Six Months in Sudan (11 page)

The nurse translated and the mother agreed.

I put the flat blade of the laryngoscope past his tiny white teeth and pushed his tongue to the side. I lifted the blade until I could see his vocal cords. They flickered with each breath. I pushed the tube past them, into his trachea, then attached the bag to it.

His oxygen saturation improved to 100%. His chest rose and fell with each small squeeze of the bag. I hoped the MOH delegates would walk by, but they never did.

Muriel arrived from compound 2. She’s young, was trained in Khartoum, and worked with MSF for years in Darfur. She is interested and competent, the best we have.

“Okay. Like this. Just a gentle push. Watch his chest. In … and out … in … and out. This is the suction machine. You work it with your foot, like this. You’ll need to suction him every hour or so.”

I addressed the other nurses. “This is a hard job. You will have to help her. You too, Mom. She can’t stop. If she does, the baby won’t be able to breathe and he will die. Okay?”

We left them, Muriel pushing on the bag, twelve times per minute, 720 times per hour.

I wonder, in cases like this, if the battle is worth fighting. The war is a long one, and the odds are stacked so heavily that perhaps energy
is best conserved. Maybe it’s best to use likely defeats to increase our resolve to work towards a day when they will be easier to win. But then there is the other tack. Battle, every time, with everything you have. Do the best you can for the person in front of you. Persuade the family of every malnourished kid to get into the truck, to come to the hospital, to be fed until they’re better. Track down each TB patient who left, frustrated, halfway through his long treatment and try to get him to come back even though the countryside is littered with tuberculosis patients we will never see and one case will not tip the balance sheet noticeably towards a TB-free future. To the world it doesn’t matter that much. Until you remember that it means the world to the patient. One exact world, bright and full of sounds, per person. That’s what is lost.

I attended to the woman I left in the emergency room. She was miscarrying, but not hemorrhaging too much. If she continued to bleed, we would do a D&C on her tomorrow.

I checked on Aweil. She was sleeping on the floor beside another child. One of the mothers was watching them both.

In the nursing room, the boy’s saturation was still 100%. I went to the gate.

“Driver?” the guard asked.

“No, I’ll walk,” I said, and mimed legs with my fingers.

The night was thick, moonless. I made my way slowly back to the compound, trying not to trip into someone coming the other way. It was late by the time I arrived, and everyone was in their tukuls. There was some food left on the stove, and I ate a few spoonfuls standing over the sink. I crawled into my sweaty bed and called the hospital. The child was still alive, saturation 100%. I told the hospital to call me if anything changed, and left the handset crackling beside my head.

This morning, when I got to the hospital, Muriel was still pushing the bag. She had not taken a break all night. The mother was lying down on the bed, her hand resting on her child’s chest, feeling its rise and fall.

I relieved Muriel, and she stumbled from the nursing room towards the waiting Land Cruiser. I explained to the mother that we
needed to take the tube out, to see if her child would breathe on his own. I suctioned his small mouth, removed the tape from around it and from the tube. I stopped bagging.

He was breathing. A little. More than a flicker, more than last night. I pulled the tube.

On my way home for lunch today, I got a call from the hospital. His breathing was getting worse.

“Put him on oxygen,” I said. We couldn’t intubate him again. We didn’t have the resources or the trained staff. Fifteen minutes later, they called again. He was dead. I sat down to lunch.

And now I am looking at this dull goddamn knife. Useless. Better for cutting boxes than tomatoes, that’s for sure.

I am not going to intubate anyone else.

08/03: bounce.

so far, at this point in the day, twelve noon, i am having my first day off. well, i went to the hospital, but only to check on a baby i admitted yesterday who was so dehydrated that you could see his fontanelle from 20 meters. he was sleeping soundly, his mother beside him. she has two oblique scars on either cheek. like this:

last night the “abyei jazz band” (and i use the already loose term “jazz” so loosely that one of the z’s just fell off) played all night at volumes that greatly exceeded my 32 dB-rated earplugs. one of the rewards i had hoped to find this far from somewhere was a night full of quiet stars. no.

it is day two of the measles vaccination campaign. we are hoping for some bounce from the undetermined electorate, particularly the hard to reach 5-year-olds.

passed some of the queues on my way to the hospital yesterday, families standing outside in the hot sun, voting measle. we had some late-night drama the night before with our newly trained local vaccinating team. they demanded more money. our field coordinator had played this game before. “those who want to leave can. we’ll pause the campaign, tell the community you don’t want to do it, and train others. no problem.” yesterday morning, they were all sweating with the patients, jabbing thin arms.

there are so many children, it is sure we are missing a few. yesterday i admitted only three for feeding. today might tell a different story. on the brighter side, we have the necessary y-shaped sticks.

i told the team, as far as i was concerned it was already a success. hundreds of kids will never, ever get measles. some of my enthusiasm is altruistic, but most of it is selfish. we need another 100 measles cases in the hospital like we need someone to crank up the heat. so whether it happens in an orderly way, people in rod-straight lines with smiles and sleeves rolled up, or if we have to run around in the middle of the market vaccinating everyone using some type of rapid-fire blow-dart scenario, it will be a success.

this morning, at 6:30, i woke up for a run. it is my only oblique entry in an otherwise linear day. my path is from the compound to the hospital. 460 paces to it in the morning, 480 on the return (so hot).

B
RIAN HAS GONE BACK TO
Khartoum. The measles team remains. Roberto, the Spanish coordinator of the measles effort, sits in the small recubra we built for him, typing out a growing catalog of measles patients. He eats only bread and jam, drinks mostly grape soda. A hummingbird.

I am just back from the hospital. For the moment, it is quiet. As my last order of business, I assessed a woman in labor. With my fingers I examined her cervix. She was 5 cm dilated. I struggled to feel the baby.

Oh. There it is. Tiny fingers. No, too short. Tiny toes. Yep. There’s the heel. Footling breech. Wait … that’s the head. Oh yeah, for sure. I can feel the sutures. Definitely not a bum.

So, one of two possibilities: some type of crazy somersaulting acrobatic compound presentation with the foot coming out just over the head, or there are two fetuses. I guess there is a third possibility. I can’t tell my heads from my asses. The unfortunate part is that neither delivery would be straightforward, and it is late, and we cannot drive to a hospital that could do a caesarean section at this time of night.

Brian told me that he did his first when he was in South Sudan, sweating over a book, his heart in his throat. I went through our surgical tools before I left today, and we have the right ones. As I locked the door, I imagined myself standing there, Mohamed beside me, sweating over a book, the woman flat on her back, her abdomen draped with the cleanest cloths we have, twins waiting to get out into the world, Mohamed showing me the book, then again, finally taking the scalpel and drawing it smoothly through the skin of her abdomen, blood quickly blooming into the yellow crevice, “suction … suction …” My heart’s in my throat.

For now I am sitting in the gazebo, watching the sun fall into deep red sunset. Whenever I see the sun come up in Africa, or go down, I think the same thing: it is easy to believe that life began here. There is just so much of it. The spectrum of light that runs from red to violet, from long to short, is proof. As the day’s starting and finishing rays pass
through the atmosphere tangentially, cutting across the dusty plains and the deep jungle instead of directly down, the smaller bluer rays are picked out by water vapor, or a piece of sand, or a tiny buzzing beetle. The reds and the oranges bend around, careening through. Each morning and each night, a collision of these, and a phoenix. When I run in the morning, thanks to the sand and the blinded buzzing beetles, I can look directly at the sun until it is well above the thick horizon. It is the most perfect circle.

There are so many living things on this continent. Not just humans, of course. Insects, lizards, birds, bats, baboons, spiders (one in Paola’s tukul the size of a fist), big cats, loping giraffes, and with them a legion of viruses, parasites, bacteria.

I look at my arm. Bites march over it, and over these a series of small pimples from the bacteria that cover my bed, my sheets, my tukul, me. Perhaps, like the rest of us, the new twins will get their start here. But maybe they are too new. In some ways it is easier to be a spider in this place than a new human trying to make it out with your brother’s foot in your face.

Bev rounds the corner.

“Hey, Bev.” I start cleaning up my plate.

The last time I saw her was this afternoon. She sped up in the Land Cruiser, pulled me aside, and pointed at two young children in the back seat.

“Two more measles cases, from Akur,” she said excitedly, and sped off.

They weren’t. Just regular rashes. I sent them both home.

“Hi.”

She sits down, reaches for the ashtray in the middle of the table, pulls out a package of cigarettes. She takes one, then slides the open package towards me.

“Thanks.”

We smoke.

“How are you doing?” I ask, finally.

“All right.” She looks worn.

“You’re not sleeping much.”

“The measles team. It’s busy. First emergency mission for all of ’em. Fuckups all around.”

“How’s the coverage so far?”

“Can’t really tell. We don’t really know how many people there are around here. All we have is GOAL’s data, and I don’t know if it’s any good.”

The handset crackles on the table between us. We both look at it. It remains quiet.

“Hey, I wanted to ask you something,” I say.

“Shoot.”

“Um … have you ever heard of … This is going to sound kind of weird, but … uh … Ever heard of someone adopting a kid while on mission?”

“Like, is it possible? Or is it against the rules or something?”

“It’s not a good idea, James.”

“There’s a girl in the hospital, in the TFC. The orphan. Aweil. Did I tell you about her?”

“Yeah. Her mom died from malaria or something a couple months ago, right? Here in the hospital. Dad’s a soldier. It’s a bad idea.”

“Think so?”

“Definitely bad. It wouldn’t be a popular move. You would make a lot of people angry.”

“’Kay.”

“I get it, James. ‘If I can’t save them all, why not one?’ Right? Everyone goes through it. Wait it out.”

“’Kay.”

Pause.

“What about money? Are we allowed to give money to particular people? Like is it okay to give her some of my per diem? Or just some money so she can go to school, or whatever? Not even now. Later.”

“People do it. But it’s not a good idea.”

I am half finished my cigarette. It tastes black. I put it out.

“Okay.” I stand up, stack my plates together, and turn towards the kitchen.

“There’s some beer in there. It’s probably not very cold, but grab one if you want.”

“Sweet.”

I leave my dishes by the side of the sink, look into the fridge. Pushed to the sides are people’s personal food reserves, each wrapped in a separate plastic bag, or labeled with tape. It seems odd not to share, but to one side, my bag. In it, a can of pineapple I bought for 60 cents.

To the side of that, 500 milliliters of beer. From Kenya. Warm as hell. Once the fridge is unplugged and opened, it quickly assumes the ambient temperature. Today it is about 104 Fahrenheit. I plug the fridge back in, and it sparks, then hums alive. I stick two glasses in the freezer.

A few days ago, I showed up and the man with the books was gone. I’ve since watched Aweil shuffle from one mother’s lap to another’s in the feeding center. She never smiles. Everything else about her seems normal for an infant. She will pick at things with her forefinger, track my movements. But she won’t smile, as if in the ten months she has been around, she has only seen things worth mourning.

She remains sick. And listless. Yesterday, after everyone left the hospital, I went to her bed and sat down. She was lying alone, half turned over, blinking slowly. I touched her bare back. She had a fever. I turned her, pulled her up to my knee. She drooped.

“What’s wrong with you, huh? Why all the fevers?”

I looked at her chart, as I had done that morning, and studied it. Her weight was falling again. I’d treated her for everything. Malaria, all the bacteria I could think of, intravenous, oral, all. I posited to Mohamed today that it might be HIV.