Six Months in Sudan (7 page)

I leave down the hospital road, and the hot wind blows across the open field. I turn right at the corner, duck at the cannon, left at the tire, and I’m back to the gate. I knock. The door opens, and I step past the guard. I walk through the compound and past the kitchen. Tim is sitting in the gazebo, smoking, the sat phone in his lap. He sees me and stands up.

“How’s the hospital?” he asks. “Bev said someone pulled a knife?”

“I didn’t see that. I was in the emergency room forever. I’m going to lie down. I ate something bad, I think.”

“Right. See you later.”

I duck inside the tukul. It’s like an oven. I poke my head outside the door.

“Dude, are there any fans?”

“Nope. Not enough power.”

“’Kay.”

I lie down on the mattress. My hips dig into the metal frame. I look up at the mosquito net, orange because of the copper dust. Beyond it is the peaked grass roof, and between its narrow strands, small lizards rustle around, trying to shake out an insect. I turn on my side and wrap the pillow around my head. It smells like sweat.

22/02: made it.

the luggage restriction proved not to be a problem. i had a fleeting fear that my undeclared kilos might send us hurtling towards the ground in a thin metal airplane shell, gasless, just because i wanted to haul ulysses around the world for the fifth time. it didn’t. the book now sits proudly on the windowsill of my tukul, fully confident that it will leave it as it came, its spine strong and unbroken.

a dirty, dusty, rumbling landing later, and i was there. here. for those who don’t know exactly where abyei, sudan, is, i will draw a map. the X marks it.

no    X    where

right in the middle.

i will spend some more time later talking about my hut, its 3-x-3-meter blank cement walls and its straw roof, how it captures heat so well, and … actually, i don’t think i will spend any more time on it. that’s pretty much it.

i will talk more about the hospital, more about the team here, and how they seem the best kind of people.

and more about abyei, the town. its braying goddamn middle of the night donkeys and barking middle of the night damn dogs, its people, and its dustdustdust.

I
AM SITTING IN THE GAZEBO
, waiting for the morning meeting to begin, the one where we discuss the day’s activities. Tim is leaning on its low cement wall sipping from a coffee cup, his face to the morning sun. I can hear the soft voices of the people who live on the other side of our compound’s thin grass fence, murmurs I can’t understand. Shadows are long and the air is still.

The medical team from compound 2, our national staff, are due to arrive soon. Like in most MSF missions, national staff make up the vast majority of employees. Nurses, cleaners, cooks, drivers, guards. Of the forty or so people who work for MSF in Abyei, only five of us are expats.

Sandrine has gone to the hospital already to say her goodbyes. Her flight to Khartoum, and from there to Geneva, is due in a few hours. The plane will land just over … there. Just behind the hospital. Right where I landed, four days ago.

She and I spent yesterday afternoon together. As we walked the hospital grounds, she introduced me to the patients that were now mine. They were difficult to keep straight, scattered as they were, some inside wards, others lying on the ground in the open air.

The hospital is a collection of disconnected rooms. As you enter, from the hot hospital road, you walk along a corridor that is filled with patients fanning themselves with registration cards, waiting to be seen. Off to the side, to the right of the corridor, is the nursing room, a small room with a drug cabinet, a single patient bed, and a crowded desk full of patient charts and open bottles of pills. Past this is the small, dark emergency room.

There are a half-dozen other patient suites. Most of the patients seem to pay no attention to our hospital structure. Their order of preference appears to be: veranda, hallway, courtyard, and, lastly, hospital ward. The rooms are hot, stagnant places. Little air gets through them and the light is poor. Contrast this with the veranda, which yesterday was packed with family members, breeze blowing through, people laughing like they were on the deck of a cruise ship.

I remember, as a medical student, working in the emergency room for the first time, trying to make sense of what it contained. It seemed so large, so complicated; it was not a world, it was a separate universe. With time, it shrank. This place will too. Right now, its rooms and hallways form a maze full of people I cannot talk to, nor properly help.

Yesterday, as we turned towards the back of the hospital, towards the two rooms reserved for patients with contagious tuberculosis, Sandrine pointed out a broken section of the skirting cement wall. An orange plastic barrier had been put into the gap. She explained that when MSF started working here, about nine months ago, government soldiers were living in the hospital. They had removed part of the fence that their military compound shared with the hospital and, with that, claimed Abyei’s most valuable resource as their own.

One of the first things MSF did was declare that our presence in the hospital was conditional on their armed absence. We put up the orange plastic barrier, and it has stood since. The hospital was returned to Abyei. I thought that of all the good MSF might do here over the years, that would be the single greatest act.

Sandrine pointed at a humming generator in the corner.

“This gives us power for some of the day. It’s mainly used to cool the drugs in the storage room and the vaccine fridge. If you need it at other hours, for the oxygen concentrator or whatever, ask the guard to turn it on.”

We passed a group of patients gathered around barrels set on a high wall.

“There is no running water. Each day the UN trucks it in for us and we pump it into these blue barrels here. The orange ones are for washing hands. Lots of chlorine.”

A room near the front held two small refrigerators and a shelf lined with reagents. A tall man in a lab coat was peering through a microscope.

“Okay, here’s the lab. Hi, Ismael.” Ismael lifted his head, raised his hand. “Ismael is great, but there is only so much he can do with the tools. He can test for malaria, meningitis, TB, hepatitis, HIV …
um … blood groups too. Oh, and urine and stool. I think that’s it. No electrolytes, no blood counts.”

“Cultures? Blood, stool, sputum?”

“No.”

We turned the corner and stopped at a patient’s bed. The boy on it looked like bones glued to bones. Sandrine told me he had measles last month and showed up on the hospital’s door several days after. She handed me his chart. His fever hadn’t broken for four days. He glanced up at me as she told me his story, then looked back at the wall.

“Where are his parents?” I asked.

“Haven’t seen them,” she said. “He came alone.”

She pointed to her right. “Almost forgot. In that room, the one that looks like a storage closet, is Mansood. He came in with a cellulitis, around his knee, about a month ago. He hasn’t been able to walk since. Mohamed will tell you more. He should know pretty much everyone too.”

Next were the patients with measles. There were two of them, on the veranda, near the female ward, their mothers fanning them with pieces of cardboard. We moved on.

“And this is the TFC. The malnourished kids are kind of mixed in with the general pediatric patients, but we try to keep them separate so we can organize feeds better. Paola is working on that.”

The children in the feeding center drooped in their mothers’ arms. One or two had their hands wrapped in gauze so they couldn’t pull at the tubes in their noses, or at their intravenous lines.

“It’s a struggle with the mothers. They wait until the last minute, when their kid is almost dead, to bring them to the hospital. Then, after a few days, when he’s no better, they want to leave.”

She asked if I had any questions. Yes, I said. What am I supposed to do? Where do I start?

She said it was up to me. There were no rules. She told me that once she left, I could talk to Marc. I told her he was gone. She seemed surprised. She promised to write me a full handover from London.

We walked down the hospital’s hot, hot road towards the compound. Wind gusted sand across the empty football field. I asked Sandrine
if she was happy to be going home. She said she wasn’t sure, that there were things she would miss. For the rest of the day, I watched her buzz around the compound excitedly, scarcely able to conceal her delight.

As sad as I am to see her go, as much as I don’t look forward to being alone with this hospital to take care of, trying to figure out how to start or when to stop, I can’t disguise my interest in her tukul. Today I woke up early to pack up my few things and move them from Tim’s to the front of hers. It is not an elegant gesture, claiming someone’s tukul before it cools, but I want it. I want a place.

I hear the buzz of voices. Here comes compound 2. It’s almost eight, time for the meeting. After it, I want to do some teaching. There’s Mohamed. I like him already. The night before, at Sandrine’s farewell dinner, he shyly showed me some pictures he was taking. One of a bird, a falcon, sitting statue-still on the top of a tukul. Another the fragile sliver of a new moon.

“Good morning,” I say, standing up, and juggle my coffee into my left hand.

“Good morning …” “Good morning …” They shake my hand, walk past me, and sit down to continue their conversation in Arabic.

Bev comes from her tukul, cigarette in her fingers. “Morning, every body. We’ll start soon. We’ll wait a minute for Jean. There was a problem with the electricity in the hospital last night. We’ll see if he turns up.” She walks to the kitchen to grab a piece of bread.

I sit on the makeshift couch, its back a futon mattress doubled on itself, Tim beside me. He has been an excellent tukulmate to this point. He said the same of me. Both were compliments to the other for not snoring. The only time we are in the tukul is when we try to sleep. It is too hot otherwise.

More people filter in, men dressed in long-sleeved shirts, the women in traditional gowns, scarves wrapped around their faces. I take a mouthful of coffee and taste cardamom.

Jean shows up, his hands covered with dirt. Sandrine is beside him. “Sorry, everybody. Fuse went in the hospital.” He sits down.

“Okay, everybody. We’re late, so let’s get this started.”

The first few chugs of our generator, then clackclackclackclackclack. Bev raises her voice above it.

“First, today is Sandrine’s last day. She flies out in an hour, so if you haven’t already said goodbye, now’s your chance.”

Bev continues, reciting the schedule for the week ahead. Mobile clinics, measles monitoring, car repair, changes in military activity. My presence is not given a mention. It seems, after three days, I am a fixture. The machine, and its exchangeable parts, keeps moving forward.

The meeting finishes. Bev asks for questions. There are none.

“Now, why does no one ever have any questions? Am I that good? I guess so. Mohamed, question? No? All right, then. Off you go.” She stands up.

There is no movement. Now, a little shuffling. Someone puts his hands on his knees, pushes himself up. Slowly, the rest of the group, about ten in total, does the same. Sandrine suggests a photo, and everyone starts to queue. I leave them and go to the kitchen.

I put my dirty coffee cup down in the sink. On the small propane burner, a large pot of water boils beside three metal water filters. There are a few pieces of fresh bread left on the counter, their outer edges black from the newspaper they were wrapped in. I take one. From the small fridge in the corner, I grab a warm bottle of water, then reach around to plug the fridge in. It begins to strain. I step back outside.

Everyone is still taking photographs. I will defer teaching until tomorrow.

I leave compound 1 on my own. I know the route. Right, tire, cannon, duck, left. The sun is already hot. Children pass me on donkeys; soldiers walk by with guns drooping over their shoulders and their caps pulled firmly down. A teenager on a bicycle talking to his friend sees me at the last second and swerves.

At the hospital the dusty MSF flag dangles from its short pole outside of the gates. Patients already line the hallway, waiting to be seen. I walk past them and into the nursing room, gather up all the paper patient charts, and start to go through them one at a time.

23/02: r&r.

friday was the traditional muslim day of rest and the day off for this msf project. however, there is little distinction between the work and any life outside of it. at 7 p.m., we are still talking about the day that passed, at 8 p.m., our plans for tomorrow. it is our last word before sleep, and our first on awakening.

of the patients that i saw on my first day, the ones thrown like match-sticks from the back of the truck, we transferred one to another hospital for an x-ray, and i have since been told his pelvis was fractured. i saw another, his arm casted, driving away from the hospital, his loose camouflaged sleeve flapping behind him like a flag.

the thing that has worried me the most so far is not the political situation, nor the risk of getting ill, nor the remoteness, nor the lack of hospital resources. it is that, on fridays, our kitchen staff has the day off, and we must cook for ourselves. cooking is easy in kensington market. you can barely find the jamaican allspice for all of the organic lemon-grass. here in the local souk, well, there are tomatoes. onions. goat. um … i’ll let you know.

M
OHAMED AND I ARE
making our rounds. Two families, both from Abyei, both with young boys infected with measles, occupy the same veranda. They are the two sickest children in the hospital. We must keep them separated from the rest of the patients and hope that the hot wind scatters their virus into the empty sand rather than into the feeding center.

I’ve seen measles a few times. The rash is particularly hard to recognize on black skin. You have to let the light hit the fine bumps tangentially to appreciate the random pattern the virus draws over the torso. If you close your eyes and run your fingers over the child’s back, you can feel it, a million soft points.