The call comes in. It is finalized, the nurse and acting medical team leader (MTL) have managed to arrange a flight for two patients – a sick man and a woman with pregnancy complications – to more established MSF facilities in the Protection of Civilians (PoC) camp up north.
We are in Leer, an MSF project in a remote rural location, where I am the base logistician. That means I work on the practical things a medical project needs to save lives, including transport.
It is rainy season and we have already had to cancel a number of flights because of standing water on the runway, so we only have a very small window to get the patients out before the next rain comes.
If we miss this chance, the plane won’t be able to land and the patients won’t get the care they desperately need.
Far from good
To make matters worse, the plane the patients will be travelling on is not coming to our usual airstrip, but to an area that is ninety minutes’ drive away in good conditions.
After several days of heavy rain, the conditions currently are far from good.
Plus the plane carrying the mud tyres for our cars won’t arrive for several weeks!
A scarce commodity
Like most people, I am becoming increasingly accustomed to the digitization of many traditional mediums, however, one area where I am still a staunch traditionalist is mapping.
Part of my insistence on physical maps comes from a nostalgia for orienteering from when I was younger. But to a much greater extent, it comes from the practical implications having a real map can have for planning.
Whilst apps like Google Earth may be useful for locating the landmarks in a new city or ‘pinging’ your location to friends on a night out, these apps just don’t compare to a large, visual representation of your entire area of interest laid out in front of you.
The ability to see not only your current location, but your destination, alternative airstrips, proposed and alternative routes, all laid out on one document, is infinitely more useful for navigation as well as contingency planning.
Unfortunately, maps – like a great many other things in South Sudan – are a scarce commodity. Prior to organizing the medical evacuation for these two patients, the most up-to-date (and only) map of the area I had dated from 2011. That made it eight years out of date, made five years before the last crisis which saw much of the country’s infrastructure destroyed, including the original MSF hospital here in Leer!
A break in the clouds
A good piece of advice I was given when I started in South Sudan was that “it doesn’t take a genius to point out what we don’t have. The challenge is to work out how to utilize what we do.”
What I have is an A4 Google Earth print-out of the area; a highly skilled and knowledgeable team of local staff; an abundance of phones and a break in the clouds.
I take the print-out, place it on the bonnet of the Land Cruiser and begin outlining my plan to get us to the airstrip.
Meanwhile the watchmen are giving me security updates for the planned route, and the drivers are communicating with their friends who inform them where conditions are good and where to avoid.
I scribble down this vital information, and with our route now planned and the flight confirmed, we help the patients into the backs of the vehicles and begin our journey on the bumpy, muddy and slippery road.
Two sides of the same coin
It is often argued that conflict should be understood as ‘development in reverse’, and much analysis of South Sudan is focused on this line of reasoning.
However, World Systems Theory views development and underdevelopment as "two sides of the same coin". So following that idea, the proliferation of conflict in mineral-rich "periphery" counties actually contributes to the development of other "core" countries, which are mostly oil-consuming.
As I attempt to navigate by the increasingly crumpled, torn and sweat-soaked paper across the mud tracks that were once roads, I can’t help but lament the surplus which means I am able to navigate to and from the shops at home by the palm of my hand!
After a very long and exhausting journey where the drivers used all their skill (and quite a bit of luck) to drag our vehicles through the near swampy sections of road and over collapsed culvers, we arrive at the air-strip – a potholed piece of sand surrounded by swampy grass adjacent to our ‘outreach clinic’.
The clinic is a simple wooden structure covered in plastic sheeting, which is yet another gentle reminder of the country’s troubled past…
During the recent peaks in violence, clinics and houses which had been constructed out of the traditional grass and mud, had been burnt down. Though it may look shabby and basic, the weathered plastic sheeting offers a mildly flame-retardant alternative to the grass.
However, this humble exterior hides a warmth and sense of community. Our drivers have barely hit the brakes when we are surrounded by the clinic staff offering warm welcomes – it has been a while since we last visited this site.
As our nurse checks on the patients, I am led somewhat unexpectedly, to inspect an almost full latrine and to advise on the repair of the clinic which was damaged in the recent heavy rain.
This warm greeting and catch-up does not last long.
Soon we hear the plane approach. The community and clinic staff rally together to help the drivers and I chase the goats of the airstrip!
In what seems like no time at all, we have helped the patients onto the plane and are beginning the drive back to base.
This time we’re navigating using only the drivers’ knowledge of the area: the ‘map’ has been damaged beyond any use!