Matters of Life and Death

21 December 2010

Yesterday, I was teaching Malo, my generator man, and electrical know-how worker about percentage. The generator fuel reads as percentage on the little control screen, and I was trying to explain that one of our generator readings jumped around between 0 and 86% when it was running. I think he understood, ‘de facto’, but not, as they say ‘de jure’. The principle was lost on him. We have been building without a tape-measure since I came here. I was proud of my own foresight in bringing a nice big 8 metre tape measure, which I learnt to the boys to build doors and roof-trusses. Since arriving here, and with the help of Tyler, my predecessor, we have all but completed a four-room isolation Tukul. I am proud of this, and it means that extreme cases of Tuberculosis, Kala-Azar and Malaria can live next to each other without fear of cross-infection. It seems that it is the double-infected who are the most difficult to bring back from the edge. We did all of this building without a working tape-measure, as mine got broken the first day. Secretly, I think the boys were so fascinated with it that they kept unravelling it all the way, and ruined it. Maybe it was on its way out anyway.

So all this week I have been compiling the monthly Logistics Order whilst my tech-team, 10 national staff, and 10-12 daily national workers, have been digging latrines, building, and cleaning-out the chaotic Logistics Store. I long for shelves, but shelf-building requires tape measures. On the plane that came this morning, came, finally, a whole bag full of tape measures. The first I knew of it was Riek, one of the newly-contracted Log Boys, running to find me in the office. ‘Look, look, Tape Measures!’.  I ran back to the store with him, and into much jubilation and hand-shaking. Christmas had come early to Lankien. It is wonderful to see this kind of commitment, both to MSF and to learning and skill.

But this morning’s plane was not on a tape-measure mission. On Wednesday night, whilst I watched a DVD after work, in the comfort of the communal Tukul, midwife Shiela was in the delivery-room of the Ante-Natal Clinic in a bloodbath.

I had wondered where she was at the end of the day on Wednesday, and simply assumed that she had gone early to bed. It turned out that just as the working day normally finishes (dusk), a mother turned up in the delivery room half-way through childbirth with a prolapsed umbilical chord. She described what happens here, where we are without ultrasound or capacity for caesarean section, with only a doppler on the belly, and a tool like an ear-trumpet for listening to the heart-rate of the baby, which, fluctuating with each contraction, was being starved of blood, and dropping to zero, then fighting-back again. ‘They’ll fight for a long time to survive, eh.’ she says, ‘But in the end, what can you do?’ Just as she was finishing ‘clearing-up the mess’, another mother came in, dragging the body and legs of her breached new-born in the dirt, the head still inside her. Sheila had to birth the rest of the delivery outside the Ante-Natal Clinic, as there is only one delivery room. ‘Ah, well, at least the mothers survived’.

So today’s plane was for a ‘green-lit’ (emergency) flight. A patient in a problem childbirth was flown-in from Yuai, one of our outreach clinics. The plane came here from HQ, dropping-off tape-measures, picking up Shiela, and then on to Yuai. It returned, coming to a perfunctory stop on the airstrip and I helped to open the door for Shiela, and carry out the mother on a stretcher.

Lifting her off the stretcher and onto our clinic stretcher left a pool of blood which reminded me again of how close to life-and-death we are here. As a logistician I am aware of the work’s importance, but the specialists often do their thing behind the closed doors of the Tukuls. The night-time still-borns were difficult for Shiela, having to ‘do it all by feel’. She had no torch or radio with her, and anyway had been too busy to call for help. She had said there was nothing I could have done, but that night I had gone to bed cursing the fact that we were still waiting for light-bulbs from HQ to illuminate the Maternity clinic, and that I had not foreseen that I could have helped somehow to make Shiela’s work easier.

During childbirth, the mothers hardly utter a peep here, if anything a soft cooing which Shiela imitates, and it sounds like the warbling of a wood-pigeon or a dove. This is their birthing cry. Without medication of any kind. Without exception. Kathrin and Shiela laugh about the profanities uttered by the average western mother at 1cm dilation, and we wonder together that childbirth is, in fact, not the great leveller across cultural conditioning. Shiela likens their stoicism to the North American Indians.

But it is so easy to get things wrong here. And it may seem that tape-measures and Logistics are secondary, but we all depend on each other. Last night I was out of action with food-poisoning, and so I was not able to check water levels in the water-tower. The generator pumps water up to it, 10,000 litres. Then there is a tap which we hold the key to, which Logistics switch on to supply the whole compound. This morning there was no water in the tap in the kitchen (nor, of course, in the delivery room), and I was still sick. Laraine had managed to get us organised for the plane with minimal help from me, but of course when the mother came into the A.N.C., there was no water for the procedure. I had asked our national staff ‘Bo’ to have it ready, but it was again somehow lost in translation, and I had more than a mild panic. It was easily remedied, it turned-out, but it shows that the margins for error can be minuscule at times, and have huge impacts.

Shiela is a careful, gentle, and consummately professional medic, whose life experience working with the displaced North-American Indian population on reservations belies the fact that this is her first mission. We have bonded a great deal because of her combination of warmth and capability, and her strong personal history of taking adventure at any opportunity. We compare notes on cycling and spots along US Route 66 which we have both visited, and she has, over the weeks, regaled me with tales of her and Rick’s (her partner)’s coast-to-coast trans-continental bike ride, and her self-build housing projects in the mountains of the Mid-West.

She deals with birth and death as a profession, and has a loving but philosophical attitude to death, as do the Nuer themselves, she reports. It was only the other night that I found out that her partner Rick had in fact died two years ago, but he was so alive in my – and obviously her – life, that it prompted me to write out my late father’s favourite quote  for her:

Immortal Love

They that love beyond the world cannot be separated by it.
Death cannot kill what never dies.
Nor can spirits ever be divided, that love and live in the same divine principle, the root and record of their friendship.
If absence be not death, neither is theirs.
Death is but crossing the world, as friends do the seas; they live in one another still….
This is the comfort of friends, that though they may be said to die, yet their friendship and society are, in the best sense, ever present, because immortal.