by Damien Brown
• • •
For an hour we drive south-west, trampolining down a corridor of dense grasses that tower beside the dirt road, our roof a wide-open sky of glorious African sunshine. The swollen Zambezi River is not far to our south, although to me it looks more like a dam, a huge lake of brown that’s swallowed farmland and now laps at low-lying villages. Mavinga’s own river drains into this same waterway too, far to the west, and I wonder now if there’s not a little soap bubble from that distant riverbank floating near us. (I wonder as well how people are faring there; there’s no way to contact anyone.)
We slow down, inch across a bridge of rough beams lashed together over a rickety timber frame, then speed up, heading past vast cotton plantations and the patches of maize that herald an approaching village. For hours this pattern repeats itself. The heavy rains have rendered this higher landscape so lush, so green, that it fluoresces as the sun hits it, and not a centimetre of ground hasn’t been overcome by a riot of vegetation save for the laboriously cleared yards of red earth surrounding the occasional hamlets we pass.
Three hours and we’re still driving—you’d think we were in the middle of nowhere—but suddenly a group of children appear in the road. They turn and freeze, mesmerised by the unusual sound of a car, then melt into the long grass as we pass: a filmstrip of blurred foliage interspersed with broad smiles is what I see from my side window. Another village nears; women in the cornfields, men clearing bush with their machetes; and we become stuck behind the local equivalent of a school bus—a one-speed bicycle being pedalled by a young boy who’s far too small for it, and who’s almost hurdling the main bar as he steps from side to side, stomping all his weight to each pedal as he propels himself and four mates (who’re clinging to various other sections of the bike) to a classroom somewhere out here. Which is nothing on what lumbers towards us next. A man has secured a live goat to the front of his bike and is seated casually behind it, the animal’s front hoofs tied to the handlebars, the back hoofs nearer the pedals so that it’s almost upright—almost cycling! And as we pass them, both rider and cloven-hoofed passenger turn their heads to regard us, as if we’re the more unusual sight on the road.
• • •
It’s late morning when we arrive in the village of Jonasse. Sheets of blue plastic cling to hastily built straw huts like Band-Aids, but it otherwise lacks the look of a disaster zone—certainly nothing like that camp in Kenya. Kids play happily and livestock roam the area, and a few dozen small fish have been laid out to dry near the side of the track, caught most likely using the mosquito nets we’ve distributed. (Pairs of children can be seen up and down the re-defined edges of the Zambezi, ignoring the risk of crocodiles as they stand waist-deep trying to scoop up the day’s catch in the netting.)
We park in the shaded central clearing and begin unpacking, and a crowd quickly gathers. None of them know why we’re here today—we haven’t told them yet—but they press around excitedly anyway. Perhaps they’ll receive another water container, I imagine them thinking, or dressings for an old sore.
But today we’re not giving out much. Our aim is to see as many children between six months and five years of age as we can, measuring their mid-upper arm circumference to screen their nutrition status. If their reading is above a threshold value we’ll send them home with a worming tablet; a dab of purple ink on their finger marks them as having been seen. If they’re below a certain level, we’ll measure their weight and height, then examine them more thoroughly. Moderately malnourished children will be given a box of high energy food and followed up by the government health post. Severely malnourished children will need to come back to Morrumbala for admission to hospital.
It sounds easy. At least I thought so when it was described to me in an office, and it looked as much on paper. But it’s not. The population we’re working with are subsistence farmers with almost no numeracy and literacy skills. To get a local worker to read a scale and write down the number is far from straightforward, although their enthusiasm to learn is boundless. And a significant number of mothers don’t have a clear idea of when their child was born—
‘Before the rain season.’
‘Which rain season?’
(A shrug.)
—so using age as a criterion is sketchy. Then, after measuring each child, getting our staff to interpret the charts is equally tricky. Either a few healthy kids are unnecessarily admitted, or some of the malnourished children are accidentally sent home. So everything has to be supervised, repeated, and questioned. And then re-explained (with patience, I hope) over and over again.
And it all goes on at once. Within an hour there’s a line of hundreds waiting, the temperature forty degrees and humidity through the roof, and we’re caked in dust. Adults get in line wanting pills for their headaches while our two nurses debate which protocol to use, and curious children sneak through the barriers everywhere. Some want to be weighed, others want more of the purple dye and a few lunge for another de-worming ‘lolly’, but most just want to sit quietly and watch us.
Occasionally a child will scream bloody murder when their turn comes to have their arm measured, and in true crowd mentality the whole line will then start—a kind of sympathetic show of solidarity on behalf of the group. So for fifteen minutes we’ll examine distressed children, trying in vain to convince them that the tape won’t do anything to their arm, but then they’ll inexplicably settle and we’ll go through a happy phase once more—until one starts screaming again. And that’s much of how the afternoon passes. Guessing ages, measuring arms, intercepting stolen lollies, watching parents wrestle reluctant fingers into the purple dye, and trying to stop yet other kids from swigging the mixture.
By mid-afternoon we’ve assessed almost three hundred children, and it’s a reassuring picture overall. Only nine are malnourished, although two are severe and will need to return with us.
We start to pack up, and dozens crowd around.
‘Please, Doctor, I need treatment for this,’ one woman tells me, showing me a deep ulcer on her leg.
‘You’ll need to go to the hospital,’ I tell her. ‘In Morrumbala, but we have no more room in our cars. I’m—’
‘My husband is really sick at home,’ another woman interrupts. ‘You must come. He is too weak to come here. Please, he’s—’
‘Look at this,’ says a third woman, ushering her daughter forward. The girl has a large fragment of her broken radius bone protruding from a wound on her forearm—unbelievable, and surely infected—but runs off when I mention hospital. João follows but can’t find her, and now the village health workers crowd around, wearing the T-shirts and caps distributed by another agency in the past.
‘We haven’t been paid for months,’ they say. ‘And we have run out of treatment. Please give us what you can spare.’
I rummage through our boxes and dole out what I can, but more people come and ask for things. I make excuses. ‘I’m sorry, we don’t have time. No, I’m sorry, I can’t treat that. And you, sir, you’ll definitely need to go to Maputo to get that tumour removed’—although I may as well tell him that there’s a clinic on Mars that’ll remove it. Maputo is about as accessible from here.
People ask when we’re coming back.
‘Well, we’re—’
‘Because there are other patients, Doctor. There are many people you haven’t seen.’
‘I know, but it’s just that—’
‘Will it be next week?’
‘Uh, the thing is—’
‘When?’
Never. This is our last day. Flood waters are receding and there’s no sign of an outbreak. The few cholera cases that have occurred elsewhere have remained limited and there’s none in this region, so MSF have donated supplies and a nurse to assist the government response there. Here, we’ve assessed thousands of people these past weeks and watched closely, and disease and death rates aren’t any higher than normal—normal for an impoverished African country, that is. They’re still atroc
ious by any other standards, just no more than would otherwise be expected. A health emergency, by convention, is defined as a doubling of background mortality rates, and there’s no evidence of that here. Our intervention can no longer be justified.
So we’re off. Development agencies are moving back in to help re-establish agricultural schemes and other programs, but we’ll pack up tomorrow. A project closure here means a readiness to respond to the next crisis; such is the reality of the industry. We should be thrilled that there’s no outbreak here, and I am, but I’m also having trouble with being a part of this again, this retrenching of staff, this having to apologise to people and wish them all the best of luck . . .
‘I’ve just ordered goat meat,’ says Katrina, one of our nurses.
‘You’ve what?’
‘Goat. For dinner.’
‘Doctor, can you look at my son’s foot?’ asks a woman.
‘I ordered it from a family,’ says Katrina. ‘They’re going to cook it for me. That drive back is too long.’
‘Katrina, you know we can’t drive after dark. We’ve got to get going!’
‘Sorry, Doctor, my arm has been swollen like this for many days. Can you just—’
‘I’ve already paid for the meat!’ says Katrina.
‘I don’t care—we need to go.’
‘Excuse me, Doctor. I am one of the other health workers in town, and we—’
‘Damien, you need to tell Katrina to get in the car. We’re going to get stuck if this rain sets in,’ says Simon.
‘Sorry, Doctor,’ says another woman. ‘I have this thing growing—’
‘Excuse me,’ begins another man.
‘Katrina—you need to get in the car! We’re going to get caught out here.’
‘No.’
‘Look at this rooster!’ says João.
‘Mzungu, can I have your pen?’ asks a young boy.
‘Look what that lady gave us!’ says João again. ‘This rooster will ride in the car back to Morrumbala with us, yes? Look how big he is!’
‘Hey Mzungu! Take our photo!’
‘Doctor—’
‘Leave that goat meat!’
‘Please, Doctor, any more of those tablets?’
But there are now storm clouds in the distance, and if this river swells anymore we’ll be stuck. We load up and flee.
‘Don’t forget us when you leave next week, Damien,’ says João, who’s sitting in the back with Katrina. Two patients and their mothers are also squeezed in, along with that rooster. ‘When you get to Maputo,’ he says, ‘don’t forget us. Tell MSF we need jobs. Tell them we are good!’
Koffi, his quieter Mozambican colleague sitting between the driver and me, laughs. ‘No, tell them we are the best!’
‘I will, guys. Now tell me, what are you going to do with this poor bird in the boot?’
‘The chicken?’
‘Sim.’
‘Eat it!’
‘But it looks so happy.’
‘Ha! And big. Of course we will eat this—you should come when we do!’
‘But please, Doctor,’ says Koffi. ‘When you go back, ask them for jobs for us.’
‘I will.’
‘Please do. Please ask MSF.’
I ask them if it’s hard to find work around here.
‘I worked for two months last year,’ says Koffi. ‘As a translator for World Vision. But then? Nothing. And now I have worked for one month this year, with MSF. But it is only March. Maybe something will still happen. It is only the aid agencies that pay well around here. Otherwise, I will have to work in the market, but this is very hard to make money for my family. Who knows, Doctor—maybe another flood will come?’
There’s no malice in Koffi’s wish for another flood. As in Mavinga, aid is not only a provider of essentials to people in need, but a prolific employer of local people. One man’s disaster is another’s opportunity to work.
By the time we pull into town most of the team are asleep in the back. The storm has missed us and a rainbow’s arcing to the east, the cloud tips glowing in the last of the day’s light. We park on the main street and stumble stiffly into one of the three diners in town, an Indian-run affair where egg rolls, Coke and grilled chicken constitute the menu. We order, then settle on the concrete veranda. Ahead, kids in threadbare clothes play with mangy dogs, and a bicycle speeds downhill with no brakes, its two anxious passengers laughing as they drag their sandals. Beside the market, young boys sell clear plastic bags of cooking oil that glint like some golden magical potion as the low sun illuminates them, and when I buy a bunch of bananas from a mother for five meticais—about twenty cents—she insists on finding me change. Meanwhile, an endless parade of people ask Simon for work, offering to unpack the cars, to carry something, clean anything.
‘No? Okay,’ they reply. ‘Thank you anyway, sir.’
And like in Mavinga, I’m moved by the dignity of it all. No moping, just people playing their shitty hand, getting on with the full-time career that is survival. The Mozambicans here have the most wonderful expression I’ve ever heard, arguably the best example of a glass-half-full outlook on life: ‘Não ha Guerra.’ It translates literally as ‘we don’t have a war’ and it’s used as the colloquial equivalent of ‘no worries’. Because what problem could anything else be in comparison? There is no longer a war!
Our food arrives. We need to eat quickly. The representative for the Ministry of Health wants to see us again (he just called Koffi’s mobile), and we need to check on our driver with malaria and then pack. I need to contact Geneva about another position, too; it’s been almost three months since I left home now, and I’ve not done much of anything productive. What I want desperately is to be busy in a hospital. Somewhere where I can settle in and stay for a while, get to know the staff and patients, and practise good medicine. I want another Mavinga.
What I get is Sudan.
* The concept of témoignage is controversial in its interpretation. To be overly critical of groups contradicts the principle of neutrality, and can exclude the organisation from being granted access to the very populations it’s trying to help. The Ethiopian government, for example, expelled MSF in 1985 after they criticised the government abuse of aid. Several founding members left MSF following disagreements related to, among other things, the application of this principle.
15. SHOOTING DOWN THE RUNWAY
Another early morning on a runway.
Another small plane.
And another pilot, perched atop a stepladder, fuelling the aircraft himself using a rubber hose, as if this were all perfectly normal. Which I’m beginning to suspect it is. Except that this time there’s a striking change in scene: against the backdrop of the World Food Program’s giant canvas storage tents, the carcasses of a half-dozen crashed or abandoned planes lie rusting alongside the tarred runway here in the town of Lokichoggio, northern Kenya—the staging point for two decades of aid missions into South Sudan.
‘MAURICE LIKES SUDAN A LOT,’ shouts my French colleague, as our little Cessna roars down the runway minutes later.
‘YEAH?’ I reply.
‘OUI. HE LOVES IT. MAURICE SAYS SOUTH SUDAN IS WILD,’ he shouts. ‘HE SAYS IT IS ONE OF THE MOST REMOTE, TRULY TRIBAL REGIONS ON THIS EARTH.’
‘YEAH?’ I ask, straining to get a little closer towards him. Only two other people are on board with us—the pilot, and an Australian midwife returning from holidays.
‘OUI. MAURICE HAS BEEN HERE MANY TIMES. MAURICE, HE SAYS MANY PEOPLE HERE LIVE AS THEY ALWAYS HAVE—LIKE IN THE STONE AGE. LOOK,’ he gestures out the window. ‘SOON YOU WILL SEE SOME VILLAGES. TINY ONES, LIKE FROM A HISTORY BOOK . . .’
For half an hour more our little plane bumps and burps slowly higher as we head due north, levelling out at just over ten thousand feet. We’re now high over South Sudan, where the world’s largest swamp, the Sudd, stretches in every direction below us, a tangle of innumerable black waterways looping and bending their way through an otherwise d
ry, flat khaki landscape, flanked by narrow corridors of rich green growth. Like veins on a giant, dying leaf, it seems. A haze of moist air hugs the ground as much of this water evaporates, and what doesn’t will drain ultimately into the White Nile, which runs from Lake Victoria, to our south, to the Sudanese capital of Khartoum, further north. And yet now is only the dry season, my colleague tells me; in the coming months, rains will flood much of what’s below us to create a wetland the size of England—still only a fraction of the total area of Sudan, Africa’s largest country.
‘THE DINKA, AND NUER,’ shouts my French colleague. ‘THESE ARE THE TWO MAIN GROUPS IN THE SOUTH. THE DINKA ARE THE LARGER, MAYBE TWO MILLION. BUT YOU—YOU ARE FLYING TO NASIR, OUI?’
‘YES.’
‘THAT IS A HOME OF THE NUER PEOPLE. THEY ARE THE SECOND LARGEST. MAURICE HAS WORKED WITH THEM BEFORE, THE NUER. HE SAYS THEY ARE VERY INTERESTING.’
‘YEAH?’
‘OUI. VERY TRADITIONAL PEOPLE—VERY PROUD PEOPLE.’
We yell at each other a little more, a not entirely unpleasant way of communicating, and a small settlement soon passes below—literally just five or ten straw huts clustered near the water’s edge, some cattle grazing nearby. Nothing in the surrounding wilderness alludes to any other human activity. A more isolated group of people I can’t imagine, a notion reinforced even by the name of this place—Sudd—that translates literally as ‘barrier’, and it was the impenetrability of this swamp that made it one of the last corners of Africa to be seen by Europeans. It’s the stuff of the National Geographic magazines I’d borrowed from my dad as a child; a place of papyrus reeds, Arab slave caravans and warrior Nilotic tribes; and an area that even now seems mythical, frankly foreboding.
My parents though are having less trouble imagining the remoteness. More trouble understanding why I’d accept this job. I told them about a week ago, after I left Mozambique.
‘Sudan?’ asked Dad, via a bad payphone connection. ‘Ag, no man. Why can’t these people offer you a job in Thailand or something? I mean, do you actually ask for this stuff, or do they just send you because you keep saying yes? And please tell me you’re not going to Darfur. Jislaaik, your Ma will go nuts if you—’