Dear Darfur…

My day started with the sight of a neonate’s head stuck inside his mother. The functionality of a head first delivery is that the head dilates the way for the shoulders, hips and everything else that comes out. If it were not for the midwife (Caroline) and the MD (Mike), the newborn would have certainly died. After a few minutes of watching the struggle to get the head out, I was expecting a sad out come. With a few nifty maneuvers the baby was delivered. To my surprise the newborn was breathing, breathing infrequently, but breathing.

I started the generator, then the oxygen concentrator, and found the manual suction. It was pretty surreal to resuscitate a newborn in a tent. With in 20 minutes the baby was breathing normally and started to show signs of consciousness. Soon after he opened his eyes, after jumping feet first into the world

This baby was enormous, 4 kg plus, which would explain part of the difficult delivery. Though healthy looking, large newborns can be a symptom of pregnancy induced diabetes Mellitus – one of many reasons to support prenatal programs. Pregnancy induced diabetes one of many issues that can be detected and often controlled by lifestyle adjustment or medication.

Later the newborn and his mother were admitted into the impatient ward. Caroline the midwife carried the newborn with a huge smile on her face. The mother picked up three rolled up mats, a jerry-can of oil and marched her self 100 metres to the IPD, full of energy and stamina. This child was the ninth delivery from this rather young looking mother. Women in the Sudan never seem to stop working.

Once settled, the mother asked everyone on the 5-bed ward his or her name. She asked me last through translation of a Sudanese nurse named Halima. She decided to name her ninth child “Kevin”. I was very surprised. I did not know what to make of this honor but smelled a bit of trouble. Halima explained that it was a tradition for the person to buy a gift if the child was named after them – typically a sheep. A sheep is 100 pounds, which I could easily afford, and willing to purchase. I was concerned that naming children “Kevin” would be a phenomenon, creating a new industry at the cost of my foreign name and presence. So I took the opportunity to explain to the mother that it was Dr. Mike who actually delivered the baby… I just set up the equipment. After a discussion with her mother she decided that “Kevin” sounds better. So “Kevin” it was.

The following day, I asked the baby “Is-much-minook?” (What is your name?). The mother perhaps forgetting my name, asked me to name the child. I decided on a nice Sudanese name: “Seif” after my translator. Seif shaking his head at the declaration stated that should still be my responsibility to purchase the sheep. I have left a message with Caroline to ask: “is-much-minook” at the follow-up appointment to see if Seif and I are out of trouble.

Post Delivery Day 3: The baby’s name is still Seif, and I will purchase the sheep.

IN THE MORNING.

At 5 am the day begins with dogs barking, roosters crowing, pigeons, goats, sheep, and donkeys all stating their opinions on the situation in Darfur. The shower is always too cold in the morning, so I wait till after work giving the sun time to warm the show tank.

Then Jabbinna (coffee), and more jabbinna. The coffee here tastes great but does not have nearly enough caffeine as I’m used to. Apparently in some parts of Africa coffee is a tradition as tea is with Japan. Every culture should have coffee as a part if its cultural fabric… just for me.

Sometimes chickens wander into the eating area trying to get my bread. I give them some when no one is looking. David (the field coordinator) and Michael (the doctor) found a snake in the eating area last week.
The snake finding made it to the weekly security report. Although I was not in on this snake exile, I have walk with caution ever since. My tukul has a hole in it just perfect for the large head of a venomous snake to poke through. Will snakes chew through a bug net?

A WALK THROUGH TOWN.

After work I have a routine to take a walk through the community. My outsider ways creates quite the ruckus. Did any of you spend your childhood car travels trying to get truck drivers to honk their horn by pulling an imaginary horn with your arm? It can be so amusing what one’s manipulation can cause people to do. The kids in Seliea play a similar game: Any obvious outsider is called “howajy”. To make a howajy talk is apparently hilarious for kids here. Every where I walk there is a little voice poking through the fence: Hey howajy!!! howajy!!!. howajy!!!

Me: Salam elecome/hello

kids: ahhh hahahaha.ahahah. Howajy!

They likely make bets on who can get the closest or shake my hand. One of the kids convince me to eat a disgusting seed or nut. I bet she got some sort of howajy-manipulation award. If howajy is a derogatory term I am truly sorry for others who have been victimized by howajy tricks.

THE HORSE.

Friday is my only day off. David suggested that we go horse back riding. I agreed if I was still up for it at the end of the day. So Abdulla set off to get the horses at 4pm. As he was leaving I requested a donkey since I have never interacted with a horse. Abdulla said he would be ashamed to ride with me on a donkey… it is not an animal that represents me. So the horses arrived with their owners who were very proud to allow us to ride them. I watch David and Abdulla “mount” their horses and I did similar. My feet
would not fit in the peddles so I kicked off my shoes. As soon as I started to look for my rope-thing the horse started to walk away. My dog sled commands were not working with this horse, nor the few phrases from western movies I knew. Then David’s horse started running… then mine started to race his at full speed! All the town saw a howagy charging at full speed on a horse yelling the most profane language. Under a thorny
tree… “howagy, howagy howagy,” through the market…. “howagy!”, shit, howagy, f-….. then out to the “not so safe” edge of town. Luckily this randy animal found himself a female horse to flirt with and settled down a bit. I put my feet in the foot peddles and he started to wander toward David and Abdulla’s horses where I received some instructions and requested a donkey again.

I ended up enjoying my horse. Working in Seleia challenges my confidence, but horses require someone who is sure of them self. I can see where ride is therapeutic. I traveled through an IDP (internally displaced person) camp which went further then eye could see, then relaxed at the house of one of my co worker’s. We ate, danced, had tea, and then it was time to return the horses. The horses must have known that their fun with howagy was over because they started running out of control again. Through a herd of goats!, Leaping over stumps, to the hospital, passed my tukul and out to the edge of town… thank goodness for another female horse. The owner of the horse found me having a long conversation with the horse and walked me back.

With my adrenaline still pumping I will willing to pay him any amount for bringing me back safely. But he kindly told me through Abdulla’s translation that he did not want any money, but would appreciate if we drop by with some food for the horse. I was very moved, there are some very good people here in Darfur whom you may not have seen on the news.

I slept well that night, having wild dreams of wild horses. Then I woke up the following day with a very sore ass.

After about 3 weeks of traveling with delays at every possible stop I have arrived in my new home for the next 6 months… Seleia! It is a beautiful clean country town with not too much in, and not too much out.

Approaching the town by helicopter I saw herds of sheep, goats and cows being kept by their herds on horse or donkey. A helicopter passing is big news in Seleia… this time good news. It is rare to see a vehicle, most people travel by horse, donkey or simply by foot.

I live in compound with several Tukuls (mud huts). I love my Tukul, it has a grass roof that makes up most of the structure except for the mud brick wall. I have to crawl into it since the door is only as high as my waist. I have this tukul all to myself, no animal friends this time.

My co workers are very fun. A large gazebo is the dinning room, office, meeting room etc. The compound is powered by generator for short periods of the day… the rest of the time I am without electricity. There are no phones, no TV, no internet. I am only able to access email sent to an address I share with everyone. In fact I am writing this blog via satellite during my beloved generator hours!

Life is very simple here. I was only allowed to travel with 15 kg of luggage which included some field equipment. So my clothes last for 3 days before I need to wash them.

The hospital/clinic is right next to the compound. It is managed by the Sudanese ministry of health. It consists of 4 buildings: a ward, outpatient clinic, a nutritional office, and a latrine. It is very tiny at the edge of town. The ward is two small rooms with six beds in each. One room for women and children, and the other for men. It is the role of MSF to support this hospital since referrals are no longer possible and because of the number of internally displaced people (IDP) camps in the area. MSF also has an operating room right in the compound (we call it an operating theater here, and it is very theatrical). This “theater” is also in a brick building with the examining area in a tent. I do most procedures in the tent since they don’t require sterility.

So far no real surgery, just a few sutures, cast application, and a few other sick situations. Working with malnourished children is very new and complex to me. In this situation it is not always because of food shortage, but the lack of primary health care to treat pathology. Here breast feeding is the only way. But if the mother get pregnant while breast feeding… both children become at risk. I saw a women bring a herd of cattle back into town while carrying two children on a donkey, and breast feeding one. It is my impression that she may not have enough calories to breastfeed 2 children hurt goats and complete all the other responsibilities a women must do. Other children get worms in their gut who seem to eat more food then they do. Worms cause cause diarrhea and a calorie nutrient absorption issue. Even non GI issues such as pneumonia will burn up too many calories to sustain. It really is an issue that is not as simple as food shortage.

But right now someone needs the computer and the generator needs to go off. I’ll write again soon.