Suddenly…Sudan.

this morning i was packing, preparing to leave amsterdam. i laid my things on the floor of my friend’s apartment and went through them, one by one. i wanted to rid myself of as many as i could. i am not sure if it is part of a larger lesson one learns while moving through an unfamiliar world, but each time i travel like this, or work like this, i do the same thing.

i picked my way through, binning many. torn, frayed jeans, worn thin by a scrubbing stone. the sheaf of papers necessary for traveling in sudan. a broken skipping rope. i came to a black plastic bag and could not remember what it held. i opened it and pulled out two sandals. once black, they were now red with dust. they seemed from another time, ancient, an anachronism. i put them back in the bag then repacked them.

i talked to a friend on the phone for a few minutes the other day, and he said, surprised, “well, you sound ok.” i wonder how he expected me to sound, if there was a fear that i had changed into someone he wouldn’t know.

i have changed. i am now a seven foot tall asian woman in her late forties. i suspect this will be the most surprising to people who know me as a medium sized man in his early thirties, but it has its advantages. concerts are one.

the other ways are less obvious, even to me. i suspect that most of us who go through with their first mission do it for several different reasons. one might be a perceived social responsibility. others are excited to see the world, others excited to test their mettle. i would say that all of us secretly expect the experience to change us. it does. you don’t feel it as much until you land into the perfect mirror of home and the friends you have left there.

i was standing in the airport line last winter, about to leave, and talking with my friend matt on the phone. he asked me why i was going. why really. part of it, i said, was inertia. i built my career towards this point, the one where i step off the plane and into something a little less comfortable. it was like climbing the ladder of the tall diving board; there is only one way down. personally, i said, i want to understand the world better. to find my true place in it. to do that, i want to be close to not only its beautiful, comfortable parts, but also its hardest, most difficult ones. it is easy to convince myself of my own happiness when i am whizzing around toronto on my bike, answering phone calls from my friends. but remove this. all of it. instantly. then who am i?

it is a similar lesson that working in downtown toronto teaches me. i finish a shift at st. mike’s and during it i see a homeless, helpless, who has had alcohol poison his life, and seems destined to die in a shelter, grizzled and filthy. a schizophrenic woman deeply addicted to crack, confused and screaming, a prostitute assaulted by her pimp. everyone who works these kinds of days leaves them and must find a way to be a friend to their friends, a son to their parents. i learned it on my bike rides home.

i succeed. mostly. but whether i do or not, on those bike rides, i see the world as it is. at the zero point. the good things, the hard things. there is no fooling. i don’t think it makes that first Frisbee throw in the park any sweeter. but it does whittle everything else away until only its true value remains.

so, part of it, amidst a dozen other worthwhile reasons, was a chance to better approach the world and see it as it is, a way to unblind myself from the millions of circumstances and possibilities that distractingly dangle dazzling in front of my eyes.

i am not sure if that is how i sounded when i spoke on the phone with my friend yesterday, but that is how i feel. unblinded. the true value of a conversation with my brother, the chance to move freely, to be in a warm house full of friends, the exact worth of these is reflected clearly back. and because of that, i better understand my place in the family of things.

somehow, miraculously, there is a life-size space for me in the world, and one for each of us. it could be otherwise in a million ways. i’m glad that, at least for now, at least for these days, i know it. sadly, there seems none for my frayed jeans. nor my chin up bar. the dusty sandals, though… i’ll make some room.

so. it was like Maurizio said. the sights, the noises, the days that surrounded me so completely, they collapse. they collapse, but they don’t disappear. it is as if you have shut off an old tv and all the images and sounds are compressed into that one bright point in the middle of the screen. incandescent, it just lasts and lasts.

abyei is still real. i am positive. i know that right now, as i type this, the people who remain are working their way through familiar struggles i have left behind, that the call to prayer will happen soon, that someone just looked at the thermometer and is scanning the sky hopefully for clouds. it has collapsed into a tiny white dot, but it is still too bright to forget.

time is different here. hours are eaten up by little tiny minutes, almost instantly. they just disappear. days too. in abyei, time felt thick like molasses. each action was deliberate, even the small ones. eating food had a slow importance to it. this is dinner. now i am done. i will go to bed.

the days since have been like water. bright, clear, diaphanous by comparison. so many mini things have happened, but their inertia is different. i don’t know how many times i have eaten today. or quite where i have been. i could tell you if i thought about it, but i am not likely to.

since i last spoke at you, i have left sudan and passed through geneva for my debriefing. i am now in amsterdam, considering ending my relationship with some parasites. you have to understand, it is not them, it’s me. there are some things i have to figure out on my own.

the debriefing in geneva was interesting. aside from the usual talk about objectives, accomplishments, and future plans, there was considerable discussion about my blog, and about blogs in general. there are some who feel that they hide the slipperiest of slopes, that they are akin to voyeurism, a commodification of the MSF experience. others, like myself, are convinced that its immediacy and combinations of media allow a story to be told in a new, powerful way and that there is a benefit in their telling. the more people who know about abyei the better. the more first time volunteers who understand what it is truly like in the field, the better. the more of our family members who know we are alive, who get a chance to feel like they hear from us every day, the better.

i am not sure what will come of it all. it is true to MSF’s spirit that there will be a heated discussion that will give way to cool consideration, and finally firm into a resolution. i can read the wisdom on both sides, and hope to participate in the dialogue.

i can’t speak to all the merits and demerits of blogs, but i think i know why they work well; they are personal, immediate, and available. they make a window in the world, and when they are at their best, it is almost clean. though i can for the first time, i haven’t looked back through mine yet. not quite ready. too many little mines, memories that need to lose some of their colour before they are recalled.

because i did not have easy access to the internet, i wrote post to post. i never got a chance to see this as a larger thing, if it manifested any particular themes. i wanted to tell the story of abyei as someone who came to it knowing nothing, and then found himself woven into it. i wanted to tell the story of MSF, an organization that manifests a particularly pure version of the humanitarian spirit we all carry around. and, most importantly, i wanted to make more real a world that is happening right now, just now, at this very minute. someone just set down the thermometer, and scanned the sky. no clouds. no rain today. good for the hospital. the roof on the feeding centre has started to leak and the mothers are complaining, threatening to leave. it is important to know not just because it provides perspective, not just because the contrast makes us realize we have the tools to do something about the world we live in, but also to remind us that we are doing something about it. we could just use more hands. maybe yours.

there are other missions. dozens of them, going on right now. people are waiting for visas, passing through customs, counting days until their R&R, coming home. my experience was not remarkable. there are forty others like it right now, some harder, some easier, some longer, all different. i once said MSF is a treadmill. one person gets on, runs for six months, and it is someone else’s turn. maybe its more like the major leagues. dozens of teams, hundreds of games, a thousand people criss-crossing. but the multiplication is dizzying, so i just focused on my small corner because it is the only one i know.

a friend of mine came to visit me in amsterdam yesterday. we drove around in the rain and looked for tennis courts. he asked me what it was like, sudan. i didn’t have much to say. “intense”, i said, “not quite over.” still that bright, burning spot.

I am sitting in Khartoum’s airport. For the moment, everything is life size. The crying kid next to me, the men walking to the airport mosque with prayer mats, the man smoking under the no smoking sign. Soon, the hatch on the KLM flight will close, the announcements will begin overhead, and the telescope will start to swivel. By the time I arrive to Europe, it will have turned completely and everything in Sudan will seem miniature, far away.

I tried to have a simple conversation with the driver on the ride here, but I couldn’t manage. Every thought was short circuited before it verbalized, my neurons a crossed jumble of sparking wires. It was then I realized that my brain had already left, maybe even the day before. Right now it is floating in an ice cream pail on some customs officer’s desk in Amsterdam. Every now and again he adds another warm mugful of vegetable stock and St. John’s Wort, and keeps an eye out for the zombified expat walking around the terminal bumping into pillars while looking at all of the lights.

I will catch up with it. For the time being… bzzzz… bzzzz… crossed, sparking wires.

It took me 48 hours to leave the field. It was a rush to the finish as I received my travel permit just as the plane was arriving, then flew off to the southern town of Rumbek to wait for a connection the next day. Rumbek is Abyei in twenty years. Wide streets with mature trees, green, calm, a large colorful market. I was enamored. This is the Africa I remembered, or at least imagined. People waving hello, children walking to schools in uniformed rows, smiling. This was life as I knew it.

I went for a run in the morning, and waved hello to chidren, even raced one on his bike. It was idyllic. I was about half way through, running on a beaten trail that flanked the side of a road. I made room for a bicycle to pass me from behind, and for a man approaching from the opposite direction. The bicycle wobbled past. As the man passed opposite, he drew his hand back, as if to strike me. In it he held a sapling, as thick as my finger and three feet long. We stood there, him poised, me nervous, waiting. A full moment passed. He laughed, and kept walking.

The spell was broken. I did not fit in. It was an illusion. No matter how well integrated I thought myself, this was not my place either.

I am wondering where that place is now. Yesterday I received an email from a friend who did his first mission last year, and he said that sine his return, he feels uneasy. He is waiting to go away again.

So much left unwritten. There are a million things. I wanted to write about the Casio F91-W, how it is the watch for all developing world traveling needs, reliable and unglamorous. I wanted to tell you about my grandfather, how he used to skate on the thin fall ice, often breaking through, and track diving muskrats to stun them with a quick blow of an ax handle on the frozen surface of the lake, then sell their fur for pocket change. I wanted to tell you about the food in our mission, how we would not call it by its name but by it’s color:

“What’s for dinner?”

“Guess.”

“Umm….yellow.”

“Nope.”

“Ummm…red and brown?”

“Nope…black and brown.”

“Shit. I hate black and brown.”

“Yup.”

I wanted to tell you how some of the women in the hospital, the mothers of the children in the TFC, wrote and sang us a song one day, wishing us strength. I wanted to describe better the team, Franck the logistician who I would trust with my life, Maurizio and his calm, wise ways. All these things, untold. And many more. Alas.

I am leaving with some misgivings. Most importantly, the visa has been slow in coming for my replacement, so she is delayed for a couple of weeks. I am to start work in August and cannot stay. I would have liked it so much more if I could walk through the Abyei hospital with the cavalry, and leave the keys to it in her capable hands.

Second, in some cruel, twist of fate, I already miss Abyei. How can that be? There were weeks that I longed for a reality that was anything but the one that hit me when I opened my eyes. Now it is strange to feel so untethered, to not have the responsibility and privilege to constantly improve something so worthwhile.

I will write some more posts, perhaps with a different frequency, as I see how well the next places fit.

I suspect more thank you’s will follow as this winds down, but my gratitude for those of you who have been there throughout this blog, to encourage, to learn, to bear witness, is so profound that even the best words cannot capture them. There were days where I bent down to enter the logistic tukul and sat at the communications computer still bent from all the weight of the world outside of it, and I would receive an email that contained comments from so many of you. When I left the tukul, it was on a thousand tiny clouds. A source of strength and inspiration when it was wanting the most. Thank you.

Oh, the flight boards. I just looked back over the post, and I capitalized everything for the first time. Huh. Imagine that. Will send word once I meet my brain again.

Soon, suddenly, not Sudan.

this is how i spent my last day in abyei.  from my tukul, to the
hospital to say goodbye to some of the people i have worked with and to
play with some of the patients i have grown fond of, then rush through
the market for the last time, rush to throw my things in the back of the
landcruiser, then rush to the airstrip, the plane comes, and abyei falls
away.  music by gui boratto.

it has been difficult for me to write lately. partly because days need space for words to creep in. partly that, but partly because across the street, a music store has opened. perhaps “music store” makes it sound a bit grand. it is a tin shack with half a dozen tapes and one gigantic speaker. at 8 am, their generator starts up and, seconds later, booming congolese tunes strain the speakers. i just sat down, enjoying some quiet for the first time this evening, hoping that a spare, bare wire may have dropped into a puddle and stunned the owner (temporarily). alas. i have been intending for a few weeks to write a smart ass post about how avant garde the minimal techno scene is here, how it was so minimal and meandering that you couldn’t even find the beat. found it.

i’ll be right back.

it is quite late. near eleven. deng graciously turned the music first down, then off. i have finished a preliminary pack. six months worth of living. it took me twenty minutes.

the abyei night. the clicking of crickets, clacking of generators. every few minutes a bat flutters in, swoops and dives its way through the crowd of insects hovering around me. mosquitoes dance over my hands then land. i blow them off. a vine that i have been watching for a few days has now crept into my tukul, and decided, for some reason, to turn left and follow the wall. i marvel at the gentle insistence of nature. quietly, it would reclaim this tukul if i let it. only bats and bugs and vines and clicking crickets. it is one of the things that gives me some solace. if we humans don’t figure it out, if we use everything until there is nothing more to use, and slowly or suddenly join fossil record, it’s ok. there are other things besides us.

mosquito whining in my ear.

one night, a month ago, i stayed up late talking to Maurizio. he told me how he had studied nuclear engineering because he wanted to know more about the universe, more about that one billionth of second right at the beginning where before it, there was nothing, and after it, everything. everything.

i told him that when i finished in africa last time, traveling with a photographer and writing about disease, she suggested that we work together again. i asked her on what. she wanted to travel the world and take pictures of people dancing. i suggested to her that we go looking for magic.

i felt foolish when i told him the story. i couldn’t explain it well. i didn’t mean voodoo, or trickery. i meant the unexplainable. like that one billionth of a second. the deep mystery of life and of time.

how do we know what life is? why is it that if we all read the headline tomorrow “LIFE DISCOVERED ON MARS”, it could describe a lichen, a bacteria hovering around a hot vent, or a wise wrinkled martian, but we would all know it was life, instantly, everyone. we would all recognize that silky equation where one doesn’t stay one, it grows, then changes, then becomes two. why that? how amidst all of the cold rock hurtling through cold space did this happen? sure, water meets carbon dioxide meets the light from a star, lipids form a bilayer and one of the little bubbles folds around a delicate piece of protein that twists on itself and pokes through its slippery cover. and then? why does that make two? why that silky equation?

though unknowable, its beauty is unmistakable. but that is what i meant by magic. and that is what this work is about. and the writing. we don’t have to look as far as mars, only around us.

we live in a blessed time where we have the chance to see it as never before. and the true gift is, we aren’t only resigned to recognizing it, we are given the chance to care for it. to let it grow. while we will never be able to answer the question, “why are we?”, we can ask with all the knowledge of where we are, “where to from here?”. we have never known “here” so well, never had so many tools.

this is our question. though its answer will not tell us why we are, in it we will discover what we are.

i would not be here, not in abyei nor in front of this computer screen, if i didn’t believe that what prevents us from treating the world and its living things more carefully is not indifference, but distance. the distance from the plastic wrapper in the gutter to the overfull landfills teeming with garbage. the distance from the groaning shelves in toronto’s organic grocery stores from the people in akur eating grass. that’s it. it is easy to remove for me. i can come here. i can only write about it for those who cannot. but that’s what i try.

i left. just now. i am on call. my last. i was called to the bedside of the woman i spoke of earlier, the one whose perineum was burned so badly after delivering her baby. she has been in the hospital for weeks. her fever would come, and go. she was losing weight, refusing to eat. tonight, just now, she started to lose her breath. when i put my stethoscope to her chest, it sounded like she had inhaled a handful of marbles. i gave her some oxygen, some lasix. i could think of nothing else to give, so i left. she won’t live the night.

allow me to answer one question. if this woman was in toronto, would she be alive tomorrow? yes. absolutely. and it is my belief that there is a part in all of us, as life not just as humans, but a deep integral part of that silky equation, that knows this is wrong. the problem is, i can’t answer alone what to do about it. we will everyone’s help with that.

it is late, this is long. my last day tomorrow. i feel sad. i don’t want to leave. i worry about everyone i leave behind.

i just stepped out of my tukul to get some water. the night is clear, silver pepper stars. the milky way is so bright, a smear of a million suns. did you see it?

from nothing, everything.

three days. friday the 13th. that is when i fly. i will overnight in a small southern town, rumbek, and continue to khartoum on saturday. in sh’allah. as i write this, one of our staff, scheduled to fly today, has been standing by the cracked air strip for several hours, scanning the sky. no plane so far. three days. were these the ones i have been waiting for all this time? they seem ordinary, the same as before. hot dry days end with hot sweat sleeps, abyei limping towards its future.

three days and i will leave this place behind. i have been told that once you step off the gangplank in geneva, this world collapses, ceases to exist, becomes unreal, inaccessible. the rupture is complete.
for now, it is all right here, available to me as soon as i walk out my tukul door and crack my head on the rafter. the clack of the generator, the taptaptap of the mirrorbird, a crowded outpatient department that looks at me hopefully as i stride past. i can’t see myself on the gangplank, only
pushing open the rusty pharmacy door later this evening and loading my arms with TB medicines, only stepping between the nylon cocoons of sleeping families late at night.

i spent last evening trying to finalize my travel plans after i leave geneva next week. next week? that seems impossible. it is too near. i feel no connection with that future, as inevitable as it might be. i spent an hour looking at flights, responding to emails, looking at the comments. at dusk, i folded my computer into my backpack, and started the long walk home. i quickly encountered some acquaintances from another NGO out for a walk. i tried to talk, but could not. the words that came were jumbled and strange. i had just spent an hour engaged in this unfamiliar interspace, pulled from this place to place to place to place at a thousand kilobytes per second, and it had left me dizzy and uncertain. it didn’t fit well with the cows, and the water pumps, and the women balancing buckets, and this group of people walking before dinner. after a short, stilted conversation that we both left confused, i walked slowly home. by the time i arrived, i found the ground beneath my feet.

and it is still there. here. abyei’s brown ground. all dust when i came in february, cracked and shifting with the wind. now, as i look out at a black and heavy sky, soon to be thick mud. it has changed. completely.

this is the point where i begin to wonder what i have changed. this is when you start the questioning, only now, just as the days push up against one another, too heavy and full to toss behind you in bunches. you don’t have today and tomorrow anymore; you have lost them. in their place, TODAY and TOMORROW, too swollen to change, and you live them like a race.

i was thinking about this today as i was sitting in the TB office, about what i have accomplished, what i will have left behind. as i was balancing in the interspace, the one between here and there, then and now, one of the young TB patients walked in. she is about eight years old, and has been on treatment for two months. after the first meeting, i have not seen her parents. she comes every week on her own, like clockwork. she always wears the same torn, overlarge, black dress. she peeks around the corner, then bashfully slides into the room barefoot, and steps onto the scale. she answers my questions shyly, only with nods. when i finally place the foil packages in her hand, she skips out of the room. i adore her. so brave. when i saw her this last time, for the last time, i had this overwhelming urge to give her everything. i didn’t even know what everything was, i just wanted to give it.

and i knew then that i was thinking about things the wrong way. when the plane takes off and the abyei ground falls from beneath my feet for good, the best things i will have left behind are not the ones that can be summarized on my end of mission report. they are the bright, beautiful parts of the
day that can only be lived here. there are many. i will miss them.

the best way to get a hedgehog out of your room is to poke him with something blunt, like a shoe or a book. then, when he curls into a ball, you just roll him gently from behind your trunk and out the door. if you try to chase him out, it quickly becomes a game of corner-to-corner, one that he can play much better than you.

one week. likely less by the time you get this. i can’t understand it. it seems not real. i am not sure if i have stopped looking for the end because i have fallen into step with the day to day cadence of this place, or because it is right in front of me. all i have for signposts are the disbelieving faces of those who have left before me as they throw their pack into the back of the landcruiser. noone believes it until they are on the way.

perhaps part of the reason is how isolated we really are. our air access routes change daily. some weeks we drive for two days to a tarmac landing strip, other days we are told that a plane might land an hour away. might. other times we drive all the way to khartoum. one of the last people to leave drove for two hours to a flooded landstrip and waited as the plane buzzed it once, twice, then banked away. desperate, he and the driver followed it in the landcruiser and watched it land on a drier piece of land a few kilometres away. they tried to reach it, but a river blocked their path. they drove along it, back and forth, but could find no place for the truck to cross. finally, the driver stopped the car, bernard hiked up his trousers, grabbed his bag from the back, and forded the river. he arrived just in time. the driver put the car in reverse to begin the drive back to abyei, but it was hopelessly stuck. it took him hours to get out.

so, who knows. maybe a week. maybe more. rain, cholera, fighting. all these strong reasons to not grow fond of a particular version of one’s future.

part of the reason i work in places like this, with an organization like msf, is that i share important common ground with the people i share space with. for instance, few seem to confuse worth with what can be owned. also, few of us have a fixed idea of the future. most of us know where we will be find ourselves when the mission is done, but after that, who knows? i am not sure if it is a quality that leads us towards work like this, or if it is something we learn standing on the wrong side of the river or from patients whose plans often cannot extend past their next meal.

so, here i sit, less than one week to go, and it might as well be a year away. i thought this would be a time for summaries, for reflection, but for now this is the only place in the world that exists. yours seems make believe. i can’t quite imagine this place without me, or me without it. quite a change from the beginning when that is all i could imagine.

the weather is bright today. tufts of harmless clouds and a scorching sun. the bird is ratatatating the mirror behind me. i am off to the hospital soon, taking a walk that i have now done more than any other. donkeys will pass me in either direction, one nearly bowling me over, carrying their payloads of water and young boys shouting “arrrraattt! aaarrrrraattt!” and slashing their backs with sticks. a young girl will peek at me from behind a grass fence and whisper “kywyja….. kywyja…”. two soldiers will bike by in either direction, and one will say “morning”, even though it is late in the afternoon. as i turn into the driveway, i will look up and see, high over the hospital, a dozen hawks drifting in wide, slow circles, up and up and up, hot air under their broad wings. soon they will be only small black points brushing the clouds, and then, too small to see.

a fever is the most comfortable thing in the world to slip into. it is like someone has covered you all over with fine, warm gauze. you are never so content to lie motionless, thoughtless, needless. you don’t want water, food, or comfort. you sweat through jagged half dreams cutting violently from one to the other and no cares penetrate your hot cocoon.

there are exceptions. one of them is when you sleep near a handset that crackles alive after midnight with “compound one for hospital.” you are already half awake, but you don’t move. perhaps the sleeping half is having a half-dream. the call comes again, and shortly after it, a guard raps on your door.

“ok… ok…” you say, and toss the wet sheet aside, fumble beside the dark bed for the radio. “hospital, go ahead.”

“… doctor james… uh… we have a patient here… a patient of gunshot… a soldier…”

normally, at this point in the evening, particularly with the halfness, you would try to get more information over the handset and see if your presence was necessary. with a gunshot, you know the best time to go is now. since your conversations are not private, there is a limit to what you can discuss over the radio. the only question you need answered is:

“are there many soldiers in the hospital?”

“only two.”

you tangle blindly through the mosquito net, find your stethoscope and the pharmacy keys, walk to the car and wake the driver. you tell him that you need to go the hospital. there is a gunshot. a soldier. you are not sure why you are telling him, but you think he should know, just in case. in case of what? you don’t know. in case this wasn’t just an isolated, personal incident, the singular result to the equation of the number of guns in the area, multiplied by alcohol, multiplied by circumstance. in case this is the beginning of something much larger, the index case for an outbreak of gunshots that will sweep through abyei. he nods sleepily, rubs his eyes. you might have told him you were going to buy biscuits.

you touch your forehead as you climb into the car. it feels hot. you ask him to touch it. he does, and pulls his hand away, and shakes his head in disapproval. the two of you pull out of the compound, and turn right. the distance is short, and you have walked it many tmes. it takes you past one of four military compounds in the area. as you pass it, you hold your breath, your half dreams wondering what it would be to see a short, bright burst of gunfire light up your last thought.

this thought was not always so close. once, being a humanitarian carried with it a certain privilege: if you declared yourself as one, you were not a target, not even on the battlefield. it is why henri dunant started putting red crosses on the backs of the people dragging soldiers off the field in 1864, and why those of us working for MSF get teased by other NGO’s for the logo’d t-shirts we wear everywhere. it marks us. it says we are here only to help, we are not part of the war; we take care of the sick. in some countries, this “humanitarian space” is all the room we have.

it is being slowly eroded. particularly in the past five years. several MSF workers were killed in afghanistan in 2005. a young woman working for MSF on her first mission, elsa serfass, was killed last month in central african republic. in recent years, it appears a shift has occurred. the red crosses and msf logos no longer provide as much protection. some don’t see them, and to others, they look like bullseyes, a sign of wealth, and of resources. more worrisome, they can mark us as a potential pawn in a larger game. with one swift stroke, they drive help away from their enemy. combine this with a deft political turn, and they can cast blame on the other side and manipulate public sentiment.

once this humanitarian space falls away, it cannot be rebuilt. the newer wars will have no memory of it, and for those of us whose only protection is this invisible margin of saftety, we are left defenseless.

this space is not only for us. it provides room to breathe for the innocent on either side. one of the reasons the roads are safe at night is because if they are not, if we are threatened, we will leave. the hospital, once full of armed soldiers, is now a place where people feel safe because every time someone refuses to check their grenade at the door, we evacuate. all of us. we demand the space, and with it comes air for everyone.

it is why we continue to refuse association with governments and military, anyone with guns. it is why we feel that “militarizing humanitarian corridors” is a contradiction, and resist it. we need people to remember that space. desperately. and not just for us.

so, that is what you think, gravel crunching under your slow tires, as you pull up to the gate. the hospital seems quiet, not the usual mêlée of multiple casualties. you grab two paracetamol from the nursing room and swallow them, and walk into the emergency room. a soldier has been shot in the arm and chest. by his brother. an outcome of an argument. though this is not good news, not for either of you (couldn’t it have been the foot?), it is not the sign of a hell of a lot imminent bad news. you insert a chest tube, repair his arm, and because he won’t stop bleeding, you begin the frustrating call for blood donors.

it is a long night, but in it, you find all the space you need.

———————————————————————–

More Info : MSF’s press releases surrounding 27 year old Elsa Serfass’ death

11 June 2007 : MSF aid worker killed in the Central African Republic

12 June 2007 : Further clarification on the death of our colleague Elsa Serfass in Central African Republic

a friend of mine once told me of an idea for a newspaper that carried only good news instead of advertising avarice and fomenting fear. headlines like:

MAN OPENS ICE CREAM STORE

or

THE TEN MOST PEACEFUL PLACES ON EARTH

franck, our logistician, just stuck his head into my tukul and said, “the car just returned from the transfer… they picked up that woman, the one you sent down last week for surgery. she is fine. so is her baby. they drove her to her home. just thought you would want to know.”

good news. even in a day where it seems far away, it can happen. just like that.

the patient we transferred down today, the other player in the patient shuffle, was a 3 year old boy who was bitten by a snake. his family waited for weeks before bringing him to hospital, and when they did last night, his leg was withered and useless. it needs to be cut off.

as the truck was being prepared for the three hour transfer to the nearest surgical hospital, where he can be offered amputation but no prosthesis, no replacement leg, we prepared the operating room. our plan was to more carefully examine the woman i spoke of the other day, the one with the severe burns to her perineum. she has continued to bleed, and we needed to find the source. we transfused her yesterday because we could not tell how much blood she had lost. the family had dutifully cleaned it up.

as we put her on the operating table, she arrested. stopped breathing. no pulse. alivealivealivedead.

we resuscitated her. breathed for her until she found the energy to do it on her own, gave her the fluid necessary for her heart to push out a pulse. within a few minutes, she moaned, confused, deaddeaddeadalive.

she had several long lacerations from the childbirth. most oozed blood, one pumped. we tried to close them, but every time the tissue was grasped with the forceps, it wept. we sutured the ones that were the most severe, and left the others open. they were all deeply infected.

i left the operating room to look for donors. it is a constant struggle here in sudan to find someone to give blood. they are afraid that what we take will be gone forever. no explanation to the contrary will suffice.

i found her group of family and acquaintances, explained the need and the urgency. they all shook their head, turned away. her father, the man who had donated to her yesterday, offered to give again. i told him he could not, that he should find others who would. anyone. tell them it’s ok, that blood comes back. it’s like your hair. it keeps growing.

i spent an hour arguing, imploring. of ten, none would agree. the father sat on a bed, holding his head in his hands. he was despondent. his daughter’s fate was in the helpless hands of friends who drifted away, one by one.

without telling the family, i left to get my blood tested. so did two members of our staff. we resist this as often as possible, and some MSF sections forbid it. it is not a solution to the greater problem, and there are concerns that if the population knows we will give, they will be even more reluctant. further, if the outcome is bad, the blood can be a source of blame. but, the esotericism is best understood on paper, or in a blog. in the hospital, however, with a young, burned, bleeding woman, all that seems to make sense is working in units of one world at a time.

i got tested, and an hour or so later, found out i could give.. i asked our lab tech to do a cross match and screen me for viral diseases. as i sat outside the lab, waiting, my translator came and tapped me on the shoulder. there was someone who had come to donate. he pointed to a sunglassed soldier sitting on a bench in green fatigues, his cap askew. he had heard, somehow, that there was someone who needed blood. haj, our dressing room nurse, came up to me and, standing tall, said in thick English, “my sister’s son”.

i walked over to him, explained the procedure. he agreed. i’m glad you came, i said. may your kindness find its way back to you. he shrugged, proud.

we took a unit of blood from him, and it is dripping into her right now, red pearl after red pearl.

i will see her tomorrow, and if the family can’t solve the problem, i will give her some of mine. it grows back. it’s like your hair. we should all donate if we can, give someone good news.

after we resuscitated the woman today, and i left the family conference on a carpet of round refusals, i stopped by the pediatric ward to continue a discussion i had left the evening before. i was trying to convince a woman to allow me to start TB treatment on her child, but she refused. the medicines were red, she said. i told her that red medicines were the best, that they were the strongest we had.

i asked her again. no, she said, it was not tuberculosis. the problem was the bones in his chest, and if i couldn’t fix them, she would leave. her child who was lying listlessly beside her, began to
wail. behind me sat two more children, teetering on the fence, their mothers watching the battle carefully. in the middle of it, another family walked into the room. it was of a patient who i had admitted for malnutrition twice before, and here she was again, a third time, bones tied to bones.

i have to stand outside for a minute, i told my translator.

i stood outside, and listened to the wailing. i thought about counting the days left but decided against it. instead, i counted out a few deep, slow breaths and went back inside.

he starts TB treatment tomorrow. good news.

abyei bus.

abyei’s most famous bull.

measles in gole, nothing attracts a crowd like a crowd.

where diarrhea comes from.

yes, you.