40 degrees in the Sudanese shade

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.

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.
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.

Photo : Michael White | Chuol, the head guard.

Salutations from the south,
Michael

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!!!

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.

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.