“How do you know which syringe is which?” I ask.
He looks at me and smiles. “I remember.”
“Right. You know the baby with the blood transfusion?”
“I know.”
“It’s clotted. Not working. Can you take it down and put in a saline lock?”
“Yes. Right now.”
He leaves the room and I sit down on the blue metal chair behind the desk. My foot bumps against something. It is the cardboard box we use to hold all of the charts from all of the patients that leave the hospital each month. It is nearly full.
I lift it onto the desk and take the top chart. It is for a patient who died last night. One of two. She was a young woman who came in with a sudden fever and a headache. We treated her for both malaria and meningitis. Her fever never left, and in the past forty-eight hours, she drifted in and out of consciousness. Mohamed was on call last night and he told me that the nurses called him at four in the morning to say her blood pressure was 220 over 140, and as he prepared to come into the hospital, they called back to tell him she died.
Probably a brain abscess. No way to know for sure. I have scrawled at the top, as a diagnosis, “FEVER.” When I tally the births and deaths at the end of the month, hers will be classified under “Other.”
The next chart is in sequence. It is that of a man who also died last night. He started feeling weak a few days ago and saw a local doctor, who gave him some antibiotics. He continued to worsen. His weakness became so profound he could not walk, and by the time he rolled through our doors, he was having trouble breathing.
Mohamed saw him last night, on call. The man started to vomit, and inhaled some of it. He stopped breathing shortly after. Guillaine-Barré, probably. Could be botulism, I guess. Myasthenia gravis. On the top of his chart I write “WEAKNESS.” Other.
I start to comb through the charts, remembering the people through their scribbled stories at the tops of their pages.
Oh yeah. This one. Little boy, came in with a sore throat. Seemed to be all right, but got worse. Didn’t respond to antibiotics, stopped eating. Breathing became noisy. We finally transferred him to Heglig, where they airlifted him to Khartoum. I heard he died on the tarmac. “SORE THROAT.”
Mansood. His chart is thick. He was here for months and never got any better. The caregiver we hired worked for a while, but after she found out I was treating him for TB, I never saw her again. I checked on him a few days ago. His eyes were still and unblinking, the skin on his face taut, his last expression a toothless grin. On the windowsill of his room was a stack of foil Plumpy’nut packages and three or four half-finished sodas swimming with ants. “WEAKNESS.”
“MALARIA.” “MALARIA.” “PNEUMONIA.” “SNAKE BITE.” “MEASLES.” “FEVER.”
“GRENADE WOUND.” The boy’s mother finally came back, and we transferred him for an amputation. Don’t know if it happened, or where in the world he is.
I put the old charts back in their box and start going through the active ones, the ones on the desk, to make sure I haven’t missed a stool or urine sample.
The nurse comes back, the blood bag in his hand, coils of tubing looped over his arm. He shakes his head gravely.
“The baby has passed.”
I nod, shuffle back through the charts to find his. Aywan Chan. Sixteen months. Male. From Anet. I write as his discharge diagnosis “MALNUTRITION” and beside it, circle “Death.”
I finish going through the pile. There is one stool sample from this afternoon that needs treatment. I calculate the dose of metronidazole. In the chart I draw half a pill, twice a day, and show it to the nurse. He nods.
Mohamed shows up at the door. He is tired. It is the end of a long, difficult day for him.
“James, are you finished?”
“Yup. I should get out of here before any business shows up. You?”
“Halas.” Finished.
I stand up from the table, put the cardboard box under it.
“Let’s go.”
“I need to lock the theater. I’ll be right back.”
Mohamed goes to the back of the hospital and I walk towards the front. It is late in the day and the sun is angling towards the horizon, its light soft and orange. Across from the hospital road a football match is being played on the wide flood plain. I can hear a soft thud as the goalie kicks the ball away from his net, deep into his opponents’ territory. Players race for it, kicking up clouds of dust.
In the space beside the hospital road, a group of younger boys is playing their own match. The ball they are using is nearly flat, likely discarded by their older brothers. One of them kicks it, and it makes a loud pock and careens erratically.
Smoke is coming from some early-evening fires. High above Abyei, on the hot drafts of a rainless day, hawks circle.
I turn around. Mohamed is standing behind me, watching. We sit down on the hospital step and watch both games.
“James, do you believe in God?” he asks after a few minutes.
I think for a second.
“Not really.”
Mohamed often excuses himself, if we are at the hospital through lunch, to go pray.
“What about paradise?”
“No. Not really.”
“Most religions have theirs.”
“I think this is it, Mohamed. Paradise, I mean.”
He shakes his head. No.
“The way I figure it is that I didn’t know what life was before I got here, and if there is something after this, I won’t know it either,” I continue. “And this world, the one here, the one with that ball being kicked up in the air, and above it those birds, I can touch it with my hands. I can taste it. And I can change it. It is the only miracle I know. You and I, sitting here, every bit of us from some distant part of the universe, filtered through a star, and put together just like this.” I hold up my two hands.
“No, I don’t think so. Too many babies die here, too many of us are fighting. This is not what God, praise be to Him, wants of heaven for us.”
“You could be right. I don’t know anything. It seems too hard. But maybe that’s the thing. Maybe we’re supposed to make it.”
The game closest to us is winding down. One by one, the younger boys are leaving for home. Now there are only two boys, kicking the wounded ball back and forth.
Pock … pock … pock …
Mohamed shrugs, stands, and brushes his pants off. “I am going to walk home.”
“Me too.”
We move step in step towards our compounds, both of us lost in our thoughts. As we draw close, Mohamed stops.
“I’m going to pass through the market.”
“Okay. See you tomorrow.”
“Yes. Good sleep.”
I watch him walk, head down, hands in his pockets, until I lose sight of him in the fading light.
18/05: arrival.
this morning, i opened the honey jar, and inside floated an ant. i held the jar up to the sun, and his wire frame swayed gently. for an ant, the sweetest of deaths.
i have been in sudan for over three months, but i have yet to fully arrive. i wonder at times if i ever will, if it is even possible. it seems part of me remains in canada, watching my friends and family through a thick glass wall, unable to hear them or touch them. another part of me is waiting on the plane, looking at his watch, ready to leave as soon as the rest of me shows up. it is an uncomfortable feeling, one i am not accustomed to, having parts missing.
i also work on avoiding the future because i will never catch up to the part of me that is already waiting on the plane. when i make it there, he will be through customs, and on the cab ride home, he will be having a glass of wine on the roof, watching the sun set, surrounded by friends. if i spend my time running to catch up, i’m only running.
so, i work on here. 11:09 a.m., friday, may 18, in my tukul, compound 1, abyei, sudan. the sky is mercifully cloudy. a bird is tapping for termites on one of my posts. a small lizard poked his head around the corne
r, and just now ran underneath my clothes trunk. a larger one, a foot long or more with a yellow head and tail, is clambering up the brick wall of another tukul, and is doing push-ups, peering around the corner, looking for locusts.
every now and again, it rushes in. not just for me, but for all of us. we arrive, completely, even if just for a short time. we sit in the middle of our compound, reading, and the donkey-boys show up with our water. the glass falls away, and you remember, right, i am in rural africa. donkeys deliver our water. a boy walks to the hand pump, waits his turn, grabs the hot, sweaty handle, and pulls up cool water hidden beneath the sand. he collects it in dirty plastic buckets, heaves it onto the back of his donkey, and together they walk to the msf compound, through the gate, to our water tank. there they stand now. such hot work.
someone calls your name, and you are gone.
TIM TAPS ON HIS KEYBOARD, frustrated. “You get any signal?”
“No,” I say. “Nothin’.”
“Shit. I’m supposed to Skype.”
“You want to stick around?”
He looks at his watch. “No. Let’s get back. We should help Paola.”
We pack our laptops into our bags.
“You wanna walk?” I ask.
“Yeah. You?”
“Definitely.”
We pick our way past the moat that has become GOAL’s driveway and wave at the guard. None of GOAL’s expats are around. Their current manager is on vacation, their health manager has quit. The compound is mostly empty.
“So, what do you think of Angie?” I ask.
“She seems okay. Different than Paola. But cool.”
“Kinda revved up.”
“Yeah.”
A bicycle, two boys on it, pedals slowly past us, front tire wobbling.
“It’s good for me, though. She was a pediatric nurse. That’ll be useful. Lots of kids in the hospital, man.”
“Yeah,” Tim replies.
The ground along Abyei’s road is now verdant green. What was once a dry field between bunches of tukuls is now filled with rainwater and grass. In the middle of this little lake, two girls are taking turns hammering the handle of a water pump. They jump in the air and land on it with straight arms. Once, twice, three. The other’s turn. Once, twice, three. As Tim and I pass, a girl waiting in line points to us. The pumping stops, and they all turn and stare.
“I think they like you,” I say.
“Think so?”
“For sure. You’re tall and thin. You’re like an albino Dinka. You just need a djellaba and a walking stick.”
Tim laughs. He has lost so much weight that on his way back from his R&R, Geneva made him check into a hospital in Nairobi. He was given a clean bill of health.
“Who were you Skyping?” I ask.
“Oh. Just someone back home.”
“Just someone, eh?”
“You know. What about your relationship? The one you didn’t know you were in?” he asks.
“What are you talking about?”
He laughs. A little boy comes running out from a hole in a grass fence, his little legs turning so fast he stumbles. He picks himself up off the ground and runs to us, crumbs of food on his fat face.
“Kywyja! Kywyja!” White person! White person!
The word irks me. Paola used to answer, in Dinka, “Hello, little black boy.”
“Hello,” Tim says, holding his hand out for the boy to shake.
The boy stands there wide-eyed until we pass.
“So what are you going to do?” I ask.
“Figure it out when I get home. Too hard from here.”
We stand to the side as a truck rumbles roughly past.
“Well, man, I was thinking about it the other day. I’m thirty-three, not in a relationship—shut up—and I was thinking that, you know, part of it is to do with me. I mean, we’re all looking for love. You, me, everyone is. It’s kinda what it’s all about. But there’s this part, this grass-is-greener part, that only ever wonders if something else is better than what we have, you know.”
“And then you just want and haven’t got.”
“Exactly. So maybe the next … I don’t know … iteration of my spirit is to realize that to find peace, with someone or just in my day, I gotta ask fewer questions, to tap into the happiness of the current moment, ’cause that’s all there is, you know?”
“Yeah, man, totally.”
“So that’s true, right? But there’s just one other thing.”
“What?” he asks.
“Maybe it’s not that fucking complicated. You meet someone, she says something, then you say something, and you start to fall in love.
And I think I would be always … kinda … sad that I was so afraid to be alone that I thought love was something I could figure out. That it was about me. You know?”
“No.”
“Yeah, dude. Me neither. Sucks.”
“I’m going to stop and buy some cigarettes.”
Tim stops at a wooden stand, its awning made of grass. Behind its counter, a Misseriya man in a white cap smiles at him, his back framed by batteries. He pulls two packages of cigarettes from a hanging basket. Tim makes a flick-flick motion with his thumb, and gives the man a Sudanese note. The man with the white cap hands him a lighter and a handful of change.
“Want one?”
“Sure. I’ll give it up when I get home. You?”
He pulls one from the pack, hands it to me, takes one for himself. “When am I going to stop smoking? Here,” he says, and points at the filter.
We are halfway back to compound 1. To our right is the muddy path to the market, its ruts filled with water, garbage, and half-buried bags.
“Here, dude, hold my cigarette. I want to take a picture of this.
“And, ladies and gentlemen,” I say, as I put my camera back in my bag and retrieve my cigarette, “that’s where diarrhea comes from. The end.”
Tim claps his hands. We continue on.
We can see some of our national staff sitting in chairs alongside the road, their backs to the sun.
“Wanna stop at compound 2?”
“Sure,” I say.
Most of the national staff are recruited from Khartoum, a handful from South Sudan. Everyone in compound 2 has relocated from somewhere else, many of them leaving families behind. One of the medical technicians on my team has been in the compound for almost a year. His newest baby was delivered in Khartoum a few months ago. He was here.
We walk to the side of the road.
“Gentlemen,” Tim says.
They all stand up, shake our hands warmly.
“You guys watching for girls?” I ask. They laugh.
“No, Dr. James. Just trying to keep cool. Compound 2 can be very crowded.”
“You mean camp 2,” Tim says. More laughter.
“Oh, Dr. James, I am verrrry tired,” one of the nurses says, his r’s trilling. “You know, Mabel, the nurse, she sleeps the whole night. She doesn’t do anything. I can’t work with her any more. I told Paola. No more for me!” he says, slapping his hands together.
“I’ll talk to Paola about it. But you know the new nurse is here.”
“Oh yes, I met her. Angela. Like angel. With one more a. Very nice. Very good,” he says, proud of his English.
“Maybe we’ll give her a day or two to get settled in. Does that sound okay?”
“Very okay. I have no more night shifts this week. Very okay.”
“We’re going to go inside. You guys yell if you see any pretty girls.”
Tim and I turn towards the metal gate. The guard stands up and opens it.
Inside the grass wall of compound 2 are eight tukuls, all shared. Over their doorways, bright printed pieces of cotton ripple in the warm breeze. Earlier in the year, when I first came here, I saw that their beds were pulled into the middle of the courtyard. All of them slept outside. I soon did the same. We have all moved in because of the rain.
Their kitchen is a white emergency tent. To
the side of it is the flat cement base of a planned concrete kitchen. To the other side, a brick shower, similar to ours, surrounded by a large puddle of water, the ground underneath it too saturated to drain. In the small pond, bright blue birds twitter and splash, then dash to the low-hanging branch of a large tamarind tree.
Mohamed is sitting down, playing dominoes with three others. He rises to his feet as he sees us, excited.
“Hey! Man! Welcome to compound 2.” He grips Tim’s and my hand in turn, pulls each of us closer to the table. He pushes his stool towards me, and turns to the kitchen tent to grab two others. “Sit down. Sit down. I’m just about to make some tea.”
“M-m-mohamed m-m-m-makes the b-b-best tea,” says the man to his right, John, a nurse. In the hospital, I rarely hear his stutter. He must be nervous.
“No, no, thank you. Tim and I are just stopping by to say hello. We have to go and help out at compound 1. Paola’s party tonight, right? She leaves tomorrow. Insh’allah.”
The men around the table are disappointed. Despite promising, we don’t make the visit to compound 2 very often. It is about five hundred meters from our compound, and this is my third time. They rarely come to ours. Too full of work.
“Tim? We have time for a cup of tea?”
“Nothing but time.”
“Two teas, please.”
Mohamed disappears into the kitchen tent. Tim and I sit down, inch closer to the table.
“Dominoes, hey?” Tim says. “Who wants to teach me?”
Each of the three men starts to offer advice, pulling pieces from the pile and laying them out in sequence. I am having trouble following their enthusiastic instructions. I turn my attention back to the birds.
Mohamed returns with a Thermos and carefully pours three glasses of tea, sugar swirling at their bottom. He picks one up by the rim and hands it to me, the other to Tim.
“Shukran … shukran,” we say. He nods.
Mohamed and I sit sipping tea, a few feet back from the table, watching Tim and John angle dominoes into a growing maze. Every now and again, the metal gate creeps open and one of our staff walks in, blinking in surprise at seeing Tim and me this close outside of the hospital.
Six Months in Sudan Page 20