Following the swirling dust, fading sound of the helicopter, and several dozen excited children greeting me on the dirt airstrip it finally sunk in: I now call South Sudan my home. The children’s shouts of ‘mali, nyakuai’ (translation – how are you, foreign girl?) helped remind me what a contrast from home the next nine months will be. ‘Mali’ as a greeting is essentially a prerequisite to any social interaction here. With the addition of a handshake, a series of ‘malis’ reveal what a social, friendly people the Nuer can be.
My new house is a mud hut. My tukul, as it’s known, has a thatched roof and cement floors. The addition of a table, mattress, electrical outlet and fan make it surprisingly comfortable. Thankfully, the number of bugs sharing my tukul has decreased with the end of rainy season (during my first meeting with my medical team leader, a nest of spiders hatched and descended on my head like a platoon of enthusiastic paratroopers. Similarly, during our weekly expat meeting I was forced to step out to get a moth out of my nose). I am happy to report all recent snake sightings have occurred outside the housing compound.
Additionally, dry season has brought an increase in the number of supply flights able to land in Lankien. More flights has meant more access to not only the supplies needed to keep the project running, but also utensils, laundry detergent and fresh food that make expat life in the field a bit more welcoming.
Now that I understand my job responsibilities more, as an Outreach Nurse, I will be spending a great deal of time away from Lankien at two clinic sites, one providing general outpatient services and the other predominantly responding to this year’s kala azar outbreak. For this mammoth responsibility, I am partnered with another expat –Tyson. Lucky for me he has been here for the last eight months and stands well over six feet (perfect for snake killing), both of which make him an excellent resource. I have lucked out in terms of partners for this job, as I have realised that we will be spending a lot of time together in very remote places with no electricity, no Wi-Fi and, a limited number of English speakers. The sudden improvement in transportation related to the dry season I mentioned earlier may be temporary. December marks the one year anniversary of fighting. Therefore, increased security measures have already limited some outreach activities, as the two towns are both a 20 minute flight from Lankien.
Chuil, one of these two sites, is in many ways a picturesque small river town. The beautiful white water birds (yellow billed egrets) nest in the trees at night, the handmade wooden canoes rest in the water surrounded by purple lily beds. The river provides bathing and drinking water, a trade route and plentiful fishing opportunities. The cattle and people appear well fed. In actuality, I came to find out, the sorghum harvest is limited and the town was heavily supplemented a few months prior to my arrival by food aid. With large numbers of internally displaced people and over two decades of conflict throughout South Sudan, harvest season is not optimal, especially for a country that has the potential to be ‘Africa’s bread basket’.
A man builds a latrine outside his hut in Lankien, South Sudan 15 January 2015.
Under a corrugated roof, one of the very few structures in town, surrounded by dusty boxes and bats squeaking and scaling the walls, I sat with Gatwick. Gatwick is one of the staff nurses in Chuil. Counting medical supply for weekly consumption reports, we began comparing what words we know in Amharic. I exceeded my list at five… he continued on. I asked him how he knew so much Amharic, on top of his English, Nuer and Arabic. ‘From the IDP camp in Ethiopia’ he told me. He later left another IDP camp in South Sudan for this small town to work with MSF, as a nurse treating kala azar, in a community ravaged by the parasitic disease.
Visceral leishmaniasis, called kala azar in South Sudan, infects its host through the bite of a sand fly. Sand flies call acacia trees home. A beautiful red tree that grows throughout South Sudan it is an important source of fuel for fire and wood for housing. While it is possible to be infected and not develop the active infection, famine, vaccine preventable diseases and poor sanitation in much of South Sudan make healthy immune systems scarce. The only treatment option for uncomplicated kala azar is 17 days of injections of two medications. Without treatment, once infected, the patient nearly always progresses to death. The default rate at all our clinical sites is surprisingly low; kala azar has ravaged this country for decades and those infected remain thankful for treatment. When I first arrived at the outpatient clinic in Lankien, it seemed there were an enormous number of out-patients with hip birth defects; I found out later their uncomfortable way of walking was from having sore behinds from repeated injections.
A kala azar outpatient waits to receive his twice daily injections to fight the disease at the Médecins Sans Frontières hospital in Lankien, South Sudan, 13 January 2015.
So…I am sitting there with Gatwick, in the ambiance of a bat filled stock room in the mid-day heat of sub-Saharan Africa, and he starts telling me about his journey to Chuil. This is a town he thought he may work in for a few months, enough time to save a little money, help treat a deadly disease and get him, and more importantly his family, out of the IDP camp. One year apart in age, same professional title and similar personalities. We sit there, in so many ways as equals, but with such unequal offerings in life. It has now been nearly one year and his very small clinic, staffed by a handful of healthcare workers, treats over 90 patients a day. Like most South Sudanese, he wants to be home and moving on with life. He has been separated from his wife and children. It takes many days ‘footing’ to reach his family and currently there are no nurses to replace his dedicated work.
‘Footing’ is a very common term here. Walking is the primary source of transportation and simply giving a distance in kilometres can be very misleading with abundant swamps, rivers, unstable areas and a general absence of paved roads. Lankien is about three days footing from Chuil and is the closest inpatient ward and surgical site. Presently, the rivers have not receded and the journey includes walking through water over four feet deep in some spots.
The openness with which my South Sudanese colleagues speak of their families, marriages and travels is frequently poignant. One of my colleagues will readily juxtapose his time footing to the next village to provide public health information to his time displaced as a young and starving boy and then reflect on excelling in geography class in Khartoum.
Similarly, Gatwick’s stories make the reality of life in South Sudan so relatable in some ways, and in other ways show it to be riddled with obstacles I am likely to never face and never truly understand. I continue to be humbled by the acceptance I am shown by the residents here in my new home. The sincerity and openness of the South Sudanese people helps me face, without hesitation, the everyday challenges of being an MSF nurse in South Sudan.