems the last harvest was poor for several reasons. Lack of access to water and to the fields for planting due to the Taliban war and drought. There was a three year drought but they have irrigation in many places which could have been used but people weren’t allowed in the fields very much and the person responsible for controlling the irrigation was not available from what we discovered in one village. As for health, many communities never had access to a clinic without walking 3 to 24 hours, even before the war. Now people wait until the last minute to seek out a doctor in a distant town. Have not noticed any malnourished but it is sure if things continue, malnutrition will rear it’s ugly head very soon. The USA military has offered to provide some humanitarian assistance but had to "check" to see if they could support with medical evacuation of injured expats, assistance with the transport of drugs and supplies by air, rebuilding bridges, providing transport trucks for movement of food, maps, etc...

Our living conditions are a bit rough here. We are living in a house, which serves as an office. At night the women sleep on floor cushions in one small room. Two of the women left just after my arrival leaving me the sole female in this household. The men sleep in the other rooms. The temperatures are near freezing at night so using the outside toilet requires putting on several layers of clothes and taking a flashlight to the Turkish style squat toilet. The cold air on your backside keeps you awake for the remainder of the night. We have no permanent electricity but can use a generator for a few hours a day. There is an inside "bathroom" which is used only for bathing, it is heated with the same wood burning stove. We have a water tank on top of the stove, which heats the water. We mix hot and cold water in a bucket to wash but can't see much due to lack of electricity in the morning. Meals are served on a square piece of plastic on the floor. One Afghan referred to this as our "plastic carpet." We sit cross-legged on cushions around the food and usually eat rice, meat, salad, tea and fresh fruit. We don’t have TV or radio so we talk for fun. Actually our dinner conversations are very interesting, better than TV. We discuss everything from Osama Bin Laden to dating. The Afghans have been so repressed by the Taliban. Sex and dating were not on their list of favorite activities, mostly because of the Taliban punishments if caught. Some penalties included imprisonment, 81 lashes in public and death by stoning. Enough to quell anyone’s libido. Our living style reflects the affluent members of the community more so than those in the small villages even though it may seem rough compared to folks in the USA.

As three members of our live in team are Afghani we have had wonderful cultural exchanges all day long. The men share with us details about their lives, religion, marriage and the life in general. When I explained the few details I could remember about the Christian religion, sins and commandments the Afghani’s shared with me some fine points regarding Islam. In the end we all agreed that the two religions are quite similar. Men don’t usually have an opportunity to talk with or sometimes even see their wives before the wedding. Two of our colleagues are single, they told of their plans to find wives. They mentioned how they would find them and from which village. They must first save between $1,500 and $4,000.00 for the bride fee! During our cultural discussions we introduced them to pop tarts and peanut butter which they didn’t like much.

All Afghans I met were happy to have been bombed by the Americans. They hated the Taliban and can’t wait to rebuild their lives. Many are wondering why the USA let Mullah Omar and Osama Bin Laden escape. They believe that possibly it was on purpose. "America is strong and powerful, they can do everything, we know that they trained Osama Bin Laden back in the 80’s so why did they let him get away?" they asked me. I couldn’t answer that one. I asked the minister of foreign affairs what he thought about the Americans bombing Afghanistan. He replied, "as long as they rebuild, it’s OK."

Mary Lightfine

I Just returned home after two turbulent months in Africa.

On May 20th I left the land of Disney and wild kingdom for the real thing in Kenya. Planned to meet a friend, DR Mickey Richer, with International Medical corps (IMC) in Nairobi. I had turned down a proposition from Doctors without borders to accept the IMC offer. Although I would be working without pay, I was pleased that the available funds were being put to good use for those who needed it more than I did. I had agreed to assist DR Mickey in data collection on HIV/AIDS in South Sudan for a future prevention program. The journey took two exhausting days of traversing a myriad of airport terminals. Upon arrival in East Africa I was alerted to some IMC administrative glitches state side. Wasn't able to gain immediate entry into Sudan, after many months of preparation, much to my dismay.

On my first day in Kenya the IMC Los Angeles office notified the Nairobi (NBO) office to order an immediate evacuation of expatriate staff from south Sudan. "We no longer have war risk insurance", they declared. That meant DR Mickey had to spend $4,500.00 of donor money to evacuate those who were already in Sudan by private charter, she had less than an hour to organize ground logistics and wasn't given full facts regarding the details. How could any organization operating in a war zone suddenly find themselves without insurance for their valued staff? IMC - NBO sent me to the stop over base in Northern Kenya, just south of the Sudan border, Lokichokio. We were 3 weeks in limbo. Something about applying for a "number" so the insurance company could cover war risk, they said from Los Angeles. You would think that they might have done that years ago. Georgianna Platt, the Somalia country director, was kind enough to let me help out on the expanded program of immunization (EPI) problem in her domain.

Most people fear working in a war zone but the non-conflict areas like Kenya are also very dangerous especially when on the road in a vehicle, walking or riding a bike. In fact the number one killer of expatriates abroad is the motor vehicle. I struck up this conversation with a Kenyan while driving together through busy crowded streets filled with bicycles, pedestrians, and other vehicles. "Did you know that 3,000 people died in Kenyan road traffic accidents (RTA’s) last year"? I asked. As we pondered this fact, I got my first African travel tip. He replied, "It is a driving rule in Kenya that if you are traveling with three in a vehicle and need to avoid a bike, better to take him out than to kill the three in your vehicle". Thereafter, each time I saw a bus filled with folks that outnumbered the total in my transport I worried about that rule.

Ten of us touched down on the arid dirt runway amongst an array of goats hidden under the thick Acacia. A furnace blast of heat struck as I wrapped my head in the traditional scarf while stepping down onto the fine red dust. Some Somali warriors in their "technicals" (Toyota pick-ups mounted with antiaircraft machine guns) pushed their way towards our small aircraft. They were questioning the contents of some UNICEF packages which had just been off loaded. If it wasn’t papers they wanted to charge a tax. Once opened it was discovered to be honey, in fact, not "papers" as listed on the manafest. Oh, Oh. They then decided to get a little pushy with their guns. The pilot quickly fled towards my vehicle for protection. I had already made my way off the congested air strip. Years of working in war zones have taught me to distance myself from angry armed militias. The pilot, a handsome seik in a white turban, introduced himself. He immediately confessed his fear as he was held hostage in that same location only two weeks prior. Confusing his rapid heart rate for love he began to flirt. Once his pulse returned to normal he got my phone number. Nothing like fear of death to inspire romance!

In Somalia, like many under developed countries, the people don't think childhood immunization is important next to food and water. Fair enough. I'd choose food and water over EPI too but it was being provided free of charge by IMC, right in their village. Somalis are business people...there has to be something in it for them to make it interesting. I suggested to Georgianna that we make the vaccination team like car salesmen. Give a base pay supplemented with a bonus commission if the subsequent survey indicated good coverage. Well something had to be done. . The village elders mentioned that no one showed up for vaccinations because everyone had already left the villages. They were nomads out with their Camels and cows deep in the bush and only lived there during harvest time (months away). That wasn’t true. We could easily see women and children hiding in their mud huts. They were holding out for a bonus package (money). In the end Georgianna came up with a plan far more interesting than mine. She closely examined the numbers. Then reminded the elders that World food program (WFP) would soon distribute food based on population figures. Georgianna replied "well if they don’t live here then your population figures need to be corrected so WFP can give food based on the correct population". She added that she would supply the new figures to WFP. Mothers and children soon appeared in full force during the next vaccination visit. We weren’t surprised by the turn out but were disappointed with the village attitude.

A few days later day Georgianna sent out a directive to the Somali health team managers in Baidoa that one of the maternal child clinics would not be opened until trained staff could be hired. One IMC local staff nurse, Amina, thought she might be canned. She alerted her "clan" to cause an intimidation disturbance. As I was preparing for an office visit the clan members arrived at the gates armed to the teeth. They blockaded the entrance and threatened all the IMC staff with their heavy weapons. They demanded an immediate meeting to prevent Amina from being sacked. Her dismissal had never even been considered prior. Finally when Georgianna arrived she reminded Amina and her clan that it was in the hiring contract of all staff members that force, threats and intimidation were grounds for immediate dismissal. Those terms have gotten folks killed in the past. Georgianna stuck to her word without worry of her own demise. She not only sacked Amina, as per her contractual agreement, but also demanded 50 Camels from the clan to be paid to IMC in retribution for the intimidation. This was in accordance with traditional Somali customs, although few westerners followed customary procedures. There will soon be a meeting, the amount of Camels will be reduced but paid and IMC will sell the animals. The proceeds will be used towards the maternal child health program. No one has yet been harmed. Somali terms can work it seems.

Somalia has changed from nine years ago when I last worked there. It is still at war although there is now a president. Anarchy remains the order of the day. Some folks have prospered while others struggle from day to day dodging bullets, disease and starvation.

I returned to the same house I lived in 1993, in Baidoa. Met some old colleagues from the past. I recalled some of those who visited me there years ago and later died, like the journalist, Dan Eldon who was stoned to death by the Somali people he so loved. I couldn’t forget the swarm of reporters, rocket explosions, bullets, and the bodies scattered like debris along the streets and back alleys. Those days have already been forgotten by multitudes. The media excitement of a new war is over...old news. This time I was the only westerner in sight...No more outside interest in a dwindling populous. Even the 60 minutes crew who once stood on our door step, back in 92, have long since moved on to other stories! Baidoa is where the Doctors without Borders (MSF) doctor was shot and killed a couple years ago by Aideeds rebels while he was working in the hospital one day. Aideed, the American ex-marine Somali war lord (he went AWOL in 95 to become a war lord) told his men to kill, as they wanted. He had convinced his "men" that westerners were attempting to "brainwash" Somalia. They were not reprimanded for this murder. Another rebel faction has taken power over this area but MSF has since "pulled out." Now the local people have a very primitive form of health care, which they have to pay for, little if any medicine, no electricity, no hospital services. A Somali doctor makes the equivalent of $0.75 for every patient he sees (a chicken cost the equivalent of $1.50). After all he must earn money to feed his family. The patients must pay for services regardless of the outcome, which is unpredictable at best even for the physician. If the patient dies the physician is also at risk (retribution). The majority of the folks are suffering from the effects of extreme anarchy. Others revel in it.

The Somalis are tired of war they tell me. "10-yr. old children have never seen school in their entire lives" one old colleague confessed. I passed the crumbling shell of Baidoa College, which reminded me of some ancient Roman ruins. The people tell me that when war broke out there was wild looting stealing, ruining of everything believed to belong to the "government" the people now know that those things belonged to the communities. They were destroyed and now the communities can not afford to fix them. Saw a windmill, which once served as a water pump. The parts, which aren’t missing, still work. The windmill still goes round and round, the bar moves up and down but the rod is lost and motor yet to be found. Now the villagers know they must protect what they have but it is too late. Currently they must walk 1.5 hours to fetch water. The Somalis have learned a hard lesson. I saw some changes towards the better. That made me feel good...but it also made me feel odd to return after all I've seen before. My memory forever tarnished.

Visited many remote communities I rarely saw before in Somalia, small nomadic villages, and oasis water holes. I gazed at large herds of cattle and Camels, which I found refreshing. Watching iron forgers construct knife blades over hot coals kept a glowing red with goatskin bags of air blown through metal pipes. Having a real glass of chai (Somali tea) with fresh camel milk. It isn't the milk from the Camel that upsets your stomach it is most likely the muddy water they fetched, from a dammed up oasis, to wash your glass. Camels are very tall when you get up beside them. My head barely reached their elbows. When one of them began making faces and swinging her lip with drool at my head...I got a little worried. Suddenly another Camel jumped up from lying down. I stepped back quickly causing the whole village to burst out laughing. At least I amused them. After all how much comic relief do they see in one week? Laughter is truly the best medicine.

I finally reached Sudan after a couple of weeks and again it happened, another budding romance blossomed. A pilot formerly from Atlanta flying a large "Buffalo" (big plane you can drive a car into), for the UN, asked for all my particulars as I deplaned his vessel. He was tall; the sun lightly bronzed his trim frame with seductive azure eyes clear as a cloudless day. Dr. Mickey had to pull me away. Oh well, I wanted to answer all his questions and ask some of my own. Why couldn’t these things happen closer to home?

During my time in Sudan, the IMC Nairobi office was robbed. Several men "in uniforms" I was told, came in over the back fence. They knew that there was a ladder stashed behind the building. They climbed the roof and dismantled the alarm system. While they were busy on the roof more men came in via the front entrance. One askari (watchman) was shot point blank in the back and killed immediately. His colleague was shot in the leg; the bullet traversed his abdomen into his chest. He survived in critical condition. The door to the office was pounded in. The robbers went directly to the finance department and took all three safes. Strange thing is that almost nobody knew that there was more than one safe nor where they were located. Sounds suspicious. It's horrible that a man gave his life for a few thousand dollars (or any amount for that reason). Without him his family has no future.

My airline ticket was in the safe as was a considerable amount of money belonging to Dr. Mickey. Because of the high crime rate in the Cosmopolitan City of Nairobi she was afraid to keep her savings at home. Robberies are common in Kenya due to the extreme disparity between wealth and poverty. Although not a conflict area guns are readily available. Weapons enter the country from the many bordering war zones. An AK-47 cost the equivalent of four or five cows.

Sudan, the largest county in Africa, is currently at war. The more developed, Arid, Islamic northern government was attempting to take the water, oil, natural resources, and ethnic freedom from the nomadic Christian/animist south when war broke out in the 80’s. My second day in south Sudan I managed to get arrested by the police (by order from the SPLM rebel movement) for taking photos and videos in town. They tried to confiscate my equipment and then sat me in front of the "commissioner" (who turned out to be a woman) other important military officials were also present (they thought I was spying). In the end when they found out I was American and that I wanted to use the pictures for teaching purposes they let me keep all my stuff and set me free. They reminded me that the USA is on their side (southern SPLM) and supporting them in their rebel activities against "the north." They allowed me to take photographs but only under supervision (just in case I was a spy).

The Sudan Peoples Liberation Movement (SPLM) says that AIDS is their "second worse enemy next to the Arabs in the north". They are prepared to fight both.

The same day I was arrested in Yambio (western equatoria, on the border with Central African Republic and the Democratic Republic of Congo) we were asked to help a young man who had been ill for an extended period of time. In this area health care was very limited due to war; the infrastructure has totally disintegrated. The local hospital could not provide adequate medical treatment. IMC had a sleeping sickness hospital but didn't have funding for general health care (due to lack of outside international interest). This young man had a wife and several children, he was so ill there was no choice but to bring him to our sleeping sickness hospital to investigate the cause of his illness. We helped him into our Toyota along with his family, a week’s worth of food, a bedroll, blanket and cooking utensils. He was pencil thin, not even able to stand or sit without assistance. It was an oppressive afternoon in the stifling heat. As we began our journey along the muddy red clay jungle road we were suddenly halted at gunpoint. The IMC driver was taken out. The armed men forced him into a small building without me. I didn't speak their language therefore was unaware of the circumstances surrounding his apprehension. After taking him they returned for me. We were escorted into a dark adobe room filled with people in torn and tattered clothing perched on rustic wooden benches. The entire room faced a single man elevated on a platform behind a makeshift table. We found ourselves in the midst of a judicial hearing... The driver had apparently committed some crime I wasn't aware of. His time had come to present his side to the jury. Meanwhile the dying man was sweltering with his family under the burning sun in the back of a weather worn Toyota pick-up truck. Our destination was yet an hour away (Lirangu). We finally made it to the hospital barely in time to begin treatment.

The young man died a few days later from complications of AIDS. He left behind not one wife but two as well as several children. The night he passed away I was awakened to the sound of drums beating. Off in the distance women wailed. By morning the entire village of Lirangu was aware of his death. At seven AM I had to load his body on to the bed of our truck along with ten members of his despondent family. It was my job to return him back to the little village where he once lived. We traveled for nearly an hour through the tropical misty fog. His family cried, sang, screamed and wailed for his loss as we slowly made our way through the jungle. I last saw his body being carried through the thick rain Forrest to his final resting place. Only one of many victims claimed by this insidious virus.

In spite of the fact that AIDS is spreading quickly trough South Sudan Christian religion (and war) has had a negative impact on the sexual behavior of the folks. An older man, Martin, the head of the local Yambio county health department told me a story. He said that in the days before the war people were more faithful to their partners. They practiced birth spacing, referred to as "45 days" when a couple was not permitted, by culture to have sex until their child was walking. They even used condoms more readily. New religions brought new ideas which have been readily accepted although some of the old customs remained. Catholics still practice polygamy in many parts of Africa. Now because Christianity professes abstinence until marriage there is a big fear that condoms will promote "immoral behavior" in spite of the fact that "everyone is now having sex with everyone." A quote I heard many times from the mouths of locals in private. Western influence has transformed many communities. Traditional nomadic lifestyles are being traded for village life. One priest confessed that because the Sudanese live without electricity or any form or diversion after dark sex and homemade alcohol are the only form of entertainment they have. Even the clergy is not immune from the ravaging effects of Sexually transmitted diseases (STD’s). Girls as young as 12 are delivering babies. Young women with several children are deemed unmarriagable and forced into prostitution to feed themselves leaving the burden of their children on the grandparents….

UNICEF has initiated a program to return "child soldiers" back to their homes. In a town called Rumbec where the child soldiers are gathering there are complaints from the villagers. The new visitors outnumber the local population. Food housing and sanitation are insufficient to maintain the health of the enlarged populous. No schooling has been provided as promised. Lack of daily diversion has caused a few disturbances. Farmers are asking for restitution for their cattle which have been used as sex toys by the boys (child soldiers) and wives have been seduced away from their husbands. Was this program well though out in advance by UNICEF?

As I have an interest in history as well as medicine there was yet one more area to explore prior to leaving Sudan. I met up with Dr. Anne Moore from the CDC. She mentioned that we were only 50 minutes away from the birthplace of Ebola. Couldn’t leave the country without a visit to the "shrine". There was no real shrine; I only found a cotton mill, where the very first patient collapsed with the disease. A watchman was guarding the huge complex when we arrived. Not many tourists (none really) ever pass this way. The gentleman was more than pleased to take us through the abandoned warehouses, over the discarded cottonseeds, past the lumber mill, oil press, the generating power plant (now defunct but intact) and through the overgrown weeds. More curious persons joined our little group as we wondered where or what did the virus come from? Was it still there? I collected a handful of cottonseeds and gazed at them with so many unanswered questions. Before the war this was a booming industrial town with running water, good roads, schools and electricity for all the town folks. All that is gone now.

After so much turmoil had to take some days off for a Safari. Went to Hells gate near Lake Nivasha, with some friends, where we could hike and picnic with nature. Fortunately we didn’t meet any cheetahs or Leopards. A little walk on the wild side was just what I needed.

Mary Lightfine

As she retells her stories, she cries. A volunteer nurse caring for refugees of the Kosovo conflict, Mary Lightfine, RN, is one of hundreds of relief workers who are trying to care for, nourish, and embrace so many with so little. To her, these survivors surprisingly mirror her own American lifestyle. To the refugees, nurses like her are a Godsend; a beacon; an angel of hope amid disaster and death.

"I can relate so closely to the refugees here," says Lightfine, of Titusville (near Orlando), who is currently serving a three-week assignment in Skopja, Macedonia, with the New York-based organization Doctors Without Borders (DWB). "Prior to their displacement, they lived a lifestyle similar to my own," she said in an exclusive telephone interview with Nursing Spectrum. "Their stories, are so clear and vivid that I can imagine myself in their situation so easily."

Among the refugees are physicians, lawyers, businessmen, and, of course, nurses. "One woman approached our clinic and identified herself as V, an ethnic-Albanian nurse," says Lightfine. "She had no proof of her name, no money, not anything. A masked man had come to the door of her family's modest home, and in an Albanian accent of her region, told her and her family to get out or be killed. They were not allowed to collect any of their belongings. In their bedclothes, they watched her father's home burst into flames. Her papers, her passport, even her nursing license and family money were destroyed. To add insult to injury, they shot and killed her dog as she watched."

The masked men are reportedly Serbian paramilitary police, a group of people throughout Kosovo who allegedly target ethnic Albanians like V and her family. V's family was spared because a Serbian neighbor was able to identify the family as not part of the Kosovo Liberation Army. Had the neighbor not vouched for their innocence, all could have been killed, like hundreds of others in her village.

Emotions Reduced to Rubble

"I can picture V's story...the police coming and her home burning," says Lightfine. "Killing her dog may sound like a small psychological torture, but now everything her hard-working family had is destroyed. Her parents are split up between refugee camps. She is devastated, yet she comes to me and asks how she can help me care for her people. It's unbelievable." Lightfine enlisted V's help. Using her as a translator, the two triaged patients who shared their own tales of terror. "Translating each person's story would make her relive her own trauma again, and again," says Lightfine. "After a few days, V became more depressed until she was only walking from tent to tent, shaking her head and saying, ? I can't work. I'm a nurse and I can't help. I don't know where I'm going or where my family is.'" Reduced to tears, two nurses, previously worlds apart, fell into each other's arms, sobbing.

No Way Home

Family losses are painful for adults like V, but they can ravage children and young adults who are caught in the exodus.

College students in Pristina, who were traveling home from college by bus just before the conflict escalated, had been sent back by Serbian police. "They knew that something horrible was going to happen, and they wanted to be with their families," says Lightfine. "Many of the teens fled on their own, only to return home to find their families murdered and their homes destroyed. Many don't know where their families are. The stress is just devastating."

Medical teams in the Balkans are dealing with several health issues, both medical and psychological, and as time ticks away, disasters continue to mount. It is becoming evident that the emotional trauma these refugees have suffered is more serious than any of their physical ailments. "The psychological needs of these patients are immense," says Lightfine. "Those in our camp are of relatively good physical health."

Although other organizations are present to help with the psychological fallout of this conflict, DWB nurses are helping by performing community-based education. "We are training people who are part of the refugee population but who are living in the nearby city and not part of this transient population," says Lightfine. "We help to teach these people to do simple counseling, therapy, and how to create diversional activities to offset boredom and frustration."

Like adults, the children are suffering psychologically. "Sometimes, the most simple of things can make a difference, like crayons," says Lightfine. "The drawings that these children create are unreal. Some are frightening. Some draw pictures of Barbie dolls and a nice house, and others draw pictures of violence - shooting, blood, and dead bodies. At least they're able to express themselves."

Not Only the Strong Survive

Those refugees who made it into Macedonia were among the healthiest. Having to endure days of dehydration, exposure to sub-zero temperatures, and a journey on foot on difficult dirt roads or along train tracks, many of the most medically fragile never made it, dying along the way. Still, some, quite ill, were carried in blankets, or on the back of a friend or family member to a camp that can only offer minimal assistance.

"I've had several paralyzed patients already," says Lightfine. "Two men who were paraplegics arrived in a blanket-stretcher, their elderly wives trying to care for them." One man had a TexasTM catheter in place and had received no personal hygiene. "He was covered with urine from head to toe. I comforted his wife, then with her bathed him, all the time wondering, how would she ever take care of him again?" Luckily, assistance was closer than she thought. A local organization had set up a site for the disabled in a nearby tent. "We placed him there and she can visit him every day, at least for now."

Another man's story isn't as bright. "One paralyzed man, obviously weakened by the exposure and dehydration, died just an hour after I had bathed and cared for him. I knew there was little we could do," says Lightfine. "I felt that he was grateful just the same.

"I was called into one of the medical tents to assist with a severely injured young man. Never in my 16 years of trauma and emergency nursing experience had I ever seen anything like it: a human body bruised beyond belief. This man, barely alive, was nothing but dark blue bruise from his waist down to the bottoms of both legs - front and back." Swollen and bleeding, the man had allegedly been tortured by masked men for no apparent reason, except that he was ethnic Albanian.

How Do They Do It?

"It isn't always easy," says Lightfine of her nonpaid, volunteer service in Macedonia. "Emergency medicine nurses hold up the best in these situations. You need quick assessment skills, a good basic understanding of everything possible, and you must be innovative." Working for DWB since 1992, Lightfine has traveled extensively, particularly to war zone sites. For her, the rewards are not measured in a paycheck.

"One woman came to our medical tent each day," says Lightfine. "She told me that she had come here just to see me smile. But she was the one with the beautiful smile - so jolly and round with the warmest face I'd ever seen. She told me how all of her neighbors' and friends' children had been slaughtered. She was still in shock. To her, a smile from a strange, American nurse helped her face the rest of her day."

Where's Our Order?

With growing numbers of refugees, finding enough supplies is difficult. In some cases, logistical constraints further complicate patient care. Getting medical supplies and pharmaceuticals through customs is difficult.

"Everything is caught in governmental red tape," says Lightfine, who must ration supplies according to the ebb and flow of the refugee population. "People are coming into the camp at irregular rates. At times, the borders are closed, and people are piling up at the border. When the blockade is open, tens of thousands of people line up to enter. It's chaotic, and we can't always be prepared."

Despite rationing of supplies, refugees are understanding. "If a patient comes to me for a supply and I tell him that there are only 10 left and that he'll have to share, I never hear a complaint," says Lightfine. "They are so grateful. They are kind. I can't believe anyone would want to hurt these people."

Mixed Medical Conditions

Common problems include impetigo, lice, and gastroenteritis. "Breast feeding is not popular in this culture," says Lightfine. "Mothers are having trouble washing baby bottles thoroughly enough to prevent disease."

Chronic problems, such as diabetes, are also a concern. "Many patients were forced from their homes at gunpoint and were not allowed to take their insulin with them," says Lightfine. "We also see patients with uncontrolled high blood pressure for the same reason." Some patients appear with complex medical histories. "We have seen organ transplant patients who need immunosuppressive therapy and those in kidney failure needing dialysis." For patients who require advanced medical or surgical care above and beyond what the medical teams in the field can perform, transport to surrounding hospitals is provided. Hospitals in nearby countries, such as Romania or Montenegro, have been accepting patients, even though most are filled to capacity. "We do the best we can with what we have," Lightfine says.

As Lightfine's tour of the Kosovar refugee camp, housing over 27,000, nears its end, other nurses and other organizations are arriving, refreshed and ready to take over the reins. "You are forever changed by each experience. You are a better nurse when you're done," she says. But can nurses like Lightfine truly let go of their patients when their time is up?

Leaving It All Behind

"I will leave here feeling that I've really accomplished something wonderful," says Lightfine. "I also know that I will hand over my job to someone else who is quite capable. I don't feel like I'll be abandoning these people." Often, cases of survivor guilt affect volunteer personnel, making it harder to work in this type of environment again. But not for Lightfine, who has a clear perspective of her limitations. "I'm not a martyr and I'm not a saint. I understand that my mental health is also important," she says. "I'll be sad, but I have to move on."

Carrie Farella, RN is an assistant editor of the Greater Chicago/NE Illinois & NW Indiana edition of Nursing Spectrum.


Article reprinted with permission from the Nursing Spectrum, Chicago/NE ILL/NW Indiana edition. Copyright May 5, 1999. All rights reserved. Used with permission.