by Damien Brown
‘Market?’ I ask Heidi, who’s busy in Nutrition, but she needs no convincing. She pries Breast Man from her hip and grabs a radio, and like a comet we’re out the front gate, stopping for no man, our tail a dozen kids trailing us from the unit. They follow us out the gate but we redirect them to their mothers, then squelch our way east along the riverbank for this, our twice-weekly exercise session and part cultural tour of Nasir . . .
First point of interest is the small brick church to our left, where the missionaries who’d arrived a century ago gave their sermons, inadvertently becoming advanced students of linguistics as they struggled to get a handle on this previously unwritten language—a language in which gender-specific pronouns such as he, she, and it are represented by a single form (accounting for such honest mistakes by our staff as, ‘Him, with the pregnancy pains’), and in which the same word can have completely opposite meanings depending only on the tone used. There’s an interesting aside to the church, too; in a smaller mud chapel not far from here, a British aid worker controversially married the leader of the rebel Nasir SPLA group in 1991 (‘The Warlord’s Wife’, the media called her), subsequently staying on to live in his tukul until she was killed in a car accident.
We continue up the bank. Thick clouds, heavy humidity—there’ll surely be another storm tonight—and Heidi averts her eyes from the group of young men washing on the edges. A minute later I avert mine as we pass the women’s bathing section, then we both avert everything as three men in baggy fatigues pass us with AK47s slung over their shoulders. Better not to make any eye contact, I’d think.
Ahead of us is the crashed plane, bold tufts of grass bursting from its broken cockpit windows, its right wing being bounced by children. Not far from it, a fishing crew are at work: two men in underwear, casting small throw nets from the shallows; beside them, a handful of empty dugouts are tethered to a tree. We pass them and head further along, towards the fish market, but before reaching it we cut across a large muddy clearing to the main market. And here, I’m again distracted by a group of men brushing past wearing their open shirts and dark glasses, all with rifles over their shoulders. One of them points to the camera slung over my shoulder and makes a menacing gesture even though I’m clearly not photographing anything; I don’t argue the point, just take it off and place it into Heidi’s hip bag.
‘Coke?’ we ask an elderly shopkeeper. He’s one of the few lighter-skinned Arabs in town and dressed in a long white jallabiya, and he runs one of the handful of little tea shops clustered at the market’s periphery. He nods and puts out two plastic chairs beside a small table for us, then pulls two bottles from the rusty chest freezer inside. A small generator sputters nearby, powering his and other stalls, and as I put my feet on the corner of Heidi’s chair and look around, I think: this could almost be a normal town. Teapots whistle on top of coals, just across the track. People stream through the dirt laneways, browsing the same variations of goods seen laid out in wooden stalls all over this continent—batteries, radios, donated clothes and newer knockoffs; foodstuffs in sacks, bags or cans; combs, mirrors and unstrung beads in every conceivable colour, and dozens of other items. Ahead of us, a few of those bike-taxis sledge their way unsteadily through the mud, and to our left the driver’s seat of an old truck has been fixed to a wood pallet, placed before a lopsided counter that’s bearing a straight-blade razor, scissors and small mirror—the barber’s shop. And beneath a large tree to our right, a game of dominoes is attracting a small crowd of men around a table. Breaking any illusions of normality, though, rifles rest casually beside them.
‘You hear the carrying-on in that tukul last night?’ I ask Heidi, and she laughs. She says she didn’t, but that she suspects she knows who it was. I’m still discovering all of this, because never mind love triangles—what’s going on here resembles more of a large, misshapen polyhedron. Unlike in Mavinga, volunteers from the South Sudan projects tend to meet often enough during briefings, evacuations or holidays, passing each time through Loki and often being delayed, to create a bit of a dating scene. As weeks go on, details of any relationships at home become hazier, and a What Happens On Mission Stays On Mission attitude seems the rule.
Heidi looks up suddenly. ‘Shit—do you think we’re both going to end up with MSF’ers? Or marrying MSF’ers?’
I laugh. It’s not unlikely. That, or another field worker, or a national staff member. We ponder this as we hand the shopkeeper a few Sudanese pounds, and I think of that recent night when the girl died, how Heidi had known exactly what the trouble was. It’d be far easier to be with someone who’s worked in these places before. ‘But that means twice the baggage in one relationship, Heidi!’ I laugh. ‘Can you imagine? Twice the maladjustment, twice the strong personality type, and twice the eccentricities from being isolated in these place for too long’—and I tell her about Maurice.
The mother of a former patient recognises us as we pass down a side track, calling for us to join her where she’s making injera flatbread on a small cooker on the ground. There are no chairs, so she puts out cardboard for us to sit on, then shouts for others to join us and directs the older daughter to prepare the injera. A few of the younger kids climb onto Heidi’s lap and a small crowd gathers, and as I watch the cook I sense another bout of gastro looming. Her muddy little hands marry grey-brown sorghum with turbid water in a metal bowl. Next, a stick frenziedly whisks the mixture as her bright eyes dart proudly between it and the unusual customers. The batter is then poured into an oiled pan and the pancake-like bread smokes; and, not long after, we khawajas smile warmly but apprehensively as the chef’s assistants—the kids on Heidi’s lap—break up the bread and hand it to us, watching as we chew the first pieces.
‘Lovely!’ we say, ‘Very nice!’ which only leads to a repeat of the whole process. This time though the batch is wrapped up for us as takeaway, but we’re not yet done—the teapot is on, and it too is filled with turbid water. More kids come, more of the woman’s friends gather, and people chat in a language of which I know less than a dozen words so we all mime and laugh, and it’s moments like this when I’m utterly at peace, thrilled to have had these opportunities. Two cultures that in many ways couldn’t be less alike, yet here we are . . .
After tea we thank our hosts and pack the takeaway, and as we stand up to go I realise I may have thought all this too soon. Another group of armed men passes. Three this time, scowling, no uniforms but with AK47s strapped across a shoulder, and as they look over I both cringe with unease and seethe with anger. They’re like belligerent teenagers with something to prove, these guys, answering to no one and acting up—albeit with guns. And right beside the kids! Have they not had enough? After thirty-nine years of war, wouldn’t they just have flung their guns into the river at the first opportunity? Yelled, ‘Ha! We’re done! We survived! Take these shitty things back!’
This moment sums the place up for me. Gorgeous kids, capable of anything given a chance; armed men, threatening again to ruin it all. After two months here, all I can conclude is that this place is a sad contradiction. Either bone dry, or flooded; at war with its neighbours, or more so with itself; filled with happy kids, but so often they die; and watched over by the international might of the UN, yet they can do nothing to intervene in the clan violence. The town was even born of paradox, founded when an Arab slave trader was commissioned by the British to lead their anti-slaving efforts here; an inauspicious beginning if ever there was one, and it still bears his name.
But what I struggle to understand most is this: that life is so precious here; that these people battle to coax an existence from this severe land, to raise their kids, to carry a sick relative for days to a hospital and then sit by their side for weeks; yet life is equally so cheap. Disregarded during a cattle raid, valued secondary to a clan’s honour, and constantly threatened by these armed men—even if the majority of people would rather get on with things.
The drain on our project’s resources due to violence is disproport
ionately large. Flights are frequently chartered, or diverted, to transfer the wounded at a cost of thousands of dollars each time (normally only two of the four projects have a surgeon). Worse, transfers are sometimes made for security reasons rather than medical, purely to keep rival clan members separate.
And what we could otherwise do with this money: educate women about nutrition and hygiene, so that the kids we discharge from Nutrition don’t bounce back in an even worse state because of poor feeding practices, as a percentage invariably do. We could run an HIV education program, because preventing the infection of someone like Elizabeth is surely more efficient than providing anti-retrovirals for two, three or five years, or however long until we hand this project over. We could teach women about family planning and provide the services, because preventing unwanted births makes more sense than re-feeding a child who’s malnourished only because he’s the eighth son, born unplanned to parents who struggle to feed their seven other kids anyway. We could train health workers like Joseph, put them through a full-time course so the hospital doesn’t rely so heavily, and so unsustainably, on expat staff, because there’s no doubt that if we left tomorrow the project would quickly fall in a heap.
These aren’t original thoughts I’m having here. Not by any means. I’ve heard them before, thrown around dinner tables in Mozambique, Angola, or in European offices, and I wonder now how many thousands of other volunteers and professionals have stood in these same places, pondering exactly the same things, in decades gone by. Or how many more will do so in the years to come. I wonder as well what impetus there is for any of these governments to step up and treat their own cholera patients, or to respond to their own floods, or staff their own hospitals properly, or to do much of anything, when they know well that we’ll simply rush back at the drop of a hat, with no strings att—
Heidi’s giggling. I’m ranting, she says. ‘So cynical, Dennis! My God! How on earth did you come to be so full of shit?’
I laugh. She’s right; I am ranting. And largely pointlessly. Whether we should be here is something I don’t question. This place is not just rebuilding itself, in many ways it’s starting from scratch. And while infrastructure and services are being put into place, and an entire generation of people are educated, we should be providing a safety net of health care. This I don’t question. So I’m clearly going to have to get over my frustrations if I’m to keep working with this organisation, because this is exactly what they do, and what emergency intervention is. They bite off only what they can chew—which here means running four major hospitals and a dozen outreach sites, keeping an emergency team on stand-by, employing forty expats and four hundred and fifty locals, and allocating six million euros to cover it each year. By any standards it’s impressive—and ambitious. No less given the logistic and security constraints.
Heidi and I head back across the mud. The sky’s darkening. Over my shoulder I can see the black rotors of the UN helicopter through their fence; ahead, a young boy leads an elderly blind man across the field, each of them clutching opposite ends of a stick—the sum total of sight aids in such places. And cutting across our path, another man with a gun. Everywhere, these fucking guns.
• • •
Joseph’s on the ward when we return. ‘One very big problems and four admissions,’ he says.
We get straight into it.
First, two kids with a cough. We’ll see them last.
Next, a young boy bitten by a snake two weeks ago, and whose hand is black and already dead. We’ll fly him out for an amputation.
Next, a teenage boy, screaming in the yard. ‘Crazy,’ says Joseph, who knows him well. ‘Always, he is shouting.’ The boy’s hands are tethered together with a coarse rope, the father holding one end. He’s normally tied to a long lead at home, explains Joseph, but last year he’d freed himself and wandered into a neighbouring village and was stabbed (out of malice or mistaken identity, who could know). I’d object that this is inhumane, that the calluses and cuts from the binds are unacceptable, but what’d be the point? I’ve seen this before. I saw it in Mozambique, in a village we’d visited. What else can the families do? What mental health teams can they access?
The father looks worn. He says the boy’s been distressed for days. Neither of them have slept. We sedate the boy with an intramuscular antipsychotic and take him to the side room near theatre; I’ll reassess him when he wakes.
Next: the one very big problems.
Joseph leads me to the little isolation room where Nyawech, the HIV-positive woman with Kala-azar, is sleeping. He crouches down and retrieves an old Plumpy’nut carton from beneath her bed, opens the lid to show me the contents. Inside is a sizeable collection of pills—all of her medications for the last two weeks, at least.
We wake Nyawech. She rolls over, weak and red-eyed, and shoos us away with a flick of her wrist. Joseph speaks with her but she doesn’t reply, just rolls further away. Joseph taps her shoulder but she ignores him. Nyawech’s mother is sitting on the end of her bed, cross-legged on a corner of their blanket, and she now leans forward and slaps Nyawech.
Nyawech cries. She turns back towards us, mewling unsettlingly. We ask her what she’s doing, why she’s stopped the tablets.
Go away, she says.
Joseph explains to her that she’ll die without treatment.
Go away, she yells.
‘But Nyawech, what about your children?’
She sobs.
‘Nyawech, why are you doing this? Are the tablets making you worse?’
No answer.
Nyawech has had enough, I suspect. Two relapses and a dead husband. She doesn’t want this anymore.
Joseph speaks with her for a while and Nyawech glowers, her face a sad picture of rage although her body is feeble and wasted. The mother becomes furious. She gets up and slaps Nyawech around the torso and head, slaps her hard, and she shouts at Joseph. Joseph then steps out and calls a handful of the other health workers to the bedside, and under the mother’s direction they grab Nyawech’s bony limbs and restrain her. The mother pries Nyawech’s mouth open and these two women yell at each other with eyes wide, shrieking with all the anger and bitterness of this shared tragedy, and Joseph selects an evening’s dosage from the box and places them into her mouth. Nyawech spits and chokes as the mother holds her mouth closed, it’s an unsettling sight, this woman who two months ago was tall and graceful as she strolled the compound with Breast Man, now a gagging skeleton with no shred of dignity because look at what we’re doing. So I turn my back and leave. This isn’t my culture. It’s not my place to interfere, and the longer I stay here the more confused I become.
Later I return to check on the crazy boy with the rope handcuffs, but he’s gone. His father already carried him home. Presumably he’d got the brief respite he sought.
21. CATFISH AND COW DUNG
I’m a shoo-in for June’s ‘Slimmer of the Month’ award in the Assassin’s weight-loss classes. Despite strong competition from others in the team, I’ve maintained my months-old head start. Paul is out (he left a few days ago and is currently heading back to New Zealand), although Heidi’s made a late bid, and Amos remains a solid favourite with the bookies. I’m meanwhile sneaking the odd sachet of Plumpy’nut to boost my weight, and my breath-holding capacity rivals that of a world-champion free diver: the little latrine doesn’t bother me much anymore. That said, this constant gastro is wearing me out.
Now midway through my eleventh week back, and another swollen sky greys the town. Heavy rains this morning have so far kept patients away but it’s no reprieve for the Outpatients health workers. It just means that this afternoon will be twice as busy. The five of them are on the outside benches when I pass, listening to a radio—a blue, dynamo-powered plastic handset with a crank handle, the type given out in camps—and they call me over to talk, but we’re promptly distracted by the sight of a young boy who’s squealing loudly as he sprints past. His arms and legs pump frantically as his little body hurtles
across the soggy compound; ‘KHAWAJAAAAA!’ he yells as he whips past—plea for assistance or merely an observation, I can’t tell—and squeal becomes shriek as he turns to look back over his shoulder. There’s trouble: not far behind him, a posse of a half-dozen other children are in hot pursuit, and the gap is closing fast.
The little boy tears past the nutrition centre. He weaves between bystanders and hurdles a low lump of mud that’s maybe a half-foot high, just clearing it (he’d be about three years old), then makes a risky move: he disappears into the crowd of people collecting water from the taps outside the surgical ward. It works. The posse are thrown. They disband as they momentarily lose sight of him. Kids fan out around the crowd—a classic pincer movement, two at the front, a couple on either flank and one penetrating the fray—but not long afterwards the boy reappears on the far side. He doubles back in a broad loop around the surgical ward, having regained his lead, and still holding in his right hand the cause of all this and what must by now be the last of such items remaining in Nasir: a half-inflated rubber balloon. It’s the remnant of a fascinating recent incident here in the hospital, and one which confirmed to Heidi and me the importance of that old adage, You don’t give one and not the other.
These South-East Sudan Balloon Wars began late last week, following the unexpected death of a child in the feeding centre. Heidi, distressed by the loss of another patient she’d spent so much time with, tried to lift the mood by arranging activities for the kids in the centre and distributing the small stash of balloons she’d brought from home. The intention was good, the time spent inflating balloons nothing short of noble, but the gesture quickly backfired: within hours, every other kid in the hospital, outside the hospital, and throughout what seemed to be the entire region who didn’t get one wanted one. What followed was unexpected.
In scenes reminiscent of the upheaval caused by that single glass bottle in The Gods Must Be Crazy, kids quickly turned against one another. Compound yard squabbles took place, interspersed with high speed chases or extended periods of hiding by some in an attempt to hang on to the precious bounty. During ward rounds, children could be seen peering under beds, opening doors and combing every corner for a balloon, and the behaviour continued like this for several days until all balloons had seemingly been accounted for: either burst, lost or stolen, at which time calm once again descended—on the paediatric population of this town, anyway. So, run hard, little man! God knows how you hid that balloon for an entire week, but hang on to it! Run like the wind!