I have been told that some years, in this season, a thin cloud appears on the horizon of an otherwise clear day. It approaches quickly with the wind and minutes later, locusts cover crops, cars, tukuls, and lie floundering in puddles. as I type this, one is doing a stop-motion crawl across my tukul floor. skitterpause… skitterpause… skitter.
last night I lay sick in bed, sweating, plastered to my sheets. I could neither sleep nor accomplish anything. I listened. donkeys braying, calls to prayer, generators clattering. but as I was drifing in and out, at once, above the usual noise, wailing. a chorus of cries from the hospital. another dead body. another throng of people and more, running from town, to join the mourning. I pulled myself up.
we have been having problems with dead bodies recently. not because of their depressing number; this is something the abyei hospital is accustomed to. other problems.
where to put them? we replaced the dusty room at the back of the hospital, a makeshift morgue, with a pharmacy. now when someone arrives to the hospital ten minutes too late, we flounder for space. in the emergency room? occasionally. it does little to instil live patients with confidence in the hospital, nor my skills in emergency medicine. in the tent beside the tfc? once. when the roof crashed in from all the rain (more later), the women refused to move their children into the tent. haunted. on the ground, in the back? too wet. in the room at the front? nope, full… measles patient. in the pharmacy? over my…
dead body problems. they don’t end there. as I alluded last week, we recently suspended activity in the hospital. an important ingredient was the police routine of bringing suspicious deaths to the hospital to confirm the cause. of course, in absence of an autopsy and a pathologist, my medical opinion mostly ends with looking for gunshots. no matter. it is area policy, and it is done. the problem in a place like this, crackling with political and military tension, is that it opens the hospital as a focus for confrontation. in our recent case, this is what occurred. like peace, war sometimes requires only a tiny piece of glass
to become real.
dead body problems. when someone is sick in a village, they don’t come to the hospital straight away. there is no road. transport is too expensive. often the family calls a traditional healer, and they spend their carefully collected money, likely saved for this exact contingency, for treatments that do not
work.. the patient worsens. there is no choice but to spend what money they have left to hire a donkey, or a car, and bring the patient to abyei. they don’t have enough, so they borrow from their neighbours. they use it all to get the patient to the hospital ten minutes too late.
they are grieving, and penniless. it is the middle of the night, and the body of their dead wife, daughter, mother lies covered with a thin sheet on the back of a donkey cart and they arrived to a place that deals only with live ones. there is nowhere to put the body, nor for them to sleep. pleading, they ask for our help to take the body to the graveyard.
they are penniless and heartbroken. we say no.
it is an impossible decision. we could easily take one of our cars, the pick up for instance, and offer the grief stricken family some relief in a day that has been immeasurably cruel. but we don’t. we cannot. we cannot be a hospital and a hearse service. nor when someone knocks on our compound door, his eyes as big as moons, and says “my wife, she is delivering at home, but the baby is stuck, can you take her to the hospital”, can we be an ambulance service. no, we say, you need to find a way, and we quietly close the gate.
they are impossible decisions because their wisdom is easy to see, but they are contrary to one's spirit. once we start transferring bodies to the graveyard, the hospital becomes their destination. once we become an ambulance service, our resources become taxed, and we may go to destinations that are not secure. further, each time we are a band-aid, we simply cover the problem, and delay the slow work towards a tenable, permanent solution. but when a family comes miles over broken roads, carrying their dying
daughter, and they arrive ten minutes too late, when you tell them that no you cannot help them bury her though you have the means, and they ask you what they can do and you say you don't know and turn away, the knowledge that you are being wise is poor comfort.
you want to drive each patient where they need to go until you run out of gas, use every last dose of rabies vaccine for the small chance the dog was infected and the child dies foaming, to give the starving family money even if will only feed them for a day, drip all of the blood into this patient, the human (someone's father, brother, son, best friend )bleeding in front of you even though it means there might be none for the next ten, bbut today you have it, and today is his lucky day, and tomorrow you will worry about tomorrow.
but we don't. we are measured, and careful. it is what tomorrow's patients expect of us. and the tomorrows stretch forever more, and today is nearly done.