The rain holds off the next morning. It’s still cloudy, but Paul checks the airstrip at dawn and thinks it’ll be fine. We radio Loki. They send the plane, and I stare anxiously at the dark clouds brooding to the north, would blow them away if I could because the plane can still turn back, but they stay put and the flight lands safely. The patient and one relative are evacuated. A couple of hours later I phone the surgeon receiving him, and he agrees that the leg is beyond salvage. He’s a Congolese man, though, so I can only hope that the family will respect a fellow African’s opinion more. He’ll let me know.
And we were lucky, it seems. In coming weeks rains of almost biblical proportions regularly batter the town, causing frequent flight cancellations (more cases need transfer but none are as urgent), although I do enjoy listening to the storms. Especially since moving into a bedroom in the old missionary house. I sleep better knowing the walls aren’t water-soluble.
By mid-June the river’s visible from our kitchen window, lapping not far from the top of the banks—the same banks on which our compound is built. The current is swift, sweeping clumps of water weeds silently west along the muddy surface, and the dugout canoes that ferry people and goods across it are now carried hundreds of metres downstream during just the short crossing. Beyond the far bank, what was until recently an endless expanse of dry land is now a large, shallow lagoon pooling alongside the river, its surface broken by a series of low islands and peninsulas on which lush grasses are already thriving. And all this is within just a month of the first rains. It’s testimony to how completely flat this region is; although water levels in the Sudd’s channels rise by only a metre and a half in the wet, even this small change will lead to a quadrupling in the size of swampland. Many Nuer will now move from the lowland cattle camps of the dry season to their higher, wet season villages, planting sorghum and maize in anticipation of an October harvest.
‘Does it ever flood in here?’ I ask Amos. It’s the Tuesday of my ninth week. He’s heaping plastic spoons of instant coffee into a mug, just beside me in the kitchen.
‘It does,’ he laughs, and he’d know. He’s worked in these South Sudan projects for much of the last five years, returning home every few months to spend time with his family in Kenya. ‘Sometimes, the water will come right in here. Right into the compound.’
‘Seriously?’
‘Oh yes! You will be living in those boots, my friend. Get used to them!’
I grab a biscuit and jump the low windowsill into the bats’ room—one of two entrances to our main corridor—then head through and wait outside the shower for my turn, sitting on one of the large food storage containers. Paul soon comes around the corner, his pants muddied and face a little off-colour.
‘Sick again, mate?’
He nods.
‘Squirts?’
‘Yeah.’
‘Badly?’
He shrugs. ‘Same as two weeks ago.’
‘I hope that’s mud on your pants, Paul.’
‘Not that bad,’ he smiles.
Either way, it seems that Nasir’s Frequent Traveller Club is well and truly open for business this month, the isle if la’trine its exotic and only destination. Paul’s looking gaunt, having lost a noticeable amount of weight since I arrived. Amos is sick again, too, and I’ve now shed a handful of kilograms since Mozambique. We still can’t work out the source of all this. Amos is confident the water’s good, and I doubt that the problem’s coming from the hospital—Heidi’s in there all the time and never gets sick, and neither does Carol. It must be the kitchen. Washing dishes outside is going to have to stop. Paul and I agree that one of us should spend an afternoon with the cook to see if she’s washing her hands and where she’s getting water from.
‘I’ll get that proper sink installed by the end of the week,’ he says. ‘I’ve been meaning to do it. Hey, you ever noticed that none of the women ever get sick? Zoe, Carol, Heidi, Maya—they always seem fine. You ever seen any of them ill?’
‘Never, actually.’
‘Seems a little weird, huh? I mean, we’re all eating the same food, and—’
‘She’s trying to pick us off.’
‘Huh?’
‘The cook. She’s trying to get rid of us, Paul. You, me and Amos. Anwar’s gonna be next. Then Ben. You watch. She’s trying to take us out, all the men.’
‘Seems that way,’ he smiles. ‘Like an assassin, you reckon?’
Exactly. Not that she’s necessarily causing the gastro—the multitude of flies and proximity of our dish rack to the latrine may have more to do with that, in fairness—but at the very least she’s ensuring that we don’t regain any weight. It’s an objective that’s accomplished using a series of unusual though apparently well-honed cooking techniques. Like the boiling of spaghetti, for example, to a paste that, when left to cool, moulds itself to a glutinous mass replicating the inner shape of the pot in its entirety, and that can only be pried from its crucible with a manoeuvre involving the sequential levering of a series of well-positioned spoons—not unlike removing a bike tyre from its rim. Or the frying of fresh meat into dark, mahogany-like pebbles, the ingestion of which harks back to a distressing childhood incident involving the accidental swallowing of a Lego block; or the transformation of freshly purchased Nile perch and its less palatable flatmate, the catfish, from appetising foodstuff into golden, oily goop. And then there’s the accompaniments. Just last night: canned chickpeas, boiled eggs and a jar of curry sauce, all served cold.
Paul stares flatly out the nearby doorway, looking drawn. I ask him why all the mud on his pants; it’s now just before seven, even by his standards a little early to have been working for long.
‘Had to do some digging,’ he says.
‘For that new ward?’
‘For a grave.’
I’d not expected that. ‘For the young boy?’ I ask.
‘Yeah. Father’s not around, so the mother asked us to help with the body. Said she couldn’t carry it.’
‘Sorry, mate.’
‘Yeah.’
‘The local guys couldn’t do it?’
‘I didn’t want to put it off any longer,’ he says. ‘Not in this heat. He’d been lying in that back room all night, you know? I though it’d be better to just get it done.’
‘I’m really sorry.’
‘Yeah, well.’
The boy had been another far-too-late presentation to Nutrition, dying within minutes of arrival. His was our first death here for days. We’re still seeing plenty of sick patients, but nothing compared with the sustained tragedy of those first weeks. Nineteen deaths had occurred in total that first month, but we’d found no obvious pattern, no consistent underlying cause. Nevertheless, MSF’s regional medical coordinator is coming out from Loki in a couple of weeks anyway, to have a look at things.
Paul’s still staring out the doorway. We stay quiet for a while, bathed in the grey light of an overcast morning. Some kids laugh beyond our fence. A bull bellows across the far bank, and in the background there’s the gentle lapping of the river; a soft, ceaseless gurgling.
‘The mother wouldn’t let go of him,’ he says, after a while. ‘I dug the hole and stood there, just waiting. She couldn’t let him go.’
‘Jesus, mate. I’m sorry.’
‘Yeah.’
‘You okay?’
He says nothing. We sit quietly.
‘They really don’t know what to do, Paul. These mothers—it’s really sad. They stay at home too long, inadvertently feeding the wrong things, giving bad water, then they see those quacks at the market that sell them aspirin or any old rubbish and they buy it because they think if they’re paying it must be good. Then the traditional healer charges them a cow to make incisions or give herbs or remove a spell, and they pay it, and when it doesn’t work they bundle them in here, three in the morning, on the verge of death when it’s all too late.’
Paul says nothing.
‘Mate, you okay?
A long silence.
‘The sister,’ he says, after a while. ‘His little sister . . . she really clung on, too.’
He removes his hat and walks off to his bedroom, and I think: Nine months ago he was a successful businessman living with his wife; today, he buried a child. I wonder how he’ll fare when he gets back. I wonder what he’ll say at the office when people ask. And I wonder too what happens if you do this often enough, if you spend year after year in the field, repeatedly living its unbeatable highs and unrivalled lows. Does your emotional barometer simply reset itself? Is it irreversible? Is there a line you cross, beyond which a ‘normal’ life at home becomes impossible? When you have to return to the field, simply because you don’t experience things to the same degree, for better or worse, back home? Like a Disaster Gypsy, maybe, just floating from one international crisis to the next . . .
I worry that that’s where I’m headed.
• • •
More rain during the week, but not everyone is lamenting the mud. On the contrary. While adults grumble as they schlurp, skid and clog their way around town, kids are having a blast—and understandably so: several thousand tons of high quality, ultra-gooey, extremely mouldable play-dough has just presented itself for their unlimited use, and young imaginations aren’t short of ideas. I discover this while heading past the TB village on Saturday morning, frantically called over by the kids.
‘Khawaja!’ a young girl shouts, and I wave back, heading past her to the ward.
‘OI!’ she yells, stomping her right foot—what appears to be a rebuke aimed my way. ‘KHA! WA! JA!’ she calls again.
I’ve been told. I change course and veer towards them, a trip very much worth it. ‘You built all this?’ I ask, in reply to which muddy little hands clasp big white ones, and excitedly, breathlessly, give the khawaja a tour of their play area: the construction site of a replica Nuer village.
Football-sized tukuls have been styled from mud and clay—some remarkably detailed, others a little less convincing—and a group of boys are currently working on a thatched roof for one, trimming straw to length. And what good is any home, replica or otherwise, without a befitting entrance? None, of course—every six-year-old knows that!—so the larger tukuls have accordingly been given little stick doors, their twig ‘beams’ hitched side by side like the poles of a raft and bound together tightly with thread. Nearby, little mud people tend to their little mud animals, and transport options have even been provided by little cars with little straw axles and clay wheels that actually roll when pushed! The site is still very much a work in progress, though; lumpy foundations allude to forthcoming developments, and the dozen-strong work crew are still in a flurry of activity. And what a work crew: ignoring that a few of the younger plasterers have arrived without uniforms (completely naked, in fact) and that madam foreperson is directing it all without shoes (but wearing a bright orange dress, although her young sister has sourced shoes—a pair of adult-sized gumboots that I suspect have been borrowed from the medical ward) they’re as coordinated and efficient as any I’ve seen. It’s just delightful. I consider taking the day off to join them. Many of these kids are the children of TB patients, although a couple are unwell themselves. Either way, they’ve all been in this hospital longer than me, and as far as they’re concerned they own this place. I’ve come to know them all by greeting now (some prefer a high five, others a lift and a few just a hug, although a couple would please like to hold my hand), and today I’m expressly forbidden from heading to the wards until I’ve opened each of the doors, looked in every tukul, then tried all the cars.
• • •
Outpatients closes at lunch. By now all the inpatients have been reviewed, and Thomas, Joseph and I have attended to a dislocated shoulder—a satisfying and easy fix. This may be as quiet as things get for a while.
‘Market?’ I ask Heidi, who’s busy in Nutrition, but she needs no convincing. She pries Breast Man from her hip and grabs a radio, and like a comet we’re out the front gate, stopping for no man, our tail a dozen kids trailing us from the unit. They follow us out the gate but we redirect them to their mothers, then squelch our way east along the riverbank for this, our twice-weekly exercise session and part cultural tour of Nasir . . .
First point of interest is the small brick church to our left, where the missionaries who’d arrived a century ago gave their sermons, inadvertently becoming advanced students of linguistics as they struggled to get a handle on this previously unwritten language—a language in which gender-specific pronouns such as he, she, and it are represented by a single form (accounting for such honest mistakes by our staff as, ‘Him, with the pregnancy pains’), and in which the same word can have completely opposite meanings depending only on the tone used. There’s an interesting aside to the church, too; in a smaller mud chapel not far from here, a British aid worker controversially married the leader of the rebel Nasir SPLA group in 1991 (‘The Warlord’s Wife’, the media called her), subsequently staying on to live in his tukul until she was killed in a car accident.
We continue up the bank. Thick clouds, heavy humidity—there’ll surely be another storm tonight—and Heidi averts her eyes from the group of young men washing on the edges. A minute later I avert mine as we pass the women’s bathing section, then we both avert everything as three men in baggy fatigues pass us with AK47s slung over their shoulders. Better not to make any eye contact, I’d think.
Ahead of us is the crashed plane, bold tufts of grass bursting from its broken cockpit windows, its right wing being bounced by children. Not far from it, a fishing crew are at work: two men in underwear, casting small throw nets from the shallows; beside them, a handful of empty dugouts are tethered to a tree. We pass them and head further along, towards the fish market, but before reaching it we cut across a large muddy clearing to the main market. And here, I’m again distracted by a group of men brushing past wearing their open shirts and dark glasses, all with rifles over their shoulders. One of them points to the camera slung over my shoulder and makes a menacing gesture even though I’m clearly not photographing anything; I don’t argue the point, just take it off and place it into Heidi’s hip bag.
‘Coke?’ we ask an elderly shopkeeper. He’s one of the few lighter-skinned Arabs in town and dressed in a long white jallabiya, and he runs one of the handful of little tea shops clustered at the market’s periphery. He nods and puts out two plastic chairs beside a small table for us, then pulls two bottles from the rusty chest freezer inside. A small generator sputters nearby, powering his and other stalls, and as I put my feet on the corner of Heidi’s chair and look around, I think: this could almost be a normal town. Teapots whistle on top of coals, just across the track. People stream through the dirt laneways, browsing the same variations of goods seen laid out in wooden stalls all over this continent—batteries, radios, donated clothes and newer knockoffs; foodstuffs in sacks, bags or cans; combs, mirrors and unstrung beads in every conceivable colour, and dozens of other items. Ahead of us, a few of those bike-taxis sledge their way unsteadily through the mud, and to our left the driver’s seat of an old truck has been fixed to a wood pallet, placed before a lopsided counter that’s bearing a straight-blade razor, scissors and small mirror—the barber’s shop. And beneath a large tree to our right, a game of dominoes is attracting a small crowd of men around a table. Breaking any illusions of normality, though, rifles rest casually beside them.
‘You hear the carrying-on in that tukul last night?’ I ask Heidi, and she laughs. She says she didn’t, but that she suspects she knows who it was. I’m still discovering all of this, because never mind love triangles—what’s going on here resembles more of a large, misshapen polyhedron. Unlike in Mavinga, volunteers from the South Sudan projects tend to meet often enough during briefings, evacuations or holidays, passing each time through Loki and often being delayed, to create a bit of a dating scene. As weeks go on, details of any relationships at home become hazier, and a What Happens On Mission Stays On Mission attitude seems the rule.
Heidi looks up suddenly. ‘Shit—do you think we’re both going to end up with MSF’ers? Or marrying MSF’ers?’
I laugh. It’s not unlikely. That, or another field worker, or a national staff member. We ponder this as we hand the shopkeeper a few Sudanese pounds, and I think of that recent night when the girl died, how Heidi had known exactly what the trouble was. It’d be far easier to be with someone who’s worked in these places before. ‘But that means twice the baggage in one relationship, Heidi!’ I laugh. ‘Can you imagine? Twice the maladjustment, twice the strong personality type, and twice the eccentricities from being isolated in these place for too long’—and I tell her about Maurice.
The mother of a former patient recognises us as we pass down a side track, calling for us to join her where she’s making injera flatbread on a small cooker on the ground. There are no chairs, so she puts out cardboard for us to sit on, then shouts for others to join us and directs the older daughter to prepare the injera. A few of the younger kids climb onto Heidi’s lap and a small crowd gathers, and as I watch the cook I sense another bout of gastro looming. Her muddy little hands marry grey-brown sorghum with turbid water in a metal bowl. Next, a stick frenziedly whisks the mixture as her bright eyes dart proudly between it and the unusual customers. The batter is then poured into an oiled pan and the pancake-like bread smokes; and, not long after, we khawajas smile warmly but apprehensively as the chef’s assistants—the kids on Heidi’s lap—break up the bread and hand it to us, watching as we chew the first pieces.
‘Lovely!’ we say, ‘Very nice!’ which only leads to a repeat of the whole process. This time though the batch is wrapped up for us as takeaway, but we’re not yet done—the teapot is on, and it too is filled with turbid water. More kids come, more of the woman’s friends gather, and people chat in a language of which I know less than a dozen words so we all mime and laugh, and it’s moments like this when I’m utterly at peace, thrilled to have had these opportunities. Two cultures that in many ways couldn’t be less alike, yet here we are . . .
After tea we thank our hosts and pack the takeaway, and as we stand up to go I realise I may have thought all this too soon. Another group of armed men passes. Three this time, scowling, no uniforms but with AK47s strapped across a shoulder, and as they look over I both cringe with unease and seethe with anger. They’re like belligerent teenagers with something to prove, these guys, answering to no one and acting up—albeit with guns. And right beside the kids! Have they not had enough? After thirty-nine years of war, wouldn’t they just have flung their guns into the river at the first opportunity? Yelled, ‘Ha! We’re done! We survived! Take these shitty things back!’
This moment sums the place up for me. Gorgeous kids, capable of anything given a chance; armed men, threatening again to ruin it all. After two months here, all I can conclude is that this place is a sad contradiction. Either bone dry, or flooded; at war with its neighbours, or more so with itself; filled with happy kids, but so often they die; and watched over by the international might of the UN, yet they can do nothing to intervene in the clan violence. The town was even born of paradox, founded when an Arab slave trader was commissioned by the British to lead their anti-slaving efforts here; an inauspicious beginning if ever there was one, and it still bears his name.
But what I struggle to understand most is this: that life is so precious here; that these people battle to coax an existence from this severe land, to raise their kids, to carry a sick relative for days to a hospital and then sit by their side for weeks; yet life is equally so cheap. Disregarded during a cattle raid, valued secondary to a clan’s honour, and constantly threatened by these armed men—even if the majority of people would rather get on with things.
The drain on our project’s resources due to violence is disproportionately large. Flights are frequently chartered, or diverted, to transfer the wounded at a cost of thousands of dollars each time (normally only two of the four projects have a surgeon). Worse, transfers are sometimes made for security reasons rather than medical, purely to keep rival clan members separate.
And what we could otherwise do with this money: educate women about nutrition and hygiene, so that the kids we discharge from Nutrition don’t bounce back in an even worse state because of poor feeding practices, as a percentage invariably do. We could run an HIV education program, because preventing the infection of someone like Elizabeth is surely more efficient than providing anti-retrovirals for two, three or five years, or however long until we hand this project over. We could teach women about family planning and provide the services, because preventing unwanted births makes more sense than re-feeding a child who’s malnourished only because he’s the eighth son, born unplanned to parents who struggle to feed their seven other kids anyway. We could train health workers like Joseph, put them through a full-time course so the hospital doesn’t rely so heavily, and so unsustainably, on expat staff, because there’s no doubt that if we left tomorrow the project would quickly fall in a heap.
These aren’t original thoughts I’m having here. Not by any means. I’ve heard them before, thrown around dinner tables in Mozambique, Angola, or in European offices, and I wonder now how many thousands of other volunteers and professionals have stood in these same places, pondering exactly the same things, in decades gone by. Or how many more will do so in the years to come. I wonder as well what impetus there is for any of these governments to step up and treat their own cholera patients, or to respond to their own floods, or staff their own hospitals properly, or to do much of anything, when they know well that we’ll simply rush back at the drop of a hat, with no strings att—
Heidi’s giggling. I’m ranting, she says. ‘So cynical, Dennis! My God! How on earth did you come to be so full of shit?’
I laugh. She’s right; I am ranting. And largely pointlessly. Whether we should be here is something I don’t question. This place is not just rebuilding itself, in many ways it’s starting from scratch. And while infrastructure and services are being put into place, and an entire generation of people are educated, we should be providing a safety net of health care. This I don’t question. So I’m clearly going to have to get over my frustrations if I’m to keep working with this organisation, because this is exactly what they do, and what emergency intervention is. They bite off only what they can chew—which here means running four major hospitals and a dozen outreach sites, keeping an emergency team on stand-by, employing forty expats and four hundred and fifty locals, and allocating six million euros to cover it each year. By any standards it’s impressive—and ambitious. No less given the logistic and security constraints.
Heidi and I head back across the mud. The sky’s darkening. Over my shoulder I can see the black rotors of the UN helicopter through their fence; ahead, a young boy leads an elderly blind man across the field, each of them clutching opposite ends of a stick—the sum total of sight aids in such places. And cutting across our path, another man with a gun. Everywhere, these fucking guns.
• • •
Joseph’s on the ward when we return. ‘One very big problems and four admissions,’ he says.
We get straight into it.
First, two kids with a cough. We’ll see them last.
Next, a young boy bitten by a snake two weeks ago, and whose hand is black and already dead. We’ll fly him out for an amputation.
Next, a teenage boy, screaming in the yard. ‘Crazy,’ says Joseph, who knows him well. ‘Always, he is shouting.’ The boy’s hands are tethered together with a coarse rope, the father holding one end. He’s normally tied to a long lead at home, explains Joseph, but last year he’d freed himself and wandered into a neighbouring village and was stabbed (out of malice or mistaken identity, who could know). I’d object that this is inhumane, that the calluses and cuts from the binds are unacceptable, but what’d be the point? I’ve seen this before. I saw it in Mozambique, in a village we’d visited. What else can the families do? What mental health teams can they access?
The father looks worn. He says the boy’s been distressed for days. Neither of them have slept. We sedate the boy with an intramuscular antipsychotic and take him to the side room near theatre; I’ll reassess him when he wakes.
Next: the one very big problems.
Joseph leads me to the little isolation room where Nyawech, the HIV-positive woman with Kala-azar, is sleeping. He crouches down and retrieves an old Plumpy’nut carton from beneath her bed, opens the lid to show me the contents. Inside is a sizeable collection of pills—all of her medications for the last two weeks, at least.
We wake Nyawech. She rolls over, weak and red-eyed, and shoos us away with a flick of her wrist. Joseph speaks with her but she doesn’t reply, just rolls further away. Joseph taps her shoulder but she ignores him. Nyawech’s mother is sitting on the end of her bed, cross-legged on a corner of their blanket, and she now leans forward and slaps Nyawech.
Nyawech cries. She turns back towards us, mewling unsettlingly. We ask her what she’s doing, why she’s stopped the tablets.
Go away, she says.
Joseph explains to her that she’ll die without treatment.
‘But Nyawech, what about your children?’
She sobs.
‘Nyawech, why are you doing this? Are the tablets making you worse?’
No answer.
Nyawech has had enough, I suspect. Two relapses and a dead husband. She doesn’t want this anymore.
Joseph speaks with her for a while and Nyawech glowers, her face a sad picture of rage although her body is feeble and wasted. The mother becomes furious. She gets up and slaps Nyawech around the torso and head, slaps her hard, and she shouts at Joseph. Joseph then steps out and calls a handful of the other health workers to the bedside, and under the mother’s direction they grab Nyawech’s bony limbs and restrain her. The mother pries Nyawech’s mouth open and these two women yell at each other with eyes wide, shrieking with all the anger and bitterness of this shared tragedy, and Joseph selects an evening’s dosage from the box and places them into her mouth. Nyawech spits and chokes as the mother holds her mouth closed, it’s an unsettling sight, this woman who two months ago was tall and graceful as she strolled the compound with Breast Man, now a gagging skeleton with no shred of dignity because look at what we’re doing. So I turn my back and leave. This isn’t my culture. It’s not my place to interfere, and the longer I stay here the more confused I become.
Later I return to check on the crazy boy with the rope handcuffs, but he’s gone. His father already carried him home. Presumably he’d got the brief respite he sought.