Band-Aid for a Broken Leg

by Damien Brown

  On Saturday afternoon Zoe attends a meeting in town with the UN and local police representatives. She calls the ten of us expats to the outdoor table when she returns, and tells us that they’re expecting an escalation of these raids. ‘They’ve seen members of the Lou clan heading this way,’ she says, ‘so the other groups are moving their herds closer to town for protection.’

  There’s a collective groan. In a region where banks don’t exist, cattle traditionally represent the only significant way for a person to accumulate wealth. Having what’s tantamount to gold-bullion-on-legs wandering around us is a sure recipe for trouble—no less given that the two larger clans along the Sobat River here, the Lou and Jikany Nuer, have a long history of animosity toward each other.

  ‘When are they going to get here?’ asks Paul, towelling his forehead. ‘When can we look forward to this?’

  ‘Two to three days,’ says Zoe. ‘Maybe longer. They may wait for the next full moon.’

  Paul shakes his head. This presumably isn’t the first warning he’s heard in the eight months he’s been here. It’s his first stint with an aid organisation, a long-term ambition, he’d told me, and the question that’s half-jokingly thrown around among aid workers—‘What are you running from?’—is, I suspect, largely redundant in his case. He’s a successful businessman who turned sixty just last month (no wrinkles yet but his brown beard is starting to grey, although I’m still deeply jealous of it—now a thick, bushy, ‘I’ve been in Africa for months’ kind of affair), and he’d left a supportive wife and daughter in New Zealand to do this. And he works hard—puts in at least as many hours as any of us who’re half his age, but he’s clearly anxious to get home in the coming weeks.

  ‘Look,’ says Zoe, ‘it may all amount to nothing. The police are going to keep a close eye on things, so let’s hope. But it’s a good time for us to revise our security procedures. So, first thing is the grab-packs. Make sure they’re easy to find. Keep them with a small bag of valuables—maybe tie them together, but limit it all to four or five kilos—and place it near your door, somewhere you can find it easily at night. It’s a good idea to keep your passports and entry permits with them.’

  The grab-packs are something we’d all been issued with in Loki, just after being shown how to assemble a large, rucksack-mounted UHF radio for emergency communications. Each pack is a generic hip bag, filled with survival essentials including a lighter, compass, pocket-knife, thermal blanket, water purification tablets, and, somewhat bizarrely, condoms—not something I can foresee needing while fleeing through a swamp. Even more useless than condoms though is my South Sudan entry permit; despite my having submitted a detailed application form and a dozen colour passport photos in support of it, the official document has me listed as being a seventy-seven centimetres high, black-eyed, brown-haired Australian national—an evil-looking, hirsute, Antipodean dwarf. It’ll be interesting to see what a soldier makes of it if I’m pulled aside.

  ‘The safe room is obviously the place to go if you hear gunshots,’ continues Zoe. ‘If you’re on the brick wards or in theatre, stay there, but waiting in the tukuls is pointless. Also, I think we should avoid going into town for the next few days. Okay, in terms of evacuation, we’ll ideally get flown out, but it takes at least two hours for the plane to get here. And we’ll need to be able to get to the airstrip, so it’s only possible if things settle. Our second option is the cars. If we need to get out of here immediately, we drive, but there’s obviously no way we can get to Kenya. We could drive to the UN compound, but only if we’re really desperate.’

  As a rule we’re to avoid all non-essential contact with the UN. Our security stems from our being perceived as strictly neutral by all groups, rather than from any reliance on armed guards or impenetrable fences. (Somalia is the only context in which MSF routinely operate with that level of precaution.) If people really want to get into our compound here, they will. It’s by taking no sides, and by treating everyone—for free, at any time, and regardless of clan affiliations, political allegiances, religion or ethnic group, among other conceivable variables—that we ensure our security. And so far there’s been no hostility targeted towards us here. The risk, although small, of being accidentally caught in crossfire during one of these raids is our only major issue—for now.

  ‘Our third option is the boats,’ says Zoe. ‘Paul and Anwar, you guys please need to make sure that both are ready, and that there’s spare fuel. So, nothing we haven’t discussed before. Any questions?’

  We move on. It’s already late afternoon, the sun drawing long shadows across the dry compound. A dozen little birds chirp brightly above us in the branches of the large tree, plopping their contributions onto the table with impressive regularity as Heidi updates us on the Nutrition unit.

  ‘It’s always at night,’ she says, speaking of the two children who’ve died in the past week. ‘Always.’

  ‘It’s classic,’ says Zoe. ‘Death rates are always higher in these centres overnight. You need to make sure that meals aren’t being skipped. Are the mothers waking up to help give them? Is the health worker checking the kids’ vital signs regularly? Do they call you or Damien as soon as things deteriorate, rather than waiting until the child’s really in trouble?’

  ‘No!’ says Heidi, with endearing German feistiness. She reminds me increasingly of Andrea: frustrated by the context, enamoured of the people, desperate to make a difference and at her happiest when working with the kids. (A small posse follow her for much of the day, including a young boy who insists she carry him, and who she’s nicknamed ‘Breast Man’ due to his propensity to grab said object on anyone nearby—men included—presumably for a feed.)

  ‘I am sure the health workers sleep,’ says Heidi. ‘Last night I got up to check on a young girl, but she hadn’t been given milk for hours. When I asked Gatwech why, he said that the container had run out. So why did he not mix some more? Oh, he said, because it was more difficult to mix at night. He said that there was no rush, that the morning staff could do it! And the mothers? Have you tried to wake them? Some are so difficult! They get funny with me because they want to sleep, and if we push too much they want to leave. One even wanted me to pay her to wake up! I really don’t get it.’

  I agree with her. There are some serious cultural misunderstandings here—from both sides. A few of the parents seem deeply mistrusting of us. We try often to convince mothers not to take their children early, but they’re extremely suspicious, almost superstitious. If a child with a nasogastric tube gets worse, mothers will remove tubes from their own kids. If a child dies after drinking ReSoMal, they’ll refuse that drink. So we explain the treatment to them. We point to the healthy kids and assure them that they all had the same treatment, then we go in circles, explain it again, then beg, and finally just insist: I tell them that the child will die if they take them home, because any cultural sensitivity on my part is vastly overshadowed by my concern for the kids.

  In terms of supervision we float the idea of rostering one of us to stay awake overnight, but it’s simply not feasible. We’re awake at least every third night anyway. I suggest creating another volunteer position dedicated purely to staff training, but Zoe says it’s impossible. Merely keeping these four projects staffed at minimum capacity is challenge enough, and MSF are currently ramping up projects in the Abyei border region, where north–south clashes have increased.

  • • •

  It’s getting late. We wind up the meeting with a quick whip round for any last comments. Anwar, the soft-spoken Indonesian log, is happy, nothing more to add. So too is Maya, the office administrator. Heidi doesn’t want to be on call tonight (she was up all of last night), and Marina requests only that she also attend the next meeting with the UN Peacekeeping commander, because he’s apparently cute, and she’s been stuck in this compound for most of the past months. Carol laughs. Paul meanwhile heads for the latrine, creating an appropriate segue for Amos, our jovial Kenyan water and sanitation engineer, to
make his last point.

  ‘I am telling you,’ he says, pointing in Paul’s direction, ‘something is not right. Look at that man. Look! Always, he gets sick. Then it was Damien—who even got a flight!—and now it is me. Something is not right in that kitchen. I am telling you, our cook is doing something strange. I have been coming to Sudan for many years, and I have never been sick so much. Never! Last week, Damien gave me antibiotics, but now, already—already!—I sheet all the time.’

  The team laugh.

  ‘It is not funny,’ says Amos, though he too is laughing. ‘I am telling you, if I cannot stop this I will waste away. Paul is already wasting away. And what if I start? I will waste very quickly. Look at me!’

  We’re in hysterics. Amos is a giant of a Kenyan, tall and thick-limbed, with probably the largest belly in the region.

  ‘It is this food,’ he says. ‘Something is not right with it. Paul and me checked the water again yesterday, but the chlorine is good. So it is not the water. But it is something. I am telling you. And I cannot go on like this, Zoe. All this sheeting—I cannot do it.’

  —But still he’s laughing.

  The generator hums suddenly into life, and a race ensues: if Amos reaches the TV first, it’ll be action movies for the night; Heidi, and it’ll be chick-flicks or sitcoms. The others fetch beers and stay put, and for the moment it’s fractionally cooler outside so I remain here. Not long afterwards the guard calls me through the gate.

  ‘No,’ I say. ‘It’s Damien. D. A. M. I. E. N.’

  ‘Desmine?’

  I chuckle as he walks me to Inpatients, where Joseph has called for help, while trying to correct his pronunciation once more.

  ‘Okay, yes,’ he says. ‘Desmien?’

  ‘No, Damien.’

  ‘Demine?’

  ‘Better Dennis,’ I say. ‘Let’s stick with Dennis, okay?’

  ‘Okay,’ he grins back, shining his torch ahead, guiding me into the assessment room. I see Joseph here, his shirt still neatly buttoned to the collar even after ten hours in this place. He’d have made a far better doctor than me, I’ve concluded, if only he’d had the opportunity. As would so many others I’ve worked with.

  ‘Looks,’ he says, unusually seriously. He’s standing beside the assessment table, putting an IV cannula into the hand of a young girl. She looks up at us. Her hair’s braided with colourful beads, and she’s got a simple string ribbon for a necklace. She’s naked but for a pair of old white shorts, but we don’t cover her up. The Nuer aren’t particularly self-conscious about nudity.

  ‘Bad fever,’ says Joseph, as I hold her arm steady for him. But the girl pushes us away, rolls feebly onto her side and moans for her mother. We catch her before she falls. The mother takes her for a moment and sits on the floor and cradles her, and the little girl sits in her mother’s lap and looks up at her, then blinks, sighs softly, and gently empties her bowels.

  Then dies.

  Just like that.

  Joseph tries gently to pick her from the mother’s arms to resuscitate her but the little sister throws herself onto the body; kids bringing up kids, now kids mourning kids; so we leave them. There’s no point interfering. I’ve not ever seen a child resuscitated from this state. Not in these places, not with those sunken eyes and tissue-paper skin.

  We give them a blanket. When they leave, Joseph and I start seeing the three other families who’ve been sitting on the benches against the wall just metres away during all this, waiting to be assessed for their own health problems, and I wonder what they must think. Perhaps that it’s just another sad day in South Sudan, because none of them walk away and they’re all very grateful to be seen when we finally get to them.

  Afterwards, I go back to the compound to join Heidi, who did make it to the TV first, and she asks me what happened. I say only that there were a few admissions, and I instead throw the question at her because she’s watching Friends, and it’s up to the series finale, I think, and Rachael and Ross have got back together and although I never had any interest in the show in Australia I’m taking a keen interest here, suddenly engaged, a lump in my throat and this strange—

  Jesus. I’m crying.

  While watching Friends?

  This is embarrassing.

  I never do cry in these projects except for that time we’d operated on Roberto’s niece, but I suspect that I should, because something’s got to give, or break. Heidi’s fortunately too engrossed with Ross, who’s now kissing Rachael, to notice at first, but when she does look over she says exactly the right thing—nothing—and just gives me a soft look and asks if I’d like something to eat. I say Yes thanks, and lie back on the mattress, watching as our resident bats fly their sorties down the corridor, past the five bedrooms then back around quickly, bundling over me and into the kitchen like leathery winged golf balls that never so much as glance a wingtip.

  But before dinner comes Dennis is yet again summoned. And Dennis cringes even though he quite likes that he’s at least being called Dennis these days (and notes too that he’s also beginning to refer to himself in the third person—perhaps this is what missions do to you after a while), but when Dennis gets to the gate this time he smiles broadly, in part from relief, in part bemusement, because it turns out this is a good summons. Just some visitors at the gate. The little boy with the beads, and two of his friends.

  He came past earlier and stood here quietly, staring, and I never do know what to do with him because he always looks so serious. Trying to make him smile, I picked him up beneath his arms, threw him straight into the air and caught him again, but as soon as his feet touched the ground he ran off—fast—so I assumed I’d upset him.

  Apparently I didn’t. He’s back. And now standing with arms raised (although still looking serious), as are his two recruits. He does a little jump and waves his arms in case I’m not clear about what he wants, but I am. So I do it—I pick them up. I fling them as high as I can, several times each, and the contrast with what just happened on the ward isn’t lost on me.

  19. AN ANGRY CLAN

  It’s mid-May when the wet season arrives. Almost on cue to the Sudanese staff’s predictions, the first storm blows in at night, a deluge of rain so grand it’s as if the gods are trying to make amends for centuries of drought in the next hours—or wash away the huts. I meanwhile lie curled in my own tukul, reassuring myself that the sturdily-patted-together walls won’t dissolve in the near-horizontal torrents.

  And they don’t. Surprisingly, none of the huts come apart, and when the storm clears in the morning the air smells clean, washed for the first time of the smoke from those cow-dung fires, although there’s now a bigger issue: a sticky, tenacious clay carpets the entire region, and it becomes impossible to walk anywhere without acquiring a few inches in height as wads of thick, brown-black earth cement themselves to your shoes. No ordinary clay, though; get enough of it on you and it exhibits a paradoxical effect, the compound instead becoming a giant Slip-n-Slide.

  Mud unfortunately isn’t the only thing born of the rains. Within days the insect population explodes in both number and variety. An inquisitive ‘Wow, look at that colourful little thing,’ is superseded by more desperate exclamations of ‘Don’t . . . Fucking . . . Move . . .’ as winged objects the size of potatoes, that didn’t seem to exist last week, torpedo from the darkness. Walking anywhere at night mandates switching off one’s headlamp lest it attract them, and if the outside light is left on following any rains, the sound of the constant barrage of insects flinging themselves maniacally towards it sounds like a heavy storm in itself. Indoors, things are little better. A bedside reading lamp quickly becomes wallpapered with bugs, and malaria prevention now seems a minor benefit of my mosquito net—keeping the three or four thousand other creatures in my tukul at bay is the bigger. I tuck it in firmly.

  The wards too are carpeted in mud. Friday morning of my third week back, and I step over the pile of gumboots near the door (Paul recently gave them to all staff), nudging my way
through a crowd to find Joseph. There are twice as many people in here these days, as patients, relatives and passers-by all seek shelter.

  Joseph and I begin seeing the newer patients, then the longer term cases. In the far corner we come to Elizabeth, the smile-in-a-red-dress, who’s still sharing a bed with her mother. She’s now a couple of weeks into her anti-retroviral therapy and gaining a little weight, but says she was up last night with diarrhoea. She looks well on examination, though—no fever and not too dehydrated—so I reassure her that this is just a small setback. But she doesn’t seem happy.

  ‘She is very angry with you,’ says Joseph.

  ‘Angry?’

  ‘Yes. She is okay with the treatments, but she is saying you are ignorings her. She is saying you have not ever accepted her offerings.’

  ‘What offerings?’

  ‘For marriages,’ he says, and the three other health workers laugh heartily. But Joseph persists. ‘Really,’ he says. ‘She is asking what your answers is.’

  ‘Come on, Joseph—as if she wasn’t joking!’

  Elizabeth fixes me with a look of sincerity as Joseph speaks with her, her bony hands clasped in her lap, no hint of a smile. But the health workers are in stitches.

  ‘She asks why would you think she is jokings?’ says Joseph.

  ‘Are you serious?’

  ‘I think you are going to stay in Sudan!’ guffaws Mark, who’s just back this morning after two days off following a scorpion sting, and who’s been affectionately, if somewhat jokingly, nicknamed ‘The Professor’ by his colleagues—a nod to his propensity to ask unusual questions on rounds. The other health workers start up, too. ‘Looks like you will be staying here,’ laughs Johnson, the youngest of the team. So I play along and make light-hearted excuses, but Elizabeth just glares. Doesn’t see the funny side. She looks away after a moment, then dismisses me with a flick of her hand.