Six Months in Sudan

by Dr. James Maskalyk

  “Also, I need you to get a bed from the container and put it in the front room, the one where the baby stayed. Ask Deng and Deng for some rope too. Once it’s there, you and the guard and the Dengs meet me on the veranda.”

  He translates to the guard and they set off together. I hurry to the back of the hospital, squeeze myself past the coolers, and unlock the clinking lock from the pharmacy’s metal door.

  A cotton roll. Two. Wait. Tape. Better than rope. Two rolls. Three. One for each hand, bind the feet together.

  I return to the front, and can see the man perched on the veranda bench like a bird. Roars of laughter.

  The bed is in the front room. The Dengs are fumbling with pieces of yellow nylon rope. I stop them, hand them each a roll of tape, and point to the two corners at the head of the bed. I start wrapping the third roll around a bar at the foot.

  The bed is ready. Chlorpromazine in my pocket.

  I turn the veranda corner and the man knows. He slowly puts his feet on the floor, starts to stand. His friend puts a hand on his shoulder.

  “It’s okay, it’s okay.” I sit beside the man, put my hand on his other shoulder. He sits back down.

  “Tell him that I think he is sick, and that he needs some medicines. I think these will make him better. Give him some sleep.”

  I take the pill from my pocket. He leans away, wrinkles his face.

  “He says he feels fine,” Alfred says.

  “He’s not fine. He needs help, or he is going to get sicker.”

  “He says no. He wants to leave.”

  I turn to face Alfred. “Tell him that I want to talk to him in a private place. There are too many people here. It’s too crowded.”

  The man nods.

  “Ask him to go towards the front room. I’ll ask him to sit on the bed. If he does, I’ll ask him to lie down. If he doesn’t do those things, we will have to help him. And tie him with the tape.”

  I gesture the man forward. My translator stays behind and talks to the rest. They follow.

  As we draw close to the front room, the man starts to run. I grab his arm. He stops. Miracle. The others catch up to us, and as they do he begins to struggle.

  There are four of us on him. Now five. He is kicking, yelling.

  “What is he saying?”

  “Nonsense.”

  Two of us have his arms now, three his legs. Mohamed is here now too, back from lunch.

  “Okay. In the room. Careful with his head.”

  With so many of us, the man has stopped resisting. He lets us lay him on the bed, flops his arms willingly to its corners. I wrap his wrists with the thick cotton pad, then his ankles. Only when I start to bind his legs with the tape does he begin to fight again. His friend sits on him.

  He is now bound, with MSF tape, in a Y on the low cholera bed. I check his restraints. They are snug, but not too tight. Good.

  I offer him the pills again. He refuses. I take the syringe out of my pocket, clean a spot on his thigh with an alcohol swab. He looks into my eyes, starts speaking softly, repeating something.

  “What is he saying?”

  “He is saying ‘Why, why, why?’” my translator answers.

  I inject the chlorpromazine into his thigh. The man winces.

  Whywhywhy.

  I throw the sharps into a cardboard container and stand up. His friend looks at me hopefully.

  “Tell his friend that someone has to stay with this man all day, and all night. They need to wake him up to give him water every few hours. I’ll remind the nurses.”

  I leave the room. A crowd of interested mothers and nurses has gathered, peeking around the corner to see the man tied up with tape.

  “Difficult,” Mohamed says, behind me.

  “Yeah.”

  By the time I return with the malaria check, the man is snoring.

  21/06: longest day of the year back home.

  a woman in the single room at the back, a cursed room that no one leaves, is racked with tuberculosis. last week she delivered a baby prematurely. he was no bigger than a bird. i didn’t even know she was pregnant. i showed up one morning and looked into the room and saw two stacks of breathing bones hanging onto each other, skin and angles.

  i need to write about other things.

  once, when i was walking through moma, i watched a man lead a woman around by her arm. he would stop at a painting and say, “this one … this one is … modern. abstract … it is a large canvas, perhaps ten feet wide and six tall … the background is yellow, and there are thick blue strokes carrying away from the center that fade to gray as they near the edge … in the bottom left is a thin circle of white …” she asked, “what is the color of the circle’s center?” “gray,” he answered. she paused, touched his elbow, and they moved to the next.

  there are snakes in the hospital. every few days you can see a cleaner carrying one to the waste area, draped over a broom handle like a piece of rope, beaten flat. earlier in the week, we found one on the bottom tray of our delivery room trolley. our midwife nearly picked it up, thinking it was a piece of cloth. the next day, they found one in the single room at the back, beneath the bed. the baby died later that day. cursed room.

  i used to sit by a river that ran through the small cambodian town near to where i worked. i often went there at the end of the day to read a book. children took turns sitting beside me. one night, as the light was fading, i looked up and saw a meteorite blaze across the sky, so close that i could see little pieces of it break off and flame out. the children beside me pointed at it, amazed.

  today a boy came to the hospital from “far away,” brought by his father. his leg was full of holes from an infection that had festered for two weeks. he was thin from it. i lifted his leg off the bed to look at the other side, and it came apart at the knee, his joint glistening brightly. we took a picture of it.

  a high-energy physicist was describing her job of accelerating particles as fast as they would go, then smashing them together and watching what bits flew off. she was talking about what makes up quarks, what she considered the smallest building block of the universe. the hand of a woman beside me beat mine. “but, don’t you think that if we keep on looking, things will just keep on getting smaller and smaller?” the physicist seemed puzzled, like she had never considered this inevitability, that no matter how much we pry into it, we’ll never get to the bottom.

  when i was in bolivia, in copacabana, i got lost. i was looking for a restaurant with a map i had drawn on a busy bumping bus. i could make no sense of it. i gave up. as i turned around, i caught the faint strains of a violin. i couldn’t place where it was coming from. i turned down one street, then another, walking further and further, following the music. i finally arrived to the edge of a valley, outside of town. across it, on the other side, light poured out of a large house, and with it, the sound of an orchestra, strings, horns, piano, thick drums. the moon was fat and full. in its yellow light i sat at the top of stone stairs that led into the valley, and listened. an orchestra. here? a music lover. this late? here? the movement finished, and i stood, dusted myself off. i turned to walk back, full of thoughts, a witness to a beautiful mystery. i saw a man standing at the door of his small house, holding a baby in his arms. “que pasa?” i said, and gestured back to the valley.

  “ella esta muerta,” he said.

  she has died. of course. a dirge.

  last year i was working at st. mike’s hospital in downtown toronto and walked into a room to tell a man he had a badly broken jaw. “what happened?” i asked. “if you don’t mind telling me.”

  “well, i’m not from here, you see,” he replied in a thick native-canadian accent, through clenched, broken teeth. “i came from the nort’. looking to get a job as a counselor. i don’t got any money, eh, don’t know anyone in the city, at least not yet, so i’m staying at a shelter. it’s not very good. lots of drugs. so tonight i saw someone, a brother, selling. i walked up to him and said, ‘what are you doing? you’re poiso
ning us, your own brothers and sisters. don’t you see that?’”

  “they got angry and chased me, then i guess they broke my jaw. but i’m not done with them, doc. i’m just getting started.”

  he is the only real hero i have ever met.

  I AM IN BED, TRYING NOT to think about guns. It is the only thing that seems to put me to sleep. I don’t know why. I don’t remember when I first used the trick, but I can remember my surprise that a character in Jonathan Franzen’s The Corrections does the same. I think there is more war inside of me than I thought.

  … the boy … did i use humidified oxygen … i did … what haven’t i … no … tomorrow … figure it out tomorrow … (yawn)… oh, good … here i go … sleep … no … Thursday today … how many left … shhhhh … tired … quiet … a black hole … that’s what i want … no thoughts … nothing in … nothing out … silent … black …

  The other day, I was walking home in the rain. In the distance, I heard the whine of a siren. Oh, I thought, an ambulance. I guess they’re on their way to the hospital. Wait. What? Ambulance? People arrive on donkeys.

  The sound approached, and a white truck with an ambulance stencil on the door flew past, its siren informing only me and a frightened goat of the emergency it held. When you are considering becoming the driver of a new ambulance in a land of donkeys, the chance to use the siren is a firm pro.

  It was new. From Agok. It was the first I had seen of it. The emergency it contained was a woman who had delivered a child eight days before. In an effort to clean her after, with some half knowledge of sterilization, her family doused her perineum with boiling water. She had thick burns around her vagina and on her buttocks. Three days ago, she developed diarrhea and the burns were deeply infected. The child had died because she was in no condition to feed it. She spent eight days in the bush, screaming.

  … black … crow’s nest … bet I could fall asleep in a crow’s nest … wind … curled up on the wooden planks … listing back and forth … creaking … clouds above wind … starless … tilt … tilt …

  Yesterday, I was administering medicines in the TB area. Developing the program has been a priority for me here. I was cutting foil pill pouches into smaller amounts to make sure taking the correct dose is as easy as possible. Dozens of patients walked in and out, some coughing, others not. I wasn’t wearing a mask. I used to, but I stopped. I watched an inpatient, our newest and sickest, leave the former measles recubra where we placed her because of our bursting rooms. She was leaning on a long stick, which she would plant in front of her, then catch up to. In the morning sun, the two of them cut the thinnest of shadows.

  She slowly picked her way across the field, leaned her back against the wall outside my door, and slid down until her head, hanging between her sharp shoulders, hung between her sharp knees. I finished with the patient in front of me, rose, and tapped her shoulder. She is deaf. She stood, shakily, and sat in the chair. I started to cut the foil.

  As I did, shrill cries came through the window. I knew what they meant. I kept cutting. Angela came to the window, pressed her forehead up against its wire mesh.

  “You know where that’s from, don’t you?” she said.

  I nodded but did not look up. The baby she and I spent three days feeding from a syringe had died because, at some point, we went home to feed ourselves. His relatives were wailing. I finished cutting the pills, and explained through gestures as best I could how to take them. More wailing. I motioned for the next person, and when I looked up to the window again, Angela was gone.

  … tilting … a hard, blue iceberg … take an ice axe and chip out a chair … sit … watch the ocean float a fleet of ice … sun glancing, glinting through cracks … cold bright light …

  Angela and I walked home from the hospital together this morning. I told her that I see her going through a similar transition to the one I did. You feel that if you leave the hospital, let your guard down for one second, someone might die. For fear that it will not get done, you take the syringe and feed the child yourself, you hold it, fret over it. It becomes a symbol of your success, the reason why you came here in the first place. If you can’t save them all, if you can’t be there all of the time, at least you can save this one, at least you can be there this time. So, you try. You keep on looking after him, and even in your sleep, you hang on tightly.

  … cold … statue … crawl into the middle … cold brass … dark … curved … echoes …

  Several years ago I wrote a list of ten things I wanted to do before I die. Sleep inside a statue was one. I have a strong imagination of how deep the sleep would be there, the sharp smell of brass, only the most insistent rays of light bending around corners, muffled museum echoes. I have eyed the Henry Moore sculpture outside Toronto’s Art Gallery of Ontario. It has the right curves, but it is not as deep as my dream.

  … hold it in the right hand … heavier than it looks … steady … now the left … steady …

  22/06: ballast.

  it is friday, our day off. it is 8:30 and the sky is a disappointing blue. at this point, we crave clouds.

  my plan for the day, after i finish this, is to break some ground beside my tukul and make a garden. i am going to plant carrots. i will leave before they are ready to eat, but i can watch them start. and it seems like honest work. like washing dishes. i am looking forward to it.

  i admitted a boy with a blind mother the other day. i didn’t notice at first, but later in the day saw her feeling along the edges of the room towards the door. i took the tube out of her son’s nose this morning, and he is drinking. he is still so very thin, his skin stretched tight over his ribs, like paper over a wire frame, like if you turned your back, he could blow away. but not for long. if we have our say, he will be so fat he will be able to waddle through the eye of a hurricane. after him, the next one the same. in fifty years, people will be writing about abyei’s epidemic of obesity, and the graph will start in 2007.

  i wrote “in twenty years,” erased it and wrote “thirty,” and finally, “fifty.”

  maybe fifty. if i am alive, i will be an old man, eighty-three. i will walk down abyei’s streets, shaking my head. i will stop for a rest in an otherwise empty nutrient shop. the man behind the counter will take off his computer glasses, and smile. he is in his 50s, fat, pleasant. we will start to talk. i will start to tell the story i have already told to five uninterested strangers, how when i was here last, fifty years ago, there was nothing. only a hospital. and now, all this.

  he will shake his head with me. he was born in abyei and, except for a few years in juba, has lived here all his life. he too has seen it change.

  he lived in a tukul, made from grass. there was no electricity, no trains. two of his brothers died from diarrhea. he nearly died too. when he was three.

  “how old are you now?”

  “fifty-three. more or less.”

  “was your mother blind?”

  that is one version of the future. it already exists; it simply needs to be arrived at, uncovered, rolled into place. another is that this place remains forgotten, largely untouched by the best of the best things in the world. your attention, like mine, turns to other more personal matters. we read about abyei tipping once again into war, about thousands displaced. we shake our heads. in fifty years, if i’m alive, i will be an old man. i will look at abyei on google universe and all i will see are sticks and plastic bags fluttering in an empty field.

  but for now, we are here. i meant to say this before, but i haven’t. when i write “we,” i don’t just mean the team or msf, i mean in the larger, more collective sense. you and me, and everyone we know. i mean the “we” as a species that has, through culture and nature, manifested a system of humanitarianism. that supports the idea that we should put ourselves in the middle of places that threaten to tilt into war or be swallowed by disease.

  i believe this sincerely. we are here, you, me, and everyone we know, because there is something inherently valuable to our presence.
it is the concrete manifestation of a quality in all of us, one that when exercised feels entirely correct. the feeling of standing between two people who are angry enough to fight, or stopping to help someone stranded by the side of the road. once you do, you realize the perceived risk is less than the actual one. we all know that it is better than the feeling we have when we turn our heads and pretend not to see. so, that’s why we are here. because of that part i share with you and everyone we know.

  I’M WATCHING MARCO hunt letters on a keyboard.

  “I can type, if you want.”

  He shakes his head. It is midmorning. I left Mohamed in the hospital so I could come back to the compound and do my end-of-mission evaluation. I leave in two weeks, and Marco is leaving on his R&R next Wednesday. I won’t see him again once he goes. Not in Sudan, anyway.

  “So, James … mmm … what would you say you accomplished while you were here?”

  The sky is cloudless. We are edged into the shadow that frames Marco’s tukul. Each minute it grows smaller and we shuffle our chairs to find it again.

  “Um. I think the part I liked most, and worked at the most, was probably the tuberculosis program.” I liked watching people get better instead of watching them die.

  The corners just outside our tukul used to hold scruffs of thin grass. They are now lush, dappled with flowers. As we speak, butterflies jag between them.

  “And I think I did okay with the medical team. I think their morale is good.” Thank god for them. They saved me. Especially Mohamed.

  We skiff our chairs closer to Marco’s tukul. A swallow dives out of his door and circles away. Marco smiles.

  “She has a nest in there. We share.”

  The compound now has brick paths that take us from the gazebo to the kitchen, from our tukuls to the latrines. The floor of the office has been poured. This morning, I watched men spackle its walls. One would take a dustpan of thin cement and fling it onto the wall. The other would smooth it with a plastic blade, work it in larger and larger waves until it disappeared. Both of them were shirtless, spatters of cement on their strong backs. Once the office is built, we will take down the walls that divide compound 1. The tents too.