Suddenly…Sudan.

Feb 27. That is not far from the truth. Today I have seen and admitted six cases. The tally would have been seven, but the family of a young patient lived just a bit too far away, and he died from measles complications before I got to the hospital this morning.

(Lizard in my tent. In fact, there are several. I can hear them rustle in the straw when I am in bed.)

The miserabled are exceeding our capacity to hold them, certainly to isolate them. Until yesterday, they occupied the veranda of one hospital ward. Yesterday, they started spilling onto the lawn. They ignore the tent we have set up for them because it magnifies an already aggressive sun. Yesterday I baked a cake in the tent. I made it from nutella. It was delicious.

Sporadic measles cases have popped up in other inpatients. Families mix freely in the hospital and it is not uncommon to have the patient share his bed with three relatives, sometimes more.

I am often asked why I ended up choosing MSF from an armada of medical NGO’s with whom I could work. For many reasons, but none more compelling than this one. At our morning meeting, I wondered aloud to the rest of the team about our space problem. A decision was made to do something about it. By 2 pm, there were six men in the corner of the hospital compound, and by 5, they had built a shelter that would house 20 patients. We also decided to find a nurse, hire one if necessary, and devote him or her to measles care. Within the day, the will was found, the money, and the hands. We did not need to add it to the agenda of another meeting, nor to a paper pile of requests on an administrative desk. Within hours, it was hammers and nails.

(Bilal call to prayer. Five times per day, I think. The first is at 6 in the morning. I think there are two competing mosques. They battle with volume. It wakes me, but somehow, it is not so bad.)

Unfortunately, as much as we like hammering things into place, sometimes nails are tough to come by. In this case, it is vaccines. My head of mission is in the next tukul with my updated measles register, trying to convince Khartoum that there is an epidemic. The curves certainly suggests it. And we have mobilized a dozen people, three cars, , bought bullhorns, hired translators, pored over maps, made site visits to places even closer to the middle of nowhere than abyei, been refused by broken bridges, and turned back by soldiers. Vaccines. Release the vaccines. Abyei has learned all that measles has to teach. Me too. Neither of us need to learn more hard lessons about life, death, and preventable disease. We get that one.

[More Info : Basic Guide to Measles and MSF vaccination programs]

My radio crackles beside me. I am on call to the hospital tonight, and am responsible for it all nights. And all days. I thought I left this call business well behind me, that I could just carry it around as a kernel of pride. “oh yeah. 30 hour shifts, I’ve done that. It’s not so bad.” It was bad, OK? I admit it. Didn’t like it at all. Uncool.

But, speaking of uncool, and its opposite, the coolest…..here is the real reason I work for MSF. Radios. The coolest. I really, really get to say almost every day: “Roger. Good Copy. Over and out.” It’s amazing.

Pictures. By Friday evening.

feb 26.today, i woke early, determined to run out of town and find a bit of space in the flatness that surrounds abyei. at 630 am, the sky was still dark. as I ran, past the trucks and buses leaving for El Obeid or Khartoum or Juba, full upon full of beds and blankets ontop of beds and blankets, dawn happened. but the sun never rose. not past the meniscus of dust along the horizon. a windstorm had lifted the sudan sand, and it covered not only my tukul and abyei, but the wide sky. by 8 am, the sun was only a gauzy ghostly hole, the color of beeswax.

today, when I was doing rounds this morning, and I was figuring out what to do with a young boy who developed a fever after a run with measles, a boy who I had already stuck a chest tube in his side and two needles in his back to try and drain a large collection of bacteria, as I was deciding whether we should stick more things into his chest or send him to another hospital or if he was going to die, and just as I was hearing that today, already looking like bones glued together, today he started refusing food, I looked down and beneath his bed was a butterfly, white wings with black mosaic, struggling to right itself on the floor but spinning in circles and circles, broken.

today, a whole rash of measles. twenty patients in the last week or so. I had it as a child. so did my brother. I have no memory of it. all I have are pictures about how miserable we both looked. I have no idea why we have these pictures. perhaps in some kind of memoriam of how sick we were, but more likely, we just sat still for more than 30 seconds. people sit still with measles because they don’t want to move. there eyes get infected, their skin flakes, there fevers are severe. measled. miserabled. that’s how my brother looked in the pictures, and that’s how these patients look. but we make most of them better. and we are organizing a campaign to vaccinate thousands. they are some of the sickest people in the hospital. you learn early on in the refugee business that if you have thousands of people together, the first thing you do, before plastics sheets and protein, the first things is to vaccinate against measles.

today, on our rounds, stopping by the miserabled, we found two girls who came in on the same day: achol kwol, and his friend, kwol achol. though we set up a measles tent for this latest surge, people refuse it because it is too hot. sudan sleeps outside these days. achol and kwol were not exception, but by moving around, they had lost their hospital cards. “which are you? achol or kwol? achol? no? kwol? which? achol kwol? the other?” by the time we were done, they were as uncertain as we were.

today, a baby died about ten minutes after coming into the hospital. she was dirty and covered in grass. the family came from far away, and asked if knew somewhere nearby where they could bury her. i said I did not. they thanked me and left.

when people I see in the hospital talk of where they are from, they answer in days. “three days away”, some say.

people here make small cuts in their childrens faces, and as they grow, their scars form elegant angles. they look beautiful. and severe.

I admitted a boy from two days away who had such severe dehydration that he tried to suck on my stethoscope as I listened to his heart. today he is better. he gained a kilogram in 16 hours. from 5 to 6.

there is a little girl here who the staff are so fond of that I think they are delaying discharging her because they would miss her too much. she is always between your legs, and crawling onto your lap. if it comes to me, I am never discharging her either. her mother stays happily too, as thrilled as we are to have someone so delighted so close by.

there is a falcon that sits on my tukul and pierces the afternoon with his high whistling cry. before they knew I was coming, they fed him bits of meat and named him james.

I must return to the hospital. already, it is a well worn path. I am going to take some pictures in the next few days, and send them so you can see what I am talking about, of abyei and some of the miserabled if they agree. if not, then of the hospital.

I am sorry I haven’t updated in the past few days. trying to find the time is occasionally difficult, as is sitting inside when it is 44 C. I believe that you can sign up for RSS feeds that tell you when something is new.

and, of course, if someone is reading this, tell me if something is new with you. no details are too banal. I am hungry for them.

feb 23. today, Friday, is the traditional muslim day of rest and the day off for this MSF project. however, there is little distinction between the work and any life outside of it. at 7 pm, we are still talking about the day that just passed, at 8 pm, our plans for tomorrow. it is our last words before sleep, and our first on awakening.

today, on my day off, I was woken by the nurse, andrea, from Switzerland.

“james? james?”

I throw the mosquitoe net from my face, and abyei rushes in.

“yes.”

“you have to go the hospital. there has been an accident. six or so casualties.”

“alright.”

I had spent much of the night in the latrine or lying on the ground outside of it. my head was banging and unclear. I grabbed some water and tried to drink some on the way to the hospital.

within three minutes I was at the front doors, and pushed past the large crowd gathered around them. inside was no better. the difference was I was surrounded by men in military uniforms. one of their trucks had crashed into a car, then rolled over. six people were hurt, one of them run over by the wheels of the truck. another was badly injured by the glass. every time I tried to move from one room to another, to get some idea of how many patients we had, I had to negotiate a dozen shouting men and women.

the situation was quite tense. there were other injured people, from a different tribe, and a different area. at one point, I am told, someone pulled a knife. I didn’t see it. I was too busy examining and stitching and being dizzy. at one point, I found myself alone in a room with some of the militia who were insisting that their injured soldiers needed to be transferred to Khartoum. by airplane. I started to explain the difficulty, about how we transfer only if it is life threatening, and never to Khartoum. we simply can’t. they did not accept my explanation. I was well out of my league. thankfully, my field coordinator, fran, entered and assumed the role of negotiator, taking the heat off of me. I went back to splinting and sewing.

I returned back to the compound several hours later. I have just heard that the military has taken two patients from our hospital, and were taking them elsewhere. unhappily.

I am here now, typing in my tukul. it is 39 C in the shade, hotter in here.

I have been here for 2 days.

the girl I spoke of yesterday, the one with the noisy breathing, who sounded like each breath was her last, she is getting better. she breathes silently. when I waved hello, she ignored me. she is ten. that is normal. yesterday, she wouldn’t open her eyes.

the thing that has me terrified the most, since I received my briefing on my arrival, is not the political situation, nor the risk of getting ill myself, nor the remoteness, nor the lack of resources. it is that, on Fridays, our kitchen staff has the day off, and we must cook for ourselves. cooking is a thrill in [Toronto's] Kensington market. you can barely find the Jamaican allspice amidst all of the organic lemongrass. here in the local souk, well, there are tomatoes. onions. goat. ummmm… i’ll let you know.

I found out that an NGO nearby has wireless access, and that i can go sit in a car on the road, and use it. I hope it works. if it does, I encourage you to send me word if you can. it has been nice to hear from some of you through the blog. all the comments are forwarded to me. again, as usual, you can email me at the MSF satellite here in abyei.

may you all find some quiet this weekend.

feb 22. made it.

i left yesterday morning, very early, to board a UN plane at the domestic airport. i was told to pay attention to the shouted arabic boarding announcements because worthier souls than I had been left behind holding 15 kg of carefully chosen luggage.

the luggage restriction proved not to be a problem. while I checked in my essential bag, I asked my driver to stand behind me and hold my equally heavy second bag which was never weighed. I had a small fleeting fear that the undeclared kilos might send us hurtling towards the ground in a thin metal airplane shell, gasless, just because I wanted to haul Ulysses around the world for the fifth time. still, we made it. my copy of Ulysses now sits proudly on the window sill of my tukul, fully confident that it will leave it as it came, its spine strong and unbroken.

there were six passengers in a plane that held twelve. as we left
Khartoum, and banked sharply over the turbid water where the blue and
white niles meet, the airport looked like a UN parking lot. so too El Obeid airport where we stopped to refuel. I am told that the MSF mission in Sudan is the most expensive in the world. I suspect the same is true of the UN.

the landscape from the sky was austere and beautiful. the earth was
flat and red and cracked. i could follow the paths of rivers only by the stubborn trees still clinging to dry banks. it seemed they were living only on the memory of the energy that once flowed to them. bits of nitrogen from dead grass, or bugs, or dropped seeds. their persistence was admirable because again, the sky was only blue and clear. I saw one small embarrassed cloud on the horizon, but it didn’t stay long.

I had the distinct pleasure of sitting and talking with a Sudanese woman
who was visiting abyei to talk to the community about how it might, one
day, own its own resources. she was born in sudan but spent many years in Saskatchewan. we laughed about coincidences; not only we were Canadians, but prairie folks. She returned to Khartoum in 2003, with her 10 year old daughter. “either you will love sudan, or you will hate it. it is a difficult place to love. but I do.” when I asked why she came back, why she left Canada for she loved her life there too, she answered “…in my heart, I am a nomad.”

[More Info : Plus des renseignements sur Soudan par MSF Suisse - en français seulement!]

we talked about sudan, and about peace, and about living. when we had finished, when neither of us had any more to say, I turned to look at the red ground below. as I watched it pass, criss crossed with dry rivers and camel paths, I had a moment of realization where I recognized that my understanding of the world I live in went up by an exponent. she helped me distill a complicated crisis in a complex country into a story. it was like crystallization of a super saturated solution. I want to talk more of it later, but have neither the space nor the time.

the rest of the flight was silent. abyei snuck up beneath me with no warning. then it was gone. “ I think we missed the landing strip”, a passenger said. “I think they were checking it for cows”, I answered. it turns out we were both wrong. it was goats.

a dirty, dusty, rumbling landing, and I was there. here. for those who don’t know exactly where abyei, sudan is, I will draw a map. the X marks it.

right in the middle.

I will spend some more time later talking about my hut, its 5 x 5 metre cement walls and its straw roof, how it captures heat so well, and… actually, I don’t think I will spend any more time on it. that’s pretty much it.

I will talk more about the hospital, because I just finished my first day. I am getting handover from the departing doctor, amina. she is excellent. my last question to her today is “is everyone always this sick?”.

she has left for the hospital again. the last patient she and I saw, a
child, is not breathing well. his oxygen saturation is 50%. if there was a hospital we could send him to, to put him on a ventilator, we would. the nearest is 3 hours away and the roads are not safe at night. she is one of three patients I saw today who would have been cared for in an intensive care unit in Canada.

but, more about that later. and about the team here, and how they seem the best kind of people. and how it´s so dry that one doesn´t need to towel off, he just needs to wait 30 seconds. and of ali, the sudanese doctor, who i like already, and how he takes pictures of the moon.

and more about abyei, the town. its braying goddamn middle of the night donkeys and barking middle of the night damn dogs. its lovely people,
and dustdustdust. and, importantly, how despite its innocent shy surface, it offers us the best lens to look at the prospect of peace in sudan. it’s a supersaturated solution. but, I guess that’s one of the reasons msf is here. it’s sure not the middle of the night damn dogs.

p.s. the subject heading is an excellent book by a white zimbabwean about the war she lived through. bracing, and beautiful in equal turns. read it if you can.

[More Info: the book that James mentions is a personal memoir by Alexandra Fuller who grew up during the Rhodesian Civil War, and post-colonial Zimbabwe. Fuller went on to study at Acadia U in NovaScotia. The book is called "Don't Let's Go to the Dogs Tonight : An African Childhood" and is available through commercial and online book retailers]