Suddenly…Sudan.

this morning, during breakfast, a loudspeaker blared thick
Arabic.  today was a clean up day in abyei.  everyone was to
clean the space outside of their tukuls, or face consequences.
tonight the air is full of the sharp smell of plastic.  fires line
the road.  as you walk down it, you can see the black shadows of
people tending them flicker and dance.

on the way back to town after my run first those weeks ago, I saw a
cloud of smoke moving across the horizon.  it bunched on itself,
then came loose.  as it grew closer, I saw it was a flock of a
thousand birds.  un marriage du ouiseau.  they landed in one
tree, all one thousand, and sang.

within twenty minutes of landing on wednesday, I was stopped and
hassled by soldiers then told I had to attend the hospital because a
child found a grenade and pulled the pin.

welcome home.  to the place with no face.

noone knows who abyei belongs to and noone comes from here.  no
face.  yet  more arrive each day.  the future is being
decided even now, but I can’t see it.  I am too close to the
centre, and today, I can only see smoke.

there are soldiers from four different groups, and I can make no more
sense of them than I could when I arrived the first time.  my
field co starts talking about recent tensions between acronyms, and I
lose the plot.  thankfully, my job is in the hospital, the radius
of my life 480 paces.

the measles is settling.  in shala. god willing.   two
admissions yesterday to add to fifteen sweating in the
recubra.    the feeding centre has grown.  the
families of  thin children spill out of rooms onto mats.  the
girl I wrote about before, the “now you see her, now you don’t”,
is still in the hospital. I talked with ali as he waited for the wfp
plane to take him away, and he told me he saw her laugh for the first
time. I was glad to see her.  I will tell more about her another
time.  I’m on call today, and need to return to the hospital.

it was 46 today.  people keep on saying the hot season is coming
with straight faces.  I’ve started to sleep outside.

old
home.
new home.

old
roof.
new roof.

flower
bike.
agok.

march 29.
the abyei night is black like thick ink. as you walk down the road, you
(not me, you) push your face into it, trying to gain a centimetre or two
of perspective, and it almost meets a soldier’s leaning over his
handlebars doing the same. you both recoil like surprised fishes at the
black bottom of the ocean. he swerves, and the flowers on his
handlebars brush your (not my, your) arm.

people fix flowers to the handlebars of their bicycles in bunches. roses, carnations, impossible pink flowers in rows. even soldiers. daisies pour off the front, a machine gun hangs from the back.

when an organism enters a new environment, with time the new stimuli
elicit diminishing responses. as it inhabits, it habituates. in a
conflict setting, for expatriates, it is called “immersion”. at first,
every soldier is registered, every weapon noticed. after weeks, in a
new normal, one sees mostly daisies.

for years i was blind to flowers. it took a friend to show me how easy
they are to love. in the hot morning, they hang for water. an hour
after, they are bright. when i leave the feeding centre, i think about
flowers each time.

i will write more when i find some minutes. they are so slick with
sweat here. five things you meant to meet in your day somehow slip
right by.

go to www.youtube.com and search for “reno balloon race”.  beautiful.

the speaker above me clicked on.

“ladies and gentlemen, we have started our descent towards
Khartoum.  we ask you to ensure that your seats and table trays
are returned to their upright position and that your luggage is stowed
in the overhead bins or safely under the seat in front of you.
the weather in Khartoum is …um…blowing sand.   the
temperature is 32 degrees celcius.  Local time is 150 am.”

I am once again in the land of blowing sand.  I am sitting in the
msf office, five minutes away from the guest house where I stay, just
past the garbage mound, and down the road.   there is a small
desk near the entrance.  it is surrounded by boxes of drugs and
equipment destined for the field, but there is just room enough for
me.  I can hear the squeal of the HF radio as it picks up signals
from abyei or darfur.  I wonder what they are saying.

addis ababa is behind me.  it was, as I hoped, a welcome
respite.  I spent a week learning about tuberculosis from some of
the most experienced people in the world and sitting beside colleagues
from all over the world.  some, like me, were visiting from the
field.  others were waiting for missions, or on their way
home.  each had their own story and their own reasons why it met
ours at this point in it.

on our last night in addis, some of us went dancing.  there were
about ten of us who became fast friends.   we shared a
similar enthusiasm for what we were learning about TB, but also about
what there was to learn about addis.  after the long days, we
discovered Yemeni restaurants, king meliniks old castle, got lost in
africa’s biggest market, found traditional music, and little holes in
the wall just down the road.  we were dubbed “the addis ababa
explo mission”.

the last thing we found was the dancefloor late on Saturday
night.  I was surrounded by people I had come to know, respect,
and like.  every hour our number would dwindle as someone left for
the hotel to pack for rural Ethiopia, or Mozambique, or
Geneva.    I was talking with my friend, maria, an
Argentinean doctor who had last seen me throwing my backpack on top of
a crowded bus in Zimbabwe the day I finished with msf last time.
she said she often wondered what happened to me.

“james, answer me something.  this life, where you get to meet
people and know them, and become friends, and then in a few days or a
few weeks, either they leave or you do…we say ‘well, that’s msf’, but I
don’t know.  is it worth it?”

I am not sure.  I think so.  maybe having your heart broken a little bit like that is what keeps it open.

now maria is back in Buenos aires.  mohammed ali (the great) is in
mozambique.  Anthony in Uganda.  all blown like sand.

I am looking at the departure and arrivals board.  on it names,
destinations, and dates are scrawled in felt pen.  mine is
there.

James  KRT ?  AB  28/03/07

but there are others.   my field coordinator is returning to
Khartoum on the day I arrive in abyei.   she is exhausted and
needs a break from the field.  on the same plane is the other
abyei MD, ali.  who is also taking a break.  when I left from
abyei, I shared the plane with one of the two Sudanese medical
technicians that work in the hospital and who, with ali and me, make up
our four person medical team.  I learned today she is not
returning to the project. the doctor who I replaced left after three
months.

my field coordinator is leaving in two weeks, and there may be someone
to relieve her.  our logistician is leaving at the same time, but
as of yet, there is noone to take his place.  in Khartoum, there
are similar problems.  we have been without a medical coordinator
for several weeks.  I saw our logistical coordinator in Ethiopia
and he told me he resigned.  our head of mission wants to be gone
by the middle of april.  no news on their replacements.

I mentioned earlier that the mission in sudan is the most expensive in
the world, for both the UN and for MSF.  talking with my colleague
about their different projects and countries, it seems that it is also
one of the most difficult.    the departures board
speaks to this truth.

I hope for the people of abyei and darfur that we find a way to work as
long as possible in the country.  i will contribute as much
resolve as I can.  i think i will need it all.

I will send word from abyei.  love the spring for me.

p.s. for each of you that posts comments, my gratitude.  I get
them forwarded to me by msf every now and again, and they are a source
of comfort.  thank you for them.

you need a visa to go to brazil.

you do.  trust me.  if you don’t have it, you will be sent
back home on the TTC in the snow.  this is a public service
announcement.

earlier this week I spent most of my day in the Sudanese embassy trying
to get a visa to return to the country.  one needs a visa to enter
the country, another to travel within it, and one to leave.  on
occasion, people have waited weeks in Khartoum for an exit visa.

I arrived to the corrugated metal gates of the embassy to a queue of
100 young Ethiopians hoping for a visa to go work in sudan.  most
of them were muslim.  the ones I asked explained their prospects
for work were better in Khartoum than in addis.

being a gringo has its advantages.  I was moved to the front of
the queue and within minutes, I was inside.  I walked to the
chair  in front of the visa window and sat down.  I
waited.  soon the small waiting room was full with people pushing
from one line to another, papers being passed over and around me,
guards pointing people to different offices.  i waved one of them
over, showed them my documents, and was pointed to another line.
after half an hour, I asked the same guard and was pointed to another
line at the front of which people were being weighed.  I could not
fathom the reason.  being a gringo has its disadvantages.

after two hours of shuffling from place to place, getting various
signatures, I found myself at the visa window, face to face with an
indifferent official.  he didn’t look up, only reached through the
window to grab my passport and msf contract, and walked away without
saying a word.   the Sudanese were sorely overestimating my
desire to return to their country.  after all, it wasn’t brazil, a
country for which you also need a visa, even if it is the middle of a
Canadian winter and you had planned the surfing trip for months.

I stood at the window with that butterfly of anxiety that one has when
someone takes your passport without discussing its return.  I
pushed my face against the iron bars of the window to try and see the
next step in the visa process.  it was the “taking tea”
step.   during it, people came and rapped on the door of the
visa office and noone in the office flinched.  he started to work
his way through the passport pile.  mine was on top (gringo
advantage).  he looked at my passport, then my contract, then up
at me.  he stood and walked to the window.  I pulled away
from it, linear bar impressions on my forehead.

“abyei?”

“yes.  I work in abyei..”

“abyei.  it is where I am from.  I have family near there.”

the butterfly settled, and its place, a small hope.

“ it’s a nice place”

“yes.  ok.  come back this afternoon.  I’ll have your visa ready.”

“who can I pay”

“it’s gratis.  abyei is my home.”

after three hours, an abyei advantage.  I didn’t realize there were any.

I left the embassy, and organized someone to return and pick up my visa
the next day.  she tried.  “come back the next day”.
she did and queued for an hour or two, then got it. I saw her afterwards, at lunch.  she looked shaken.  she had
my visa, but while she was waiting, she saw a man beaten  by
the guards.  she didn’t know the context.

“here’’s your visa.  better you than me.”

I leave addis tomorrow.  I will be in abyei in a few
days.   I must confess it is something I am steeling myself
for rather than anticipating.  i will leave Khartoum from the
domestic airport, trying to find anyone in the chaos who can tell me
when the WFP plane for abyei will leave, then standing up every five
minutes to scan the runway.   the plane will take off, bank
over the nile, and head south over the desert and brush.  we will
climb to 10000 feet in the thin air, and the cabin will rattle.
the hot desert wind will push us from side to side, and drop us like a
stone for a few hundred feet and I will think “is this the end for
batfink?” and turn up my ipod to distract myself.   we will stop in no less than
three increasingly small airports, and fly for miles over land whose
only sign of humans is a pipeline built by the Chinese and shared with
the Sudanese government.  it is powered by rolls Royce engines,
and is the only straight thing for miles.

abyei will come up swiftly.  we will buzz the landing strip once
in an attempt to frighten the nonplussed livestock, then land on
the second pass.  the doors will open, and I will step out onto
the dry, cracked runway and smell the dust, and feel the harsh
unflinching heat.   a cloud of approaching sand will turn
into an msf landcruiser, and I will throw my bags in the back, and
return to my world.  compound 1.  the hospital.

but for now, addis.  last night the moon, my favorite moon.
just waxing.  like someone had taken a pencil and poked it through
the black cellophane of the night sky, letting in only the
smallest sliver of the bright light that lay beyond.  it was
surrounded on all sides by clouds but it stayed there in the centre of the sky, in its gray frame,
for hours.

allow me to apologize for the running pestilent theme of the blog these days.  i am not always this way.  i have outside interests that run deeper than disease.  two months ago, the only thing that prevented me from talking even more about the abysmal state of hiphop, particularly the lack of mc’s with skills, was that my fake mustache was starting to slide off.  for the time being, my life is a bit different, and so too my days.  and so too this blog.  that said, for me, irreverence is my highest form of worship, and I will remember to add it when I can.

for this post at least, i will write a bit about health.  i think that when one does, statistics are best avoided.  1 in 4 with hiv, 40 million infected, 200 billion dollars needed.  what do these mean?  numbers just numb us.  we can’t place them in proper perspective, even worse when they describe a world that we can’t inhabit.

it is better to provide a narrative.  a description of someone with whom we can empathize.  a woman who lives with hiv, and now has to care for her two children to whom she passed it.  that is the unit of our understanding: the story.  that is why there was so much philanthropy after the tsunami.  we could see the boat in the tree and understand the size of the wave.  so too the recent attention to Zimbabwe.  it took the black eye of tsingivrai for the world to appreciate the black eye Zimbabwe has worn for years.  a bruised man is an easier symbol to understand than a life expectancy that has declined from 73 to 35 in the past decade.

but as much as i try to avoid them, today i was astounded by two statistics. i’ll tell them to you. first, guess the percentage of people who live in africa.

thirty?

forty?

how about ten. ten percent.  i was shocked. there is so much disease here. most of the HIV, all of the sleeping sickness, leprosy, kala azar.  and most of the NGO’s. the MSF data that I have shows that 70% of our global budget is devoted to this continent.

i see it as a sign of great hope, linked in part to what i spoke of in the last post.  we are better able to understand our world, even parts we will never visit.  and once we do, we respond. perhaps not fast enough, or in a scale commensurate to need, but we do.  we are.   in an important way, our treatment of this continent, the birthplace of all of mankind, is a litmus test of our ability to empathize with our fellow man.  about how much we care about the plight of innocent people whose lives will not intersect with ours, and for whom we can make easier lives without making ours any more difficult.  it is an interesting and important question.  and i think we are answering it.

i will discuss the second statistic at length in another post, lest this one gets too long and you get disease fatigue.   i’ve increased my tolerance through regular doses.   but this one is as astounding.   1 in every 3 people are infected with tuberculosis.  what?  for most of us, it is a disease more
properly placed in the dirty cities of the industrial revolution, more george orwell’s “down and out in paris and London” than in our world of paris hilton.  untrue.

it is increasing, mostly on the rising tide of hiv infection.  a marriage of inconvenience.  you should know that though there are millions infected with the HIV virus, none will die of it.  most will succumb to tuberculosis.

alright.  again, sorry for the all disease all the time radio.  tune in soon for a discussion about how nice rakim was on the microphone, how his use of alliteration and internal rhyming, though having little impact on tuberculosis, made the prospect of surviving the disease that much more attractive.

lucy.  we can only hope we look this good in 3.2 million years.  sunscreen is the secret.

our nearest ancestor, in the background.  160 000 years old,  he doesn’t look a day over 30.

i arrived to addis ababa late last friday night.  my flight was delayed because of a sandstorm in khartoum so thick that it blocked the sun from the sky, and for several hours, our plane.  i shared
the flight with a sudanese colleague, yassir, our assistant medical coordinator in khartoum.  we waited for our luggage on the carousel, and together walked out into ethiopia for the first time.

we shared a taxi to the hotel with a colleague who was attending the workshop from mozambique.  it is a strange but certain phenomenon that when you identify a stranger as someone who works for msf, you welcome them into your fold of friends.   perhaps family might be more apt.  you may not get along, nor agree, but there is a common ground and with it, some forgiveness.  at least you know
that the person wearing the msf shirt who stole the last cold pepsi has been through a metafilter, that they could be working somewhere else, somewhere easier, closer to their friends and family, for a hell of a lot more money.  so, you just grab the warm pepsi, and sit back down.

though i landed in africa more than a month ago, i didn’t feel like i had arrived until i found myself, the next day, crammed into an ethiopian minibus with 15 other people.  it was so full i had to lean over two rows of passengers, and brace myself on the back of the drivers seat.  the cross hanging from his rearview mirror swung left, then right, as he angled his way through a thick mix of cars, goats, and pedestrians to pick up more people, reggae music bumping from under his seat.   it is no wonder that the largest single cause of morbidity for expatriates is road traffic accidents.   i am sure the same is true of goats.

I visited the Ethiopian anthropological museum.  ethiopia’s rift valley is one of the richest sites in the world for fossils. several years ago, they excavated a nearly complete skeleton of our oldest ancestor, “lucy”.  she is 3.2 million years old.  her bones lie in the basement of the museum here in addis.  I believe an older fossil has been found, an even grayer relative of ours, but I don’t think the skeleton was as complete as lucy’s, and at the least, isn’t just down the road from my hotel.

so there she was, a pile of old bones.  3 200 000 years ago, she walked in the mountains I can see from my window.  there’s no way to know if she had any children, nor what type of food she preferred,
nor how she died.  we can’t know if she had a ringing laugh, or if she was afraid of the dark.  we can tell that she walked, and that her brain wasn’t much smaller than ours.  she represented an important advance.  once she was an adult, she walked on two legs for her entire life.  some scientists suspect that it allowed her to search the savannah for prey or enemies.  others believe it was a step towards being able to throw and catch a Frisbee, the most perfect manifestation of human ability.

it is somewhat different for most humans now.  rather than responding to our environment, we change it to suit us.   we don’t grow more fingers, we build tools. I wonder how we are evolving now that we can see our enemies on google earth.

I believe some of it is an evolution towards collective consciousness, and with it a recognition of a shared human condition.  it began, perhaps, with the first morse signal, from there to radio and
television, and has been made manifest with the world wide web.   the perspective it provides properly places us in the world and offers a clearer understanding of our role in it.  in that way, the internet is not an infinite series of portals, it is a mirror in which we can see ourselves reflected more perfectly than ever before.

lucy can be forgiven for not caring about what lied on the other side of the mountain.  she could not have known.  one hopes that if she did, she would make the walk.

I do not think that is a naïve hope.  I am sitting in a room with 32 people from 22 countries who have made it to stand on common ground.  there is room enough for more, for all of us.

there is little choice but to tell the story again, better, to more people.  about humans and war and disease and fairness and success.  and we hope that if we do it well enough, people will respond with whatever tools they have available.

everyone has a collection of their favorite
travelling malapropisms.  beauty saloons are mine.  they
abound here in addis, and in other places in africa.  when i see
the sign, i can’t help but think of a dusty beauty saloon in
arizona.  the swinging doors burst open.  people look up from
washing hair and peek from underneath hair dryers.

“must be the wind.” someone says.

just
then you here the tack….tack…..tack of high heels on a parquet
floor.  a middle aged woman with a beehive hairdo and wearing a
pancho turns  the corner,  a curling iron hanging
dangling loosely from her right hand, the business
hand.  everyone is silent, watching.  the only sound is
the drone of an upright hair dryer.  she fixes it with a steely
glare and it whines off.

“i don’t suppose anyone here knows anything about a straightenin’ hair….”

“umm….ma’am…ah do…..” says a stylist crouching behind the washing sink.

people
breathe a sigh of relief, the dryer goes back on, and
the beehive woman collapses into an old barber chair, dusty
and relieved.

arrived to ethiopia yesterday.  have
successfully avoided any beauty saloon trouble.  the weather is
mercifully cool.  i needed some time to regroup from abyei, and
will find some.  i am grateful.

i am not sure who
noticed, but the picture of a girl i spoke of, one who was abandoned at
the hospital dehydrated and motherless, was taken down.  my
colleagues at MSF communications called my attention to it, and rightly
so.  after posting it, i felt uneasy, and looked to take it down
myself, but was unable to access the web.  luckily they were one
step ahead, and removed it  until they could discuss it on monday.

it
is probably better down.   on matters like this, it is better
to err so far on the side of caution, that the chance of harm is
zero.   when i speak of patients, i am careful to make them
unidentifiable.  when i send pictures, i spend considerable
amount of time discussing possible consequences with each
family. i try to make them understand that others will
see their pictures, and one day might recognize them. of course that
will likely never happen. few of you will go to sudan, fewer still to
abyei, fewer still  cross
paths with anyone here.   it remains my duty to
explain it as best i
can.  when i travelled africa last time, with a photographer, we
were exhaustive with our consent forms because our subjects were people
with HIV, and the stigma towards the illness is
strong.    no matter how well we did,  it
is likely that they never fully appreciated their right to
refuse.   a similar criticism is often levelled at clinical
studies in developing countries.  we speak in our language, from
an insoluble position of power.

i have been meditating on the the picture before it was
brought to my attention.   both because it made me
uneasy, but so too to better understand my reasons for posting
it.  it was obvious that this one patient had been occupying my
thoughts.  she typified a problem that i did not have the tools to
address.  i can’t properly explain why it was her when there
are five children a week whose positions are as
tenuous.   the best i can come up with is that when there are
so many battles, one can choose only a few to fight
completely.

i compromised a bit.  i gave him enough money for transportation,
and a good, long dose of antibiotics in case he decided to keep the
money.  he did, and survived the appendicits without
surgery.  i saw him two weeks later in the fields.