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.
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,
Photo : Michael White | Mike, John, Peter, and Lual.
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!
Photo : Michael White | Signing off on the cold chain delivery.