Six Months in Sudan

by Dr. James Maskalyk

  I ran upstairs, took my coat off, and left it hanging on the back of a kitchen chair for someone halfway home. I vaulted back down the stairs, stepped into the open car door, and the vehicle rolled away.

  THE OVERHEAD announcement woke me.

  “Ladies and gentlemen, we have begun our descent into Khartoum. In preparation for arrival please ensure that your cabin luggage is stowed in the overhead bins or under the seat in front of you and your chairs and table trays are returned to their upright and locked position. The local time is 9 p.m. The temperature in Khartoum tonight is 95 degrees Fahrenheit.”

  I looked around me. The plane was full. It would continue on to Ethiopia after a stop in Sudan, and I tried, with a glance, to guess who would be stepping off the gangplank with me.

  Some were obvious. Men dressed in long tunics and white kufi hats glanced at their watches and set the time. Others were less clear. Two Europeans sat in the row in front of me. I tried to catch their eyes a few times, but could not.

  The plane slowed to a halt and I stood up. Few others did. In total, eleven of us, in a plane of a hundred, pushed past the other passengers towards the door. Whatever business was being done in this country, it was largely closed to the world.

  The door opened, and with it, desert air blew in as from a bellows. For a cold-loving Canadian who, when he was a child, would clear a pond and fire pucks at his little brother in below-zero temperatures and return red and exhilarated only when they had lost all the pucks in the snow, it was an unavoidable embrace.

  We stepped down the stairs and onto the tarmac. Row on row of white planes, bare except for the black UN stencil, sat silent: a plane graveyard. It would not be the last time I marveled at the immense resources the United Nations poured into Sudan, nor at its rows of idle machines.

  On a bus to the airport terminal, the Europeans chatted with one another, or on their phones, old hands.

  We stood silently by the luggage carousel and waited for it to turn. I pulled my MSF shirt from my satchel and put it on. Bags rolled onto the rubber conveyor belt, and one by one, people grabbed theirs and walked towards the exit, mobile phones to their ear. Mine came and I followed. I took my sheaf of documents from my bag and presented them to the uniformed man behind the customs counter. He barely acknowledged me. Midway through his bored inspection of my papers, a man walked past, stood in front of me, and clapped the customs guard on the shoulder. The guard broke into a smile and rose to give him an embrace. They spoke brightly in Arabic for a few minutes, laughing and gesturing. I was forgotten. Any importance to my arrival was in my own mind.

  Their exchange finished, the guard cast a flat glance at me and waved me through with a flick of his fingers. Next. Next person trying to save the world.

  Past the swinging door, a Sudanese man held an MSF sign. I walked up to him and smiled. He smiled back, gestured for my suitcase.

  “MSF Swiss?” I asked.

  “Oh. No. MSF Spain,” he answered, looking over my shoulder. He waved at someone, stepped past, and grabbed a blue duffel bag from a man behind me. They walked out of the airport, duffel swinging between them.

  I sat in the airport hall for half an hour, backpack and suitcase at my feet, and watched it empty. Soon I was alone. I wondered if I had misunderstood my instructions. I slung my satchel to the front and put my backpack on. Rolling my suitcase behind me, I walked out of the airport, past its single shop selling fragrances and chocolates labeled with looping Arabic script, and into the warm Khartoum night.

  On the step of the airport, leaning on a signpost, a man with an MSF shirt was smoking and talking to a friend.

  “MSF Swiss?” I asked.

  “Yes. Dr. James?”

  “Yes.”

  He grabbed my suitcase and hefted it into the box of a nearby pickup truck. I threw my backpack beside it and climbed into the passenger seat.

  “Where do we go?” I asked.

  “Guest house.”

  We pulled out of the parking lot, past rows and rows of white cars and onto the street.

  “Where are we?” I asked. “In the city, I mean.”

  He smiled at me, then made the “small small” sign with his thumb and finger. No English. I rolled down my window and lit a cigarette.

  We turned onto a road several lanes wide, separated by a broken and crumbling median. Traffic was dense and moving slowly. We edged through it towards a dark laneway. A final corner and the truck lights swept across an empty lot. At one end, a pile of garbage smoldered beside the steel skeleton of an abandoned car. The truck rolled to a halt.

  I pulled my bags from the truck and set them on the ground. The driver handed me an envelope. Inside it were a thick bundle of Sudanese dinars, a form letter explaining which room I was to sleep in, and a briefing schedule for the following day. I thanked the driver with my only Arabic word, and stepped into the black guest house. It was mine alone. I dropped my bags in my room and lay down on a foam mattress, pressed flat from all of the backs before me.

  I WAS PICKED UP the next morning and taken to the MSF office. The sun, at 8 a.m., was already intense. I tried to memorize the route the car took so I could walk it alone.

  The sky was cloudless. Above the low buildings in all directions were slender minarets. We ground slowly past an empty dirt lot, broken bits of concrete mounded at each end to form football nets. Sand gusted across it, billowing plastic bags in whirling circles. We turned right and continued straight on our dirt path until it crossed a tarmac one. Just beyond it was a school, a type of university. Women wearing fine headscarves sat together fanning themselves with their textbooks; men walked arm in arm, talking and smiling. No one looked at us. The car stopped.

  On a white metal gate was the MSF emblem. In front of it were two cars, each marked with the same red dashes. I got out and opened the metal door to a courtyard, and past it was the Khartoum office of MSF Switzerland.

  I was greeted at the front desk by the Sudanese receptionist. She asked for the papers I carried from home and handed them to another woman who quickly left the office. There were several iterations of travel permission in Sudan. I needed a visa to enter the country, another to travel to specific places within it, and a third to leave. There were stories of people waiting in Khartoum for weeks both on their way to the field and coming from it. I was told in Geneva that because of political sensitivities, a travel permit for Abyei was very difficult to get, and to expect delays.

  The office was large, and on two floors. At the entrance, row on row of boxes sat, the names of projects written on their rims. Of the projects administered by this office, mine was the only one not in Darfur. In the box for Abyei sat three manila envelopes. I put them in my bag.

  I waited in the foyer for my first meeting, with Brian, the head of mission. I picked up a month-old newspaper, its headlines shouting at the mistruths contained in a recent NGO report detailing violence in Darfur. Propaganda. I set it down.

  On the wall behind me was a corkboard of faces, everyone who had been through these doors, sat in this chair, read these papers, and headed off to the field. There were about forty, some yellowed from the heat, some smiling, others stern. I recognized one of them. Someone I went to medical school with? I wasn’t sure. I couldn’t place the name. Perhaps she was married now. As I studied her face, she grew less familiar.

  “Dr. James? Brian will see you now.”

  I was pointed upstairs. There was a broad door with “Head of Mission” stenciled on it in black. I knocked. A tall man, my age and with curly hair, opened the door and gestured me in. He was talking on a cellphone, his accent Australian. He smiled and held up a finger.

  As head of mission, he was the person most responsible for MSF activities in the country. It was his job to liaise with the coordination center in Geneva and the field to ensure that the mission was fulfilling its mandate and adhering to humanitarian principles. As the most prominent face of the organization in the country, the position required political skill and exp
erience. Particularly in Sudan.

  His analogue in the field was the field coordinator, Bev. Her function was to see that the objectives were carried out on the ground, her attention to security one objective lens closer. She had less interest in the larger political tableau, and instead had a closer relationship with local military commanders and community leaders. If violence flared in Abyei, the discussion about whether to evacuate would be between the two of them.

  Brian finished on the phone and offered me his hand.

  “Glad to meet you, James. And that you could come on such short notice.”

  “No problem. Glad to be on my way somewhere.”

  “Have a seat. So. What brings you to Sudan?”

  I sat down and told him my story.

  In turn, he told me his. He was a general practitioner, trained in Australia. He had worked in Sudan for several years, first in the field as a physician in the South, during the long war. He knew it well and had worked closely with the population of people I would be working most with, the Dinka.

  “You’ll know the Dinka. Dark skin, tall. Like six feet at least. Even the women. Some of them have ritual scars on their foreheads and faces.”

  Until the war came, the severe geography of Sudan isolated them from the rest of the world. A desert in the summer, in the winter full of swamps, mosquitoes, malaria. Many were nomads, and traveled with the seasons.

  Abyei was home to another group, the Misseriya. They were Muslim, had lighter skin, spoke and wrote Arabic. They too moved with the rains. They came to Abyei in November or December and stayed until the wet season that started in June. We tried, as MSF, to employ people evenly from both groups.

  The two tribes had lived in the area for generations. They would trade with each other, sometimes even marry. Occasion ally a fight would erupt over grazing land, or the theft of cattle, and some men would go to war. Since it was in neither side’s interest to perpetuate conflict, tribal leaders would mediate a solution.

  The British, in their flight from colonialism in the fifties, left a Sudan united in name only. Khartoum, in the North, with greater ties to northern Africa and the Middle East, remained the focus of power, and it soon became clear that it had no intention of sharing with the South. A civil war began shortly after the British left, and ended with the Addis Ababa agreement in 1972, and with hundreds of thousands dead or displaced. It was a short respite. In 1983, in response to an edict that the Khartoum government intended to make Sudan an Islamic Arab state, fighting started again. It was much heavier this time because the SPLA was formed, uniting southern resistance.

  “You know the SPLA?” Brian asked.

  “Yeah. Sudan People’s Liberation Army. John Garang and all that.”

  “Exactly. And the SPLM is their political arm.”

  Now war was brought to even more of the South, but in a different way. Tribal militias were used, particularly around Abyei, and exploited traditional differences. Groups like the Dinka and Misseriya, used to occasional conflicts, now found themselves part of a greater one, one with planes and guns, one with no end in sight. And this time, civilians were targeted. Villages were burned to the ground, hundreds of thousands of people fled, took nothing. Many went to Ethiopia, or Kenya. Many, even the Dinka, went north to Khartoum. It was safer there, right next to the enemy, than it was in their own homes.

  “Anyway, the North didn’t care. It just wanted fewer soldiers in the South. Got it?”

  “Uh-huh.”

  “So, basically, the South doesn’t have much of anything. Never really did. That’s what they were fighting about. They have land, but no infrastructure. Whatever there was the war knocked out. The rest of it has been built piecemeal by NGOs and the UN. So they’re hungry.”

  “Right.”

  “Okay, last piece. When you fly to Abyei, you will pass over two straight things on the ground. One will be the road to El Obeid. The other will be an oil pipeline, built by the Chinese, running from the oil fields around Abyei to the Port of Sudan. Full of oil around there.”

  “Oh.”

  In 2005, a peace agreement was signed, and both sides agreed to stop fighting and establish an administrative border that would allow the South to function autonomously. Except. Three areas were not delineated as belonging to either North or South: the Nuba mountains, the Blue Nile State, and Abyei. Abyei was the most contentious. There was to be a referendum in 2011 that would decide whether it would belong to the South or to the North. In anticipation of it, people were being encouraged to return. By both sides. They were being told they would find schools, a hospital, that they should build a tukul—a hut— for themselves and one for another family. When they arrived, they saw that there wasn’t much of anything.

  Both sides have their armies in town and militias in the surrounding countryside. There were soldiers from the North, SAF—Sudan Alliance Forces—and the SPLA. There were also some from the JIU, the Joint Integration Unit, a combination of forces from both sides, intended to allow the SPLA and SAF to withdraw.

  “They’re not, though. Neither side seems ready to back down.”

  “Right.”

  “When we did our exploratory mission there, we thought there might be as many as a hundred thousand civilians coming this year, but there haven’t been that many. But we’ll see. Maybe people are afraid to come back. We don’t quite know. Anyway, that’s why we’re there. Any questions?”

  Yes … what? Holy shit.

  “Um. What is the compound like?”

  “Pretty basic. Everyone has their own tukul. No cellphone, no Internet, no electricity. Power is from a generator. There is a sat phone, satellite email. You’ll see. Anything else?”

  His phone started to ring. I shook my head.

  “All right. Well, I’m around.” He stood up. “You’ll get more details in the field from Bev. She’s good. She’s non-medical so she’ll need your help with the hospital and stuff, but she really knows what’s happening on the ground.”

  “All right.”

  “You’re meeting with Marc next, right? He’s our medical coordinator. He’s across the hall.”

  I shook Brian’s hand, walked to the facing door. I knocked. It was answered by a thin man wearing wire glasses, in his hand a cigarette.

  “Come in, James. Come in, come in. Please. Take a seat,” he said in a round French accent, gesturing towards a chair.

  “Thank you.”

  “Sorry. The air conditioner is not working.”

  “It’s all right.”

  “Well, let’s get to business.”

  This meeting was longer. We sat and smoked at his broad wooden desk, fan spinning lazily above us, as he outlined the main areas of my medical responsibility. First, I would be responsible for all of the inpatients in the hospital, and all emergencies. I would be supervising one Sudanese MD, newly graduated, and two Sudanese medical technicians, both of whom had done a short training course and could diagnose and treat simple things, like dehydration and malaria. Second, there was the therapeutic feeding center, the TFC.

  “Have you worked with malnourished children before?”

  “Um. Not really.”

  “First mission?”

  “Yes.”

  “Ah. Well. We are approaching the hot season. You’ll have more and more starvation, mostly children. The youngest ones. There are guidelines.”

  “Yeah. I’ve seen them.”

  “Okay. What do you know about TB?”

  “A little bit. Diagnosed a few cases. Never treated anyone for it.”

  He paused. “Well, MSF is having its first ever TB workshop in March. All sections, people from all over the world. It’s just around the corner in Ethiopia. I think you should go.”

  I told him I did too. Today was my first full day in Sudan, and already I was thinking about when I would next be out of it.

  We weren’t done. I would be responsible for collecting statistics and monitoring epidemics. There had been some deaths from meningitis in a
nearby military camp, and Abyei was cinched, with much of Sudan, by Africa’s meningitis belt. Further, a couple of cases of measles had been diagnosed nearby. The last vaccination campaign in the area had been years before. Finally, I should be prepared to handle several wounded at one time. There wasn’t just the threat of multiple casualties from an outbreak of war, but a week ago a vehicle collision had sent thirty people to the hospital.

  I would be given more specific instructions by the MD I was replacing. Marc handed me a stack of medical articles to take to the field, and showed me to his door. I shook his hand.

  “Good luck. I’m sorry to say tomorrow is my last day. After that, you will ask your questions to Brian. He’ll be acting as head of mission and medco.”

  “You’re leaving?”

  “Yes.”

  “Oh. Well, good luck.”

  “And you.”

  His door closed. I went downstairs and received my per diem for my next days in Khartoum, and was told that if my travel permit was approved, I would be leaving Wednesday on a World Food Programme plane, which traveled twice a week to Abyei.

  I stepped out from the office and onto the street. The doors to the university were closed, the students gone home. It was near dusk, the sun shadowed and fading. Somewhere behind me, a muezzin took up the call to prayer. It was the first time I had heard it.

  I couldn’t make out his words, only long-drawn syllables. I turned past the university, crossed the tarmac road, and walked towards the guest house.

  19/02: sudan.

  it is dusty here. and windy. not a cloud. i am having trouble sleeping. not just from the heat, but because my head is full and my mind too active. i wonder about things i cannot know, like how i am going to recognize my first case of kala azar, or how i might manage the dozen injured patients i may never see. i have gone from not thinking about the future to completely inhabiting it.

  MY TRAVEL PERMIT came through on time and I was due to leave the next morning. I had spent my two days in Khartoum wandering back and forth to the office. The first day I walked back, I got lost. Went too far. Ended up walking around in smaller circles until I recognized the dry, empty lot and its stone football nets. Through practice, I established a direct route.