by Damien Brown
‘Maybe,’ he chuckles.
‘And you’re a hard man to replace, Peter. No one knows what’s going on in this place more than you.’
‘This is true!’
‘I know it is. You’ve got a monopoly on it.’
He laughs as I explain the term, clasping my hand in his. ‘But, I do needs tomorrow for holidays, Doctor. Really.’
‘Why?’
‘Because, we needs to get the cattle.’
‘Cattle?’
‘Yes.’
‘Why cattle?’
‘For the bride,’ he states matter-of-factly. ‘We needs to give cattle for the bride,’ he says, as if it were the most normal reason in the world for a day off.
(And I suppose it may well be out here.)
After the TB village I head through the surgical wards with Thomas, where I find myself reprimanding two young men, each fixed to traction devices, for smoking in bed. In fairness they can’t get up and go outside—not for the next few weeks, in fact—but come on: this is a hospital! ‘For every other cigarette you light in here,’ I stir the pair, ‘we’ll add another brick to that rope. Deal? And if you start drinking, the traction goes on the other leg as well. Then the arms. Both arms. And then you’ll be really stuck. Okay?’ I mime what they’d look like with all four limbs weighed down and they laugh, their young faces lighting up and those gaps between their teeth smiling through. They’re lean, good-looking guys—just a pair of cheeky teenagers, it strikes me. Teenagers that were recently out shooting, and being shot at, on the weekend.
Evening falls and the sky remains clear. I head to our compound and throw the Frisbee with Heidi, then take a last walk around the hospital before dark. It’s now a different beast. Kids run around in the cooler air, while adults lean against the outside walls or squat in the yard, chatting, smoking, laughing and spitting as they habitually do here. Two of the night workers are also sitting outside—reclining in chairs!—but hey: it is a killer sunset. And mothers are now gathered around fires behind the feeding centre, boiling pots of water and stirring meals as their kids smear the evening packets of Plumpy’nut over T-shirts and cheeks.
And then, once more before my holidays, I stick my head over our grass fence. The river’s lapping only metres away; behind it, a full moon’s rising into an orange-pink horizon, reflecting off the water that’s on its way to join the Nile somewhere, and clouds of smoke drift from the cattle herders’ fires on the far bank. It’s stupendously beautiful. I stand and soak it all in, but there’s a tap on my leg.
‘Malé, khawaja,’ says a voice. Hello, White Man.
I look down. It’s the little boy from our TB treatment village, still naked but for his strings of red and white beads. He’d be only three but he still always greets me like a gentleman, oh-so formally, talking softly in Nuer as he extends his hand to shake mine. I wish I could speak his language. He looks like he’d discuss something very adult with me; the weather, perhaps, or maybe the cattle he’ll inherit one day.
He raises his hands.
‘Throw?’ I ask.
He nods enthusiastically.
‘Just one, okay?’ I lift a single finger to clarify.
He shakes his head, puts up three fingers.
I put up two.
He ponders this for a moment, a businessman considering a counter-offer. He tilts his head, and I notice that his haircut is the same as when I’d first met him months before—shaved, with just a square tuft of hair left at the front. It’s a popular style for the young boys here, and I remember reading in one of the Lost Boys’ memoirs that this tuft had been likened to a handle: a handle with which God could pull the children up to heaven, the writer had said, because God was taking so many of them in those days.
The little boy taps my leg again. He nods, raising two fingers. We shake on it, so I do—I throw him twice; and when we’re done, I hold him up to see over the fence, where a group of children are yelling excitedly on the riverbank. They’ve just caught a large catfish in a nylon throw-net and they’re slipping breathlessly on the mud as it flaps and squirms, grasping at it as they try to drag it up, clearly determined to take this one home for dinner. Meanwhile, not far behind them, a scene of rare tranquillity: a man paddles upstream silently in his wooden dugout, the moon shimmering in its wake. I dare say it’s a perfect moment.
Except that it’s soon shattered by gunshots.
• • •
The first victim of the fighting arrives in the early morning. He’s the only one to be brought in—the others are dead.
His leg is badly wounded so we set up theatre, but we’re going to have to rush—my flight out will be landing soon. We give him an anaesthetic and clean the debris from the wound, and as I drill a steel pin through his tibia so we can set up traction, something happens. The pin slips. It breaks, and a sharp pain shoots up my arm.
Damn it. I wasn’t concentrating.
I look down, hoping desperately that the pin hasn’t pierced my glove.
It has.
It’s lodged in my palm. And it’s covered in blood from the man’s leg wound. Heidi comes over and walks me to the basin to pull it out and scrub my hand, and as she does I look back at the patient: a young male, in sub-Saharan Africa, who may well have been a soldier. What’s the likelihood of HIV?
I scrub my hand again. Nothing else I can do right now. I re-glove and finish setting up the traction, and the plane lands as we get him back to the ward. I need the man’s permission to run an HIV test on him, but he’s still unconscious; Heidi will chase it up for me, she promises. She’ll call the result through. We hug warmly and she asks if I’m okay, and I lie. Of course I am. In ten days we’ll get to do this together again.
I board the little Cessna, landing in Loki a few hours later. For the moment, though, I’m less worried about HIV than about making the trip back to Nasir in ten days. The door came open during that flight. Wide open. A hurricane of wind, papers and shouting in the cabin, with nowhere to land nearby. Could we even land like that? No matter; the pilot dropped his speed and climbed back over his seat, helped wrestle the door shut with a nearby passenger and then continued steering us between thunderheads.
I step out, onto the tarmac at Loki. The MSF driver meets me and takes me back to the compound, where the evacuated team members from two of the other projects are still killing time. They’re unsure when they’ll be returning to the field. Security there remains problematic, but if nothing else there’s at least plenty of company.
By the time I manage to contact the team in Nasir, it’s late afternoon. Zoe picks up the phone. The good news is that the HIV test was negative, she tells me, but I’m to bear in mind he could still be in the window period. The bad news, she says, is that just after I’d left, clan members came into the surgical ward and stabbed that same man I’d taken to theatre this morning. He’s alive, but severely injured. The hospital has meanwhile shut down; the gates are locked and police are around, and Outpatients is closed. All staff are okay, but no one’s sure what will happen next. Evacuation may be a possibility.
A night of catch-ups ensues in Loki, but I can’t relax. Nor sleep. I get up to phone an infectious diseases colleague in Australia for advice about my needle injury, and he tells me to start anti-viral prophylaxis immediately. I check our inventory, but we don’t have the drug he suggests. So I wake the other doctor out here in Loki for an opinion, and she says I’m being paranoid. She wouldn’t take anything, she says. Either way, I find a prophylaxis kit from the warehouse. But do I start it? Committing to the month-long course of these old medications will mean blood tests, probably in Nairobi, and some potential side effects. But not taking it—?
I’m not thinking clearly. I don’t trust myself anymore. And yet I’m the one who’s supposed to be making medical decisions for others.
The next afternoon, I’m preparing to head to the coast when we get the news that there’s been an aviation incident in South Sudan. A Canadian pilot, a guy I know well
from my previous times in Loki, has made a difficult landing and suffered a broken arm, among other injuries. The plane’s too damaged to fly, so he’s walking to an airstrip some hours away so that a rescue flight can fetch him. He’s apparently got a GPS handset to guide him.
All I can think is that we use that aviation company.
Boarding my own flight out, I’m worried. None of this is right. Is this the tail end of a bad run, or just the start? I’m not sure. It’s been an unnerving, frustrating six months, and I think I’m pushing it. I’m ignoring signs, and I don’t think I should be here. Or I’m just being paranoid. I can’t tell which—but I never felt this in Mavinga.
Later that afternoon, I arrive in Nairobi and check into a motel room, but again I can’t sleep. I don’t know what scares me more: the needle injury, the recent flights, or my growing lack of desire to go on with the aid work right now, or to have to actually care about anyone else. I’ve not thought like this before.
I call Zoe the next morning. She tells me that the team are okay and that their evacuation has been postponed, and she says also that a permanent surgeon is confirmed to be arriving within days.
‘Definitely?’ I ask.
‘For sure. He’s already in Kenya. You’ll probably cross paths in Nairobi.’
I ask her if the doctor covering me can stay on for extra weeks, and she asks why. I ask her to please just check, and when she comes back and says that she probably can, I say that I’m really sorry.
‘Then please ask her to do so, Zoe. I’m really sorry. I’m out. I can’t do this anymore.’
22. HOW YOU GETTIN’ HOME?
My belongings will be flown out on the next charter. While waiting for them I take a few days’ break on the east African coast, relieved by my resignation, embarrassed for having done it.
I speak to my parents, but the mention of gunfights and aviation incidents predictably garners frantic support for my decision. Mum’s beside herself. I shouldn’t have mentioned the guns.
I recount some of the more benign recent incidents to a group of travellers I meet in a Kenyan bar—South Africans at that, and well travelled in Africa—and they’re wide-eyed.
And I’m bored by everyone else’s stories. Disaster Gypsy, here I come . . .
Maurice is in Loki when I arrive to fetch my bags. Maurice isn’t impressed. Maurice, he says that South Sudan is one of the last truly remote, truly tribal regions on earth, and that surely one doesn’t come here as a volunteer and not expect difficulties. One can’t sign up for this and just walk out when it gets difficult, and particularly not when it’ll affect the team and cost the organisation money to find a replacement. If every volunteer just walked out when things got difficult, asks Maurice, what mission would be left running?
He’s right.
I brace myself for more of the same when I pass through the head offices for my debriefings, but it doesn’t come. A manager in Amsterdam listens quietly as I recount the past months’ events and make my excuses; afterwards, she concedes that my departure is a significant inconvenience, but adds that this is preferable to dealing with a meltdown in the field. Her only criticism: that I’d put my hand up for Sudan rather than going home after Mozambique. That was shortsighted. I’d pushed them too hard for another placement.
In the Sydney office the reaction is much the same. They insist only that I meet with an experienced psychologist—at their expense, and confidentially—and tell me they’d be happy to have me back, but only after a good few months’ break.
So that’s it. I take another flight home, then slide back into that other universe. To dine, to date, to decompress, and to spend time with friends and family. And, after a month or so, to head off to work . . .
• • •
. . . Which, in short, is how I come to be standing in this outpatients department almost a year later. This is the hospital I’ve been working in for much of the previous twelve months. And, somewhat predictably, it’s in the one environment I’ve come to know well these past years—an isolated, dusty, troubled outpost, somewhere back in the centre of this vast continent.
‘Betty?’ I call into the room.
A half-dozen black faces look over, but no one says anything.
I try again. ‘Betty?’
There’s a cough and a shuffle of bums, but still no answer. The old man sitting on a plastic chair nearest the door looks up at me, swats a fly buzzing around him and squints from beneath his hat. ‘Nuh,’ he says, and looks back down. The handful of kids playing on the floor continue their games. No one else answers.
‘Namatjira,’ I try. ‘Betty Namatjira?’
Still nothing.
I walk towards the main door to see if she’s sitting outside. People often wait there after registering with the triage clerk—on the grass, the steps or beneath one of the tall coconut palms lining the road—because this hospital, being better equipped than those in Nasir and Mavinga, possesses luxuries like air-conditioning. Ironically, though, many of the locals dislike it: it’s far too cold, they complain. Which is quite a call, because this little town is located dead in the middle of one of the hottest, most arid parts of this continent. Cold is not an adjective one often hears.
A group of locals is sitting near the entrance, chatting quietly.
‘Betty with you?’ I ask.
No, they say. They’ve just been visiting a relative on the ward.
‘You seen her anywhere?’
‘Nuh.’
‘You seen any of her family?’
They shake their heads.
I’d normally stop now; I’d not look much further for a waiting patient—they frequently head off after a short time and return later, when the department’s emptied a little—but the triage clerk said that Betty had some young kids with her. So I keep looking some more, walk a few metres towards the street, but I see no sign of them. It’s already late evening and the last of the day’s light is draining into the western horizon; only a faint purplish glow lingers. A block to my east, the metal security grates by now will have been pulled over store windows and business fronts along the main road, and the town’s population of white people will have settled into their houses, or behind a table at one of the two social clubs here.
‘Betty?’ I call.
I hear shouting further down the road. There’s movement near an open clearing, about fifty metres away. I step closer and can make out the silhouette of a small crowd of black people weaving their way towards town. Dogs bark. Someone in the crowd yells at a passer-by noisily, aggressively—Betty and the kids are hopefully nowhere near the group—and it dawns on me that today is Thursday. Payday. A great day to be a pub owner, but a bugger of a day to have to do the night shift. The main street will be buzzing with people, and there’ll undoubtedly be fighting. Of some consolation, there aren’t many guns in town, but the sticks, boots and fists that will be used will cause more than enough injury, anyway.
I head back in.
‘Oi, fella,’ calls the old man with the hat, nearest the entrance. ‘She ’roun there,’ he says. ‘I jus’ saw ’em. She there, with ’em kids.’ He nods towards the far corner, where a passageway leads to the wards. I walk over and find a round-shouldered, squat old woman hunched on a plastic chair, a shock of grey hair bursting from beneath her yellow beanie.
‘Betty?’ I ask.
‘Yeh.’
‘Great. Come through.’
She straightens her dress and reaches for the two plastic shopping bags on the chair next to her, knots the tops carefully and calls to the three kids playing nearby. Patients generally arrive with much of the family in tow—the ‘mob’ as they call them up here—even for small presentations, and there’s no sitting quietly like on the benches in Mavinga. The adults will, yes, but kids generally lay siege to the waiting room, whirling through like little cyclones of inquisitive destruction. In the wake of just these three: food packets, paper towel, two soft drink cans and a trail of unused medical gloves. The older
of the trio is still occupying himself with the latter, a fistful in his right hand and a semiinflated one in his left (they make great balloons), while his younger brother has his hands under the nearby washbasin, splashing away with the taps turned on full. What I presume is the sister—each of the children has the same charcoal complexion, skinny limbs, big eyes, and dark, tightly curled hair, the tips of which are sun-bleached a golden yellow—is flicking through an old magazine.
‘You got enough gloves there?’ I ask the older brother.
He stops and looks at his right hand. The gloves jiggle; he looks back up at me uncertainly.
‘You leave any for us?’ I smile.
‘Yeh,’ he says, and promptly marches over to the cardboard dispenser on the wall. He stands on tiptoe and tries to jam the handful back in, but they fall straight back out and flop to the floor. He quickly bends down to retrieve them, then hands them gently to me. ‘Here!’ he says brightly. Betty meanwhile lumbers toward the assessment cubicles. The rest of us follow. I direct her to the only room that’s free, where she settles into a chair, and I grab her medical notes from the bench. The kids immediately make their respective beelines for the nearby glove dispenser, otoscope, and sink.
‘I’ve met you before, Betty,’ I say. ‘About a month ago.’
‘Yeh.’
‘Diabetes, I think it was.’
She nods.
‘What can I do for you today?’
She adjusts her beanie and pauses for a moment. ‘Not jus’ me,’ she says. ‘All ’a this mob, too. All ’a them crook.’
‘The kids?’
‘Yeh. They crook.’
‘All of them?’
‘Yeh.’
‘And they’re your grandkids, yeah?’
‘Yeh.’
‘You look after them normally?’
‘Yeh.’
Many of the grandmothers look after the children around here. For various reasons, some of the mothers aren’t up to the task.
‘And what’s been the trouble with the kids, Betty?’
‘They got ’em bug, y’ know?’
‘What, like the ’flu bug?’