Six Months in Sudan (15 page)

Yusuf, one of our nurses, looks up from a fan of patient charts. “Dr. James! Welcome!” he says.

We shake hands, smile at each other. He leads me to the emergency room. I feel better here than in my hot hut.

A man is lying on one of the cracked plastic beds, his shirt red with blood. A small pool of it has clotted on the floor. A boy, about eight years old, sits beside him, a bandage around his lower left leg, a red target at its center. He’s staring at me with wide eyes, tears at their corners, and as I come closer, they streak down his cheeks.

30/03: in the shade.

i’ve started sleeping outside. it’s better.

most writing about africa touches on its heat. touches on it, then jumps back with its burnt finger in its mouth. i was determined to avoid the cliché, but today i cannot. today, it is smothering. but at least it’s a dry smothering.

i woke up this morning, underneath my tree, grateful for my thin sheet. it was dawn. roosters shouted. murmurs of morning voices. i was covered in sand. i could feel its grit in my mouth and underneath my back. a breeze lifted a corner of my mosquito net that had come free.

the day brightened, this day, the one right now. the wind started to blow warm, and with it, sweat beaded on my neck. after a few minutes of lying and listening, i needed to move. i lifted the mosquito net, shook the dust from my sheets, and bunched them in a ball at the foot of my bed. i walked to the kitchen, to find coffee, to find some bread.

by 9 a.m., i couldn’t sit in the sun. by 10 i had moved into my tukul. i decided to write before i walked to the hospital on this, my day off. and here i am. it is 10:39 and 104F in the shade. it will climb to almost 120. i am typing with pieces of tissue underneath my wrists because sweat pools on my computer. i have taken my headphones off because it affords me another fraction of uncovered body surface area.

i will soon leave my tukul and go to the hospital. i will step out into the sun, and touch the top of my head where i have just clipped it on the door frame. my hair will be hot even after these few seconds. i will look down at my scrubs and see dark sweat at my knees. i will walk 480 paces under a cloudless sky, walk it in zigzags, looking for any piece of gray shade, no matter how narrow. fence, lightpost, piece of barbed
wire. anything. the last 100 meters is across a dry courtyard, and the wind will sweep across it, gusting heat into the hospital.

i will move through the different wards, each hanging with their different smell of sickness, the hot drafts stilled by the walls. mothers in the tfc will fan their babies, and the man in the back room—i can’t decide what is wrong with him, why he is wasting away—he will lie on his back and stare at the ceiling. of the 51 patients, i will see the sickest ones. i will go back, sometime in the afternoon, through the courtyard and its hot wind, down the road, then left, and enter compound 1. i will go into the kitchen and drink a liter of warm water from the fridge that was just unplugged. i will leave because i can’t stand the heat. i will walk to the shower and turn it on. the water will flow from the pipe, and, warmed by the white sun, it will be almost too hot to bear. i will stand in the doorway and towel my hair, and by that time, the rest of me will be dry. i will return to my tukul, take the thermometer that is hanging by my plastic desk, and take a photograph of it. i will then post it here.

you feel the heat like a real thing, something you must push against when you open a door. at times, you can’t tell where your body stops and the air begins. in other places i’ve been, the heat seems like it comes mostly from the top. here it comes from all sides. you step outside, and it presses firmly on the back of your neck, scolding you. you pass the metal gate, and the reflection hits you like a punch. you bend to pick up a vaccine box left in the sun, and touch the metal handles and get burned. all sides.

that is my final word on the heat. my tissues are soaked through. sorry for the digression but i hope the telling will be an exorcism. perhaps with it i will be able to stop thinking of the white shock of diving into icy mountain streams, or sitting on a surfboard at sunset swinging up and down with the swells, or the clear silence before the snowboard lands ten feet below on a cushion of dry snow that stings your face in a million tiny points.

M
ANUT’S LEG IS SHATTERED
. The story goes that he found the grenade, and his drunk uncle started fooling with it, pulled the pin.

Bang.

When I assessed the uncle, he had a hole through his stomach. His body lay in the baking-hot emergency tent for two days, much to the horror of the mothers in the nearby feeding center. We have no morgue, and Abyei has no discernible system for dealing with dead bodies. Bev sent our community liaison to talk to Abyei’s paramount chief, and the body was soon removed.

Now the boy is lying in a bed in one of the dark rooms, his mother on a mat on the floor beside him. Her forehead is scarred with hundreds of arching dots. I am looking at his chart. No fever. The discharge from his wound seems clear. No infection so far.

I push down on Manut’s lower eyelid. His conjunctiva is pale. I’m not sure how much blood he has lost since the injury. We took him to the operating room the other day and picked out as much shrapnel as we could. I couldn’t tell if his leg was completely shattered. Some of his tibia was splintered, but there seemed to be a thick column that was intact. I needed to open it again.

“Can you tell Ismael we need to check his hemoglobin?”

I write it on the bottom of the chart, and then hand it to the nurse behind me. She nods and writes it down on a ledger pad, then bunches the chart with the thirty others I have given her so far.

“We’re done, right?” I look at my watch. With Mohamed away, I have all the patients in the hospital, save those with measles. The emergency-team MD leaves in a few days, and when he does, the measles patients become mine too. Brian sent word that we might be able to borrow a Sudanese MD from Darfur. I am glad.

“No. One more. Mansood,” says Alfred, my translator. He’s new. Our previous translator quit last month.

“Oh, right.”

We move to Mansood’s room at the back of the hospital. His walking stick sits beside his bed in the same place it was a month ago. He
has stopped eating normal food. We have tried to give him Plumpy’nut, a nutritional supplement we usually reserve for children. Two of the foil packets lie near his head unopened. He is flat on his back on a plastic mattress, his head inclined towards the small mesh window at the back of the room. On its ledge sit a half-dozen bottles of apple soda, their bottoms littered with flies. It is the only thing he will drink.

When Mohamed and I aspirated his knee joint, the fluid was clear. We have treated him for conventional bacteria, and tuberculosis, but he has not improved.

“Mansood,” Alfred says, stepping into the room before putting his hand over his mouth and nose, and stepping back out.

“Mansood!” he shouts again, one foot on the threshold, the other outside.

A slow turn of the head, and he lifts a thin hand. I walk into the room. It smells of urine and feces. I gag. I put my hand over my face, grab the chart wedged underneath his mattress, and move back out.

He has been tested for malaria, hepatitis B and C, and HIV. The only other test we can do is a hemoglobin, but that will tell us nothing about his sickness, and blood is not the cure.

“What are his vital signs?”

The nurse leans over my shoulder and scans the chart. They haven’t been done. Nor did he get his medicines yesterday. Forgotten by everyone except Alfred.

I feel his pulse. It is normal. He doesn’t feel warm. I look at his eyes. No jaundice. His knee remains swollen.

“Mansood.”

He raises his thin hand again, turns his head slowly towards my voice. His eyes are thick with cataracts, dull pearls.

He’s probably uremic. Kidney failure. Can’t confirm it, but seems that way. From what? Hypertension? Diabetes? His sugar was okay. Maybe he got a bunch of gentamicin or something before I arrived, wrecked his kidneys. I check his chart. No. Well, if he is uremic, then he needs dialysis. He’s not going to get it. He’ll be dead soon, and I won’t know from what. No one dies from old age. It’s always something.

“Why is he lying in his own urine?” I ask the nurse.

She shrugs.

“He’s not dead yet. We can treat him better than this. This is not a way to die.”

“Dr. James, we have no time for this. There are not enough of us. At night, we are busy trying to give medicines, and there are not enough nutritional assistants, and …”

I know. Some of the MOH staff are unreliable, our MSF nurses are haggard. We need one full-time in the measles area. Muriel has left the project, requesting to return to Darfur. Those who have worked there all prefer it to Abyei. Others have been talking of going back.

“We’ll hire someone, then. But until we do, I want him cleaned. And I want someone to help him get up and sit in the wheelchair. I know it’s broken, but we can just have him sit outside. Okay? This is bullshit.”

I’m angry. I can’t stop.

“Just because he is from far away, just because he’s old, doesn’t mean we can’t care for him, does it? That’s our job, no? Sick people. No matter what, or who, or where, or when. Right? It’s not easy, but sometimes that’s the way it is. If they can’t bathe, we have to bathe them. If they can’t eat, we feed them. Okay?”

She nods. I take the chart from her hand and look at it one more time. I can think of no more medicine to add, none to remove. I close it, hand it back to her, and turn away.

I am standing in the courtyard, in the hot sun. Patients line the halls, trying to find shade. Alfred lingers nearby, glancing nervously at me, seeing if he should step closer or effect some kind of retreat.

“Alfred, come with me,” I say. “I want to talk to you.”

We walk towards the front of the hospital and past the laboratory’s open door.

“Hey, Ismael.”

Ismael looks up from his microscope, grunts hello. Alfred and I sit down on a bench outside his door.

“Okay. I’ve been meaning to have this conversation with you for a little while. I’m sorry it’s taken me so long.”

He fidgets.

“I know you are new. How long have you been working here with MSF?”

“Two weeks.”

“All right, very new. Now. For me, you have the most important job in the project. I can give people medicines, and do many things for the patients, but I can’t talk to them. And they can’t talk to me. Without that, it is almost impossible for me to find out what is wrong with someone. We say in medicine, the story is 90 percent of the diagnosis. And even if I get it right without one, I can’t tell them. I am useless.”

“Okay.” He looks at me with a small bit of pride on his young face, in place of his nervousness.

“So I need you very much. Now, I also need you to understand something else. First, you must translate what I say exactly. All my questions. If you don’t know what they are, I don’t mind. Ask me. I can explain it again in a different way. It is very important.”

“Okay.”

“The second thing is this. I know I get frustrated sometimes. But I am not frustrated with you. I am frustrated with me. It is difficult to not be able to talk, or to understand. This is not my country. I can’t meet someone in the market and make a friend, I can’t make a joke with my patients. So when I seem frustrated, it is not with what you are doing. I promise. It is because I feel helpless. Okay?”

“Okay.”

“I’m sorry I haven’t said that before. I meant to.”

“Thank you. I worry about my English.”

“I know. I’ll try to remember to speak more slowly, more simply. We’ll help each other. The translator before you used to write down words, and we would go over them together. I have a medical dictionary and we can start with easy things.”

“Oh yes, that would be very good. Very-very good.”

“We’ll decide on a time at the meeting tomorrow.”

I am hungry. It is lunchtime soon. Alfred is long overdue for his. The Sudanese eat no breakfast, taking their first break at ten. Despite
our best attempts to shift their schedules to ours, the hospital empties for an hour at this time. My translator sits and waits for me, stomach grumbling.

“All right, enough of that. Let’s go for lunch.”

We move together towards the gate of the hospital and out onto the hot red road.

“Where did you learn English?”

“In a refugee camp. In Ethiopia.”

“When did you come back to Abyei?”

“Only this year.”

We duck at the cannon. Across the flat flood plain, men in white robes walk between market stalls.

“Are you married?” I ask.

“Yes. I have two children. Two girls. Are you married?”

“No.”

He laughs. “But you are very old! And rich! You should have many wives.”

“Maybe I’ll get one while I am here. A Dinka woman. So my children will be tall. How many cows do you think it would take me?”

“For a rich man like you, maybe twenty cows.”

“Twenty! Would she be tall?”

“Oh yes, for twenty cows, you can get someone very good.”