Like highways, these dawn skies. I stand at our fence watching thousands of bats return from their nocturnal food hunts to settle into the few trees on the far riverbank. They chirp noisily as if swapping stories from last night, jostling and crowding upside-down in dense clusters where they’ll hang like fat black plums from the broad branches and sleep the day away. Then it’s the water birds—herons, we think; hundreds of them flying in almost perfect arrowhead formations, off to some mysterious swamp somewhere. They’ll return this evening in much the same manner, too: a single bird at the front, the others trailing neatly behind. No bird ever strays. Periodically, the leader will drop to the back, the next bird momentarily picking up his pace to assume the role of guide as they plough on, the whooshing of their collective wings audible even from inside my tukul. A glorious sound to wake up to.
It’s late in the second week and I’m up earlier than normal. The rest of the team are still in bed but Paul’s already busy, cutting long beams for the new nutrition ward with hand tools before the sun climbs. At our front gate, the best-dressed MSF employee I’ve ever met—European offices included—has meanwhile arrived for work: our guard, who’s this morning back on day shifts, wearing a full black suit with neat business shirt and tie. ‘Hi, Dennis,’ he smiles, and I smile back: two weeks of cajoling, and we’ve just moved on from Shamiane.
The main hospital yard is still. Nothing like what it’ll be in an hour. For now only a few kids play near the fence, and a handful of women are boiling water in the communal fire-pit behind Nutrition, using pots that look like relics from the British colonial era (and that may well be). Beside them, the hospital cook is stirring the patients’ breakfasts—mud-brown sorghum, bubbling in a large pot like thick lava—with a length of wood that looks suspiciously like the oar of an old rowboat (and that also may well be). I stop to greet them; then, avoiding the wards entirely, head straight for the main entrance, where David, the watch-tapping health worker from Outpatients, is going to meet me. He’s promised to show me his home before rounds.
David and I stroll north, away from the river, and head against Nasir’s morning traffic—a single UN LandCruiser, two trucks from the military compound, hundreds of people walking towards the market, and the groups of kids who’re hopefully off to one of the schools. A few bicycles are around, too, and even some taxis—also bicycles, these ones adorned with bright plastic flags or boldly painted signs, and whose riders will give you a lift on the back rack for a few Sudanese pounds.
‘My house is not a very big house,’ David apologises. He shows me into a grass-walled enclosure, one of a small cluster of compounds about five minutes from the hospital. Within it, three tukuls and a plastic-roofed shed are arranged around his dry yard, a few goats wandering about. Unusually for an African village, there are no fowl—the Nuer don’t eat birds.
David leads me inside the first tukul (two single beds, a table and some chairs provide the furnishings), and I’m immediately impressed. They’re clearly not easy to build. The wall is circular and mud-covered, but the roof reveals the intricacy of the inner frame—a latticework of thicker sticks bent carefully into shape, dozens of smaller wooden ribs tied across them using natural twine, and thick straw woven over the top of it all. The shape conferred from the outside is that of a giant, grass-coloured Bacci chocolate; the larger tukuls, used as cattle byres, reach over four metres in height. Seeing hundreds of these near-conical structures on a barren moonscape, all silhouetted against a red sky each evening, is quite other-worldly.
A group of kids jostle in the doorway. ‘These all your children?’ I ask David, but he laughs. No way, he says. He has only five children to two wives, all of whom live in this compound. He points out his three younger ones and explains that the older one is in Juba, and another son with the herd. ‘These other ones, they have come to see you. I think they have never seen a Khawaja [white person] so close before.’
I’m inclined to agree. I’ve become used to the startled reactions of some children to seeing me these past years—the fleeing, the screaming, the transfixed staring or the more adventurous patting and prodding of my skin—but these kids take the prize. Three kneel down and pull gently at my leg hairs. Two of the younger boys have taken instead to rubbing my forearm, and as my arm heats up they rub it more vigorously, faster each moment, and I wonder what on earth they’re doing. One of the boys stops to cool his hand with spit but immediately resumes rubbing, even faster this time, and it dawns on me that perhaps they think I’m also black—that beneath a layer of white, firmly adherent dirt, I too have the same wonderfully dark complexion as them.
David shoos the kids away and shows me proudly around the rest of his compound. ‘But it is not like your home,’ he says. ‘I am sure your home in America is big, yes?’
‘In Australia,’ I reply. ‘I’m from Australia. Do you know it?’
He turns. ‘Oh—Melbourne, or Sydney?’
This I didn’t expect. I tell him Melbourne, and his face lights up.
‘Oh! My friend is living in Werringbee.’
I stop dead. Blown away!—that this man, who’s surely not ever been out of the region, can name a suburb in Melbourne! I ask him if he’s been there, and he says no.
‘But many Sudan peoples went to Australia,’ he says, which is a fact I’d discovered inadvertently while working in a small coastal town a few years ago. Several Dinka families had been resettled there as part of Australia’s intake of twenty thousand South Sudanese over recent years, creating a small but highly conspicuous group in an otherwise very white town. What they must have thought when arriving in a rainy, affluent coastal town in the throes of a southern winter, having been recently ushered from a hot, dry, crowded refugee camp, I can’t imagine.
Nor can I imagine what the town’s people would have thought. Because even having spent time in Africa, I find the Nuer remarkable looking. Take David as an example: six-foot three with long, thin limbs and utterly black skin; a soft, handsome face; and the distinctive dentition of many of the adults here—the absence of his lower front teeth and two upper canines due to ritual extraction during childhood. (These teeth, the Nuer believe, make people look like hyenas.) And then there’s the gaar—those six prominent scars across the forehead, the incisions having been made so deeply that it’s said that marks can be seen on skulls found in the region.
David nods vigorously when I ask if he remembers having it done. He was about fourteen, he says. ‘It is when a boy becomes a man, and he must not cry. It is a shame to cry. And he must not move. If he moves, it will not be straight, and everyone will know forever that he was not brave.’ He was very much awake at the time, he explains, the procedure having been performed with a sharp knife by the Gur, a ceremonial leader, following which—ensuring a truly memorable afternoon—the initiates were circumcised. But it’s a proud moment, David tells me, and the point at which a man will be given his first head of cattle.
What I’d really like to ask David though is about the war, and more specifically how he’d survived: Nasir was the scene of some of the worst of it. For decades the northern government armed and encouraged horseback-mounted Arab militias, known as djellabas (not unlike Darfur’s infamous janjaweed), to conduct raids on southern villages. Homes were torched, women raped and children taken into slavery, with many thousands of others killed. As well, the region was bombed extensively by government planes; in Nasir alone, the crowded hospital and UN feeding centres were hit on more than one occasion, a fact to which the twisted beams of metal in the corner of our compound still attest.
Things took an even worse turn here in the early 1990s, when the southern forces—the SPLA, or Sudan People’s Liberation Army, a group ostensibly formed to defend the people here—split into two factions: a Nuer faction, and a second, Dinka-based faction. Now, Southerners were pitted against each other along tribal lines, and a war-within-a-war ensued—a conflict every bit as devastating as the north–south war, which meanwhile continued. Both tribes attacked the others’ villages. Both were responsible for rapes, kidnappings, and the burning of essential crops. And both continued like this for almost a decade, until an agreement between the respective southern leaders in 2002, just three years before the north–south war ended.
As in all these conflicts, though, it wasn’t just violence that caused deaths. Starvation and disease took a greater toll. When MSF first arrived in 1988, a parasitic illness called Kala-azar had killed a hundred thousand people near Nasir—around one-third of that area’s population. My briefing documents described volunteers coming across villages that were either deserted or filled with bodies. And then there were the food shortages. In 1988, a quarter of a million South Sudanese starved to death. Barely three years later, another food crisis resulted in thousands dying along this riverbank, with individuals so desperate they were seen to be digging in search of any grain stored in ant nests. In 1998 the region was again on the verge of another catastrophe, and an international aid effort named Operation Lifeline Sudan was set up, carrying out widespread food distributions (mostly by air drops, using Lokichoggio as a base) that at its peak cost donors over a million US dollars a day—the largest effort of its kind since the Berlin airlift.
Perversely, the manipulation of this food aid was a feature of the war, and perpetrated by all sides. The north threatened to shoot any plane it didn’t expressly authorise, and southern rebel leaders frequently dictated where and how the aid was to be delivered. In a more extreme example, the leader of the SPLA in Nasir was suspected of deliberately keeping twenty thousand people in a state of perpetual starvation nearby so as to bait further deliveries.
Yet walking around here, as in Mavinga, I find it hard to reconcile such stories with what I see. The kids are still with us (they sneak back within moments of David shooing them away, jostling to hold my hand, one of the smaller ones happy enough with just a thumb), and the oldest would be no more than ten. When I was last in Loki, a colleague had lent me two memoirs, both being the first-hand accounts of young boys who’d fled fighting during the war—boys of about the same age as these kids now with us. These children, having survived the raids on their villages, and being unsure as to whether their families were alive or not, walked for months across Sudan in the late 1980s, arriving in Ethiopia like ‘walking skeletons’. Camps were set up to accommodate them, and more generally the growing numbers of Sudanese being displaced from all over the south, but Ethiopia’s own security situation deteriorated and they were forced to move again, this time south to Lokichoggio—on foot. Many spent their next decades in the refugee camps nearby.
More than twenty-five thousand children made this journey overall, either alone or in groups, and became known collectively as the ‘Lost Boys of Sudan’. Few girls set out. Boys survived the militia raids because they were tending to cattle away from their villages when they occurred, whereas girls were either killed or taken into slavery; and of those boys who did escape, at least one in five died travelling. It goes without saying then that the accounts of their journeys are heartbreaking. Of an aerial bombing raid, for example, one boy wrote that there was a plane standing above the trees, pouring fire on them; another boy noted that during the walk he’d envied those who had a cup of urine to drink, and that the journey had become a game where the object for him was to go as far as he could before dying. I did manage a smile, however: on being given milk and butter as part of his rations in an Ethiopian refugee camp, one boy pondered how the UN could possibly own enough cows to produce such quantities of dairy.
So, could David have been in this group? Very possibly. As too could Joseph, Peter, John, Gatwech, Deng—any of our two dozen health workers. Almost all are men in their thirties and forties, the same demographic as the Lost Boys, and all had to have learned English somewhere. A refugee camp is as likely a place as any. (Birthdays are a giveaway for someone having spent time in them: a significant number of our staff and patients list theirs as being January 1st, a date conferred by unimaginative registrations staff at the camps.)
But I ask David about none of this. I’d hate to upset him. He looks delighted showing me around. And I’d previously tried to ask staff about such experiences, and it hadn’t gone well. I’d asked Roberto about the Angolan war, sometime towards the end of my time there when we’d started to banter a little in the afternoons, but he just looked away, said only ‘Confusão,’ and stayed quiet. It killed the conversation. And I see the consequences of mental stress often enough in this hospital to know that it’s an issue here. Since I’ve arrived, we’ve admitted a dozen patients, usually women, whose conditions are almost certainly a manifestation of psychological trauma: pseudoseizures—atypical, non-epileptic seizures that tend to respond promptly to a placebo; extreme states of hysteria, including the transient inability to speak, dramatic outbursts followed by a collapse, or other unusual neurological symptoms; or just inconsolable crying. All of which seem to improve with a night on the wards, some reassurance, and the doting of loved ones. (And I wonder as well, with regard to the men, whether these gunfights aren’t another expression of trauma—or at the least a result of desensitisation to violence, given a lifetime of exposure to it.)
David looks at his watch. ‘Already eights,’ he says: time to get to work. I’m not quite ready to head back, though. This is what I didn’t get to do enough in Mavinga, just spend time with staff, and I’m quietly intrigued by him, his kids, and really all of these Nuer people. That some of them show symptoms of post-traumatic stress disorder isn’t what surprises me—it’s that not all of them do. Maurice was right. These people are tough.
David’s tapping his watch now. I know, I tell him, but I remind him that he did also promise to show me the fish market.
‘Yes, but we will be late,’ he says.
I shrug. He laughs; the fish market it is.
• • •
Carol, our midwife, returns the week after walking out. She still doesn’t want to talk about it although she at least seems rested, and things have generally settled this week—no more gunfights, fewer deaths, and what I assume is the more normal routine has set in: busy mornings, a long lunch break (staff go home at one and return at four to avoid the hotter hours), and late afternoons spent in the hospital again; and, if we’re lucky, pleasant, lazy evenings at the outdoor table, or sitting on the riverbank, or watching DVDs in the room with the bats. Morale seems okay even if people are tired, and there’re enough of us here to at least allow for some social variety.
On Saturday afternoon Zoe attends a meeting in town with the UN and local police representatives. She calls the ten of us expats to the outdoor table when she returns, and tells us that they’re expecting an escalation of these raids. ‘They’ve seen members of the Lou clan heading this way,’ she says, ‘so the other groups are moving their herds closer to town for protection.’
There’s a collective groan. In a region where banks don’t exist, cattle traditionally represent the only significant way for a person to accumulate wealth. Having what’s tantamount to gold-bullion-on-legs wandering around us is a sure recipe for trouble—no less given that the two larger clans along the Sobat River here, the Lou and Jikany Nuer, have a long history of animosity toward each other.
‘When are they going to get here?’ asks Paul, towelling his forehead. ‘When can we look forward to this?’
‘Two to three days,’ says Zoe. ‘Maybe longer. They may wait for the next full moon.’
Paul shakes his head. This presumably isn’t the first warning he’s heard in the eight months he’s been here. It’s his first stint with an aid organisation, a long-term ambition, he’d told me, and the question that’s half-jokingly thrown around among aid workers—‘What are you running from?’—is, I suspect, largely redundant in his case. He’s a successful businessman who turned sixty just last month (no wrinkles yet but his brown beard is starting to grey, although I’m still deeply jealous of it—now a thick, bushy, ‘I’ve been in Africa for months’ kind of affair), and he’d left a supportive wife and daughter in New Zealand to do this. And he works hard—puts in at least as many hours as any of us who’re half his age, but he’s clearly anxious to get home in the coming weeks.
‘Look,’ says Zoe, ‘it may all amount to nothing. The police are going to keep a close eye on things, so let’s hope. But it’s a good time for us to revise our security procedures. So, first thing is the grab-packs. Make sure they’re easy to find. Keep them with a small bag of valuables—maybe tie them together, but limit it all to four or five kilos—and place it near your door, somewhere you can find it easily at night. It’s a good idea to keep your passports and entry permits with them.’
The grab-packs are something we’d all been issued with in Loki, just after being shown how to assemble a large, rucksack-mounted UHF radio for emergency communications. Each pack is a generic hip bag, filled with survival essentials including a lighter, compass, pocket-knife, thermal blanket, water purification tablets, and, somewhat bizarrely, condoms—not something I can foresee needing while fleeing through a swamp. Even more useless than condoms though is my South Sudan entry permit; despite my having submitted a detailed application form and a dozen colour passport photos in support of it, the official document has me listed as being a seventy-seven centimetres high, black-eyed, brown-haired Australian national—an evil-looking, hirsute, Antipodean dwarf. It’ll be interesting to see what a soldier makes of it if I’m pulled aside.
‘The safe room is obviously the place to go if you hear gunshots,’ continues Zoe. ‘If you’re on the brick wards or in theatre, stay there, but waiting in the tukuls is pointless. Also, I think we should avoid going into town for the next few days. Okay, in terms of evacuation, we’ll ideally get flown out, but it takes at least two hours for the plane to get here. And we’ll need to be able to get to the airstrip, so it’s only possible if things settle. Our second option is the cars. If we need to get out of here immediately, we drive, but there’s obviously no way we can get to Kenya. We could drive to the UN compound, but only if we’re really desperate.’
As a rule we’re to avoid all non-essential contact with the UN. Our security stems from our being perceived as strictly neutral by all groups, rather than from any reliance on armed guards or impenetrable fences. (Somalia is the only context in which MSF routinely operate with that level of precaution.) If people really want to get into our compound here, they will. It’s by taking no sides, and by treating everyone—for free, at any time, and regardless of clan affiliations, political allegiances, religion or ethnic group, among other conceivable variables—that we ensure our security. And so far there’s been no hostility targeted towards us here. The risk, although small, of being accidentally caught in crossfire during one of these raids is our only major issue—for now.
‘Our third option is the boats,’ says Zoe. ‘Paul and Anwar, you guys please need to make sure that both are ready, and that there’s spare fuel. So, nothing we haven’t discussed before. Any questions?’
We move on. It’s already late afternoon, the sun drawing long shadows across the dry compound. A dozen little birds chirp brightly above us in the branches of the large tree, plopping their contributions onto the table with impressive regularity as Heidi updates us on the Nutrition unit.
‘It’s always at night,’ she says, speaking of the two children who’ve died in the past week. ‘Always.’
‘It’s classic,’ says Zoe. ‘Death rates are always higher in these centres overnight. You need to make sure that meals aren’t being skipped. Are the mothers waking up to help give them? Is the health worker checking the kids’ vital signs regularly? Do they call you or Damien as soon as things deteriorate, rather than waiting until the child’s really in trouble?’
‘No!’ says Heidi, with endearing German feistiness. She reminds me increasingly of Andrea: frustrated by the context, enamoured of the people, desperate to make a difference and at her happiest when working with the kids. (A small posse follow her for much of the day, including a young boy who insists she carry him, and who she’s nicknamed ‘Breast Man’ due to his propensity to grab said object on anyone nearby—men included—presumably for a feed.)
‘I am sure the health workers sleep,’ says Heidi. ‘Last night I got up to check on a young girl, but she hadn’t been given milk for hours. When I asked Gatwech why, he said that the container had run out. So why did he not mix some more? Oh, he said, because it was more difficult to mix at night. He said that there was no rush, that the morning staff could do it! And the mothers? Have you tried to wake them? Some are so difficult! They get funny with me because they want to sleep, and if we push too much they want to leave. One even wanted me to pay her to wake up! I really don’t get it.’
I agree with her. There are some serious cultural misunderstandings here—from both sides. A few of the parents seem deeply mistrusting of us. We try often to convince mothers not to take their children early, but they’re extremely suspicious, almost superstitious. If a child with a nasogastric tube gets worse, mothers will remove tubes from their own kids. If a child dies after drinking ReSoMal, they’ll refuse that drink. So we explain the treatment to them. We point to the healthy kids and assure them that they all had the same treatment, then we go in circles, explain it again, then beg, and finally just insist: I tell them that the child will die if they take them home, because any cultural sensitivity on my part is vastly overshadowed by my concern for the kids.
In terms of supervision we float the idea of rostering one of us to stay awake overnight, but it’s simply not feasible. We’re awake at least every third night anyway. I suggest creating another volunteer position dedicated purely to staff training, but Zoe says it’s impossible. Merely keeping these four projects staffed at minimum capacity is challenge enough, and MSF are currently ramping up projects in the Abyei border region, where north–south clashes have increased.
• • •
It’s getting late. We wind up the meeting with a quick whip round for any last comments. Anwar, the soft-spoken Indonesian log, is happy, nothing more to add. So too is Maya, the office administrator. Heidi doesn’t want to be on call tonight (she was up all of last night), and Marina requests only that she also attend the next meeting with the UN Peacekeeping commander, because he’s apparently cute, and she’s been stuck in this compound for most of the past months. Carol laughs. Paul meanwhile heads for the latrine, creating an appropriate segue for Amos, our jovial Kenyan water and sanitation engineer, to make his last point.
‘I am telling you,’ he says, pointing in Paul’s direction, ‘something is not right. Look at that man. Look! Always, he gets sick. Then it was Damien—who even got a flight!—and now it is me. Something is not right in that kitchen. I am telling you, our cook is doing something strange. I have been coming to Sudan for many years, and I have never been sick so much. Never! Last week, Damien gave me antibiotics, but now, already—already!—I sheet all the time.’
The team laugh.
‘It is not funny,’ says Amos, though he too is laughing. ‘I am telling you, if I cannot stop this I will waste away. Paul is already wasting away. And what if I start? I will waste very quickly. Look at me!’
We’re in hysterics. Amos is a giant of a Kenyan, tall and thick-limbed, with probably the largest belly in the region.
‘It is this food,’ he says. ‘Something is not right with it. Paul and me checked the water again yesterday, but the chlorine is good. So it is not the water. But it is something. I am telling you. And I cannot go on like this, Zoe. All this sheeting—I cannot do it.’
—But still he’s laughing.
The generator hums suddenly into life, and a race ensues: if Amos reaches the TV first, it’ll be action movies for the night; Heidi, and it’ll be chick-flicks or sitcoms. The others fetch beers and stay put, and for the moment it’s fractionally cooler outside so I remain here. Not long afterwards the guard calls me through the gate.
‘No,’ I say. ‘It’s Damien. D. A. M. I. E. N.’
‘Desmine?’
I chuckle as he walks me to Inpatients, where Joseph has called for help, while trying to correct his pronunciation once more.
‘Okay, yes,’ he says. ‘Desmien?’
‘No, Damien.’
‘Demine?’
‘Better Dennis,’ I say. ‘Let’s stick with Dennis, okay?’
‘Okay,’ he grins back, shining his torch ahead, guiding me into the assessment room. I see Joseph here, his shirt still neatly buttoned to the collar even after ten hours in this place. He’d have made a far better doctor than me, I’ve concluded, if only he’d had the opportunity. As would so many others I’ve worked with.
‘Looks,’ he says, unusually seriously. He’s standing beside the assessment table, putting an IV cannula into the hand of a young girl. She looks up at us. Her hair’s braided with colourful beads, and she’s got a simple string ribbon for a necklace. She’s naked but for a pair of old white shorts, but we don’t cover her up. The Nuer aren’t particularly self-conscious about nudity.
‘Bad fever,’ says Joseph, as I hold her arm steady for him. But the girl pushes us away, rolls feebly onto her side and moans for her mother. We catch her before she falls. The mother takes her for a moment and sits on the floor and cradles her, and the little girl sits in her mother’s lap and looks up at her, then blinks, sighs softly, and gently empties her bowels.
Then dies.
Just like that.
Joseph tries gently to pick her from the mother’s arms to resuscitate her but the little sister throws herself onto the body; kids bringing up kids, now kids mourning kids; so we leave them. There’s no point interfering. I’ve not ever seen a child resuscitated from this state. Not in these places, not with those sunken eyes and tissue-paper skin.
We give them a blanket. When they leave, Joseph and I start seeing the three other families who’ve been sitting on the benches against the wall just metres away during all this, waiting to be assessed for their own health problems, and I wonder what they must think. Perhaps that it’s just another sad day in South Sudan, because none of them walk away and they’re all very grateful to be seen when we finally get to them.
Afterwards, I go back to the compound to join Heidi, who did make it to the TV first, and she asks me what happened. I say only that there were a few admissions, and I instead throw the question at her because she’s watching Friends, and it’s up to the series finale, I think, and Rachael and Ross have got back together and although I never had any interest in the show in Australia I’m taking a keen interest here, suddenly engaged, a lump in my throat and this strange—
Jesus. I’m crying.
While watching Friends?
This is embarrassing.
I never do cry in these projects except for that time we’d operated on Roberto’s niece, but I suspect that I should, because something’s got to give, or break. Heidi’s fortunately too engrossed with Ross, who’s now kissing Rachael, to notice at first, but when she does look over she says exactly the right thing—nothing—and just gives me a soft look and asks if I’d like something to eat. I say Yes thanks, and lie back on the mattress, watching as our resident bats fly their sorties down the corridor, past the five bedrooms then back around quickly, bundling over me and into the kitchen like leathery winged golf balls that never so much as glance a wingtip.
But before dinner comes Dennis is yet again summoned. And Dennis cringes even though he quite likes that he’s at least being called Dennis these days (and notes too that he’s also beginning to refer to himself in the third person—perhaps this is what missions do to you after a while), but when Dennis gets to the gate this time he smiles broadly, in part from relief, in part bemusement, because it turns out this is a good summons. Just some visitors at the gate. The little boy with the beads, and two of his friends.
He came past earlier and stood here quietly, staring, and I never do know what to do with him because he always looks so serious. Trying to make him smile, I picked him up beneath his arms, threw him straight into the air and caught him again, but as soon as his feet touched the ground he ran off—fast—so I assumed I’d upset him.
Apparently I didn’t. He’s back. And now standing with arms raised (although still looking serious), as are his two recruits. He does a little jump and waves his arms in case I’m not clear about what he wants, but I am. So I do it—I pick them up. I fling them as high as I can, several times each, and the contrast with what just happened on the ward isn’t lost on me.