A War-Torn Continent

In the midst of a late winter blizzard, armed with a sturdy, heat-resistant lipstick and a new tropical medicine handbook to help me through the diseases indigenous there, I set out for Africa. From Boston, I stopped in Amsterdam and then flew on to Nairobi, Kenya. I arrived exhausted and late at night, so I just fell into bed at the IRC guest house in Nairobi. The unmistakable sounds of the third world, the barking of several dogs, the crunch of feet on gravel beneath my window, foreign voices carried on the warm night air, the hum of birds and insects, mingled with the peculiar local scents, and all of it soothed me into sleep.

The camp to which I would head was called Kakuma. Located in northwest Kenya, close to the border with Sudan, Kakuma is a UN-sponsored camp of sixty thousand, providing refuge for those fleeing war and crisis in neighboring Sudan, Ethiopia, Somalia, Eritrea, Burundi, Rwanda, DRC (Democratic Republic of Congo), Uganda, and Angola. In 2001, Kakuma resembled a multinational African city. Each ethnic group had its own section in the camp—the Sudanese, for whom the civil war in their nation still raged, comprised 80 percent of the camp population and were housed in one area, Ethiopians were in another, Somalis in yet another, and so on. The groups had little in common, I was told, save that they had all escaped desperate conditions and were now in competition for the scarce resources the UN could provide.

Several days after my arrival, I flew in a rickety old commuter plane to Lokichoggio, the border town that was home to all of the UN-sponsored programs in Sudan. The town was dusty, dirty, and crowded with so many NGOs and aid workers that local entrepreneurs had opened a restaurant, a rooming house, and a small shop selling trinkets. Sleek UN and World Food Programme (WFP) jets floated momentarily in the sky before slipping through the high clouds and gliding to a landing on an airstrip ringed on one side by a village of simple mud and grass huts, and on the other by miles of scrub and dirt. The roar of the jet engines and the crush of road traffic created a fog of swirling dust that almost obscured the villagers who came out to watch, but they stood firm amidst the fog. Those planes and vehicles carried supplies and people and the promise of new life in this place with little greenery and less hope.

I was headed to an even more desolate area. Kakuma was a two-hour drive from Lokichoggio along a dusty, bandit-infested road. The desert landscape was occasionally broken by bursts of lush green and primitive grass shacks. The villagers, some so poor they had only pieces of faded and threadbare fabric to cover their skin, walked slowly, shoulders hunched, heads down. They acknowledged our passing by turning away from the veils of dust our car generated. We had more attention from the animals—camels, giraffes, donkeys, zebras, horses—all living in the wild and somehow thriving in this land of drought and dire need. They occasionally paused in their feeding and gazed as we passed, some even racing alongside our car for a while.

Finally, after a long, hot, and dusty ride, we arrived at Kakuma. The refugee camp was a sprawling compound of mud and grass huts and small sturdier buildings that housed medical clinics and warehouses and administrative offices, all arranged in neat rows that wound through the camp’s dusty roads.

I arrived in the afternoon and was assigned a room in the dormitory-like staff compound located on the periphery of the camp. The area housed Kenyan staff and the only other expat with IRC—Aimée, a French nutritionist who spent as much time as she could manage with her boyfriend, who was working back in Loki, the shortened name we used for Lokichoggio. My narrow room held a metal frame bed topped by a thin sleeping pad, with an unyielding slab of stiff foam for a pillow. There were also screened windows and, when there was electricity, a floor fan. It looked like heaven to me, much more than I had expected.

The bathrooms, housed in a separate small building, were another story. Combination squat toilets and showers in one tiny, closet-sized space. The shower water was drained off through the latrine-toilet. The overhead shower piece did not work, but the tap coming out of the wall at waist level worked fine. I always shared my shower with lizards, frogs, beetles the size of my fist, and other unknown insects, all of them scurrying feverishly at my feet. The sinks were outside and were awash with more large insects not eager to share their space with me. I had to jockey for position and hope for the best when I turned the water on. At home, I would surely be horrified and shouting for an exterminator, but here there was nothing I could do. I had to learn to coexist with my new roommates and keep my complaints to myself. The last thing I wanted to be was a whiny self-absorbed pain in the ass. The cockroaches, beetles, bugs, and frogs would be here long after I was gone. This, after all, was their turf, not mine.

More than the logistics of life here, it was the endless waves of heat that would take some getting used to. I took a deep breath; I’d survived worse, though this time, there’d be no American Club, no place to really unwind or feel the cooling breeze of an air conditioner on your skin.

The six clinics covered a population of sixty thousand. They were spread out to ensure reasonable proximity throughout the camp so that no one would have to trek for very long distances in the blazing sun.

The hospital included several whitewashed, one-story buildings throughout the main medical area in the center of the camp. A large tent housed the pediatric ward. The tent had a bed capacity of about forty, but there were often many more patients than that. To accommodate the number of sick babies and children, they shared beds. Mothers and siblings also stayed with the patients, so the ward was usually very crowded; sometimes it was hard to know which ones were the patients, though family members usually slept on the floor.

The maternity and male and female wards were small, separate buildings and were often covered in dust and dirt. The infectious ward was housed in a tent away from the central hospital and was surrounded by a fence to protect the camp from the communicable diseases and infectious patients housed there.

The next day, I started in the hospital-based clinic, and just as I did with the Afghan refugees, I followed the standard protocols for diagnosis and treatment of so many familiar and unfamiliar diseases—malaria, diarrhea, skin infections, and dysentery. But Africa also had her own particular diseases and dangers for the population here. Exotic maladies like kala-azar (leishmaniasis), caused by the bite of a sand fly; filariasis, caused by infected blood feeding black flies and mosquitoes that transmit worms with their bite; and trypanosomiasis (African sleeping sickness), caused by the bite of a tsetse fly, all unusual diseases with similar initial presentations—fever, fatigue, headache, enlarged liver.

That first day, an old man from South Sudan, tall and bent, limped into our clinic complaining of swelling to both lower legs. “It’s filariasis,” a young Kenyan aid announced, pointing to the man’s legs. “See here,” he said, directing my gaze to the tiny undulating worms that were evident just under the elderly man’s skin. The old man nodded. He’d had this before. He knew what the treatment would be, and we both watched as the experienced clinic staff made several small incisions just over the worm sites. These would be routes to allow the worms to migrate out.

His wounds were loosely wrapped and he was instructed to return so that we could monitor the worms’ progress, and though he lived right here in the camp, he never did return, much like the Afghan refugees. I also saw several patients suffering from trachoma, an eye infection that, if left untreated, can result in permanent blindness. The swelling, the drainage, the pustules that cover the eyes and lids all render the victim essentially blind with disease. It was frightening for the patient, and difficult for us to convince them that if they adhered to the relatively simple treatment of antibiotics instilled into the eye and taken by mouth, they would be fine. Until I saw the dramatic improvement myself, I was a little skeptical as well.

As busy as my days were, my evenings were filled with the simple beauty that was Africa—the sunset a glow of embers on the distant horizon before finally giving way to the deep wash of stars that blanketed the night sky. Pictures will never do it justice. It has to be seen to be appreciated.

Within days of my arrival, the rainy season started in earnest. Great sheets of water fell from the sky. It barely cooled the air. Worse, it created rivers and streams of standing water throughout the camp, and that brought out the scorpions and camel spiders, whose bites were painful and had the potential to be life-threatening to an already fragile populace.

Dear God, I thought, clutching my tropical medicine handbook, I had a lot to learn. But at that moment, even with everything there was to learn and the bugs scurrying by, I was certain there was nowhere else I’d rather be than right there with the refugees.