Thread by @coffeeheadaches, Sat at the airport waiting for the flight to my first ever [...]

Sat at the airport waiting for the flight to my first ever MSF mission. This is what I've always wanted to do and now I'm doing it, so here's hoping I'm up to the job. I'll be pretty quiet on Twitter for the next 9 months. Behave yourselves. x

Arrived safe and sound. Chapattis and Malarone for breakfast. I've never been here before, but lots of time spent in neighbouring countries means there is just enough about it that feels familiar.

Animals I have met so far in the expat compound:

1) Suprise frog that scared the shit out of me
2) Hard as nails looking cat
3) Yoga cricket
4) Tiny hedgehog, looks cute but would not pet

They were not kidding when they warned me it was rainy season.

The hospital is very rural, and inaccessible by road for much of the year. We rely on flights for supply, but even that requires the dirt airstrip being solid enough to land on, which isn't guaranteed. This is the ground outside my Emergency Room.

It is also apparently grasshopper season.

It's ok though, because the tiny hedgehogs are on the case.

This is my Emergency Room. Two beds, one room. I usually dislike the American term "ER", but that's what they call it here and to be fair, in this case it's an entirely accurate description.

@bad__EM

My role is to cover ER and the adjacent ICU (usually 10 beds, currently 18). Luckily there is also an excellent local Clinical Officer assigned to ER/ICU, so we work together.

The rest of the hospital is run by a varied mix of local and expat nurses, docs, midwives and COs.

The weather here really is quite something.

Today somebody's nine months was up. A helicopter carried her away, a different expat arrived to replace her and just like that, I'm no longer the newest person in the project. Time passes quickly here and things are always changing.

This was a rookie first missioner error.

Never pet the goat.

Friday night entertainment in the MSF compound.

Well the goat is less cute now.

But smells significantly better.

This place is full of surprises.

Just when you really, really need something positive to happen... a box full of kittens appears.

Note the disappointment on the face of the medical equipment technician, who called us into the office in the hope that we would help him deal with the "cat problem".

We did not help.

I'm kidding, of course we helped. We have done a dynamic risk assessment and come up with a comprehensive kitten management plan.

(The plan is definitely not to just let the cats have half the office for as long as they want...) https://twitter.com/coffeeheadaches/status/1187013975667597314?s=19

https://twitter.com/coffeeheadaches/status/1187013975667597314?s=19

It's 7 weeks since I arrived here, so technically I'm supposed to go on R&R. We usually get flown out to a town in a neighbouring country for a break, but planes still can't land due to the water. I am contemplating what to do with four days off, inside the hospital compound...

At least there is always plenty of wildlife to spot inside the compound. This is my new friend, who I have been assured is not a crocodile. I call him Snappy.

Photography in public isn't allowed in South Sudan, and photogenic opportunities within the compound are somewhat limited, but at least there is always the sky...

Ok important news, we have just learned that the grasshoppers which are plaguing the compound in vast numbers are EDIBLE and actually quite delicious.

Kitten update! Still alive, still adorable, though the small scrawny one looks like he would love to be able to bite us, and is just waiting till he's big enough to try.

Who was it that invented the phrase "beauty to death ratio"? I'm sure I first saw it on EM Twitter. I am struggling with my beauty to death ratio today. There is beauty to be found even inside the compound, but I miss the mountains. Show me something beautiful, Twitter friends?

Improving the ratio.

Wherever you are in the world, cats want to prevent you from working.

There's about 10 meters of entirely unoccupied bench around this table, but where does he sit?

Today's featured animal that doesn't want me to get any work done:

Going through our major incident cupboard today and I found this. Nobody has a clue what it's for. Honestly, I dread to think. Any ideas?

Felix has had another hard day at the office.

There is no pre-hospital care in Lankien. Very few vehicles. Much of the year, no usable roads. This is a home made stretcher, used to transport a patient to the ER. It took 9 hours for their family to carry them to us.

This is my colleague Arie, explaining how we've responded to the flooding here in Lankien. https://twitter.com/MSF/status/1200728930816159744?s=19

https://twitter.com/MSF/status/1200728930816159744?s=19

Yesterday I left our little town of Lankien for the first time in 3 months. A UN helicopter dropped me back in Juba, the capital. I spent today marvelling at luxuries such as brick walls and hot water. Now I'm on my way home to the UK, for two weeks leave.

In the last three months I've left the hospital compound only a handful of times, and never been more than 5 minutes away. It really has become my whole little world. Being away feels strange!

My flight landed horribly early, so I'm hanging around a park near the station waiting for the first off peak train. Completely freezing, because I have no appropriate clothes. Being given a wide berth by commuters, as I pick up handfuls of leaves and gaze at them lovingly.

Enjoying being free from my radio, which I've had on me 24/7 since September (no phone signal where we're based). Though I expect it will take me a few days to get over the nagging feeling that I've forgotten something important.

We are spending Christmas a very, very long way from home. Weirdly, I don't think there is anywhere else I'd rather be.

Merry Christmas from Lankien

Came back from morning meeting to find Felix the compound cat has learned how to open the door to my tukul, and is using my mosquito net as a hammock.

Now to find a way of extracting him, without ripping a hole in my mosquito net. If I get malaria, this furry little bastard is to blame.

Hot season is here. I thought it was hot already, but apparently I was wrong. 40 degrees with dust and wind, makes for an interesting working environment.

No, we don't have AC.

Yes, I have cut my own hair.

No, it did not go well.

I have done exactly six months in this place. Three more to go. Time is speeding up. I'm happy but tired. My job is endlessly fascinating and rewarding, frustrating and exhausing. As is often the case, it isn't the actual clinical work which is my biggest challenge.

We share the compound with all kind of wildlife. These Genets (spotty long tailed little wild cat / mongoose thingies) like to observe us from above.

Moonlight over my tukul.

It rained today for the first time in months, and the air smells different.

We're still out here, all over the world, trying to maintain existing projects despite closed borders, preparing for the impact of COVID19 on fragile health systems.

If you are able to donate, it's more important now than ever. https://twitter.com/MSF_uk/status/1245818705675726848?s=19

https://twitter.com/MSF_uk/status/1245818705675726848?s=19

First day off for two weeks and I'm in my favourite spot, though looks like my hammock time might be cut short by these storm clouds.

Yep.

I have just look up, and discovered that monitor lizards can climb trees.

I'm not sure how I feel about this.

I just hope they're very good at climbing.

Deep cleaning the ICU today. This involves hauling all our equipment outside, making it look like we're running a strange open air hospital.

Another BBQ goat, another excellent Sunday for Felix the compound cat.

Copying this here, so my lengthy thread on life with MSF retains a little balance and realism. https://twitter.com/coffeeheadaches/status/1262794138329767938?s=19

https://twitter.com/coffeeheadaches/status/1262794138329767938?s=19

This is a deeply complicated and difficult situation. We are a small hospital in a small community, many of our staff have lost people they know. In spite of everything, I'm incredibly proud of how our team are handling it. https://bit.ly/2Xe6aAa

Renewed violence in South Sudan kills MSF staff member | MSF

A flareup of intercommunity violence in Pieri, northeastern South Sudan, has resulted in the death of an MSF staff member, and left scores more injured.

https://bit.ly/2Xe6aAa

We have a major incident plan. We'd prepared for a mass casualty situation by holding drills. Everyone knew their role, where to go, which triage category they are assigned to, where emergency supplies are, how to free up space in the hospital. This was the calm before the storm.

I long ago gave up searching for the words to explain my experiences here. Luckily there are others who do it better.

If all goes according to plan, I don't have much time left as Lankien MD 1.

Felix the compound emotional support cat, who has seen hundreds of expats come and go, knows this place will be just fine without me.

But as @StSenka says, it ain't over till that little plane leaves the airstrip. Lots can still happen, so I'd better try not to jinx it.

Not sure if this is a care package, or a comment on my current state of mind and amount of weight gain.

Today's edition of my occasional series - slightly menacing looking creatures we share the compound with.

You guys clearly love the animal tweets. I wish I could show you the video of me being chased off the ward by a monkey, but I say a rude word extremely loudly so I don't think comms would approve.

Seven months later, and I never did manage to get the cat to stop using my mosquito net as a hammock. There is now a perminant Felix shaped dip in the centre.