Well here we are. It’s been around a year since my last humanitarian project. Thinking back to who I was then, and who I am now, it’s hard to say if anything has changed. As the conclusion of my residency draws near, I come closer to facing the reality of the life I am choosing. Another friend got married. Another three have gotten engaged. The world turns.

My future is most informed by what has been excluded more than what is possible. Plans to stay in the US for a fellowship in ultrasound have gone out the window by virtue of my visa status, so in 7 months I will be leaving Philadelphia, that much is certain. Where I go next remains to be seen. I am hoping that some experience with a mission like this will help me find a path. Alas, these details can wait, because as of right now I got bigger fish to fry. An unexpected email on a weekday afternoon was followed by a few strategic schedule modifications and some money Tetris before I was set: a one-week humanitarian project at the Kyangwali refugee settlement in western Uganda. First though, I got myself a flight with a two day lay-over in Addis Ababa, the multi-cultural capital of Ethiopia.

Shortly after walking home from my seventh night in a row of admitting too many patients to the medicine service at Pennsylvania Hospital, I was on a train to New York carrying a culturally sensitive (dark-skinned) lumbar puncture mannequin through airport security. Despite my concerns, I had no trouble, and comfortably flew from JFK to Ivory Coast before landing in Addis.

My first time traveling in Africa without the rose-tinted lenses of a safari tour quickly had me feeling all sorts of ways. My hotel was in a relatively central district in Addis, just blocks from the United Nations compound. I was told to stay inside after dark due to the threat of violent crime, which is never a cause for excitement. However, I am no stranger to such things (America Latina papá), so I didn’t let it put me on a downer. I hired a driver, Ayob, nice guy, he wore a futbol shirt and listened to Arsenal radio shows. He introduced me to some of Ethiopia’s rich history and its place as the only African nation never colonized by the white man. Despite this, it was hard to ignore the dilapidated conditions throughout the capital: dozens upon dozens of buildings left under construction and abandoned, the constant eyes followed by aggressive pleas for money, dust and dirt everywhere. It was unfortunate.

Still though, I spent the first day bopping from one spot to another and had a great time. I went to St George’s church, an important symbol of the Ethiopian Orthodox credo that impressed me with its simple elegance. I spent several hours at the Merkato, which were some of the best I have ever had traveling. Rounding every corner through colourful streets rich with sights, sounds, and aromas fit to revive the dead, I heard constant cheers in my direction.

‘Argentina! Messi!’

Que lindo que es ser Argentino.

I ate more Injera than any man should in 36 hours, went to an Ethio-jazz show at an iconic club, and walked through the palace of Halle Selassiea. All for less than 200 US dollars. Africa isn’t too bad.

Nevertheless, I constantly drifted back to the wounds of corruption and poor governance seen throughout the city, which opened me up to internal questions. If the Europeans never colonized this place, never raped and pillaged the hills for all their worth, how are we still in this mess? Indubitably things are much more complicated, but it’s a thought. If only things were different.

Either way, I had a great time.

I bid farewell to Eyob and headed into the airport on Saturday afternoon. To the dismay of my palpitating heart, I had one of my bags separated at customs. The Ethiopian security officer dressed in military slacks pointed at the cardboard box and signaled me to the side. It was my black half-human plastic torso in a cardboard box that the team had asked me to bring to Uganda.

‘Open it,’ she said

I peeled off the industrial duct tape and opened it towards her.

‘What is this?’ she asked in broken English.

‘Uhh… It’s a training model for a medical procedure. I am a doctor.’

She just looked at me.

‘You use a needle to go into the back. It’s a medical procedure,’ I said pointing towards my butt.

‘There are needles here?’ she asked.

‘No no… No needles,’ I answered. Why did I mention needles? Fool.

She seemed to have lost interest by this point and turned away. I took the opportunity and slowly packed it up, making sure she could see before heading towards the terminal. Crisis averted. The black torso would travel safely after all.

On arrival to Kampala, I was met at the airport by some of the other doctors on the mission. Most of them had arrived the night before, with plenty of activity in our group chat to make me partially regret my layover in Ethiopia. I met Susana, a UK-based trauma surgeon of over thirty years from Spain, and Pradeep, and Indian surgeon who was now on the tail end of a registrar pathway in the UK. They both worked together in London and flew in as a tandem, making up the bulk of our surgical services. I also met Justus, one of our drivers, a native of Western Uganda who lived and worked out of the capital.

The ride into Kampala was notable for the dense Ugandan traffic. I would learn during this ride that Susana had done this mission several times in the past, as well as many other missions as a trauma surgeon in both conflict and non-conflict settings. Pradeep on the other hand, like me, was learning the ropes of this kind of an operation. We shared our feelings of inadequacy about how we’d meaningfully contribute amongst such seasoned colleagues. This made me feel better about my place both in that van and the world around me.

From the airport we went directly to a local restaurant. I met Tayseer, our leader, a Syrian Oncologist who now dedicated himself to contracting humanitarian missions. He had put the team together. This would be his fifth yearly venture to the camp. Acting on behalf of his donors, he corresponds directly with both the government branches of administration in the camp and NGOs to support various different projects. Not only does he bring highly specialized medical and surgical staff to teach and improve the quality of local actors, his efforts also contribute directly to the improvement of infrastructure for the local school, micro-lending campaigns for widowed mothers to stimulate the local economy, and locally sourced construction projects for water wells. His skillset and connections have led him to contract for several NGOs and UN projects. He is a humanitarian in every sense of the word, and surprisingly down to earth. I met him for the first time at the front door of the restaurant after months of WhatsApp messages and a few video calls. He was older, probably in his mid to late forties, with a worn face and pleasant accent. Notably, he carried a clunky handheld vape, surreptitiously sneaking puffs throughout the day.

‘Captain’ I said, ‘It’s nice to finally meet you. Salem’

‘Yes Jwan, great to meet you as well,’ he said. ‘Come, dine with us and meet the others.’

I went around shaking hands. One by one, I met Hamdi and Nikos, a Tunisian and a Greek who worked together in Italy at an academic institution for humanitarian studies, Lazaro, a Cuban physician, formerly of the WHO and now working with a multinational based out of Ethiopia, then there was Julie, a French surgeon in training and partner of Susana and Pradeep, Basel, a Turkish IT specialist with plans to educate in data security and develop an IT based curriculum for the secondary school with remote-income applications, Lily, a Ugandan lawyer living in the Netherlands and expert in human trafficking and gender based violence, Neda, an American ED physician with a wealth of humanitarian experience, and lastly I shook hands with Alex, or Dr. Bonnel as he had been to me before that moment; he was the attending at Penn that put me on to this project in the first place. The feeling out process over dinner was short-lived before Tayseer jumped right into the briefing on the situation at Kyangwali.

Kyawngwali, of the province of Kikuube, was established in the 1960s primarily to house Rwandan refugees. Over time, the population of the camp has ebbed and flowed with shifting demographics, evolving from primarily Rwandans until the 1990s when migration patterns brought a larger group of Sudanese and Congolese refugees. When South Sudan and Sudan separated, many of the South Sudanese were repatriated from the camp, leaving mostly people from the Congo. However, in 2017, a large influx of displaced peoples from the DRC meant that over three years the population ballooned from 38 000 to around 125 000. Currently, more than 130 000 asylum seekers live within the settlement. Our objective for the mission was not just to give money and provide services, but to transfer expertise and build capacity for further growth. Tayseer went over the internal politics, cultural context, and other details before discussing the travel itinerary for the next day.

After dinner we piled into the van and drove back to the hotel, where everybody put their feet up and shared stories over wine in one of the bigger rooms. I was taken aback and humbled at the range of incredible people in my presence, all as equally motivated as me to make an impact on the darker corners of the world or drown trying. It was a welcome step out of my world of occidental thinking in Philadelphia at a time that was desperately needed. Tayseer, in his ever present tenderness even got us all shirts as a gift to thank us for our participation. I took these ruminations to my dreams as Alex and I shut out the lights to sleep. Tomorrow we would ride out to Kyangwali.