A South African Doctor in Darfur

Today, as I promised I would, I had a good day. I was disarmingly charming. I made some child come alive with the sweet cocktail of 50% dextrose for her hypoglycaemia and her parents thought I was a magician. Not a skilled doctor of course. So after we did what we needed to do for her, I decided to play a game we all know all too well. Called ‘telephone’, you whisper conspiratorially into an ear and sees what comes out the other end. Today I decided to explain to the nurse what the numbers on either side of an infusion bag of fluids meant. First, admittedly quite wicked on my part, by testing them endlessly to see who knew the answer. Then the playful part which meant they had to each pass on the info to the next shift and three shifts later, I would have the pleasure to check on my morning ward round what came out the other end, so to speak! Discover if the infusion numbers meant how much in the patient and how much left in the bag or if one of the exasperating Medical Assistants wore red women’s knickers.

Well well, no surprise there, the message was not passed on. Why am I not surprised? Silly optimism. Optimism is the fool. Naïve at best and harebrained at worst.

Today, Friday – the one precious day described candidly as weekend, I found in it a few extra hours of sleep under the progressively lighted night sky and stingily cold night, awaking to a considerate phone call from Khartoum and a good earnest discussion about some of the project concerns, then making the trip to the ‘mushtashfa’ to see ”hows evvverrything”. I’m greeted by the herds of visitors to patients and the sweet nurse who accompanied the gunshot victim yesterday to Zalingei. The nurse took my hand, led me the only 5cm of shade to be found, preparing to spare me the knock he was about to deliver. He died. The gunshot victim who exsanginuated out of his bleeding kidney died. He died. He died. He died. How can anyone feel inspired or thrilled when we surround ourselves by impracticalities. Death is an impracticality really. Which any dimwit would agree with, well except a deranged serial killer. I guess this posting is really trying to convey and grapple with the fatigue that creeps and resultant disillusionment that comes with expenditure of vast amounts of energy, but also how I’m trying to climb beyond it. I’m so tired of feeling tired that I want to end it now. I’m prone to the turbulent ruminations about everything, I know that. I know that also I’m a really cool chick. I know how to have fun, I know how to sneak into people’s spaces they stash for special ones, I know well how to cheat at card games and I can be intuitive and silly simultaneously. Today I decided to be faithful to all I am.So I cheated at cards and stroked my geriatric patients cheek when no one was looking.

When I returned to the expat house, I finally completed what I have been putting off for ages. Finishing the novel I’ve been reading for just too long a time. It’s written in the voice of a 55 year old man, who is ridiculously witty, intelligent, equally bewildered by life and insights are downright honest and admittedly doubtful. So in these strange circumstances of isolation, I’ve been enjoying the relationship that’s now so amplified, I felt at a wits end to let go of. I also transferred all things lost, by the way of many lives lost here in Darfur (the stories of 2004 from the staff are frightful) to the loss of my night time author companion. The loss strikes so hard when I close the book and think of the young man who died today that I weep. Both chapters closed. But after this outpouring, I open another book and look forward to another new-fangled spell. To conclude this long recitation: I feel like tomorrow I’ll be better. What I will do is make the medical meeting into an exercise of dissecting what we did right for this guy and what we can improve the next time someone comes in. Motivation comes when we feel inspired and if I don’t feel the kick and buzz, I can’t let that trickle down to the staff, they are in need of it as much as I am and they need it desperately.

For 14 minutes, uninterrupted, I stare at the sweet offering of a box. It has my name and the ultimate destination: Serif Umra. It’s from the far off land called Canada. Its contents offer less than its surprising unforeseen materialisation. A care package from an MSF ‘familial’ colleague. Pure joy seeps from the corners of my lips that slowly give away what I am actually not all hard to disguise: unimaginable happiness.In the lonely confines of the field, it’s terribly unfortunate that what can constitute to happiness is the manifestation that someone you left behind cares. Of course it’s also the chocolates and silly other small things compacted to make best. That’s what we try to rekindle, but never reach match is it? With e-mail, I mean. It’s not the same as handwritten postcard or the carefully crafted care package. The package holds for me the fascination for my own intensity with which I experience each moment, well for these 14 minutes of moments of pure stuffed exhilarating anticipation.

I experience the arrival of the offering with as much zeal as the disappointment that the staff have weak internal alarm bells for sick children as for the man with an accidental gunshot through his right kidney as for the piece of most perfectly barbequed camel meat. The feisty sometimes riotous brooding I have for this life’s imperfections makes all moments longer than they should be. It also makes the ever growing ulcer fed by copious amounts of chilli and cigarettes but on a respite from alcohol for 6 months, an impending threat to my greater wellbeing. The mind however is harder to erode than the fragile lining of the ceaseless call of the stomach. The mind’s nutrients come from resources you have hard to concoct as well as from the simple most easily available of nature’s offerings. So life in the field is not always the story about the kid we waited to feed until it was starving, or the providing the basics we consider essential to human dignity for those who have had to flee their lives in fear. It’s also about keeping sane and healthy ourselves to persevere. It’s about being inspired and thrilled and when these become scarce, to dig deep to find it.

Rashida, our Medical Assistant, an incredibly beautiful woman with some grace, arrived in 2005, with her husband (a soldier) who was posted in SU. He now lives in EL Fasher where he is studying to be a Medical assistant himself. She is markedly different from the locals by the sheer manner by which she is able to contend with her scarf. She is never having to tackle the challenge of wearing a 3 meter piece of material in a strange contorted swirl that means you have to keep your arm close to your chest wall to keep it from falling off. So striking Rashida remained here in Serif Umra with their five kids. The smallest one called Waly (Walydeen actually) who accompanies her to the dispensary daily as she has no one to look after him. The rest of the kids are in school but they are alone here, no family and it seems no friends. No one she can entrust with gorgeous apple cheeked Waly. Of course I can see why she would not let him out of her sight. He is just simply cute. He is also now a permanent fixture in the dispensary and ward rounds. He opens the gate when the pick up approaches and always shakes your hand with his snot soaked hand of his. His snotty nose impels me to make a passing mention that I’m doubtful the dispensary, itself soaked with as much disease you can find pretty much anywhere else, is the perfect playschool for him. Although for me it does. She agrees on both accounts and feels hard pressed to reiterate her loneliness and lack of a chaperone for him. So we think that a good alternative is that he waits with the guard or someone while we do the ward round.

Took about 6 minutes into the round when we heard his wails and I, not Rashida, gave in and ended doing the round with him wrapped around my non-existent hips. He snotty soaked lips kissed me at the end and gave me the two eye wink he’s been perfecting and I knew I was walking down the treacherous road of having my heart lacerated and unalterably tattooed.

The staff and I laugh together about my unrelenting search for yogurt. I’m always soliciting it. The local version in Serif Umra is extremely acidic and so I look to our neighbour in Birka Sera for their softer version and if I’m lucky I get the factory version from far away. However, trying to make a bid for it is not so easy. On one occasion I implored our driver to try and get some in Zalingei when he was done with the referral, he came back with box cream cheese. I asked the other driver to please take some of our local baklava to the other MSF project as a small gift, but instead he brought me the baklava from Zalingei. So apart from most gone astray in translation it begs for my Arabic to be finer tuned. Yogurt seems universal though. So does New Year’s Eve for that matter.

I always regarded New Year’s Eve with an inkling of suspicion. Christmas’s weak twin sister. So this year I thought that maybe the four expats could muster up a small party. In vain. I was called at 10pm and saw in the New Year in the dispensary debriding a gunshot wound on the sole of the foot of my midwife’s treasured son who made his way to town for a celebration. I also spent the night with the survivor of a gang rape… She too looking to welcome a New Year. She had to swallow her pride as well as the noxious cocktail of prevention – meant to deter an unwanted pregnancy, sexually transmitted disease and HIV. She came and that means something in a place we struggle to get women to present to us early, if at all. We need to understand it more closely, but usually women cannot come on their own; they have to report it and the family has to bring them and here they go to police first. Impediments galore. But when my staff cry at her story, unbearable circumstance – I wonder, are their hearts just a muscle that’s been well exercised for compassion? How close are they to it really? Whether they too know this moment long past… they are not young and nothing changes the past. Does the consoling hand sliding across the melancholy girl’s head mean anything? The hair on my neck stand to attention. How amazing is empathy. Is empathy enough? Is it worth anything? No dry eyes in this house this eve that beckons a New Year. The past behind, the future of little concern. I’m all for sadness. Now I’m beginning to be all for an off-license.