The guard calls me back to the assessment room within half an hour. I run in but this time there’s a young boy lying on the bed.
‘Where’s the girl?’ I ask.
‘Who?’
‘The girl. Where is she?’
‘Back to the Nutrition,’ says Deng. ‘When this boy come’d, we moved her. Gatwech is looking after her. With Heidi.’
‘Is she all right?’
‘What?’
‘She okay?’
‘Same.’
The boy’s a year old and in much the same state as the girl. Fragile, wasted, desperately fatigued. Why the two severe cases in one night? Is there an outbreak of something? Jesus—is this normal for South Sudan?
His father and three other men sit in silence on the wooden bench along the deep-red wall when I walk in. His mum stands quietly by his side. She looks up meekly at me, says nothing. Deng gathers equipment as I examine the boy. He’s worse than the girl. Not drinking at all, no appetite, and I try to insert an IV line in the back of his hand but miss the little vein and his eyes don’t even flicker. Big eyes for such a little body. His face looks peaceful though his chest is heaving.
I put on a pair of gloves and prepare a nasogastric tube so we can at least start giving fluids, and Deng explains the procedure to mum who then holds her son’s head still. I grasp the tube, push the tip back, through his nose and down his throat, and he cries only weakly. His disapproval is feeble. He doesn’t even have the energy to fight me. It’s a worrying sign.
The tube doesn’t go in properly. I pull it out and his tired eyes dart between mine and his mum’s as he silently sobs. Why are you doing this?, he must be thinking.
Sorry little man. We gotta do it again.
I hate doing this.
We try the other nostril. A dab of lubricating jelly on the tip of the tube and then insert it horizontally, all the way to the back, pushing with a little more force as it curves around the bend at the back of his nose into his nasopharynx. He gags. I push a little harder and the tube suddenly slides easily, down the length of his oesophagus. Deng hands me a large syringe and I fix it to the free end of the tube. A draw back on the plunger confirms the placement as gastric fluid refluxes into the chamber. We tape the end to his cheek and give ReSoMal down it, then a small amount of milk. Deng performs a malaria test. Passers-by are watching from the doorway. It’s now pitch dark outside, and the generator’s humming life into the two bulbs hanging from the roof but there’s still not enough light in here, never enough light in these places.
I set up again for an IV. The little boy passes copious amounts of green diarrhoea with an effortless gurgle, and it oozes like a little green tidal wave across the plastic surface of the examination table. His mum reaches over, mops it with the hem of her blue shawl. She doesn’t even blink. Only a mother would do that.
Deng holds a torch as I retry for an IV, and more green foulness oozes from the boy’s body, spreads across the table but my hands are occupied and I watch as it drips onto the floor next to me. I won’t wear sandals to night calls anymore.
The line goes in. We give fluids and antibiotics, but his diarrhoea keeps flowing. He becomes sleepy. We add dextrose to keep his blood sugar levels up and give extra fluid whenever he passes diarrhoea, and I lose track of time. Ten minutes, six hours—it all feels the same. Eternal moments of watching, standing, and waiting; of doing nothing, then re-examining him and adjusting his infusion, but according to the chart we did that only two minutes ago. Always feels like we’re not doing enough. What we should do is rig up monitors, adjust oxygen and reset alarms, insert half as many central lines as Mr Feldman had going into him in ICU and then yell for X-ray because this is an imminent code-blue, people, on a one-year-old—
Deng’s lamp is running flat. It’s rechargeable, but it needs the sun. Not a great invention for busy nights. He excuses himself and retrieves the one from the surgical ward.
The boy’s diarrhoea won’t settle. We keep giving fluids but for all we give even more shit comes out. Green filth, burbling from his little body. Impossible quantities for such a small boy. I draw up more ReSoMal, and the health worker from the feeding centre comes in.
‘Doctor?’
I look up.
‘The little girl has died.’
I nod.
‘The mother will take the body. In the morning. Is this all right?’
I nod again.
‘There is no father to help bury it. Only a brother, but he is away. So can it stay here?’
Okay.
For hours the little boy stays much the same. We don’t leave the room. His diarrhoea settles and we recheck his fluid status, and some time later he actually starts to sip from a cup if we prop his head up; a small but clear improvement. I re-check everything—his IV line, his tube, the quantities, my notes. What we’re doing is right. I draw up a plan for Deng: what to give every fifteen minutes, what to do each time he has a bowel motion.
I head back to the compound. I’ll come and check on the boy soon, but right now I need a quick bite, a drink, I need to put my head down for a bit because I didn’t sleep much before that outreach closure yesterday and this morning’s ward round begins in a couple of hours from now, and I’m going to have to start from scratch reviewing all those new patients again.
The guard calls me.
Jesus, I fell asleep?
I run to the assessment room.
Two dead children, lying on the table.
The little girl from the feeding centre and the new little boy, just there, right as you walk in. Like two mannequins. They don’t look real. Not old enough to be dead, I think, but I’m forgetting where I am.
I walk over to them and their eyes are open. Not peaceful, not anything, just glazed and expressionless. Their bodies lie side by side on the plastic surface and the boy’s mother is silent, the whole family silent and the generator off and I hear only the noisy breathing of a sick infant next door, and Deng carries over the other portable lamp which is also fading and shines it onto the bodies. I walk to where the mum of the little boy is kneeling at the foot of the table and she looks up at me pleadingly, waiting for me to say something. Surely she knows?
I listen to her son’s chest as a formality. No heartbeat, no breath sounds. I try to shut his eyes but they don’t stay closed, and I wonder why they put the two children together like this, naked, it makes no sense.
I try again to close his eyelids with a soft sweep of my fingers but they remain open. I turn to the mum with the same stupid look of resignation I’ve had on my face far too many times in these places, and I don’t say anything, just look at her, and she grabs my hands and sobs into them. The family on the bench start crying too, so I just stand, don’t move, never knowing what to do because I’m no better at these moments than that very first time this happened in Mavinga.
The mother stands up and begins pacing. Her sobs build, becoming wails. ‘Ayoy ayoy ayoooooooooy . . .!’ she screams. I’ve not ever heard people yell like this before. Strange that cries should sound different in different places.
‘Deng, please tell her I’m sorry.’
‘Yes?’
‘Tell her I’m sorry. Tell the family.’
‘It’s okay—we gave it before.’
I try again but he doesn’t understand me. ‘Is that what you called me for?’ I ask him.
‘Yes.’
‘No other problems in here?’
‘No.’
‘I’m sorry about all of this, Deng.’
‘What?’
‘Nothing. But Deng, could you please cover the bodies next time?’
‘Yes?’
‘The bodies. Can we not leave them like this? And not just near the entrance.’
I turn to walk out but he asks me for boxes. ‘For the bodies,’ he says. ‘We are losing many blankets. It is better we use boxes.’
‘Which boxes?’
‘From the pharmacy.’
‘Yes—like for the medicines. The medicine boxes.’
I get the key to the pharmacy from the small shelf in my hut and fumble around in the room, retrieve two empty cardboard boxes.
I return to the ward with two little coffins.
And walk back to the compound.
And go to bed.
• • •
Morning, and I’m back on the ward just hours later. Self-consciousness engulfs me like a dark cloud as I walk in. The children died just around the corner, beneath this same roof. There are no doors, no privacy. Everyone here knows what happened. Everyone would’ve heard the crying. And I wonder now what the patients think when I come to see them: This new doctor—two patients dead on his first day! My God, whatever you do, don’t take what he prescribes . . .!
Joseph’s waiting for me. He heard about what happened. ‘Very sad,’ he says, ‘but today I have maybe happy newses. I think maybe we should start with this ones, yes?’
I couldn’t agree more. I follow him to the far corner of the ward, a free-standing brick building that’s a replica of the surgical unit—same high tin roof, same white walls painted dark red along their lower half, only this is longer and houses a dozen or so extra beds. Thirty-something patients are in here—men, women, adults and children, all together, all languishing in the diabolical heat. Most will go outside shortly to lie on the dirt in the shade of the eaves.
‘You have met Elizabeths?’ asks Joseph, whose English, aside from a tendency towards the plural form, is excellent. ‘You know, Elizabeths, with the HIVs?’
I do. She’s in a bed at the back right corner of the room. She’s a thin, frail woman in her mid-twenties, with a halo of short black hair. A bright red dress drapes from her bony shoulders like the lining of a sagging, broken tent, and she sits up on her cotton throw-down as we approach. She ideally should have been started on anti-retroviral therapy for HIV when she was admitted two weeks ago, but she doesn’t meet our criteria for therapy; according to the guidelines, she lives too far from town and is consequently at a high risk of defaulting.
‘We have spoken withs her,’ says Joseph, ‘and today she is saying that her family will move. Before, she didn’t wants to move, but now she does. She is getting sicker. She wants treatments.’
Elizabeth stares intently, looking from side to side at us while we discuss her future. Joseph speaks with her in Nuer, a lilting tonal language with soft-sounding consonants and none of the distinctive ‘clicks’ of the Xhosa I’d heard around me in Cape Town.
‘She knows this will be forever?’ I ask, looking at Elizabeth. ‘And that she must take it daily? She knows that she’ll need to see John regularly?’ John’s the supervisor of our small HIV unit, and one of only two members of our Sudanese staff with formal qualifications, having trained as a nurse in Juba. Joseph and the others attended only basic health courses.
‘Yes,’ says Joseph. ‘She knows. John and me talked with her.’
‘Great!’ I smile. ‘Then let’s get the treatment started! I see no reason to wait.’
Joseph translates, and now just look at that: the widest grin you’ve ever seen, and a red dress. There’s not much more to her, really. She’d be thirty kilograms at most. I’m really looking forward to seeing her through this treatment, too; I’ve not treated patients with anti-retrovirals previously, although the manual is currently top of the pile at my bedside.
Elizabeth talks with Joseph.
‘What’s she saying?’ I ask, as he starts to giggle.
‘She wants you to marry her,’ he grins.
‘Oh?’
‘Oh yes—very muches.’ The three other health workers standing with us chuckle, too. ‘She says because you will save her life, she should marry you. And I think this is something for you to consider, yes?’ he smiles, raising a querulous eyebrow.
‘Tell her I’m very flattered,’ I say, suddenly aware of the heat in the room.
‘Doctor?’
‘Honoured,’ I clarify. ‘Tell her I’m very honoured by her proposal,’ which I really am; no less as I turn to see the next of the thirty-something unwell patients in here.
The afternoon starts well. I have lunch with the team, then spend my time flitting between the five plywood cubicles in Outpatients. At some point we hear screaming. I run outside, following the crowd heading towards our main entrance, where there’s a sea of commotion. A flatbed truck has pulled up at the gates. Armed men are milling about, a throng of distressed people gathering rapidly. There are no police, and no soldiers—the guys with guns here are in jeans and T-shirts, and they’re carrying semi-automatic rifles. Some of them look half my age.
An injured man is passed from the back of the truck using an old sheet for a stretcher, then another patient, and another, all laid onto the ground. Marina runs back to get proper carriers. Zoe steps into the fray with an interpreter.
‘How many injured?’ she calls, and the men say that there are only these three. The others are dead.
Marina returns and we load the patients and carry them through the gates. The crowd tries to follow but Zoe steps in, looking improbably calm. She’s a veteran of several years in war-torn contexts, and I watch as this short Dutch woman in her mid-thirties confidently addresses armed Sudanese men who tower a foot or two above her. ‘No guns in the compound!’ she declares. ‘For now, only one relative per patient can enter. Everyone else—please!—wait outside!’
They comply, although they really could do as they please. The guards shut the gate behind us as we carry the injured to the operating block, an old brick building on the river side, where we lie them down. Marina and I make a quick assessment of their wounds. Heidi puts in IV lines as the health workers draw up fluids, and Thomas clears three surgical beds while Ben takes blood samples to screen for transfusions. It’s a polished effort, considering the circumstances. The team have obviously done this before.
Within little time Marina is scrubbed and operating. All of the patients have only limb injuries—one is relatively minor but two involve bone and significant blood loss—and Marina works for the following hours with her two Sudanese theatre assistants. Heidi and I meanwhile stay on the wards. By nightfall, the crowd has dispersed and all three patients are stable, although two of them will now be fixed to brick traction devices for the coming weeks.
And thank God there’s a surgeon out here, I think, because there’s no way I could have handled this as well as Marina did. A pity then that she’s leaving in three weeks, no replacement found yet. A pity as well Zoe’s comment at dinner. ‘We should review our security procedures tomorrow,’ she’d said, ‘because there’ll be payback for this. There’s no doubt.’
• • •
Wednesday morning. The medical ward is by now even more packed, but there’s a saving grace: Joseph. He’s outstanding; organised, efficient, and only too happy to ask about anything he’s unclear of. So too is Peter, the gregarious supervisor of the TB village, who, no less than half a dozen times a day, bounds across the compound to ask if now I’ve got time for his patients. And no less than half a dozen times a day I apologise and ask if it can wait a little—because the watch-tapping health worker and his five Outpatients colleagues deal with a hundred and fifty presentations daily and invariably ask me for second opinions, and John, the HIV nurse, calls me whenever his patients arrive, and Heidi usually likes me to see the sicker kids in Nutrition with her—yet Peter always just smiles and says, ‘Okay, because, it can wait.’ But now it cannot wait, he says. Not this afternoon. And he’s frowning deeply.
‘Young boy,’ he explains, ‘very sick,’ leading me to the square TB hut at the north of the compound. Peter cautions me that I’m not to enter this tukul without a mask as the patients in here have highly infectious coughs. ‘Too dangerous,’ he says, then puts his on and bounds in. He emerges moments later followed by a man carrying a child over his shoulder. The man lies the boy gently on the clay earth outside the entrance. It’s a tragic sight. The boy’s a ghost; skeletal, unable to speak, his body without tone as the father manoeuvres him like a rag doll. His face is fixed in a grimace and he recoils from the sunlight, whimpering like a frightened animal.
I kneel beside him. ‘My God, Peter. How old is this poor child?’
‘Ten years, Doctor.’
‘Are there any other patients like this in these tukuls? Are the others this sick?’ I’ve seen less than half the TB patients so far.
‘Only him,’ Peter assures me.
‘But why didn’t you call me earlier?’
Peter explains that there’d been a management plan before, but now the boy is worsening.
We sit the boy up. Tenacious threads of saliva hang from his mouth, pooling on his raggy T-shirt. The dad spoons them with the side of his hand and wipes it into an old metal tin he’s carrying in his other. I lift up the boy’s shirt to listen to his chest, but stop suddenly: extensive, deep cuts run vertically down the boy’s back, some old and others new, and there’s more scar than healthy skin.
‘Jesus, Peter—has this guy been whipped?’
‘Traditional medicine,’ says Peter. ‘Because, they did it to let the chest problems out. It is from his village.’
I’ve not seen anything to this extent before. Peter tells me that the boy has been ill for a year and was admitted here three weeks ago, but he’s since remained frail. In the last day he’s developed a fever and stopped eating.
We get a sheet and lie him on it. I examine him here, outside the TB hut, then arrange a few tests, including for HIV, haemoglobin, hepatitis, and some other local infections. Ben’s lab here is better equipped than what we’d had in Mavinga. We insert an IV line and add another antibiotic, but the boy can’t swallow well so we put in a nasogastric tube too. I explain to the father how to give milk down it and we watch him give the first bolus, then Peter fetches an old clock from his office to aid him. ‘And sir,’ we caution, ‘you must call us if he vomits, or if anything changes. Okay?’
The father nods. Then bends down, picks up his crumpled boy and carries him back into the gloomy dampness, Peter trailing with the IV line.
• • •
By night-time a gentle breeze has picked up. It’s a pleasant change, but with the cooler air comes the rich smoke from the fires on the far bank, where cattle herders are burning dung to ward off flies. No clouds, though, and the moon illuminates the cracked earth like a floodlight, silhouetting the hospital buildings and conical tops of distant tukuls. I turn my torch off as I make my way across the yard to bed later. I stop, relish the moment, gaze back over the fence, but a sharp CRACK rips into the sky.
I freeze.
Another CRACK.
Gunshots?
I’ve never been anywhere near a gunfight before but this sounds like guns. I can’t tell how close they might be. Great currents of fear wash down my back like an electric shock, what a strange feeling and that explosion in Angola was just the warm-up, this is worse. I should run but I stand still, paralysed by fear. So, I’m clearly not the dashing-bravely-into-battle type that I may have thought. No fight response here, only flight, except my legs aren’t moving.
Another CRACK.
Holy hell it’s all too real. This isn’t like I imagined in the briefings and I’m not willing to die for this work, not like this, not here, I should at least have been treating a patient and not just standing—
‘Safe room!’ yells a voice. It’s Zoe. ‘Get in the safe room!’
The others run over. The dry grass fence surrounding us isn’t going to stop any wayward projectiles and I should follow my teammates but I’m still just standing with my heart in my throat and I’m unsure of which way I should go right now because there’s a problem, a big problem. I can’t just run to the safe room because I was getting ready for bed and this should be the furthest thing in the world from my mind right now but the issue is that I only just stepped out of the shower. I’m not wearing any clothes—only a small towel around my waist. Adrenaline purges my brain of rational thought and I come to the panicked conclusion that I need underwear, because who knows if we’re going to be in that room for hours, days, or weeks, and if I’m going to be shot or holed up it’s not going to be like this—not without underwear. Pride and misdirected terror take over and in nothing resembling an act of fearlessness I make a rapid side trip in the opposite direction to my mud hut just metres away.
I bolt. Fling open the door. Scramble inside, but my bag’s still not unpacked. Fuuuck! I pull it apart, search frantically in the dark because I’m not stupid enough to flick the light on, so I throw things, T-shirts, textbooks, sunscreen, insect repellent, OhMyGod OhMyGod those guns sounded seriously close—Boxers! What about my passport? Where’s my—fuck it, I need to hurry and join the others.
Outside again. Not even ten metres of yard between me and the house but there’s another CRACK, more adrenaline, OhMyGod!, I duck nonexistent bullets as I run, weaving erratically all the time because what if now I get hit and the team find me like this in the morning, right near the latrine, and even worse than wearing just a towel, now clutching my underwear like it’s some sentimental object. I wonder how they’ll explain to my family that my final gesture on this planet wasn’t to reach for a photograph of loved ones or to write a touching note but to fetch this.
Halfway there. Another weave. A dash. My bald head would be gleaming like a white flare under this moon and make for an unmissable target, but I hear no more shots and there’s been probably only a dozen at most so far. I tear through the brick house and out the other side and bang on the heavy steel door of the safe room, which is locked. ‘Open it!’ I yell. ‘Come on!
The rusty blue door swings open and I dart in, shut it behind me and join my team-mates, who are sitting on the mattresses along the wall.
‘Where the fuck were you?’ asks Zoe, as I scamper to the corner.
‘Had to fetch something.’
‘Fetch what?’
I wave my underwear. Nine blank faces stare back. Paul rolls his eyes but everyone else starts to laugh, and I turn my back to them and slide my boxers on beneath my towel, then take my place on a spare mattress. And now, instead of not being hit by a bullet, I begin praying that we won’t have to be evacuated; images play out in my head of the press coverage following our flight from danger as I descend the aircraft stairs behind my colleagues, worried relatives and MSF seniors gathered below, the world’s media, teary parents—and me, in an old pair of boxers.
The shots soon stop. Half an hour later we leave the safe room and I head to bed, fully clothed this time, my passport at the door, although there’s little chance of getting to sleep. Not when drenched in adrenaline like this. And there’s little point, either. A middle-aged patient with liver failure breathes his last just hours later, vomits blood on the cool clay sometime before sunrise. Heidi is up with him and calls me for help but I just kneel uselessly beside the family under a dramatic banner of stars, sponge him occasionally and look up at the sky in between times because there’s nothing else we can do.
• • •
And this is how the week continues. A macabre pattern of sorts, a series of busy but productive days, and sleepless, tragic nights.
On the fourth night, two patients die; a child, before we can even get her to a bed, and an old woman, suffering from a fever we can’t get on top of. The following morning my paranoia regarding how patients may react is validated when two mothers take their children from Nutrition and carry them home. They’re scared about all these deaths, says Joseph. They’re worried that we’re doing this. They say we’re making mistakes.
On the fifth night, it happens again. Another death—perversely, one of the children who’d been carried home by a wary mother. The remaining mothers become even more frightened. Two of them argue with Heidi. ‘If we go home,’ they say, ‘this is what happens! But what if we stay . . .?’ Meanwhile, we admit three new patients, one of whom has frequent seizures overnight.
On the sixth day, a teenage boy is carried in following a gunfight far outside town. He’s suffering severe abdominal injuries, and dies while Marina’s operating on him.
On the sixth night there are no deaths, but now a new problem: a woman has arrived in labour, and we’ve got no midwife. Carol walked out this morning. Just up and left, trudged past our breakfast table dragging her suitcase, and got onto the supply flight. Zoe said to leave it. It’d been a long time coming, apparently; there’s been ongoing personality differences among some of the medical staff, and the gunshots were likely the final straw. But working without a midwife is a huge problem, and Carol in particular has three decades of experience. Big shoes to fill. As I discover tonight, shortly after ushering the labouring woman to the small room behind theatre.
‘Delivered?’ asked Deng, looking at me uncertainly.
‘Yes—babies. You delivered a baby?’
‘Never. But I would like to.’
‘Good. Anyone else here that can help?’
‘Gatwech.’
‘Has he delivered before?’
‘Never!’
‘Who normally helps Carol then?’
Two women, says Deng, though he doesn’t know how to contact them. Nor does he know where the keys to the obstetric cupboard are. I’ve got no idea either, so the pair of us run around and quickly try to assemble what we need from the other wards, and by midnight I’m shredded, my mind foggy and I’m desperately in need of sleep, and I’m tempted to just kick the fucking cupboard door open because this is the last thing I need; and like most first-time deliveries I’ve dealt with, mum lingers in labour for most of the night until sometime just before sunrise she bites her bottom lip, moans slightly, and a pushes a healthy, bald little Sudanese boy out into the world.
Which is how my seventh day begins.
How it continues is much the same. Busily, mostly with the young boy from the TB village, who’s become jaundiced.
How it ends is a different story.
Heidi kindly agrees to do my on call. It’s a promising enough start to the night but we end up together in the safe room after gunshots anyway, very much awake. Not long after we get out, the guard is back at my tukul again.
‘SHAMIANE!’ he yells; he can’t get the ‘D’ right in my name.
‘Heidi’s on call,’ I say. ‘Heidi. Not me.’
‘Yes?’
‘HEIDI. CALL HEIDI—NEXT DOOR.’
‘Shamiane?’
‘HEIDI!’
‘Hello?’
Fuck it. I get up and stomp across the yard to Inpatients. This had better be justified, this call. Seven nights of being repeatedly woken—I don’t mind when it’s for the severe cases, but too often it’s been for minor things that could wait—but an unusually cheery ‘Good morning!’ greets me as I enter the ward. Not what I’d have expected if this were an emergency.
‘What’s the problem, Deng?’
‘Just a little question,’ he says, leading me down the ward. We step carefully between the sleeping bodies filling every available bit of floor and bedspace. A tunnel of light from my headlamp, but it’s otherwise pitch dark. No one stirs. Halfway down to our right, a bag of blood is emptying its last drops into the vein of a woman with anaemia; beside her, a young infant with a respiratory condition breathes as if sucking the dregs of a thick milkshake through a straw. We pass them, stopping at the bed of a man who’d arrived yesterday with marked facial swelling—the result of a snakebite to his scalp (it happened while he was sleeping, he says). He’s since had a good dose of antivenom and antibiotics.
Deng picks up his drug chart. ‘It says to give this one,’ he says, pointing to a medication name on it.
I agree.
‘What must we do?’ he asks.
‘With what?
‘What do you mean?’
Deng looks at me uncertainly.
‘Well?’ I ask.
‘We are just making sure you wanted this,’ he says. ‘And we are wanting to check the dose.’
I turn to walk out. The first cracks in my façade of calmness are going to reveal themselves if I don’t get away now, but Deng follows me. I stop. I’d like to give him the benefit of the doubt and assume that his real question has been lost in translation, but I don’t. I unleash all of my exasperation on the man. I pull him away from the ward and give him an earful as he stands quietly and wears it, looking down, his head a good foot above mine. When I finally stop he sheepishly asks me to confirm the drug dose before I leave.
‘The normal dose, Deng.’
He’s not sure what that is.
I step inside and find the MSF drug book. Copies are on all the wards. It’s the standard manual for health workers in all projects, and easy enough to follow. ‘You look it up, Deng. I’m not doing your job for you.’
He thumbs through the book, flicking the pages.
‘Flucloxacillin, Deng. “F”. Look it up in the index.’
He looks at me.
‘The index—the back of the book.’
He stares.
I take the book and open it to the index, hand it back to him.
‘Pro. Pran—’ he sounds out.
‘That’s “P”, Deng. Flucloxacillin is with an “F”. Go to “F”.’
He flicks the pages. Backwards, then forwards, completely randomly. He sounds out words. ‘Sal. Bu. Ta—.’
‘Jesus, Deng! Here. “F: Flucloxacillin”—page sixty. It’s arranged like the alphabet. See? And here are all the doses. So now you look at this table, and you tell me what dose you’re going to give an adult.’
For a long time he stares at the page and says nothing. He tracks the text with his finger as he sounds out each word, slowly, determined to find the dose, and I want to crawl into a hole suddenly because look at me, what a big man I am right now: berating a young, semi-literate, junior health worker who’d grown up in a war. When did I cross this line? I’ve seen behaviour like this in some others in the past. I’ve seen it in volunteers, even among the local staff, and I loathe it. I caught myself doing it in Mozambique, too—a large group of people kept pushing into our tent, crowding it, and I repeatedly raised my voice to tell them to stay back or we’d have to leave; in the crowd I no longer saw individuals, just a wall of demands.
I take the book from Deng. ‘I’ve just had a bad week,’ I tell him. ‘I’m sorry, mate. It’s not you. I’m just being an arse. I’m tired. I’m really sorry.’
His reply disarms me. ‘The doctor here is like a father,’ he says, graciously. ‘We respect them very much. But for us, it is very hard. Sometimes the doctor will not like it if we call. Sometimes they get angry if we do not. I am sorry for calling you.’
I tell him he needn’t be. Wake me whenever, I say.
And I go back to bed.
And bury myself under my mosquito net. Deeply, horribly embarrassed.
• • •
But embarrassment is the least of it by the next afternoon, now my eighth since coming back. I’m more unnerved: the TB boy has died. He’s the ninth patient to die during this past week. Our catchment area is huge; one hundred and sixty thousand people, we think, making it well over five times Mavinga’s, and the team here see forty thousand outpatients a year and admit five thousand others. Even so, this number of deaths is worrying.
In the afternoon, myself, Heidi, Marina, and Zoe (who’s an experienced nurse, although working non-clinically in this project) all meet to talk about it. We gather at our outdoor table in the shade of a large tree, where we spread out the patients’ charts and try to find a pattern to these deaths. Are we doing something wrong? Overlooking something obvious? I find myself getting defensive as we go through each of the cases: what if the underlying problem is me?
I tell the others that I’ll tabulate the patient data, looking closely at how and when the patients died. I’ll talk with Joseph and the nutrition guys, go through all the protocols they’re using and make spreadsheets, and I keep talking because if I stop I’m either going to cry or fall asleep. But Marina’s great. She assures me it’s been a far busier week than normal, and reminds me that we’ve all lost patients—not just the ones under my care are dying. And the thing to do, as I’d learned well in Mavinga, is to focus at times like this on the positives. So I do. I think of the fifty-plus inpatients, the forty TB patients, the twenty-two malnourished children, the dozen HIV patients, and this week’s thirteen hundred outpatients who’re currently doing okay.
In aid of such reflections, Marina fetches cold Ethiopian Bedele beers. We lean back in our chairs as we sip on them, regard those smoky dung-fires and the sun that’s dropping slowly behind our fence, but I see sudden movement at the gate.
I cringe.
I can’t possibly deal with another emergency.
I look over hesitantly.
The guard?
It’s not the guard. It’s a little boy who lives in the TB village, and who I only ever see wearing beads—a white string around his waist, red around his neck and not a stitch of clothing—and he’s standing with hands on hips, watching us. He waves hesitantly when I do but otherwise just stands, completely still. Regarding us. Concentrating and contemplating, his podgy belly out and little eyes squinting, and his head tilted just slightly.
I’d give anything to know what he’s thinking.