Six Months in Sudan

by Dr. James Maskalyk

  “That’s cool.”

  “Totally. Anyway, she worked mostly with old people, of course, and whenever she met someone who had been married for years and years, she would ask them their secret. I don’t remember all the answers, but one was from a woman who said, ’Well, you just can’t fall out of love with each other at the same time.’”

  Tim nods. “I kinda thought it would help being here.”

  “And?”

  “Well, I don’t seem to think about it too much. Mostly I just keep on thinking about how terrible the food is.”

  “And how hot it is,” I add.

  “And how there’s no beer.”

  “And no girls.”

  “Which is probably good.”

  I throw my cigarette into the coals. “I think at some point, you just have to decide to go for it or not,” I say.

  “Yeah. I don’t know. I’m just hoping for something that fits. But it’s tough to find, I guess. Some people do.”

  “Maybe. You ever look around, like on the subway or something, at all the other people reading or listening to music or whatever, and think, how does everyone have it so sorted out? Am I the only one who’s just trying to hold things together with, like, bits of … wood and white glue? You know? Why aren’t we all freaking out, or making out, or something.”

  “But everyone on that subway’s thinking that, about you.”

  “Yeah, exactly. Sucks.”

  The handset crackles. Tim takes his lighter from the table and reaches for the radio below his stool.

  “Think we should get back?” I ask.

  “Probably. Bev’ll be worried.”

  We stand up. Tim hands the girl a crumpled dinar note.

  “Thanks,” I say.

  “I never know what to pay,” he says.

  “Dude, when thirty years from now economists look at Abyei’s inflation rate, you know, with a line graph? The first thing they are going to point at, right at the beginning, is a mark that says ‘Tim’ and below it will be your face.”

  “So true.”

  We start to walk back. The light from the stalls’ naked bulbs shadow ruts from last year’s rain. We creep along carefully.

  “So, Tim. Paola, she has a boyfriend for sure?”

  “Yeah. I think so.”

  “What about her friend, the one who works for the UN?”

  “Think so.”

  “This is going to be a long six months.”

  We are nearing the end of the market and are close to the compound. To our right, a Misseriya man leans on his counter, his chin in both hands, a small selection of canned and dried goods behind him. We stop to buy some tins of pineapple.

  “You know how much to pay for these?” I ask.

  “Not really,” Tim says, handing the storekeeper a 1,000-dinar note.

  We turn onto the last market stretch and pass a group of armed soldiers sitting down, drinking. One of them stands up, lurches towards us.

  “My friend,” he says, extending his hand, “my friend!”

  I have never seen him before. Neither has Tim. His hand is naked, dangling. The silence stretches. His smile starts to fade. I reach to shake his hand. He grabs mine tightly.

  “My friend!” He takes a step closer, and I smell the booze on his breath and see his red eyes below the brim of his cap.

  I pull my hand free.

  “We’ve got to go, partner,” I say, and clap him on the shoulder.

  Tim and I turn and start walking.

  He shouts, “My friends!” then adds something in a language I don’t know. The rest of them start to laugh. We quicken our pace. He is shouting as Tim and I turn the corner, but as we draw close to the compound, his voice is lost in the generators.

  28/02: all measles all the time.

  that is not far from the truth. today i have seen and admitted six cases. the tally would have been seven, but the family of a young patient lived just a bit too far away, and he died before i got to the hospital.

  the miserabled are exceeding our capacity to hold them, certainly to isolate them. yesterday, they occupied one veranda. today, they started spilling onto the lawn. they ignore the tent we have set up for them because it magnifies an already aggressive sun. despite our best attempts to keep the miserabled separate, several cases have popped up in other inpatients.

  i am often asked why i ended up choosing msf from an armada of medical ngo’s with whom i could work. for many reasons, but none more compelling than this one. at our morning meeting, i wondered aloud to the rest of the team about our space problem. a decision was made to do something about it. by 2 p.m., there were six men in the corner of the hospital compound, and by 5, they had built a shelter that would house 20 patients. we also decided to find a nurse, hire one if necessary, and devote him or her to measles care. within the day, the will was found, the money, and the hands. we did not need to add it to the agenda of another meeting, nor to a paper pile of requests on an administrative desk. within hours, it was hammers and nails.

  my radio crackles beside me. i am on call to the hospital tonight, and am responsible for it all nights. and all days. i thought i left this call business behind me, and could just carry it around as a kernel of pride. “oh yeah. 30-hour shifts, i’ve done that. it’s not so bad.” it was bad, ok? i admit it. didn’t like it. uncool.

  but, speaking of uncool, and its opposite, the coolest … radios. they’re the main reason i work for msf. every day, i get to say: “good copy. over and out.” for real. so sweet.

  BRIAN PASSES MY TUKUL door on his way to the shower. He arrived a couple of days ago to help coordinate our response to the measles epidemic. A convoy of vehicles is working its way towards us from Khartoum carrying bullhorns, ice packs, vaccine coolers. We have hired translators, made site visits to places even closer to the middle of nowhere than Abyei.

  There are several new measles patients every day. Some show up at the hospital on their own and we find them sitting in the registration line, feverish and spotted. We pull them out as soon as we can to sit on a bench beside Ismael’s lab until we can find a place. Other times, Bev will pull up in the Land Cruiser, drop off a measled family she found in the countryside, and then speed away. We are running out of mattresses.

  Mohamed and I no longer work together much. Most days, I round on the inpatients, he on the growing number of measled now housed in a series of traditional recubras, long huts covered with grass. We meet in the early afternoon to talk about the sickest, then leave for lunch at our respective compounds. His, compound 2, home to our national staff relocated from Khartoum or Juba, the southern capital, is becoming full as we draw more people into Abyei to help us cope. I visited compound 2 on my first day, with Bev. Haven’t been back since. I don’t go to the market any more. Nor anywhere else. I talk with patients through a translator, or Mohamed when he is around, and only some of the Sudanese nurses speak English. Most of the time I walk around in a bubble.

  It has been good having Brian here. The team has been feeling adrift. We all have questions. About the children who won’t get any better, about the dead bodies no one will claim. The end of the month has come and gone, and I don’t know how to do the statistics. Sandrine has not sent me her handover. When Brian asked me how I was doing, I looked at his tired eyes and said I was doing all right. I probably am. A lot of dying people, though. I try not to think about that too much.

  Paola is struggling too. She is trying to coordinate her large nursing team, to bring the nurses up to basic MSF standards. On top of this, she must manage the pharmacy, and plan an international order for supplies. Between the two jobs, and with the new measles drain on resources, her list of tasks is bottomless.

  Brian has told us that more people are due to arrive to help with the vaccination effort, including another MD, from Spain. I will be glad to have Mohamed back.

  The shower door slams shut. It is best to shower at least three times a day: morning, noon, and night. You never really get clean, at leas
t not for long. As soon as you step from underneath the pipe and into your flip-flops, the dust between your toes changes to mud. In those few seconds, though, a lifetime.

  I hear Brian turn the pump on. It pushes water from a tank on the ground to one three meters above it. Twice a day we receive water from the sloshing buckets of the donkey-boys, a term we all agree is pejorative, but one we use anyway. The donkey-boys are about twelve years old, dressed in rags, legs as thin as their arms. They turn the bent spigot of their donkey-drawn barrel, fill a plastic pail with water, then bend and strain to pour it into our tank. We pump it up, splash it down.

  He’s done. My turn. Brian is sharing Tim’s tukul. I claimed that the constant interruptions in my night would be too distracting for him to find sleep. More true is that I wouldn’t find mine with someone so close.

  The spatter of water hitting cement. Shit. Paola must have beaten me.

  I lie back down and grab a book from beside my bed.

  What time is it? Nine. I should probably try to go to sleep soon. I’m on call tomorrow. How many cigarettes did I smoke today? One after lunch, one just now. Two. That’s pretty good. Maybe, if I get to sleep, I’ll try to run in the morning.

  The water continues to splash.

  I put the book on my chest and look through the crack of my door. Brian and Bev are laying out a map on the gazebo table. They did the same thing last night. I returned from the hospital late, and they were still up, talking vaccinations. Everyone else was hiding in their huts. I have heard that other NGOs are concerned about our approach, some wondering if our estimation of the populations in the countryside is accurate. They want us to delay. We won’t.

  Finally.

  I walk outside. Paola passes me with a towel around her waist.

  “G’night,” I say.

  “Uh-huh,” she mumbles, not looking up.

  The shower floor is wet. I kick my flip-flops into the dust outside and turn on the water. It’s cooled a bit. This afternoon, the water in the pipe was so hot from the sun, it burned.

  The water pours over my face, my back. I’m careful not to get any in my mouth. For a minute, the dust and the heat retreat. I let the stream thunder on my head. Feels like forever.

  I reach for the handle and it squeaks as I twist it off. I grab my sarong hanging on the bathroom door and rub my hair, then tie it around my waist. The rest of me is already dry. I step into my flip-flops. The dust in them turns to mud.

  The door to Paola’s tukul is mostly closed. Beneath it, I can see a sliver of light. Don’t know where Tim is. Bev and Brian look up as I turn the corner to my tukul.

  “Going to bed?” Bev asks.

  “Yeah. Think so. Hope so. Good night.”

  “Good night.”

  I duck under the awning of my tukul, and again under the door, turn on the light. A lizard skitters from under my bed to behind my metal clothes trunk. I hang my sarong on one of the roof’s branches and sit down on my thin mattress.

  My tukul’s cement walls are bare. In the corner is a plastic desk, and on it, books I brought from home. The history of the twentieth century, Ulysses, Zen in the Art of Archery. Kapuscinski’s Shadow of the Sun is beside my bed. I haven’t read more than a few words of any of them. Too hot in here, the gazebo too full of work.

  I turn off my handset and set it on the desk. The crackling keeps me awake. The guard will come get me if the hospital calls.

  I open my clothes trunk. Since this morning, a thin film of dust has collected on it. It tumbles off the back and lifts in a fine cloud. I pick up my running clothes and put them under my bed, then set the alarm on my watch for 6:20. I turn off the light, pull up the mosquito net, slide underneath it, and tuck it in.

  Behind me, through the thin grass of our compound wall, a song warbles. With each of its million plays in the past ten days, its tape is becoming thinner, tinnier.

  A dog barks. Yipyipyipyipyip.

  I’m sweating. I roll on my side. My hip digs into the string underneath my mattress. It was Sandrine’s, someone else’s before that. I slide closer to its edge to find more foam.

  I wonder how that little girl is doing. The orphan. Aweil. So quiet. Can’t read her. Fevers, not eating. Dehydrated, dry eyes. I can’t stop thinking about her.

  Dude, tomorrow.

  I turn onto one side, then the other. The mattress is wet from sweat. An insect starts to crawl slowly over my leg and I swipe at it in the dark. Familiar thoughts circle, circle, circle.

  What time is it? Ten. Okay.

  Yipyipyipyipyipyip.

  I curl the pillow around my head. The outside world grows quieter, the amplitude of my inner world louder. Circles. They slowly start to break, their lines becoming more oblique. I realize I am about to fall asleep. The thought wakes me.

  Maybe I should just call the hospital and check on her. No. Tomorrow.

  What time is it? Eleven.

  I reach down to where my watch is, change its alarm to 7:15.

  Won’t have time to run. Whatever.

  A mosquito whines in my ear. I swat at it. It whines again. I throw a corner of my net free and feel blindly for my headlamp. I turn it on and begin to sweep my bed for the interloper. I find him hanging upside down, in one corner, and smear him against the mesh.

  I turn my lamp off, lie back down, wrap the pillow around my head.

  Yipyipyipyipyip.

  I’ve got to have a conversation with that dog.

  Knockknockknock.

  Huh?

  Knockknockknockknock.

  “Yes?”

  “Dr. James? Hospital. Channel 6.”

  “’Kay.”

  06/03: y-shaped sticks.

  “may you live in interesting times” is one of the greatest curses. the measles vaccines have arrived. 43,000 doses. they sit in … oh shit, they should be in the fridge. i’ll be right back.

  while we were building recubras for our measles patients, we were setting up three tents for a vaccination campaign command post. one for equipment, one to house the extra team members flown in from geneva, and the other to plaster with maps and strategies. 4,000 kg of cargo for the measles emergency arrived from khartoum last night.

  interesting times. we have made it part of our campaign to screen all the children we vaccinate for malnutrition. because the population of abyei has tripled in the past year, there is a food shortage. there is one harvest a year, and it happens at the end of the rainy season. that will be in september or october. abyei is about to enter its food gap, and starvation will worsen. if we vaccinate 35,000 children in the next few weeks, and we find 1% severe malnutrition (a local ngo estimates it at 3%), that will mean 350 children, perhaps 1/2 under 5. we will offer all transport to the hospital. if 1/2 are under five, and 1/2 refuse, we still might end up with 80 more children in the tfc. right now we have ten. interesting.

  so, that’s what we talk about over lunch, and that is why there is reason to be nervous. 80 children. it would double our current census, measles patients included. what about latrines? showers? kitchen? where would they sleep? who will take care of them?

  right. the max capacity of latrines is 20 people per. we have five. we can build more. we’ll send a car for more gas and stoves. build another shower. we shouldn’t put children at the front of the hospital because they would be vulnerable to fighting or the chaos of a big accident. so they go in the back. away from the tb patients and the measled. ok. we’ll set up a tent. no, they don’t like tents. too hot. they like recubras. fine. big hut, back of the hospital, put starving kids in it. more latrines, a shower or two.

  this could start tomorrow. wednesday. ok. maybe we’ll get there and everyone will be so fat they can’t even waddle to the front of the vaccination line. so let’s wait and see. then move fast if we have to.

  our logistician spoke up. “well, maybe one thing. those y-shaped sticks, you know the ones we use to make the recubra? they are hard to find. people have to travel to get them. we should go to the market ri
ght now and buy as many as we can so we are not scrambling tomorrow if we need them. i’ll do it after lunch.”

  we’ll sort it out as we need to. except for the y-shaped sticks. today it’s all about the y-shaped sticks.

  logisticians make things happen. if it wasn’t for them, the rest of us would be standing knee deep in dust, waiting to get started but not sure exactly how to begin. we add things to their lists, and put request forms on their desks. yesterday i put one on jean’s desk for “world’s largest emerald.” he didn’t mention it today, so i guess it is on its way.

  “WHERE’S HE GOING?” I ask Tim.

  “Who?”

  We’re sitting at the table in the gazebo, eating our lunch.

  “The emergency-team log, what’s-his-name. He just went into our kitchen and took our kitchen knife.”

  The emergency team has been here for a few days. They are here to run the vaccination campaign and help take care of the infected measles patients. Right now, we have about forty in the recubra next to the cement fence. With their families, nearly one hundred people sleep there, hospital on one side of their buttressing wall, soldiers on the other. One noticeable effect is that, since we started flanking the soldiers with the infected, we have not seen them sneaking in to use our latrine.

  The emergency team, thus far, has cut a wide swath through our normal activities. Three new people in our compound, five or six in compound 2. There are so many people there now, we have started to call it camp 2, because the number of people sharing a latrine exceeds the WHO standard for refugees. Our showers are flooded, our drinking water disappears from the fridge.

  “I don’t know where he’s going,” Tim answers.

  I charge after him. I find him in one of the emergency tents, cutting open boxes.

  “Bro. What? That’s our kitchen knife. There’s gotta be a better option.”

  “I need to open these. The ice packs.”