Rain Dance

April 21st, 2008 by mikew

I’m not what I would call religious by nature. Once in a while, however, you witness something remarkable, granting reason to ponder the matter further.

Last Sunday I awoke to sounds of a distant chant long entrusted to bring with it the rain that abandons this dusty land for nearly half the year. Slowly the song of Pieri’s elders seemingly surrounded our compound and enveloped the entire village with music. Elders who came to pray under the sacred tree that lives between our compound and MSF’s clinic accompanied the ancient harmony.

For an hour ladies danced around this tree and prayed to the sky to bring forth the rain and discard the drought that turns this land into desert. A daunting task for even the most devout among the dancing elders considering there hasn’t been a rain cloud over Pieri for months.

As hours passed, their singing was burned away by noon’s hot sun. Afternoon turned into dusk and then dusk disappeared into something dare I say miraculous. Slowly, Pieri’s blue sky became cloaked in the blackest of clouds, at a pace that mirrored the steady summoning beat used just hours earlier. Thunder growled in the distance as if woken from a seasonal slumber. The thunder must have startled the swathe of dark cloud because the rain fell in a manner that felt accidental. Not enough rain to call a cascade but sufficient enough to shower the evening in the idea that perhaps the songs of the past can lead to harmony in the future.

This piece is for our guard Nhial (Nhial is rain in Nuer).

Salutations from the South,
Michael

The Hardship of Darkness

March 26th, 2008 by mikew

Southern Sudan is hard.

The soil is hard to plant, water is hard to get, and food is hard to find. Birth is hard, and living is harder. The air is hard to breathe, and the weather is either hot as hell or wetter than the river to it. Southern Sudan is hard.

From 1955 through 2005 the people of southern Sudan knew roughly 11 years of respite from civil war. By some counts, nearly two million civilians were killed during that time and approximately twice that number were displaced. Children were taken from Pieri and villages just like it all over southern Sudan and turned into soldiers, a story I’ve heard first hand from a few of our staff. People were murdered, and villages were massacred; so southern Sudan is hard and it can’t help but harden a mans soul.

My girlfriend works for MSF as well. She supports an HIV project in Bukavu in eastern DRC on the Rwandan border. We try to speak every Sunday by sat phone, and every week I look forward to it more than anything else. But as the days turned into weeks and weeks into my first few months in Sudan, I could feel myself distancing from one of the few people that offered a lifeline to love and a sense of home.

Being surrounded by the ugliness of an unfamiliar and unrelenting hardship led me to start resenting the beautiful things in my own life and to feel a sense of weakness for missing my friends and family when I awoke to famine and the pockmarked face of a cruel world. What have I done other than be born into a plush country with the luxury of land and laws? My ability to help in Sudan is based on nothing more than winning a geo-genetic lottery in Canada 35 years ago. The only thing I really know is that I know nothing, and even with the knowledge of nothing I sense that the sum of my own steps has afflicted more harm than good. Why them and not me? And on and on and on and on it goes. At least that’s how my mind sometimes sounds as I lie and stare through the darkness of my mud hut.

Thankfully the darkest of nights happens but once in a month and even then the sun rises to burn away the bleakness and brings with it a new day, a new month and a new reminder that it is not hardship that bonds the souls of people but rather the humanity of simply caring for another that unites us in something more important than ourselves.

Excuse me – I’ve got to go call my girl.

Salutations from the south,
Michael

Killing Kenya

February 22nd, 2008 by mikew

My first night in Africa was perhaps the most important evening of my time away. Having completed the day’s briefings and settled into the MSF staff lodging in Loki, luxurious by Pieri standards, I found myself sipping an after-work Tusker (Kenya’s finest quality lager) with some of the boys. At this point I had been away from Toronto for a little under a week and away from my girl for a little over a month. As the outsider sitting amongst my new colleagues, time teamed up with a twinge of melancholy for the first time and forced me to take in how long a nine-month MSF mission really was. What became very clear, very quickly was that the loneliness of being was not mine to own on that Friday night in September.

For the most part the south Sudan project is supported out of Kenya, although at present more and more of the support structure is moving west to Juba, Sudan. As our individual tales circled through the Kenyan evening I learned that everyone to a man had left his family and friends somewhere in Kenya to work for MSF in Loki. My own sense of sadness succumbed to a singular sense of solidarity with my Kenyan contemporaries.

Over the past five months my fondness and respect for my Kenyan colleagues has only grown. Expats come and go, but it is the Kenyans that keep MSF’s projects running in southern Sudan. In Pieri, our Project Coordinator (PC) Chris and our Laboratory Technician (Lab Tech) Sammy make up our Kenyan constituency. Chris is my direct supervisor and I think our team would agree that we hit the boss bonanza in Pieri. Sammy splits his time between Pieri and Lankien and is one of the most respected MSFers in our mission. It has been heartbreaking to witness these two friends—both fathers—monitor the Kenyan news for the past five weeks. At some point in time the trials of men like Chris and Sammy will become a footnote in the social history that makes up today’s current events. But that day is not now and tomorrow’s history is today’s misery.

By now the atrocities that have occurred in Kenya are well documented and as horrific as the manifestation of murder can be. There is an affliction of digital dullness and predictability to today’s world that turns global misery into Western melodramas played out on an endless loop every evening. Rwanda, Darfur, Zimbabwe, or the Congo melds with malaria, malnutrition and HIV to form a banality of evil and hardship that few care to distinguish. Kenya stands apart from this however as an erosion of hope and serves as yet another reminder in an already skeptical world about the brittle nature of life in this region. But the great people like Chris, Sammy and MSF’s “regional” staff stand strongly as a reminder that as long as a few good people remain committed to a life of meaning there is hope for all!

NEWS FROM THE FIELD:

1) The Schatzker Snake Report – brought to you by my dear friend and fellow snake fearer – Mark Schatzker: Last week there was a one-metre snake spotted in our OPD (outpatient department) tent. This tent is where we register our outpatients and get them prepped for whatever test or examination is forthcoming. The serpent in question slipped through our fence and slithered over and into a baby basket (That’s a basket where little babies sleep.) It was horrific. And in case you’re wondering, shrieking at a snake to STOP! does not amount to much in the way of swaying a serpent. As it turned out, the baby was getting an examination, the snake was harmless and I scared the good folks in OPD more than the snake.

2) It’s official: I now weigh less than I did when I graduated from high school! For those of you that missed that ceremony I wasn’t exactly confused for the school’s star football player or renowned for the maturation of my adolescent musculature. Seventeen years later I look like a sunburned hairball supported by two furry sticks. I had been living under the illusion that if I managed to shed those last few pounds I would find a set of Brad Pitt-like abs. The reality is that what I had thought were abs are actually ribs! What’s more unfortunate than my physique is that I still outweigh every Sudanese member of our staff by at least 5kgs.

3) Do you remember the scene in Butch Cassidy and the Sundance Kid when Paul Newman takes the Sundance Kid’s girl for a ride on his new bicycle? “Raindrops Keep Falling on My Head” is the song that accompanies that scene if I’m not mistaken. Well that scene keeps getting played out in Pieri as bicycles have arrived en masse. It’s hilarious to watch everyone learn how to ride and wonderful to see how happy it makes everyone race through our dusty village.

4) MSF’s Pieri project has our first female labourer. Maybe not the Jackie Robinson scenario of southern Sudan but progress nonetheless. Nyakol Nyang Puot was previously a water lady/cleaner who, over the course of my first few months in Sudan, I found poking around the generator and working with tools whenever the opportunity arose. The team admires her and the logistics gender divide has been bridged seamlessly.

5) It’s hot! How hot is it? It is so hot… I know the grass is always greener but for those of you that are currently enduring a harsher than usual winter please believe me that it is better than a never-ending succession of forty-degree days. My tukul looks and feels like a wood-burning pizza oven. It’s unbearable! You have no idea what I would give right now to make a snow angel.

Salutations from the south,
Mike

The Goat

February 1st, 2008 by mikew

Last weekend we held our MSF Pieri staff Christmas party. In case you’re wondering the good folks of southern Sudan do not celebrate some fandangled African Orthodox Christmas, we were just a little slow to get cracking on last year’s festivities. In Canada, a boy can make an evening out of dodging the dance floor. In Pieri, that Dane step doesn’t fly. Yet, much like Canada, the people in Sudan enjoy mocking those of us not blessed with the gift of rhythm (almost as much as they like dancing). Despite the self-shattering blow to my ego and the realization that I am now officially the worst dancer on two continents, the day was a great success filled with music and merrymaking.

Without doubt the party’s main event was dinner. We served up two goats, 25kg of rice with gravy, orange punch and enough candy that every kid in the village got a treat. Three ladies spent the day cooking up a feast fit for the Paramount Chief and, with the exception of the vegetarians in the group, everyone went home full. At this point it should be noted that the last time I ingested the flesh of a mammal was December 1995 so I didn’t go home full but I sure went happy.

True or false: one of my crazier concerns coming to Sudan was how I would handle a situation where I was offered the soft tissue of an animal, knowing full well its value in a starved village? True, and last week my dietary distress was elevated to new heights when I was given a live goat by John Deng, one of our compound guards and possibly the nicest man I’ve ever met. At first I wasn’t sure how or what I was going to feed my new pet Goat. That problem quickly subsided when I figured out that in fact it was Goat that would be feeding us! John’s gift was truly one of the greatest that I have ever received and one I consider to be a huge honour. But regrettably my sense of honour didn’t trump the fact that I don’t dine on swine, cow, fowl, or my short-lived pet Goat!

Thanks to a couple of nicely timed sidesteps highlighted by the donation of the goat to the party platter, my flesh-eating days are still a thing of the distant past. This coupled with the fact that during a speech John Deng was credited with feeding half of the staff, and low and behold in Sudan like the rest of the world we had the classic win-win. Unless of course you were Goat!

I did cut a ceremonial piece of meat with John Deng and believe me I tried to get it past my teeth and down my throat, but at the end of the day I couldn’t do it. Thankfully in my younger days I was trained in the fine art of hiding food in my mouth, chipmunk-style. John laughed with me and I took consolation in the fact that there were 80 other people at the party who truly needed to eat Goat.

Thirty years ago my Mom would tell Kim and I to finish our dinners because there were starving kids in the world. Thirty years later I can tell you this: finish your dinner because even with the aid of MSF’s Therapeutic Feeding Centers there are still far too many kids starving in Sudan.

Salutations from the south,
Michael

An Overdue Thanks

January 15th, 2008 by mikew

The Pieri project is slowly turning into little Canada. Our base nurse Sue is from Alberta, our new technical logistician Peter is from Nova Scotia, I’m from Toronto, and our new outreach nurse Jodi is from the Windsor region. The MSF outreach nurses are, in my opinion, the true superstars of the work we are doing in southern Sudan. For the most part these nurses who travel and work in pairs move through the most inaccessible regions of Sudan. Every 10 days, Uriah, our Liberian nurse and Jodi trade in the luxury of an MSF mud hut for just mud and—during the rainy season—routinely hike up to 10 hours a day through dark and dirty terrain that would test the valor of any person.

The healthcare MSF’s outreach nurses provide is basic to be sure, but basic medical care saves lives and our outreach team is on the frontlines of this work. During the malaria season (November – January) for example, simple Paracheck testing to determine if a patient has malaria, medication and a mosquito net can be the difference between life and death for a countless number of people in southern Sudan. Over the past month nearly one half of our suspected malaria patients have tested positive, and the numbers continue to soar. I’m not going to bore you with the specifics regarding the various strains of malaria but like everything else in Sudan, the malaria that our patients contract is the deadliest in the world.

What can be said to people who could work anywhere in the world as nurses but instead choose to sacrifice basic comforts, and in some cases their own health, to tent through remote regions of a forgotten land to help people most in need?

I suppose thank-you Uriah, and thank-you Jodi is a good place to start!

Salutations from the south,
Michael

Measles, and the Curse of the Flying Snake

January 3rd, 2008 by mikew

Some of my earliest memories are of a doctor’s office. I had the misfortune of having a family doctor whose clinic was like a nightmarish scene from a Coen Brothers film. There were about 57 stairs from the street to the good doctor’s second-story office, and every step was like ascending one tread closer to a shadowy medical hell, boasting only an absence of daylight. When you’re a kid, “doctor” might as well be spelled N-E-E-D-L-E. Sterile daggers plunged into infant arms with the grace of a blind bandit. I’m still branded on my left arm from a traitorous small pox vaccination.

For half of November our project implemented a mass measles campaign (MMC) in Wuror County, South Sudan. I was fortunate enough to help out for two of those days. This was significant for two reasons. First of all, the opportunity to take part in and promote any immunization campaign is in my opinion as meaningful as a day’s work gets. Second, this was the first time in nearly two months that I traveled more than 1000 meters, and to say that I was a little excited to get out of Pieri is an understatement of epic proportion. Don’t get me wrong — I love my home away from, but once in a while a man needs to stretch his legs.

Although I try not to hold much stock in the currency of “cool,” it is hard not to be just a little bit pleased with one’s self when you’re four-wheeling through the southern Sudanese bush. Our ride lasted a couple of hours and if I had my way it would have lasted a few days. The Sudanese planes are incredible. Massive herds of cattle highlight the horizon and, in the right light, a cow can be a rather striking creature.

The village elders fronted by their Paramount Chief welcomed our team when we arrived in Rubllet. Although we had sent word of our vaccination plans days earlier, our message for whatever reason had never reached its intended recipient. Such is life without phone, email or trained pigeon. We had hoped that there would be a line of kids awaiting our arrival but as it turned out we had to mobilize the village’s children ourselves. Our team, five strong, split into two groups. The first group rallied the willing, and the second setup shop. Within an hour we were ready and awaiting our first child. As the late morning bowed to early afternoon, our target population of a thousand kids between the ages of six months and fifteen years started to trickle in.

There have been a few occasions in Pieri when children have been terrified simply by my presence — and by terrified I mean Jason, Freddy and Jaws wrapped into one furry Canuck. On one occasion I was exiting our compound and startled a little girl so badly that she shrieked and bowled over her older sister before my first step hit the ground. At any rate you combine 500 needles with my uncanny ability to scare kids and you have more crying on Day One of our MMC than a sorority at a double bill of “Beaches” and “The Notebook.”

A mass vaccination campaign is a fairly straightforward procedure if you have the requisite ratio of staff to injectable arms. For each line of kids you need a person to fill out a vaccination card, another to load the syringes, and a trained person to give the actual shot. You need a fourth person to ensure that the child takes a vitamin A gelcap post injection to protect them from blindness, and a final person to tally the whole ordeal. Logistically you need only to ensure a safe means of disposing used needles and a cold box to keep the vaccines between two and eight degrees. Other than that, a good sense of humour helps to keep the ankle biters at bay. It is remarkable how simple and effective the vaccination process is. MSF estimates that by vaccinating one child, we are potentially stopping the spread of measles to 10 other unvaccinated children.

To quote Ice Cube: “today was a good day”.

Some Facts on the Ground:

1) Snakes can jump! On the afternoon of our second day in Rubllet I witnessed a meter-long green snake jump into the air. And by jump I mean attack a man in a soaring fashion. The potential victim of this sadistic serpent was too busy laughing at me as I fled in terror to be bothered by an emerald snake balls high in the air. Rumour has it that the snake was harmless. Somebody should tell that to the snake!!!

2) Camping out under the stars in southern Sudan is as wild and wonderful as you’d imagine. I understand that after two decades of civil war the elephants have returned to their Sudanese home and that the lions may not be too far behind.

3) Our hosts in the village of Rubllet slaughtered two goats to thank MSF for our efforts. A beautiful gesture but a gesture that, combined with some hard-core backcountry driving, lead to some hard-core backcountry barfing! I’m a vegetarian…

4) As much as I dislike the political arm of the UN, disagree with the Insecurity Council and despise baby blue in general, I must give it up to our friends at UNICEF. Since 2005, they have immunized over 3 million children from measles in southern Sudan.

5) During the two-decade civil war in Sudan it was only Non-Governmental Organizations (NGOs) like MSF that offered lifesaving immunizations in southern Sudan.

Over the last couple of years the majority of my dearest friends and family have either had children, or assisted in their making. It is beautiful to watch the friends you love develop into parents you admire. Sitting here I wonder what their lives would be like today if they had never had access to a single checkup while pregnant, a midwife to assist with the delivery or doctor to consult during the first months of their baby’s life. How different would my life be if my parents had not been blessed by the same fortune? In Sudan that speculation is befallen by reality, a reality that every day MSF helps to make a little bit better.

Salutations from the south,
Michael

Birds of Pray

November 16th, 2007 by mikew

Our compound, which is bounded by a scrawny six-foot fence of sorghum sticks and dried grass, is home to between three and nine MSF international staff at any one time. We also reside with Felix the world’s most futile feline, a number of well-documented rodents, reptiles, insects and, as it turns out, a dozen different types of birds. Over the past couple of weeks, I have grown fond of the family of blue birds that live in the tree that shades my tukul from southern Sudan’s hellish heat. The blue birds work hard all day to build a grassy garrison that will protect their chicks from any of the many dangers that lurk around Sudan. But no matter how hard the blue birds work, there are always bigger birds with bigger nests to build, and now there is no longer a family of blue birds living in the tree that shelters my tukul from the sun.

Over the couple of day’s one patient, a little four-year-old girl with a big belly, has dominated our dinner discussions. Without the aid of diagnostic machines, our miraculous team of medics does daily lifesaving work with what they have. And although in Pieri, Sudan the MSF health centre looks like Mayo Clinic, that doesn’t change the fact that without the aid of x-rays or ultrasounds, they cannot see through skin. For a few days, our medics did what they could for the little four-year-old girl with the big belly until finally it became clear that she would die if MSF didn’t immediately transfer her to a surgical facility. MSF calls this “green-lighting”, which in our case means flying our patients for life saving surgery.

Southern Sudan is entering the dry season, and the rain is supposed to be on hiatus until the spring. Well I was supposed to be born in January, but my Mom decided to shovel snow in December and now I’m a Sagittarius. On days when Pieri is the first destination on the MSF flight rotation, it is my responsibility to update our Management Team in Loki at 06:30 on our current weather and airstrip status. When I woke up last Tuesday to a torrential downpour that immediately delayed the little four-year-old girl with the big belly’s green-light flight and put her life in further danger, the obvious lack of control that befalls a sardonic world did very little to make me feel any better. The problem isn’t the rain itself—our pilots can fly through a shower. The difficulty is landing a plane in a pool of mud, and moreover having it take off again. At any rate, the flight was delayed indeterminately and all this before 06:35.

pieriairstrip.jpg
Photo : Michael White: Pieri air strip.

The next five hours consisted of an endless number of trips to our dirt runway. I also discovered that Pieri alone was caught under a sadistic cloud, hell-bent on ensuring that nothing was going to land, while the rest of southern Sudan was sunning itself. Hourly radio calls did nothing to change the fact that Pieri was only getting wetter. At noon and after much consultation, I radioed Loki that our landing strip would not be landable for the day, knowing that at the same time I was likely issuing a death sentence to the little four-year-old girl. I uttered a final plea on behalf of the team for the pilot to fly over Pieri at the last possible moment to judge whether he felt our strip was landable.

It takes approximately two hours to fly from Loki, Kenya to Pieri, Sudan. So by 14:00, we would know for certain whether or not our little patient’s sentence would be commuted or not. Moments later, the sun found its way through a tiny crack in the clouds and hope finally made its grand entrance. Ninety minutes later, Loki radioed us and said that Allan (our superhero pilot) would pass over Pieri in 20 minutes to make a final decision on our airstrip. As I’ve mentioned before the Pieri landing strip is renowned in the area for being the longest and the best, but as I ran from our compound all hope seemed to vanish when I saw pools of standing water on the airstrip, a sure sign that any landing would be next to impossible. Still the little four-year-old girl had no chance if she stayed in our clinic, so it seemed only logical to hope for the best and prepare to transfer her for surgery.

The difference between my job and our medics is while I was doing my daily duties and obsessing over one patient, they were busy working on over a hundred. I was reminded of this fact when I rushed over to our clinic only to discover that the little four-year-old girl who had dominated our discussion for two days was no longer the foremost thing on our medics’ minds. In southern Sudan the moment we have all been waiting for has a nasty habit of quickly becoming the moment we were dreading. As it turned out, only minutes earlier a woman who was having a deadly delivery was admitted and once again our medical team were called upon to save not one life but two.

Seconds turned into minutes and the minutes turned into many, when from in the distance above I heard the sound of a single prop plane. It is generally not the job of the logistics department to organize the transfer of a green-light patient to a plane but with both our doctor and nurse in the O.T. (operating theatre), it became clear that logs were going to have to help out. While our second nurse, Uriah, got the medical equipment together, the logistics team headed by our P.C. (Project Coordinator) Chris, started to move the little girl and her mom to the airstrip. I had, of course, forgotten at this point that there was very little chance that the plane was going to land. That’s the great thing about hope: it can blind a man from the fact that he is standing ankle deep in mud.

Moments later I could hear the plane making a final pass at the runway, and as we rushed toward the strip with the little four-year-old girl on the stretcher, I heard the sound I had been hoping for all day—our plane touching down on the runway and 10 minutes early to boot. When the plane finally came into sight, my heart sank. I knew instantly that the single prop plane on the runway was not ours, and as it turned out it only landed because it was desperate for fuel. The white plane was covered in black mud, and as we reached the runway I was reminded that it was still very, very wet. But moments later our plane hit the horizon, and I knew if one plane could land so could two and thankfully Allan felt the same way. When Allan’s Caravan touched down it looked like a floatplane landing on a darkened pond. Most importantly, however, was that the plane had landed safely, and at this time on this day impossible shed its prefix. As we rushed our patient and her mom to the plane, hope rose again.

Back in the clinic, our incredible Dutch doctor, Ortillia, and Canadian-nurse, Sue, had been locked down in the O.T. for over an hour. I would shortly learn that the baby was stillborn and never had a chance. If not for the efforts of our MSF medics, however, the pregnant mother would have also perished. Instead, as I write this blog, she is at home taking care of her three other children. Two days later, our team discovered that despite all MSF efforts, the little four-year-old girl with the big belly passed away in Juba.

I don’t know how to explain what it is like working in this setting any clearer than the three sentences that precede this one. People die in Sudan for no other reason than they had the medical misfortune of being born here. There are also the miraculous MSF doctors and nurses who could literally work anywhere in the world but choose to work in the harshest environments on earth to help people who are most in need. And although it is human to focus on those you couldn’t help, I’m learning that it is important to remind ourselves that every day MSF saves lives and helps people who would otherwise suffer needlessly.

Salutations from the south,
Michael

MikeJohnPeterLual.jpg
Photo : Michael White | Mike, John, Peter, and Lual.

Epilogue

I managed to make it through my first WFP (World Food Program) food drop. MSF partners with the WFP, which is a United Nations organization that aims to guarantee a steady supply of food for our inpatients. It is quite a spectacle to watch a U.N. plane drop 36 metric tonnes of food into a drop zone that on any other day would be the school’s soccer pitch. Sudan is the only country that still receives WFP food drops, and I was under the impression that the bags fell with a little aerial finesse. In fact, the white bags come hurling from the heavens like wet bags of cement.

It’s also quite a spectacle to watch the MSF logistics team sort, transfer and ship over 20 metric tonnes of sorghum, lentils, salt and sugar more than a distance of 2 kilometres. Our water ladies and cleaners helped out as well, carrying 50kg sacks (110lbs) on their heads. You would be hard-pressed to find a woman in Pieri that weighs 50kg, and yet their strength never ceases to amaze me. MSF’s logistics team persevered over three days, with 35-degree heat and a driving rain that would test the fortitude of any group. I am proud to say that the MSF team stood up to every challenge but looking down at my own hands, I’m not sure that I did!

ColdChain.jpg
Photo : Michael White | Signing off on the cold chain delivery.

The Conspired Circumstance of the Downward Rise

November 6th, 2007 by mikew

I had never really seen a dead body before. I’ve seen a few open caskets but at present I can’t remember any specifics save one and that image has been ceaselessly scorched where my soul and mind meet forever. Well forever just got company…

Last Sunday was supposed to be a reprieve from life in Pieri, which after only a few weeks has diminished beneath its already diminutive size. Pieri, for sake of reference, is located in the region of the Upper Eastern Nile, where if The Economist is correct war is likely to return first should it once again come to that. There is a lot of disputed oil in the Upper Nile regions of Sudan so I’ll let you do the math.

Pieri is large only in comparison to the outlying areas that surround it. Pieri is home to a durable albeit dirt landing strip, which performs double duty as the soccer pitch and goat pasture when not pressed into action by the roughly twenty planes that land in Pieri each week. Pieri is renowned in this neck of the woods for having the best strip going, which from what I understand is not saying much. The village is built around nongovernmental and governmental aid compounds. MSF, Tear Fund, the Carter Center, the WFP [World Food Program] and the WHO [World Health Organization] all represent.

Pieri is landlocked and for eight months of the year it is cut off from road access. On the east side there is a dusty market with perhaps ten stalls that sell mainly meat, sugar, cooking oil, some spices and an assortment of seemingly used clothing and trinkets presumably from Khartoum. Some chairs are set beneath one of the few trees brave enough to take on Sudan’s sun, and seem to serve as the village’s café. A small school and a Presbyterian church, both of which are housed in tukuls, are on the west side. At night and on Sunday mornings the most magnificent music and accompanying drumbeats can be heard coming from Pieri’s place of worship.

Throughout Pieri and its outskirts, cows, goats, and tukuls are scattered as far as the eye can see, which is pretty far because the local geography makes Saskatchewan look like the Himalayas. Her horizon, however, allows for the most breathtaking sunsets, and on moonless nights our village disappears into darkness, while I take comfort under Orion’s majestic belt.

dusk.jpg
Photo : Michael White | Pieri at dusk.

I’ve digressed! Last Sunday was supposed to be a reprieve from Pieri. The plan of action was for the team to do a reconnaissance trip to Yuai. Yuai is one of our two outreach programs and it’s about 2.5 hours away by truck during the dry season. Our goal was to assess the road’s (and by road I mean 4×4 course) condition and our medical facility in Yuai after the rainy season. Long story short, the trips got cancelled and despite my hopes that work would not sequester this Sunday, it turned into a day that will remain with me until all others have passed!

The Divergent Nature of That Sunday

October 30th, 2007 by mikew

08:00 Road trip to Yuai cancelled.
08:15 Learn that our beloved Sudanese nurse/midwife Hellen needs to return to Khartoum for an undisclosed amount of time for personalreasons (a solid blow to the team—we just lost our African Mom).
08:45 Start playing darts with Maina.
08:50 I am either drunk or was dropped as a kid because nobody should be this bad at darts…
09:15 Canada 2 & Kenya 0 – Maina is worse at darts!
09:20 Hear screams of life-halting horror coming from our medical clinic more then 200 metres away.
09:30 Learn that a middle-aged man has passed away from unknown causes in our Inpatient Department (IPD).
10:00 The deceased is from a village over a day’s walk away, and his wife, daughter and son have no way to remove or dispose of the corpse.
10:01 It’s Sunday and we’re short staff, which in this case is the same thing as a short straw.
10:30 Nothing in my life has prepared me for this. Flies and fecal fluids have filled the middle-aged man’s tukul. He’s naked and dead and I’m breathing and confused by the simplicity of it all. I can taste the smell of death in the back of my mouth. I keep thinking the middle-aged man is going to move and it scares me a lot.
10:35 Thankfully John Yany (pronounced Yang) and a guard crawl into the tukul ahead of me and roll the middle-aged man onto a stretcher. To be honest I don’t think I could have done it.
10:45 Yany, our guard and myself pick up the emaciated middle-aged man, a pickaxe and two shovels. There is only one sandy road and it runs right through the middle of Pieri. Every step is taken with the fear that the middle-aged man is going to fall off the stretcher. We stop about half a km past the market and I’m amazed at the weight of death.
11:00 Yany has stopped in the middle of a never-ending pasture. Every effort is made to be as dignified as possible but I feel like somehow I let the middle-aged man down. I quickly remind myself that this isn’t about me.
11:01 We start digging beside a couple of the week’s other tragedies. No cemetery, no markers … just mounds of death in the middle of a field.
11:10 Maina and six men from Pieri including Stephen Mai, our logistical supervisor, come and relieve me of my duties. (Which for the record are not my duties).
11:15 Maina and I pay our final respects and head back to the compound.
11:20 A bee attacks Maina and we run like hell to avoid it all.
12:15 Hellen’s plane comes and goes. It’s sad as hell to see her leave.
12:45 Sue gets a call on the radio that a woman who has been in labour for 9 hours is now at the Antenatal Care Clinic (ANC), and ready to give birth! Come back Hellen…
12:50 Our amazing 29-year-old Dutch doctor Ortillia and super-star Canadian nurse Sue know that I’ve never witnessed a birth and want to. Sue suggests that in Hellen’s absence they could use an extra set of hands. My first thought is that 1 in 6 babies die during childbirth in Sudan, the highest toll anywhere in the world. My second thought is that I should man up and do it!
1:00 Stephen Mai has beaten us to the clinic. The man is everywhere. It turns out that he knows the woman and brought her and the family to the MSF ANC clinic. The delivery room is spotless and one of our few buildings with a cement floor.
1:05-30 The girls put me to work immediately as our regular ANC gang is either enjoying their only day off or on a plane. I sort through keys, grab stuff out of the ANC closet and run to my medical store to grab some extra supplies.
1:35 Without the aid of any drugs this woman has withstood a barrage of contractions, and an episiotomy and has barely made a sound.
1:40 The mood suddenly shifts when Ortillia calmly mentions to Sue that the umbilical cord is wrapped around the baby’s neck. With only basic medical tools at their disposal, the girls continue their inspired work, while for the first time since arriving I’m grateful that the woman in labour doesn’t speak English
1:41 I can’t stop watching Sue and Ortillia do their thing. They are so calm and never once let on that there may a problem. But there is a problem, a huge one.
1:42 Ortillia performs some orchestrated moment of magic with her arms and like that the baby appears untangled in front of Sue and its Mom.
1:42 Silence surrounds us.
1:42 Everyone and everything is soundless. It feels like we somehow stepped into a vacuum. In my mind I start chanting…

Cry… Cry… Cry… Time passes with a glacial sense of speed. Please cry!

1:43 For those of you who have heard the first cry of a newborn, you know that there is no sweeter sound on earth. It’s a boy and I’m never having sex again!

Stephen Michael (that’s right Michael) Deng was discharged from our clinic on Tuesday, October 23rd two days after the birth. Mother and baby are doing great and every day that MSF continues to work in Sudan, the odds get a bit better for the next baby.

MSF waiting room
Photo : Michael White | The MSF waiting room.

I don’t know how to reconcile the divergent nature of that Sunday. I’ve learned that the Sudanese circle of life is the same as anywhere else it’s circumference is just a lot smaller. I have always had a very difficult time with the concept of life and death. Ever since I was old enough to understand death it has frightened me more than I believe is either normal or healthy. Notorious B.I.G. summed it up best, when talking about Tupac’s demise. “Death, there ain’t no comin’ back from that shit.” While I don’t pretend to know if that’s true, I do understand that although death is inevitable, sickness and suffering doesn’t always have to be. To that end MSF’s work in Sudan and around the world is a tribute to human compassion, and inspired action.

An ode to Stephen Mai: What a guy, that Stephen Mai.

Rarely have I been more taken with a person quicker than Stephen Mai. Mai is my age, 34. He has three wives, and after today ten kids (six boys and four girls), four tukuls and ten cows. Today’s addition has been named Maker (A very good Sunday). Four years ago, Mai brought his dying sister to the MSF clinic in Pieri. Our lab technician Sammy diagnosed her with kalazar. Mai was so grateful to MSF for saving his sister’s life that he helped rebuild our current laboratory, which is a simple yet solid rectangular building, with a tin roof. Right angles are hard to come by in Pieri as the Nuer people seem to prefer circles to straight edges but our lab is an exception, and there is always a constant line of people having their bodily fluids tested and yours truly has been among them. You’ll be happy to know that evidently it only felt like giardia. In four years Mai has risen from the ranks of an MSF guard to our logistical supervisor. He is resourceful, compassionate, dedicated to MSF and maybe the hardest worker I have ever had the privilege of running with.

Some Facts on the Ground:

1) Seven snake sightings since I last wrote. Four of them were baby Red Cobras. We think there’s a nest!
2) Snakes eat frogs and at any given time I have a family of five frogs in my tukul.
3) Constipation is a lot better than diarrhea.
4) Suggested reading on southern Sudan. What is the What by Dave Eggers.
5) I’m currently reading Endurance: Shackleton’s Incredible Voyage (Thanks Billy). It is about Ernest Shakleton’s failed voyage to the South Pole in 1915. For some reason it helps keep things in perspective. Frying is better than freezing and canned beans are a hell of a lot more appetizing than seal blubber and penguin brains.
6) The term “computer bug” was coined when the first computer (The Mark I or IV I think) unexplainably shorted out. After a look under the hood it was discovered that a moth had shorted out one of the circuits, and the term computer bug was born. At this moment there are 4 different types of bugs on my screen and another 3 chilling on the keyboard.
7) Bat pee smells much worse than bat pooh.
8) The going rate for a wife in Pieri is 35 cows to be paid to the eldest male in the female’s family.
9) The Nuer engage in scarification rituals. When a boy enters manhood, six cuts are driven into his forehead from ear to ear. If the scars are crooked, it means the boy moved and couldn’t take the pain. I’ve yet to see a crooked scar.
10) Some women have a tapestry of facial scars that I’m told are actually much more painful to receive than the scared lines. As if there was ever any doubt having just witnessed a woman silently deliver her first child without any drugs.

Chuol-headguard.jpg
Photo : Michael White | Chuol, the head guard.

Salutations from the south,
Michael

The Peculiar Power of the Untamed Mind

October 12th, 2007 by mikew

I could have sworn that the Warden sentenced me to seven days in the hole, I would have dropped a dime on it, I was that certain. As it turns out it must have been a Larium-fueled dream. Who knows, who cares, the reality is that what I thought was going to be a stopover in Lokichokio (Loki) Kenya, turned out to be seven days (28/09/07 – 04/10/07) of endless and restless waiting. In fairness to Loki and the great people of MSF who work there and will be supplying and managing our project in Pieri, I was simply ready to get down to the business at hand.And for me that business was in southern Sudan.

Loki is about thirty kilometers from Sudan and at one time was the hub for the world’s humanitarian action in southern Sudan. For the most part that work has followed the UN and Government of South Sudan move to Juba, the capital of Southern Sudan. Loki is an uncanny town, home to a few remaining NGO’s, an airport, the Turkana tribe and a couple of small camps that look and feel like two-star resorts, complete with pizza nights and satellite television. If you’ve been to Loki then you know exactly what I’m talking about. If you haven’t been, watch HBO’s Deadwood, transplant that town to Kenya, and you’ve pretty much nailed Loki’s surreal vibe and wild west aesthetic.

By the time the 4th of October rolled around I would have flown into Sudan on the back of a sparrow. Thankfully it didn’t come to that. During my time in Loki I befriended Jim, an American pilot in Kenya who best belongs in a Howard Hawks’ film and is the proprietor of one of two airlines that MSF trusts to fly their international staff in and out of Sudan. Our flight rotation from Loki to Pieri is every ten days if the dirt airstrip in Pieri is dry enough to land on, and thankfully this time it was. The two-hour flight was mercifully uneventful and confirmed what I had heard about southern Sudan. It is flat and what is not flat is a swamp. It also confirmed what I’d heard about small planes — they’re really small!

I’ve got to give Loki credit for one thing: it cured my fear of flying!!!

Pieri arrival!
Photo : Michael White | Pieri arrival.

Welcome to Pieri

For a brief moment in time I felt like Elvis on his famed Farewell Tour. When Jim’s Casa touched down in Pieri it looked like the entire town was on the airstrip to welcome me.Children and adults were swarming the airplane, and as far as I could tell I was being recognized for my humanitarian service. Granted I hadn’t yet started my work but who was I to argue with my new community. If they wanted to celebrate my arrival, so be it. The Farewell Tour turned out to be more accurate than I had imagined. As hard as this might be to believe, the good people of Pieri were not there for me at all. Ahmed Al-Sarraf, an MSF doctor with a really cool-sounding name, had finished up fourteen months of dedicated service and the fanfare was in celebration of his departure. Somehow a 6’3” Canadian, with a giant black (fine grayish black) beard went unnoticed and as the reality of my new home hit me for the first time, I was happy to hide in his shadows.

When you land in Pieri it takes about twenty-two seconds to recognize the amazing impact that MSF has on the community. Our clinic is located in the centre of the village and is directly across the road (or path if road refers to something that cars drive on) from our compound and logistical office. The MSF medical clinic is the residence for roughly 60 inpatients at any given time and another 70 fulltime TB patients, who spend six months in treatment. MSF also runs antenatal care, STI (sexually transmitted infection) and EPI (expanded program for immunization) clinics, a TFC (therapeutic feeding centre) and a very busy medical lab. Moreover our doctor sees approximately 130 outpatients every day. Among our patient list are people suffering from meningitis, leprosy, pneumonia, brucellosis, gunshot wounds and snakebites. (Please see snake update below.) A single doctor and two nurses supervise the enormity of all of this, and I work and live in constant awe of their miraculous efforts.

An incredible secondary benefit of MSF’s work in Pieri is that we employ and train a number of local staff with the hopes of handing over a fully functioning and sustainable health centre to the Ministry of Health or another NGO whose mandate is not that of emergency medical care. Currently our clinic employs approximately 80 staff from in and around the Pieri area. Stephen, David and John (good, solid Nuer names) are the three men that I have quickly learned to rely upon the most. Quite simply our clinic would not function without the efforts and dedication of our national staff employees! If we evacuate, it is them who are left to care for our patients.

JohnandDavid.jpg
Photo : Michael White | John and David.

Everything that MSF relies upon to run our medical clinic, feed our patients, and house our international staff arrives in Pieri by aircraft—and I mean everything. If you forget something, there’s no running off to the corner store to pick it up. FedEx doesn’t deliver, and the World Wide Web and cell phones might as well be intergalactic travel. So if you screw up your medical orders and the clinic runs out medicine, our patients are the ones that suffer but it should never come to that. So as you might imagine the logistics of running a sizeable medical clinic in the middle of Sudan is immense. I would be lost if it weren’t for the guidance of my predecessor Maina, “The Machine”. Right now it feels like The Machine has forgotten more about MSF medical supply than I am ever going to know. He has the memory of a top-notch pharmacist and runs the logistical department efficiently and without compromise. I have a pair of giant-sized Kenyan shoes to fill and it scares me to death!

SomeFacts on the Ground:

  1. Southern Sudan is home to more tropical disease than any other place on earth (Stat according to Dr. Stan Houston – TB genius and all around solid Canadian)
  2. The mosquitoes are worse than you could possibly imagine
  3. The flies are the only thing worse than the mosquitoes
  4. So far the heat has been tolerable
  5. Our latrine is first-rate and so far sans snakes
  6. We have no running water and a beautiful star-lit bucket shower
  7. The bugs are the size of Tonka trucks and just as tough
  8. Our entire medical clinic and “expat” office/compound is powered by solar panels and a small generator that only runs four hours a day
  9. Our base nurse Sue is from Calgary and she is amazing
  10. We all sleep in tiny tukuls (mud huts). I share mine with an assortment of bats, rats, ants, frogs, locusts, and spiders, all of which feel it is their given right to use my dirt floor as a toilet… and they wonder why we call them bugs?

Snake Update : Have you ever observed a person who has been freshly bitten by a snake? Well I can now say I have, and it is a horrifying sight to behold. It’s worse than I could have ever imagined, and I had imagined it being really awful! When I saw the patient in question I thought she was a gunshot victim with a bad case of tuberculosis to boot. With this in mind, last Wednesday morning (that’s right – here it comes) as I was trying to enjoy a nice cup of Kenyan tea, Theresa, a lovely woman who works in our compound, lost her bloody mind (you see it’s not just me). As Theresa turned over a bucket, low and behold Sammy the big-ass green serpent was having its own breakfast, thankfully it wasn’t Theresa’s leg, although it sure sounded like it. I could have sworn that Sammy was at least two metres long but Simon our super-cool Assistant Medical Coordinator tells me it was barely longer than a foot. Simon wears glasses, I don’t, and that’s all
I’m saying about that. To be completely honest I had started to acknowledge the fact that I would very likely see a snake at some point over the next nine months but week one … Welcome to the Sudan!

I promised honesty in my last post so here it is! If you want to share the ride, then there are some things you’re going to have to accept. MSF international staff seems to spend a lot of time talking about shit, and no I don’t mean talking shit, although we do that too. When I decided to work in Africa I knew there were a couple of things that I was going to have to get used to and at the top of that list was diarrhea. So imagine my surprise, when now ten days in and I’ve never been more constipated.

I have a low-end theory…

Do you remember the game Snakes and Ladders? I use to play it for hours with my sister Kim when we were kids. There was one giant snake on the board that would send you back to the beginning. It was a real mean-looking bastard, Sudanese green if I’m not mistaken. Anyways, for whatever reason before I left Toronto I kept imagining this Parker Brothers serpent, with its monstrous snake tongue, slithering up from the depths of our latrine and biting my … Lets just say, it wasn’t a pretty image. I sincerely believe that I have come to grips with the fact that there are no snakes living at the bottom of our latrine, still the peculiar power of the untamed mind can be a force to reckon with, let’s hope fiber supplements are too!

My next blog will be in roughly ten days… In that post we will talk about MSF’s outreach projects in Phathai and Yuai, the kids in our TB clinic, the lives of Stephen, David and John, the village and people of Pieri and these mysterious blister/bites that keep appearing on my body! Until then, be well, sleep tight and hope the bed bugs don’t bite.