James Maskalyk

yes.  even here.

I have had a tough time sleeping lately, and by lately I mean the last few decades.  After a couple of years of success, things have worsened here, and i lie in front of a blowing fan blowing blowing sand, and watch circles’ seams twist into impossible scenes in the blackness behind my eyes.

Yesterday, I passed by our maternity ward and saw a crowd of people pushing themselves in. I used a line privilege unavailable outside of MSF projects to cut the queue, and wedged through the wooden door to find several women sprawled on a concrete floor slick with chlorine.  34 women in the ward, labouring, and the staff hurried, harried, from one to the next then back.  A concerned group of elders came to the hospital later that day, worried about our capacity.  Keep sending them, we said. We’ll deliver them all.  Better here than the bush.

“This is where the people come out”, Annie Dillard wrote in reverence, from the delivery floor of a hospital.  So too in Dagahaley, blue or bloody, screaming or silent, one after another, life effervesces through women into the cold, clear air, and so it goes.

If the earth was a ship carrying humans, pregnant women would be our most precious cargo. That is why those of us  care to compare health statistics between nations look to maternal mortality first. It tells us where our fastest leaks are. Countries like Somalia lose women, and the life that bubbles through them, a hundred times faster than a country like Canada.  a hundred times more.

(figure: proportion of maternal deaths/1000 population, courtesy of worldmapper)

I left the crying chorus in maternity for a more familiar one in the pediatrics ward.  I moved slowly down the growing rows, and listened to my translator recite each mother’s rolling woes, then edge slightly closer to her child who had never taken her suspicious eyes from me.  i would talk to her like and adult, though she might be only one.  ”pleasant weather we’re having.  a bit hot?  agreed. me, i like the cold.  you?  no preference?  what do you like?  sleeping.  i get that.  eating?  no kidding. me too!  how’s that going?” and if our conversation goes well enough, i can pat my stethoscope from the bed, to her knee, then her mothers wrist, to where it belongs on her rail thin chest and its fast beating heart. bumpbumpbump.

i don’t have any kids, but i get it.

halfway down a row, i came to a woman with one blind eye, her globe white where the dot of her iris once was.  i sat on her bed, and she set her child in front of me.  he was in no condition to cry. ass I turned his lolling head to the side to search for nodes, I noticed a necklace of carefully threaded white buttons ringing his neck.  i held it between my fingers. she smiled and said something to my translator. she shook her head.  the family was so new, from so far away, they didn’t speak Somali.

It didn’t matter. I knew what she said. She loved this one so much, that she saved what she could to get buttons better used for something else, and made him this so it might keep him safe.  I said I would do my best.  she nodded.

I’ve heard it said, from people at home, that women here, because they have ten children and lose 4, must suffer the loss less deeply, that they get used to it, their love hedged like a bet.  These people haven’t sat in front of rows of women fanning one child, the rest hungry at home, or with the woman in the maternity who delivered a tiny, tiny child, small as a bird, and who was angrily refusing to stay in hospital where he might be fed.

She sat, resolute, arms crossed and adamant, until I said how hard it must be to have walked so far, in such heat, with so much hope inside her,  to now be sitting beside it, watching it fade, and her eyes became glassy with tears.  it was no abdication of love, but generations of hard truths of the land she came from, and she was taking her baby back to her stick house to die.

life is precious cargo, even here.  Especially yesterday. Bunch of people came out, in dagahaley, hope manifested, all healthy, and today, is quiet so far, a third as many new humans as yesterday.  we’ll see if we have become victims of our own success, if all of our entreaties to send women to the hospital, day or night, have worked.  if it is a trend rather than a solitary spike in birthday parties from a particularly amorous may night, we’ll put up tents while we build another ward.  better here, on the clean chlorine floor than in the blackness of the bush.  this is a beautiful world.  may the people that come into it live to see it through their bright eyes.

from some of JR’s work in kenya.  beautiful.  blessings. j.

a black figure approaches on the horizon, jittering up and down with the car. it is a small boy and as we pass, he points at the blue jug on this forehead.  we slow, and my kenyan colleague in the passenger seat rolls down his window and tosses a litre of water from it.  it cartwheels in the dirt, and the boy races after it.  i look back, and he is holding it high, waving it in thanks.   we drive on, passing many more people with perched plastic buckets, but have no more water to share.

i have left dagahaley, for two days, to the nearest town.  it is as hot, as dusty, but there are people, a broken pool, a room with air conditioning.  i am in it right now, and ive made it so cold that icicles dangle from my exhalations. my left foot, frozen, fell off when i hit it on the bathroom door and is thawing on the balcony.  i have set the thermometer to zero kelvin, and need to finish this before it reaches it, and molecular activity stops.

the best thing, beside the plummeting temparature, is that i can take a walk. after sitting in my room for an hour, i took one towards the nearest barber.  it was a few hundred metres before the freedom felt comfortable, like i wasnt breaking the rules, accustomed as i have become to the last month’s circles.  in the chair, the barber took the most delicate care, and i payed him double despite the jutting hairs.

who do you work for, he asked, shaking the hairs from his sheet. the UN?  do you live in dadaab?

no, i told him,  dagahaley, my whole team, in the camp there, with the refugees.

tell me, he said, what is it like?

well, i said, fishing the shillings from my pocket.  yesterday, before i left, a nurse told me that 142 new people arrived after a month in the desert with no rain. some had lost everything on the journey, even had their clothes taken from their backs, and were naked. they had risked it all  to get to dagahaley.  and to your country, the first safe place they may have ever seen.
thank you for the haircut.  it was just what i needed.  he nodded
thoughtfully, and took my money.

i walked back in the hot sun, thinking about what else was lost on the long, dangerous way.  about my country, canada, which takes as many refugees in a year as dadaab might in march as my countrymen think only about what is lost, never fully what is gained.

i have been outside of the project for a day, and it feels like a month.  i think it is that i get to decide what i do with my next minutes, so the ones that approach are unexamined, unplanned, fresh, full.

those 142 people, they’ve given that up for a different kind of freedom.  a dismissal of fear.  of watching their children die, or of their husband disappearing for good this time, when he takes the goats to graze on the disappearing grass, two days away.

but here, they get free medicines, i hear people say.  free food, too. free tents.  school.

yes, everything’s free, i say. everything except them.

today, however, i am free and am going to exercise it in the best way, by lying down in bed and sleeping some more.  maybe some room serv….ice……oh..tempe..r…a..t….u. r..e…..f…a…
.l…….l…….i……n.. ….g……… …m……u……s……t
……..p….  …..r……..e……….s…………………..s……….end.

This morning I arrived to a quiet blue bundle on the wards first bed
The cleaner, his beard dyed henna red
Waiting patiently to clean the plastic below
A boy, newly dead

A family of cats lives in the cupboard where we store the mosquito nets. During the hot afternoon the mother lies outside of it’s door, panting, just beyond her mewling children’s sweeping paws.

Yesterday, as I was leaving for the day, a young girl was dropped onto a still warm stained bed sobbing sweating, crusts of infection tracking from her ear.  Her head was torted so fully to the right that her eyes looked behind her. and she pushed mightily on that ear, trying to get straight enough to repel me better but could not. This morning she was sleeping, her head still turned, but the fever gone.  Minutes later, I watched through the wire as she walked beside her mother in a trailing orange scarf looking sideways at a tilted world.

I turned to the woman in front of me,  twenty,  and asked her why she was not breastfeeding her baby. She became bashful and turned away. She doesn’t because she’s already pregnant again, the nurse said. It’s still ok, i answer, but this battle is one I’ve yet to win.  How many children does she have so far? The one in her stomach is her fifth.  Five? So young. How many will she have? Many, many, his answer .

And you, i ask him. How many children will you have? Ten, he says. Ten? Yes.  My heart is too big for any less. I have too much love.

The next in line is a breathless girl, old enough to be in the hospital alone, her mother at home with the youngest. I sat beside her and placed the bell of my stethoscope on her back.  As I listened, her hands trembled bravely.

A father pushed through the door carrying his dangling dehydrated daughter, in his fingers a card marked “urgent” that matched the look in his wide eyes. He paced back and forth past rows of beds, not knowing which, if any, was his. One of our staff, in a smart shirt,  took the paper from his hand and said on  she’s for the feeding centre and pointed him out.  No, I said, he’s walked enough. For now we’ll let him lay his dying daughter here.

Today, when we walked to the ward we were met with a chorus of cries from 31 patients, their mothers and sisters wrapped in scarves and bright dresses, stretched on beds below blue mosquito nets waving hospital cards over their bare children.  Beside the first, a sad family stood, the cleaner beside them, patient as charon, his beard dyed henna red.

They knew not their new home nor the right ground for the dead, lost from weeks walking, sharing the boy on their backs,
the sun high overhead.

So we wait for a car to ferry them to their new, bare ground: one patch for a house of sticks another for the quiet blue bundle between them.  Behind my desk, the cat arches herself from the behind the cupboard’s cracked door, lands softly, stretches on the dusty brown floor.

it’s too early to be up, i think, and blink one eye open to see if it stays, and it does. i roll away from the beds heavy divot, the pressed form of the person whose room i inherited, and push my hands through the mosquito net onto the cool wall. i linger here, letting my dreams sift back to their soft world, then push myself up through the plastic gauze and into the early light of a compound deeply asleep.  a breeze flutters my torn curtain, as i scrape my chair to the corner of my room and the computer that sits there on the desk i hammered together on my first day.

where to start.  so much happens in a moments infinite breadth. during the medical meeting a glimpse through the wire of a woman hanging her bright scarf on the branch of a tree, and then a bird swoops smoothly into the frame in and the world is born new again.  it seems no matter where you find yourself, you are always in the middle of your story,  the landscape racing away in even distances at all sides, like future and the past.

our medical meeting informs us, each day,  of the night’s events, patients added to our census, coughing and feverish, or subtracted, their body loaded onto a donkey cart at first light.

the bird wheels away, and she turns to watch it fly.

“maternity….twelve admissions…..nine deliveries…”

the afternoon before, i left a child huffing and breathless on a  plastic bed, his parents beside him. he had fever for days before his  mother took him to the health post, the clinical officer there taking one look at his shaking frame before calling a car to take him to the hospital.  i was returning from the lab when i saw the land-cruiser enter the hospital grounds, fast and bumping, and seconds later, the driver was trotting across the yard towards my ward, the boy cradled against his chest, arms and legs dangling.

“….one mother has failed to progress, and will be taken to theatre…”

he was four years old, previously well, until he caught a fever. seizures started yesterday.

“….adult ward…five admissions….four discharges…”

he was unconscious when he arrived, and you could feel his hotness before your hand hit the skin.  his malaria check was negative, his  blood sugar normal.  we cooled him with tepid water, gave him intravenous tylenol, but the convulsions continued.  his body didn’t move much, exhausted from all the shaking, but you could tell the seizures from his eyes, the way they looked up and to the right, just over your shoulder, like he was seeing something you couldn’t.

“…one death…total patients in the adult ward….17….”

we eventually sedated him enough that his seizures stopped, giving his brain a rest from the electrical short circuit that if perpetuated, would scar it, maybe already had.  his breathing became regular, and his lids closed. if you pried them open, the irises stared dully forward.  we moved him to the bed nearest the front, and set him resting on his mothers lap.

“….pediatrics ward….”

i went back a few minutes later, and someone was trying to give him milk while he was on his back.  no, no, i said, taking the cup, shaking my head.  he’s too sleepy.  and when he wakes, you sit him up, so he doesn’t choke, like this.  when he’s sleepy, leave him on his side.  do you understand?  i turned to the nurse beside me and said, make sure she understands.  he nodded.  the next time i checked back, the child was sputtering, milk bubbling from his nose, his breaths coming in jags.

“….seven admission…”

he worsened over the next two hours.  i sat on the edge of the bed, with his worried mother, shaking him when he stopped breathing, trying to figure out what to do.   he needed a ventilator to let his small ribs rest, but we have none, nor was there one nearer than nairobi. i decided to to take him to the operating theatre and intubate him, suck what milk i could from his lungs before it got pushed to the edges, suffocating him further.    i explained to his mother that there’s a chance it might make him worse, and only a small chance it would help.  it was, however, a chance, and it’s what i would do if it was my fathermothersisterbrother, and its the only thing i can think of that is doing something besides hoping, each time, that when he stops breathing, he starts again.  she agreed, and when the OT team arrived, we removed him from his oxygen.  she took him in her arms followed us across the hot, blowing yard.

“….five discharges…”

an hour later, he was lying on his side, back in the pediatrics ward. we removed only a few teaspoons of milk, and watched, our hearts in our throats, as he coughed and coughed and coughed when we removed the tracheal tube, our flutter settling with his heart rate.  now, back on the plastic bed, oxygen whistling into his nose, he was breathing easier.  not as fast, not as ragged, no pauses.  the truck was calling for me to come to the gate.  it was near curfew.  coming, i called into the handset, and left him, huffing, beside his mother.

“….deaths….”

comeoncomeoncomeon.

“….zero…..total patients in the pediatric ward…24…”

i left the meeting and walked to the first bed.  he was there, eyes closed, working, taking it from the top with each breath, but alive,  still in the middle of his story.  he remained there when i left him again last night, eyes closed on his blue bed.

we do what we can when we’ve the chance.  sometimes, in places far away from the world’s eyes and priorities which seem more focused on 3D TV’s (it’s almost like the real world!) than half breathing refugee kids, it’s not enough, but the trick is to not let defeats diminish the verve for trying honestly each time, let motivation to rise, again and again, as new as each moment.

compounds up.  coffee time.  happy new day.

last night i shared a shower with a frog.  as the water poured from the pipe, still hot from the sun, i saw him bouncing in the corner of my eye.  i thought at first it was a jittery cockroach, jagging back and forth in the light carrying through the door’s warped frame.  or is it a mouse?  neither prospect made me start, accustomed already to sharing space with insects and animals who,  in my usual home, so insulated from the real world, would seem intruders.  i blinked the soap away, and it hopped onto the bottom of the doorframe.  it sat there, wet from the splashes, throat bulging with breaths.

i considered kissing it, but couldn’t remember if frogs were only princes disguised, or if there were a princess or two in the mix, similarly cursed.  i  decided against it, to spare the awkwardness.

(poof).

“oh.  hey.”

“hey.”

“…..”

“……”

“i didn’t expect that.”

“i’m sure. to be honest, i didn’t either. when i saw you go in for the kiss, i was gonna say something, but, well…..”

“you were a frog.”

“right.”

“not a great place to be a frog.”

“tell me about it.”

“not much water around.”

“hardly at all.”

“…..”

“…..”

“well.  i guess i’ll get going.  i should probably get back to my kingdom.”

“sure.  and i should….finish rinsing off.”

“soap can really dry your skin out.”

“definitely.”

“…ok….”

the door creaks open.

“hey….uh…frog prince.  my sarong’s outside on the line, if you need some clothes.”

“actually, that would be appreciated.  when i make it back home, i’ll send it back with some jewels or a goblet or something.”

“don’t worry about it.  and hey, sorry i wasn’t some damsel or whatever. i kinda forgot that the frog thing was, like, a dude thing.”

“yeah, we’re pretty much all guys.  the girls usually get put to sleep, or held in a castle.  that kind of thing.”

“noted.  anyway, good luck.”

“you too.  thanks again.”

“no problem.”

“bye.”

“see ya.”

(fade)

i rinsed off, and creaked the door open a crack.

“you sure you want to do this buddy?”

he bounded out, hopping in the dust towards the middle of the compound.

i’m told, that an hour after the first rain, the night is so loud with the jubilation of their croaked calls that you can’t sleep.  these days, it’s silent.  no rain, none for months.  some mornings, there are clouds, but by noon, they are burned off by the sun’s blaze, harmless things.

last week, i visited the new arrivals’ area.   in a midday heat of 40 degrees, an acre of plastic jugs, yellow, red, white attended to by women and children who had heard of a possible water delivery.   we stepped out of the truck, and into a crowd of children, each trying to hide behind the next, then getting pushed to the front in a churning cycle of curious eyes.  i tried to read them for the dull daze of sickness, or starvation.  i knew, though, that those children would surely be in the homes of sticks we had just passed, a hot breeze flapping the plastic sheets above their bed of rags.

i ran into one of our nurses crossing the compound yesterday, and she told me that she had brought water and soap to ten more people who had just arrived, and that tomorrow they would get food.  not today, though.  no food today.   a leader of the nearest camp block put a call to the other refugees to contribute what they could for the newest citizens of one of the world’s fastest growing communities.

6000 last month, more expected this one, most arriving with no food, nor water, nor shelter, to find none, a weekly call going to those who have anything, to share it with these strangers.

and yet, this place, with all of its nothing, is better than what they left.  some say its market, barely a blink, is the biggest they have seen. and the most peaceful.

i talked to a man who has been here, in dadaab, for twenty years.  “i have no plans to go back,” he said.  “everything is here.  my friends, my children. one day, though, perhaps my sons and daughters will return.  where did you say you were from?  Canada? yours is an amazing country.  you take many somalis.”  he smiled and shook my hand.

i dry myself off, open the door.   i walk behind the shower.  the ground behind it is dry.  no sign of the frog.  i listen.  the drone of a distant television.   above, the clear night sky sparked with stars.

i take my sarong off the hanging line, and walk towards my room.  in the corner of the compound, the frog pushes himself into the smooth dust, deeper, sand dry on his skin, the showers splashes a memory.   far below, in the baked earth, he waits, saving his voice for a kingdom yet to come.