Six Months in Sudan (17 page)

“What are you doing?” Antonia asks.

“I like it.”

“Well, you and Tim can have ful tonight. James and I will eat pasta, yes, James?”

I nod and reach for the pudding. I offer Antonia a bowl and a spoon. She looks at me warily.

“Try it.”

She does. “Hmm. Not totally bad.”

“Yeah, just 80 percent.”

She laughs. “Yes, just 80 percent bad, 20 percent not bad.”

10/04: twenty-four.

i am trying to paint a picture of abyei, but all i have are hurried strokes.

yesterday, after dinner i was sitting in the open space of my compound, compound 3. it is adjacent to compound 1. the measles emergency tents used to be here, and eventually a warehouse will be built. right now it’s empty. except for my bed under the tree.

the night was ink. overhead a flock of white birds flew, fluttering like pieces of paper. they landed above me, and noisily settled in for the night. the shuffling wings mixed with the voices of my neighbors and the tinny music of their radios. the air smelled of dust and burning plastic.

i woke at dawn and the birds were gone. the sky was cloudless as i folded my mosquito net and shook the dust from my sheets. the smell of plastic was still in the air.

on my way to the hospital, 480 paces (tired), i passed children on donkeys and men on bicycles. i answered them, fine, how are you, i am fine. plastic bags blew by with gusts of wind and were carried into a nearby open field where they flapped, thousands strong.

i passed two sisters. the youngest, ten, was dressed in a white dress, frills on the shoulders. it was torn and its white was choked with dust. no princess ever looked more important.

i returned from the hospital for lunch and lay down. i was somehow sick again. in the middle of a feverish dream (organizing something, again, what, again), when i was called on the handset. a woman had
been run over by a car. i opened the door to the emergency room and saw the piece of white bone pushed from her leg glistening brightly.

later, a large truck pulled into our road and backed up to our gates. they carried from the box a stretcher with a woman and her new baby on it. twins, we were told. one delivered, the other not. we took her to the delivery room and removed the blanket. between her legs, a tiny blue arm. i touched it, and the skin came loose. how many days ago was the delivery? six. six days ago, a baby was born, and her brother, almost. he made it to his shoulder, and finding nothing to hold on to, went no farther.

i saw a child in our feeding center whose mother carried with her two pieces of wood. what for? well, my translator explained, when she was born, there were three. now she is the only one. so her mother cut two pieces of wood and said, these, these are your brothers. how long will she keep them? forever, he said.

it is later that same day. near dusk. i am sitting in the compound, in the gazebo, typing on the medical computer. just to my left, paola is giving jean a haircut. he leaves soon. antonia has just handed me a mirror to inspect my own sorry state. i need both a haircut and a shave.

the radio just crackled beside me. i am on call. once i am done with whatever night business the hospital has in mind, i will walk to the kitchen, eat what i can, leave for my compound, shake my sheets, tuck in my mosquito net, and fall asleep. 24.

I
T IS LATE, AND I AM
leaving through the hospital gate when I hear the handset crackle with a call to Antonia.

“Antonia … there’s a woman here who delivered a baby at home two days ago …. She has high fever and it feels like … like she has another baby inside. Can you come to the hospital?”

She will. I turn around, walk to the hallway that leads to our delivery room. In it, a young Dinka woman is lying flat on her back. Her eyes are closed, and she is breathing quickly. Her new baby is on another bed, crying. He appears healthy. She does not.

I put my hand on her abdomen and can feel the bulk of her uterus through her hot skin. It is so swollen it comes nearly to her chest. I reach for the pulse in her wrist. Can’t find it. I move the sheet to feel for the femoral pulse in her groin and see an umbilical cord hanging loosely between her legs. The placenta is still inside, infected. She has been losing blood since the delivery and is now both septic and profoundly anemic. She moans, half-conscious.

Antonia arrives with our national midwife, Atol. Together we carry the woman to a delivery-room bed. She is limp. I ask Atol to put an IV in place, and call on the handset for Ismael. The woman will need blood.

Antonia finishes her examination. We agree there is little choice but to remove the placenta manually and risk the hemorrhage. I go to the pharmacy to gather the necessary anesthetic drugs, antibiotics for the infection, and ergotamine to help the uterus clamp to itself and staunch the bleeding. Before I clang the door shut, I throw two vials of adrenalin in my pocket. I can recognize last breaths when I see them.

By the time I return, she is worse. Why does it always happen this way? You move them, and …

She is now comatose. Her breathing is becoming noisy. I show Atol how to hook her fingers behind the angle of the woman’s jaw, pull it forward, with it the tongue, the pharynx. She breathes better.

I cross the narrow hall to the operating theater and get a bag and
mask, replace Atol, and start to assist the woman’s breathing. Someone got an IV. I look at the bag of saline above it. It is dripping too slowly. I don’t trust it. We need another IV. Better two.

I see Ismael, Mohamed behind him.

“Ismael, do we have any blood?”

“No.”

“Are you O negative?”

“No.”

“Mohamed, you?”

“B. You?”

“O positive. Okay, someone take over for me … no, like this … fingers under here, squeeze the bag like this. Here, give me a cannula, an 18, and a syringe so I can take some blood. Ismael, go and find some of the relatives, see if they’ll donate.”

The veins are tough to find. They are flat, slippery, move one way or the other as I try to cannulate them. Mohamed is working on the other arm. Can’t get it. We need a central line. Don’t have one.

I feel for a femoral pulse. None. Her neck? I don’t know. Maybe. Barely. Her breathing is becoming intermittent, agonal. It stops.

“Keep bagging. Yup, like that. Faster. About ten times per minute. Don’t stop.” No pulse now.

I lace my fingers together, feel for the hard flatness of her sternum, and start compressions, try to squeeze her heart between her ribs and her spine, push whatever thin blood she has towards her brain. Come on.

“Someone take over for me. Like this. Push like this. One, two, three, four, five, six, seven, eight, nine, ten … Breath … One, two, three … Faster.”

I take one of the glass vials of adrenalin from my pocket and snap its top off. I draw it into the syringe and push it into the slow intravenous. It might cause the small arteries and capillaries to spasm and cramp, push whatever blood they have towards the middle, maybe form a beat.

“Good. Okay. Now stop for a second.”

I reach for her neck and feel for a pulse. None.

“Resume compressions.”

I take the second vial of adrenalin, snap the top off, pop, and draw it up. I pull back her sleeve.

Above the cannula, her arm is a balloon. The fluid is trickling slowly underneath her skin, not into her vein.

No intravenous, no fluid, no blood, no adrenalin, no breaths, no pulse. I check her pupils. No response. No more.

“No more. Stop.”

I look at my watch, out of habit, for the coroner.

Fifteen minutes. That’s what it took, from the first crackle of the radio to no more.

No death is easy. If it starts to become that way, I’ll change professions. But this one is more difficult than most.

The four of us stand for a moment, then Mohamed and I quietly bend to clean the ground of scattered intravenous lines and tossed pieces of gauze. Antonia takes the intravenous out, wipes the tiny bullets of blood that are scattered on the mother’s arm from all of our attempts. Atol puts the bag and mask into a blue bin to sterilize later. We do not meet eyes.

I leave the room and walk down the hallway. The baby is lying on the bed, where we left him, crying. I push through the curtain and a man with wide, wet eyes looks at mine, and knows.

“Malesh,” I said. I’m sorry.

Sorry I can’t speak Arabic or Dinka. Sorry about the intravenous and the baby and your wife and the fifteen minutes and the no more.

He tells me, through one of our nurses, that he wants transport to the graveyard. I tell him we don’t do that, we can’t. We couldn’t save his wife, and we can’t move her body. He asks, What am I to do, hire a car, where, the market, where?

I don’t know. Malesh. Sorry.

I return to the delivery room. Antonia and Mohamed are almost done. Together we carry his wife to the hallway and lay her on the bed.

I go to the back of the hospital, click the lock on the pharmacy shut, then move around sleeping families towards the front. I walk past
the hallway, and at the entrance, the man stands, lost, baby crying beside him. I walk past.

“Malesh.”

Ismael, Mohamed, and Atol are waiting in the idling Land Cruiser. Antonia is disinfecting the delivery room and will be a few minutes yet. I tell the driver to go to compound 2 and we will call if we need him.

I sit on the front step of the hospital and look across the flood plain to the broad hallway of light that is the market road. Shadows cross from one side to the other, disappear down it. Dogs bark. I rest my elbows on my knees and my chin in my hands. I feel flat.

Antonia sits down beside me.

“The driver is gone?”

“I sent him to compound 2. We can call him back if you want. I’m going to walk.”

“Walk? It is safe?”

I shrug.

“So far. Do you have a cigarette?”

“Sure.”

We sit on the step of the hospital, smoking. We finish our cigarettes, stand, dust ourselves off, and walk on the black road back to our compound. Antonia tells me that this is not what she signed up for. She came to help train midwives, not deliver babies. And the compound. The hospital. No hygiene. Not at all.

I listen. I agree. I’m not sure what I signed up for either. But I’m silently glad about one thing. I’m glad that we don’t take bodies to the graveyard, glad that I am walking back along the black road instead of struggling to roll a corpse into the back of a pickup truck. It’s not my problem any more. I can shut that door now.

We arrive back at compound 1. There is a meal prepared for Jean and Bev’s departure, and they are waiting for me so they can begin. Many of our national staff are there, clustered in one corner of the gazebo. Mohamed is not among them. I eat quickly and move to my bed under the tree. I shake my sheets, tuck them under the corners of my foam mattress, then my mosquito net. I climb in.

I saw clouds for the first time yesterday. They hung around the
horizon, lurking. Tonight they are still there. I can see flashes of lightning around the edges of the dark horizon. Flicker. Flicker. Finally, I fall asleep.

I wake up in the morning, too tired to run. When I return to the hospital in the morning, the body is gone. Later that day, the rains arrive in Abyei, one month early, and lash us, unprepared.

11/04: statistics.

to compare health between nations, one most often uses statistics. when i was working as an editor at a medical journal, i asked a potential author to explain what they really meant. numbers are meaningless. what lies beneath under-5 mortality rates? what shortens a country’s life expectancy? what does maternal mortality really mean? why do the mothers die, what is the human cost? he wrote the article, and answered some of my questions. more have been answered in the past few months.

“S
HIT,” JEAN SAYS
, stopping the Land Cruiser.

“What?”

“Tim, get out on your side. I’m too close to the fence. I think I hit the bulb hanging over the road.”

Tim’s door creaks open.

“Yup.”

“So much for being discreet,” Jean says.

Tim gets in and slams the door.

We are on a narrow donkey-cart path that carries off the main market road. I have never been here before, or at least can’t recognize it this late at night.

“Think we should stop and find out whose light it is?” I ask.

“Probably,” Jean says, shifting the truck into gear and driving slowly ahead.

We are on our way to buy beer. We had a dinner for Bev and Jean the other night, with our national staff, but on this, their last evening, we are throwing a party.

“Isn’t it right here?” Jean says.

“Think so,” answers Tim.

“Let’s just stop and walk.”

Jean stops the truck and turns it off. We don’t want to be seen too close, in our MSF car. Without the lights, it is black all around us. I can’t see a thing.

“I bet you guys this is where ‘black market’ came from,” I say, stumbling into Tim.

“Here,” he says, gives me a flashlight, then turns on his headlamp.

We work our way down a dirt corridor, lined on both sides with grass fences. The fences give way, and to our right is a courtyard. We bounce our beams off its two tukuls and long recubra. It is quiet.

“You sure, man?” I ask.

We enter the open space and stand, waiting for someone. No one. We step towards the tukuls.

In front of one, a young girl, kneeling on the ground, is tending to the coals of a small fire.

“Hello,” Jean says softly, startling her. In Arabic, he asks her where her father is. She stands and hurries away, disappearing into the dark.

He shrugs. The town is mostly Dinka, but many speak basic Arabic, a few English.

A man appears from the blackness. “Hello, my friends!” he says, then roundly shakes our hands. “Sit, sit!”

He pulls up three chairs, their plastic backs removed to serve some other purpose.

None of us is wearing our MSF shirts, but there can be no question who we are. In all of Abyei, besides the UN, there are a dozen expats at most. He sits down beside us and smiles.

“So, welcome,” he says, prepared to start a long conversation.