I’m struggling to close this chapter

May 5th, 2008 by prinitha

Darfur is cursed.  If it not the blistering swelter, it’s the scorched earth, if it’s not the hot sand at your feet , its walking along side you in a desert storm. If it’s not raining sand, it’s the drops of sweat rolling down your forehead that blinds you. Its either VERY hot, or VERY windy or VERY wet or VERY dry. What is VERY clear is that it’s a tough and exacting place.  It sings an ancient song of sadness dusted with weather  and socio-political storms alike.  Few days left here for me, I get to return home to woolworths foods, family and friends. Here life will go on. A cruel and testing one. The sun will continue to strike and the guns will continue to run. The tribes will be tribes and cows will never be camels.  It’ll be smeared with oil and those who hunt it. And it will be a periodic headline rearing its head for the world to remember. We will remember Darfur but not do much for it. it’s hard to say goodbye. It feels like a fracture. You never quite heal back the way you were. The collage of Darfurians I have encountered on this brief jaunt will always make me smile. It will always make me know this place exists. Not just that it exists but that it is. It is- in all its faces, misfortunes, poverty, richness, complexity, fragility, forgottenness and austere beauty. 

With every goodbye, comes the nausea of loss. So as my replacer arrives and I try to provide the best briefing I can muster, I feel like a stranger in the place I have called home for the last 6 months. The petite dispensary, microscopic world I have inhabited feels alien again to me just as it did when I arrive. The staff have to get use to a new doctor her new prescription habits and her way. They have to have the patience to show her the way as they did me. They reveal their habits, so engrained I wonder how long we have to break the bad ones and she has to show patience too. Patience is a virtue for a reason. Im struggling to close this chapter as is evident from the glaring brevity in this post, but post mission woe settles in nicely now. I have to say goodbye to these companions and to the 4 expats I have had to share every day every meal every thought and every hour with for the last 200 days. What stroke of luck I have to have a Kenyan lass, German and Danish blokes come to be my friends. No trivial acquaintance, but a relationship built on a shared vision, strength, stories of melancholy, luxury, wounds and loads of giggles. So as I spend one of my last nights in the dispensary with a gunshot victim and child with meningitis- I know the boomerang is a sad game played in Darfur without game over potential. I shed a tear for all of it and a smile for the beautiful bambinos.

Hunger gap

April 14th, 2008 by prinitha

Watching a CNN documentary on untold stories is bizarre. Its odd to see an image of Darfur, one that more than just a few are striving to keep on the world agenda, and then realising that I am there. I am here. I am swimming so deeply in a pool of women clad with colourful wraps, camels and delectable children that I forget its stark desert charm is sinking under a weight of an impenetrable state of affairs. Its hard to pin the exact situation which is soaked with deaths of countless Darfurians and counted aid workers. The desert is a tough place. I take a look around this world and its nothing less than nuts. Food prices rising and so are the hungry. I try to present to you a face of Darfur. Not the one I watched on TV, but one that’s idiosyncratic. You remember my 1kg baby? He returned to haunt me today when we had a 1kg girl arrive today, born to a 15yr old mom who is unmarried and whose grandmother wants to take her home. What’s her chances here in the desert? What are the chances for the 3000 odd new arrivals to Serif Umra from their homes up North where they fled to a piece of land that’s foreign in their own country? They don’t demand the expensive extreme ventilator that minute poopsie does but just running water and FOOD. I’m sitting on a premature man made hunger gap. It’s a population trying to cope with damaged infrastructure, looted crops, decrease availability, escalating food prices and a distressed migration. It seems like the brink of an irreversible breakdown of all societal character and a degradation of the nutritional status of the most vulnerable first, the non productive next and then the many men who are still home protecting what they have or those who have enrolled in any one of the scores of armies present.

Our TFC is within walking distance and we have a cadre called a Home Visitor who visit each household at least once a week, to provide information and screen the kids to pick up the ones that have tipped from healthy to malnourished. We provide plumpy to the bambino and a food ration of sorghum, lentils, oil, salt for families who are in the nutritional programme so that we help not just the one already afflicted but hopefully its sibling too. I talk about what we do, but its meeting a 3year old girl in our therapeutic feeding programme, who walked from Wostani 40km away for her weekly ration, that I realise her efforts cannot go unrecognised or acknowledged. Wostani is a 3 hour ride by donkey! This day no donkey taxi so they left home before dark, she accompanied by her 14 year old sister who testifies that her mom is ‘busy’, walked for 6 hours to pick up her packets of plumpy and to make the return homeward bound journey, blessed are they for arriving for the late summer sunset. How to characterise this? Just plain extraordinarily mind blowing! I’m bloody well sure her mom is busy trying to care for the 9 other kids she has at home who timetabled to amuse themselves with the daily labour of fetching water and wood. What to cook though? Not enough to go round that’s for sure or I would not have had the chance to witness a testimony to pure grit, courage and tenacity packaged in the littlest of adults. This is just one piece in the puzzle though…is it enough?

Deep irony is lost on my staff as I ask the butcher about the cow who trampled him and who might have ruptured his femoral artery. It does not escape me though when I’m standing in the ward round midnight. When, the butcher and the quiet of this night that’s makes its inviting, we meet up with our Nurse assistant Hussein who has returned from leave. Hussein is an old greying man and most of the grey on his head bears the name of each of his children. His son allegedly killed someone. I have been privy to bits of information about but which Jens as been more drawn into. Jens has found that soft spot that now bears Hussein’s name. He has gone out of his way to accommodate the needs of a staff member who is desperately trying to keep his family intact. I however, standing in the ward this night saying hello and goodbye probe Hussein to see if he really ok. Of course not, he has managed to sell everything he owns to pay off the blood money demanded as retribution by the family of the deceased. It ties off somewhere around R100 000 or 10 000 Euros. Half in raw cash and rest in breathing cows. So he sold his house and now lives in a reed hut. His lucks extends to a family member accommodating him on his property. Its more than just the money that any Darfurian is hardly likely to see in a lifetime, more than the benevolent sacrifice but that’s its an unyielding one. For Hussein its his daily heartache. For me, it’s a raw moment of joy that seeps across my mind as I comprehend why am I here. This rare moment of being present in a rusty old nurses station sandwiched between 2 wards, tents and the sleeping sick; to share a warm handshake, a nod for mercy, and a sincere conversation about the butcher and cows, makes it all the clear why I chose this life.

  • Butcher fine
  • 1kg treasure’s grandmother stole her and ran away from the dispensary
  • I’m devastated
  • Hussein still the epitome of dedication
  • New member of team- logistician from Norway
  • Staff still treating headaches as well as prescribing me one daily.
  • Woman permanently bent over 100 degrees who has never seen a doctor or dispensary
  • Adam our manic guard, who lights up everyone’s day will now be accompanying me on the children’s ward round.
  • Maybe I take him too to medical meetings?!
  • Confession: I had a whiskey in Khartoum
  • Something fishy about Jens these days
  • I have a small crush on a new stern shahib nurse supervisor
  • I cried with my assistant against the wall of the pharmacy
  • I give, I take and something is taken from me
  • 40 degrees in the shade and my cracked heels beg for a pedicure
  • 3 weeks left……

Just a quick note for those who have spared a moment to post a comment on the blog. These have managed to help nourish me at times when I’m lost wondering where in my reservoir do I hide the rage for the hundreds of thousands of lives lost and of the other silent ones that have fallen. There are those who despite the bewilderment that can cloud the present and make you distrust the future, still rise to the fight to right the ills with much concentration. Concentration of all their finest into their unstinted hearts and weariless bodies. MSF is renown for this. I guess we are here to fuel the useful longing we all need in our lives ……to be…………present. Anyone reading this will surely nod a complicit yes. The loved one of those of us who choose this life will mourn its relevance but forbid its importance when loss replaces. I just wish more can appreciate that these sweet, powerful and sometimes vicious moments that I have related mean something to someone. I send you a heartfelt thanks for your moment to take note and then post one.

Humanitarian

March 19th, 2008 by prinitha

My tummy is tickled when a woman about to deliver her 8th child anyday now and the bambino found lying transversely across her uterus instead of head down, are pled with to go in the referral car for a c/section before she arrives at 3am and I’m helpless. She refuses so I ask her if she truly understands why we are concerned for her… and her response knocks me off my feet when she replies ‘it’s cos you are a humanitarian”……where did she get this? It’s so funny that I’m laughing as I type this. Just as this word is bandied about, that you know that MSF has been here a long long time!! I double over even harder when I learn the ‘Jens’, the name of our expat nurse means sex in Arabic!! So calling ‘Jens Jens for Prinitha’ on the radio has had the staff sniggering to themselves and ‘we are happy to have Jens in the project’ triggered shy chuckles.

Actually we are very happy to have Jens here, he has been a wonderful addition to the team with his saccharine charm and deep appreciation for Tom Waits and Blazing Saddles alike; Rachel who I had the pleasure of working with in South Sudan and now graces me with a shared history of the Mad Strange Fools life as we know it; and thus we have matted together as Serif Umra team. This and my much appreciated, flat turned delight-FULL daily debriefings with Daniel and our little quirky budding friendship provides all the armour I need when I leave the confines and safety of the house to walk to the dispensary to attend, where I cant tell the peculiar from the aberrant or the habitual from the ordinary.

I’m sinking fast

March 15th, 2008 by prinitha

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A wedding though is and should be all about joy, communing, fusion of families and elated feasts. Here gunshots mark the misery instead of celebration and they certainly did that for the Friday family riddled with bullets- 2 who died, 2 with minor injuries and the 13 year old girl with a gunshot right dead centre between her eyes into her budding brain. I feel like shouting out loud against the injustice and I feel like swearing this family who shot their little girl. I feel like saying the cruellest things… cruelty is a touch of hardness that comes from drowning in the worst of sorrows. I’m sinking fast. No counsel leads to comfort as our collective heads dips and our collective pain tremors. I wish someone can pilot away  all the pain in the world.

The burns of a family

March 14th, 2008 by prinitha

Night time brings it joys and its horrors. Night time in the dispensary resembles instant gravity. It’s Friday again, and I try to muster some much needed slumber. ‘Ma moomkin’…not possible!  I’m called to attend to a family riddled with gunshots.

If the night is not fraught with the constant battle of troubled sleeping with the deafening opera of braying donkeys, the hours are spent debriding the burns of a family whose house went to flames. The papa got away with 20% of his body surface area burned. He will not use his hands or feet again. It seems painstakingly obvious his body was shielded as he grabbed his wife dragging her out and so his hands and feet suffered the onslaught. mama however has 70% of her body burnt. Now, for the non medicals…even you can admit that her body will not sing a song again. Amazing they uttered not a single word in the 5 hours that Jens (nurse) and I peeled away their skin like a boiled potato and dressed their wounds. No oohs no aaahs not a word. It might well have been the morphine I was careful to dope them with as the pain of a burn will tear your heart apart and very little compares to that.

Problem is that the baby, found by the neighbour and brought in first had 99% burns, as he started to fade and with a sorry momentary lapse of reason on my part, that the staff and other patients had to tear me off as I refused to cease breathing into his mouth and trouncing his chest. Fighting a lost battle. I despise pragmatism. Who knows what happened exactly, a fire for food left to sinder a bit too long, someone torching the place that’s no new occurrence in Darfur…no one here tells the whole story.  I can only speculate that fear is infiltrated their beings and loss has mutated their genetic makeup……

IDPs

March 6th, 2008 by prinitha

This past week we have had an influx of new IDPs (internally displaced persons) from north of Serif Umra, about 500 a day. They have settled on the outskirts of the town, fleeing the area they live after a spate of attacks and deaths. Outskirts means… no water, no shelter and they have the dear little that they grabbed when they ran. After some obstacles encountered, we successfully managed to do something for them. The logistic team, a team of pure sinew had the arduous task to build a 2metre sandbag structure for a bladder that accommodates 15.000 litres of water and a water tap so that the displaced would not desiccate away in the 40 degree swelter. Their makeshift shelters were really carpets hanging on 4 sticks and some reeds planted together to shield from the wind on 3 sides. The sun beats down in a vengeful stare that usually on my 5 minute walk to the dispensary melts my brain. So shelter prevents them frying theirs. We build some trench latrines and distribute non food items, like blankets, soap and jerry cans to carry the merciful water. As Daniel said, it feels like a drop on a hot stone, what we have done for them. Protection, well that’s all the harder for the mostly female headed/guarded households as the men stay behind to safeguard what they have left. One of the new IDPS was shot last week. He too, dead on arrival, despite being less than 5 km away from the dispensary.

More losses

February 29th, 2008 by prinitha

8 patients who were admitted to our dispensary this month of February died. We admitted more than a hundred and did more than 5000 consultations . approx 20 died in the town, and I have no idea how many have died in the greater Serif Umra locality. So you must wonder why do I spend so much of my time writing about so few deaths and not about the countless we save. Morbid fascination, depressing bouts, enthralled with the bleak, dark curiosity with downfall, powerful insult to a vulnerable ego, compassionate condolence? Not sure, but it penetrates deeper than revelling gratification from saving lives.

Until…… the wizened look on a marasmic infant consuming every simple thing in sight as a few designed meals beef him up;  that when he smiles and uses his teeny weeny fingers to grip your finger with all might summoned, it imprints his memory into mine forever, ever.

Cold, hard and cheerless

February 28th, 2008 by prinitha

5 dead on arrival. All littered with gunshots. Examining a cold, hard cheerless body leaves you cold, hard and cheerless. 4 of the men shot were relatives to our guards. Abaker, one of the guards, is big man. In many ways. he is towering figure with a deep ravenous voice that keeps u awake when he is on duty at the expat house. He has equally deep dimples that liquefies all malevolence. He is a big guy. Today he shrunk. I think it might have been the first time I have witnessed someone wilt when their loved one has died. Maybe because he lost 3 in one shot so to speak. Usually I get to observe families members when we come bearing bad news and overarching grief strikes most in the form of shock and disbelief and then a deluge.

I have never visibly seen someone wither down as he did the night he came to identify the body of the now immeasurable loved ones he has lost since the conflict began.  I have little to offer in times like this. For another gentleman I break all taboos and stroke him tenderly to commiserate. I felt so charged to sympathise, that when I saw some men outside the morgue sitting, I went over to… you know just try to say something. Nothing came out of my mouth of course.

I noticed the men were sewing together pieces of material for the burial rites, using the edge of the material as thread, making gloves for the body. Now you must be let in on a secret, a man sewing (and daddy caretakers), turn me to mush. More so in a dense patriarchal society as this one. All I mustered was ”moomkin?” meaning possible?  Pointing to the carpet asking permission for lady doctor to sit beside them. Solemn nods of approval. I watched and dropped my head each time someone came over to greet preparations were halted and the offering of their palms up to the heavens in prayer. Every 30 odd times. In a raw second, I catch the eye of the gentleman I hugged earlier. His eyes caught mine and I think he’s saying with a sense of stoical forgottenness he feels the world owes him nothing, nobody is watching and none of his pleas to bring back his relative is heard. I’m sure when we lose a loved one all we want is to replace and restore. I think all I have to offer him is the hope that owing and watching each other is a priceless surrogate.

An elephant with a toothache in need of a root canal

February 27th, 2008 by prinitha

Where does this brave reservoir of mine reside? It reveals itself like a seductive dream you can’t help feel like you remember when you awake. The dream you are sure of just between the aphasic phase and denial phase of the new day that awaits you beyond the bulky blanket. Sometimes though, I have the swaddle resembling an elephant with a toothache in need of a root canal. The life in the desert immediately anaesthetises me and I’m then left juggling the numbness and inflammation. The harsh environment provokes emotional masturbation. Inescapable. On reflection this is par for the course – this initiation and rite of passage in Sudan, I had it in South Sudan and now North Sudan seems to hold no special mystery otherwise in this respect. In other ways it is incredibly special. Here you will walk the ambidextrous path leading you to all the philosophical quandaries. You think you heading for the Nile instead you feel you are just in the middle of nowhere. But nowhere is somewhere for someone!

Meningitis takes its toll and my heart falls

February 25th, 2008 by prinitha

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Last night a woman with a previous caesarean section and prolonged labour kept me awake till she delivered at 6am. Why do they always come in the middle of the night? The call to maternity during the wee hours of the night takes me back to those days of protracted humiliation as a medical student, and those ghastly days of community service, and that shows me up again. For one, obstetrics always gets my knickers in a twist, I can’t seem to act quick enough, I panic deep down and (as usual) in the end you do just fine. But it makes me feel completely inadequate because you always feel like the life and death issue so much more urgent here. And it beats hands down the purity of fighting the social injustice when you do paediatrics. So after my doctor skills get called into action and question at 2am, my focalising eyes are also evaluating the electricity and the carpentry work and my heads spins as I walk away during the full mooned night not just a stress ball of emotions but also notes to self for logistics and pharmacy and more and more and more and more and my heads spins so I don’t sleep.

I fall asleep when I get called again to the ward for 2 babies who just arrived, both facing their first 6 months of life. The odds were against these babies. One had a bulging fontanelle, fever and was having seizures. I put on the works with heart numbing speed trying to halt the ticking hand and left eye but it was just a brief sojourn. My heart fell. The caretakers of the other Baba’s sighed in unity. I refused to give up and eventually the seizures abated and I added the antibiotic and then rushed the other triaged with the poorest of prognoses. He, and I say this with a whimper in my voice, was gasping for something and air I suspect was not it. His gasp was his farewell words to his parents and his limp decrepit senile seen-it-all grandfather who had that look in his eyes, as he joins in the fight for his lineage that shows he himself has not yet plateaued.  This little one too had the signs of severe complicated meningitis clinically and so I threw all in my arsenal right at him, dextrose, anticonvulsant, antibiotic, steroid and some analgesia. Pain is a killer too. In his case it had something to do with him being born in the vast stretch between here and the next health centre. Both too far outta reach. We need to go to him I guess. His parents assure me they tried everything to get him here, but in Darfur I’m doubtful the Donkey going to get you more than water from the water pump or a head injury, and a car that drives by is probably not going to stop for anything other than that – a drive by shooting! Our referral car has been shot at, the roads are not safe and the number of viable vehicles is not available for ambulances, even makeshift ones implored for by parents of a dying infant. So meningitis rears its ugly head again.

In MSF, in the meningitis belt from Ethiopia to Senegal across 20 countries I find myself inhabiting, it is not the isolated disease you isolate as you would in a Danish hospital. No. Here you get the cases, you spring into action. 700,000 people have succumbed in the last 10 years to it. No time to waste then. You check your stocks of drugs, you make sure your staff know the protocol, make a plan to get specimens to the nearest laboratory 3 hours away by plane, you track the cases and you evaluate the cold chain for vaccines in case of outbreak. Cold chain… Ha! In the desert with no electricity, no open road to get gas… Ha Ha! Some life saving force makes me hold my tongue and not laugh out loud. I just get to work. I check my darling of a person with meningitis who takes five days to smile and something deep within me resonates that there is indeed something precious to hope for sometimes and its this that dissolves away all angst and muddy reasoning.