But saying ‘goodbye’ is what hurts
After three years as a nurse with Médecins Sans Frontières (MSF), Sharifah Qureshi (’00 BS Nursing) is relieved to be alive; happy to be home; and grateful to the families who shared their villages and their lives with her from 2005-2008.
She is other things, too: mournful, exhausted. Fully aware that many of the people she treated as a nurse in Darfur, Sudan and rural Zimbabwe still face a day-to-day struggle for food, water, safety and shelter.
Especially in Zimbabwe, a once-prosperous nation that was the “bread basket” of Africa. Today it’s something very different.
Zimbabwe in disarray
“It’s unbelievable how the situation in Zimbabwe has been compared to Kenya and Rwanda, yet for so long the people of Zimbabwe remained calm,” says Qureshi.
But in the four months since she left Zimbabwe, things have only deteriorated. Robert Mugabe has ruled the country since 1980 and in June began his sixth term as president – a title he’s held onto despite a March 29, 2008, loss to opposition candidate Morgan Tsvangirai.
“People are living on less than $2 per day, there’s 80 percent unemployment and 70 percent of the hospitals there are understaffed,” says Qureshi.
This destabilization stems partly from the dramatic and deadly buildup to a runoff between the presidential candidates. Radical land reforms ordered by Mugabe in 2000 also are to blame. The government seized nearly all the country’s commercial farms over three years. Africa’s bread basket is no longer a prolific producer of maize, corn or beef; its citizens live – and many starve – on dwindling supplies of imported and donated food.
After being arrested five times this June and seeing a political crackdown displace 200,000, Tsvangirai withdrew his candidacy to protect his supporters. Power-sharing negotiations continue, but the political crisis and food shortage have contributed to a total economic free-fall. At press time, The New York Times reported that hyperinflation in Zimbabwe reached 2.2 million percent.
Her work opening new clinics for HIV/AIDS patients and teaching HIV prevention kept Qureshi removed from Zimbabwe’s political scene – as did MSF’s doctrine of unwavering political neutrality. The nongovernmental organization’s apolitical stance is what allows it to set up camps, hospitals and clinics in the world’s most volatile conflict zones.
But it’s hard to separate politics and public health for the 3,000 Zimbabweans who receive an HIV/AIDS diagnosis every week. Or the 1,500 who die weekly.
“Short of calling Zimbabwe a failed state, when you have a damaged economy like that and a politically unstable environment, it’s the people who suffer,” says Aaron Buseh, associate professor of nursing at UWM. “Those who have HIV need good nutrition, regular supplies of food. Without it, how can you even take your medication?
“In such an environment people with HIV will not do well. They will not survive.”
African culture, military clash
Not that Qureshi was ill-prepared to take on the challenge of providing medical care in extreme situations – like her first mission in Darfur, Sudan.
When she arrived at the foot of Darfur’s Jebel Marra mountains in December 2005, Qureshi brought with her a solid education and several years of experience as a traveling nurse on America’s West Coast. And as a UWM student in the late ‘90s, she twice traveled to refugee camps along the border between Burma and Thailand to deliver medical supplies.
“A big thing I learned at UWM was not to set boundaries for what I could be or do as a nurse,” Qureshi says. “Learning skills was an important part of my education, but we really got into nursing theory, research, nursing across different cultures.
“So I was very open-minded about what a career in nursing could look like.”
Gaining a broader understanding of disease, wellness and lifestlye, and how differently practitioners and patients consider these issues from one culture to another, is a key piece of the curriculum at the College of Nursing.
“We know that every person comes into nursing with his or her own prejudices and a unique cultural perspective,” says Buseh, who researches social stigmatization among HIV/AIDS populations in sub-Saharan Africa and Wisconsin.
“But students can get a broader understanding of what it means to be culturally competent over time. The idea that we have to treat every person equally despite who they are, how they became ill, where they come from is threaded through every course.”
All of the above meant Qureshi was prepared to take on the basic medical tasks associated with running a 50-bed hospital: delivering babies, supervising in the operating theater and working in the hospital’s pediatric malnutrition clinic.
Other facts of life in Darfur, where polygamy and female circumcision are common – and the next large town was two helicopter rides away – made her cultural competence as important as her technical competence.
And some things you just can't train for.
“I hadn’t expected to see myself in a war zone,” says Qureshi. “And nothing can prepare you for it.”
Like the time a rebel soldier put a gun to Qureshi’s head as she made her way to the hospital. Or the day she treated a village woman who had been kidnapped and raped by soldiers over the course of 10-12 days; she returned to the village pregnant and disoriented.
These are isolated examples of the violence that has made Darfur an op-ed staple in newspapers around the world. The conflict between Darfur’s Janjaweed militia and rebel soldiers simmered throughout the early weeks of Qureshi’s six-month mission. Despite the ever-present sound of distant gunfire and other signs of unrest, Qureshi felt relatively safe.
But she wasn’t. An all-out battle took place in the town and within the hospital in early 2006. The details are chilling. Mindful of MSF’s policy of neutrality, however, Qureshi is reluctant to say very much publicly.
After nearly 24 hours in a safe room hiding from the mortars and gunfire, six hours performing emergency surgery and a forced evacuation by a caravan of trucks from the African Union, Qureshi and her MSF colleagues reluctantly left the village about two days after it was destroyed in battle.
After a rest and debriefing in Sudan’s capital, Khartoum, Qureshi resumed work in Darfur’s Zum Zum refugee camp. A month later MSF asked members of the Jebel Marra mission to leave Sudan one week ahead of schedule to deal with the trauma of nearly dying in a military battle. The hardest thing to process, says Qureshi, was knowing that many of the Darfurians they had treated were either dead or hiding in the mountains surrounding their village. Many of the initial “survivors” died from cholera, dysentery and famine in the weeks after the battle.
“I feel lucky to be alive,” Qureshi admits. “But the hardest part of any mission is leaving the struggle behind. When people let you into their lives like that and share their stories of living in fear, you can never forget the endurance and strength of the human spirit.
“Darfur opened my eyes to a whole different world, to how people can live in such unstable environments. But they were living calmly, day-to-day, and this instability became normal to them. You draw strength from that, and with it this promise to yourself that you will try to do something more the next time – that there is always something in life worth fighting for.”
For now, Qureshi is enjoying her time with family, including her father and a sister who both are physicians, her mother and another sister who are nurses, and friends – many of whom she met at UWM.
She won’t rule out another mission with MSF, but still considers Milwaukee her home and is busy babysitting her two nieces and four nephews. It’s a quiet life for someone who can get “addicted to emergencies,” but Qureshi says she “worries that I might miss out on their lives if I’m away for too long.”
Another year of this, Qureshi adds, and she might be ready for mission No. 3.