South Sudan Journal, Parts 12 & 13 (of 29)

Message #12 November 10, 2003


Hello Mom and Dad.

It is Monday afternoon, and I think I found a dull moment in South Sudan. I will write quickly, and hopefully finish before this little dull moment is over.

We just had a pretty big storm yesterday and last night. By 1500 in the afternoon we needed candles to see the playing cards. The sky opened and really dumped on us. At one point I looked outside and couldn't see anything holding my tent out of the water. When I 'swam' over there, and checked inside, it was afloat. I am very happy about the quality of equipment MSF provides, nothing was wet inside, the bottom was holding tight.

The roofs on the tukels here are not as good as the ones in Lankien (different type of grass), and these ones leak a little. Leaks here and there aren't so bad... back in Canada. Here, sections of the mud walls fall off with a little water, and once again I fully appreci­ate the wonderful building materials we have back home (like concrete, steel, and termite free wood).

This morning was filled with some repairs to the compound and clinic, and planning for more repairs for tomorrow once things have dried a little more. Lunchtime brought a slowdown to activities, and everyone had personal things to dry or repair, and now I have some time to tell you about a walking trip we had on Saturday.

Part of our role in this outreach location is to observe the health conditions in the greater Wudier area (and surrounding as far as we can walk, or patients can get to us), and note any risks to the population. It is easy to get bogged down in the clinic, just handling the cases at hand, and ignore the people that cannot come in to the clinic. Many stories are around of people concentrating on a couple of people and missing the dozens dying just 5 minutes away. So on Saturday the four of us, and 3 guides walked for the day, around Wudier to observe things, and survey the health conditions.

Here are a few comments from my journal about that trip.

We packed mostly water, but also some food, and our 'run-away' hip-packs, and that's all. What a day to remember. We left shortly after 0730, heading off on a small footpath out the back of a family clearing around 50 m from our compound. Two steps more and we were out of Wudier, swallowed into the bush. After only 30 minutes, we came up to a small river. Other people were crossing and showing us the depth, so we stripped down to our modesty, put our packs on our heads and crossed. We (the Kawagas, silly white people), must have been a sorry sight. After crossing and getting dressed, an old lady (her age shown by her wrinkled body) stripped, threw her belongings on her head and commanded herself across that river, as if she was walking across dry concrete in hiking boots, instead of muddy river banks, and 1.5m of water, in bare feet. I wanted to help an old lady cross a river, but I think my 'silly white guy' coordination would have killed us both.

We continued on our walk another 45 minutes and came up to a small settlement, aban­doned. It was a little eerie, no kids playing, no cooking fire smoke, no dogs barking. Our guides told us that this group has gone to another area to fish, since there was no food there. On we walked.

As we walked, we talked to people and saw different medical anomalies (and referred them to the clinic). We saw cattle camps where 20-30 cows were grouped together, sur­rounded by piles of burning cow dung (to ward off the flies). We saw families where there was more farming (maize and sorghum) and some goats too. We met people on migrations, to look for more food, or to return to families after finding food; some were merchants from Ethiopia bringing their wares here to sell. People asked us, which migration we were on. ("They must be on a migration, look at how much they are carry­ing.") Our paths we joined many family clearings.

Something I have observed more and more here, is many things are held common among people. For instance we walked through people's clearings, because that is where the path lead. I asked about that, "should we walk around people's property?" Our guide questioned back, "property?" I guess when there is so much land; no one owns any of it. The only problem with coming so close to the people's dwellings, is that some of the children ran away (from the people who forgot to put their skin on.)

So there we were, popping out of the bush, and viewing a snapshot of life in south Sudan. Some of the snapshots I saw were: families sitting under a tree, grinding sor­ghum, old men lying down in the shade, as young ones played nearby, old ladies smoking big pipes, one time we came out of the bush and saw the sorghum refinery tree (a few fires under large pots, distilling the spirit out of the sorghum, while others lounged under the tree sampling the drink), sometimes we would see objects that really didn't fit the scene like a metal bed or chair that must have been carried for a few days. Usually peo­ple were working on things, grinding maize or sorghum, repairing tukels, caring for cows, etc.

We arrived in a small village, and started doing some MUAC (Middle Upper Arm Cir­cumference) testing on children. This is a test to get a rough idea of the malnourishment of children 6 months to 5 years old. It is a simple test, just wrapping a plastic tape around the arm of a child, and measuring the circumference. (For those with kids back home, less than 136mm length is where we define children being at risk of malnourishment, and an arm of a circumference of 110mm or less, belongs to a child that is severely malnour­ished.) We tested about 30 children, and almost all of them were very healthy and fat (for kids here. I have yet to see a fat person, as fat as I am at least.)

We finished the MUAC testing, had some lunch and headed back. It was just a 2-hour walk (at the most, one guide said), but nothing is as it seems here, (I am learning.) As we started walking, a tremendous storm started up behind us. Here, as in times I've been in open waters, I am humbled by the size of the weather. The darkness was creeping up be­hind us, as lighting and thunder shot out ahead like the first shots of a battle to be had. The wind too was kicking up our feet ahead of us, but there were still a couple hours to go.

As we passed people's dwellings, makeshift repairs were being done, and people were huddling inside their tukels. Dust was being kicked up to and rising up quite high as it whipped down-wind and gone out of sight.

Then the rain came, first light (but the wind shot it across pretty hard to sting the sun-burned backs of our necks). We talked of taking shelter, and everyone agreed we had the time to wait it out a little. One of our guides walked up to a large tukel and pulled aside the wood from the opening and walked in. I started a familiar thought, "In Canada..." then put my unique finish to the phrase, "I would knock first." The second guide paused at the entrance and indicated for me to follow, then disappeared in the dark tukel. The rain started heavier, so I stooped low and charged in. I fumbled around a little, knowing there may be people I have to walk over and not step on, but the darkness of the tukel didn't allow for more guidance than just feeling around. I felt a clearing, and squatted, hoping my sight would come to me soon.

Slowly, I began to make out where I was. The smell should have given it away first, but my optimism prevented me from premature judgments. As my eyes adjusted, I slowly made out the shapes of about 20 goats, 3 calves, 1 very large cow, and a 12 year old boy, all standing there in complete silence. I think that was the first time any of them had seen white people too, and they were politely quiet about it as well. Everyone else came in, and we all had a nice silent moment to take in that we were holding out the storm in this unique situation.

The silence was broken when the cow urinated about 2 litres and everyone couldn't hold back the laughter.

The storm dumped pretty hard, but then was over. As we were planning to go, the mother of the boy came in, and mid sentence she paused. I think she too had never seen white people, and definitely not ones hanging out with the animals. "Son, I told you not to invite strangers, stranger than most, into our animals home!" I think I heard her say.

When we were leaving, our guides took off their shoes, and two steps into the walk back, I knew why. This damn black cotton soil is cohesive as glue! Within two steps, one could put 10kgs on the bottom of each shoe. Bare feet are easier to get around on. Fortu­nately, there are no stones here, so the soil is actually quite soft and almost enjoyable to walk through. After passing one river on the return, I left my shoes off, and after a cou­ple times sinking up the knees in mud, this would be fun, in a different setting. The first time was great, the second time fun too. After a couple hours (on our 2 hour walk home) walking through mud, the magic wears out.

We crossed another river, a little more sloppy than the first one 10 hours before, the within 30 minutes we were back in the compound, and we crashed.

What a day. Sightseeing in South Sudan. I think I have traveled off the track, once or twice before, but nothing like this. Also, to travel off the track here, and bump into peo­ple living their everyday lives, as they always have, and as they always will, was a real privilege. I think of all I give when I am here is humbled by all I get by being able to live here, and live with these people.
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I continue now, Nov 15th.

I think I will make this an even longer email by also telling you about my week.

There really is so much going on, and too much to describe. This week the full moon was celebrated but singing and drumming by children at the church. (Actually every night here, they have been up till midnight singing and drumming, and up again at 0530. I don't think it is related to the moon at all.) One night we went there, to see what was going on, great stuff, people singing their hearts out, even the little kids.

I got out of the compound one day when I wasn't feeling too good, and walked the air­strip. A couple of kids wouldn't let me go, without smiling, joking with them and trading greetings back and forth. At the end of the walk, I was feeling much better, and the local young men persuaded me to play soccer with them. (A tight bundle of leaves with a cloth stitched around it makes a great ball.)

The Lankien team had been evacuated on last Friday. There is a peace process going on in Sudan between the north (Gov of Sudan, GoS,) and the south SPLA, but there are a couple of groups of soldiers that have not been considered in the peace talks, and it is uncertain what their motives are. Word was spread that one of these militia groups was headed towards Lankien, so a plane was called and the team left. The UN controls secu­rity here, so they have been gathering information on what is going on, and will send in a plane to talk to the authorities and see what is going on. We have heard from the authorities here, by radio, that the militia is in Lankien, but they are having talks, and the clinics are running well without us.

We anticipate seeing Lankien again this week, we'll see.

After the dust settled from the strike issue in Lankien, a decision to close the TFC (Therapeutic Feeding Centre) was made. Earlier, the management team was questioning if we were running ourselves too thin, by running a TFC, Kala Azar and TB clinics. The strike issue clarified it to everyone that we were doing too much, to do things right. So, it was decided to close the TFC and concentrate on the big ones, KA and TB.

A former PC (Project Coordinator), Dennis, is here in Wudier, and he had the most appropriate comment to this decision. It was roughly, "You can throw a dart at a map of South Sudan and hit a place with a real medical need 20 times out of 20. The question then becomes, 'what to do?' If you want to do it all, you'll die trying, then no one gets your help." A lot of valuable research and development comes out of Lankien. A lot of success has come in the roughest of environments. In the north, there are hospitals treat­ing Kala Azar, where they can do blood transfusions and have far fancier facilities, yet we match their effectiveness.

Anyway, it must have been hard, but staff was dismissed and patients discharged back into the medical shadow that is their South Sudan.
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Here, the patient load is much slower than Lankien. For curiosity sake, we invited over for tea, the TBAs (traditional birthing assistants) to hear how they do it, and answer some other curiosities. That was interesting. DONT BE IN SOUTH SUDAN IF YOU THINK THERE IS A CHANCE YOU MAY HAVE TO GIVE BIRTH HERE!!! At the end, they had some medical questions, and wanted to refer a couple of people to the clinic for a look, and now the clinic is filled with everyone and their spouse and their STIs (AKA: STDs). Another example of just asking a question, then the floodgates of requests come it.

Our food situation is becoming the conversation topic every meal, if not, every 5 min­utes. Usually there are only 2 people here, so having 4 was a little surprise to our stocks of canned foods. Plus, with the evacuation in Lankien, the flights have been changed so another 3 days were added onto this 12-day rotation (plus the regular rotation is usually only 10 days). Anyway, I have learned quite a few new recipes, including refining my chapatti rolling technique. (I am the holder of the last beer. The beer cans roll the cha­patti better than any other can. For many nights the team has been trying to drink my chapatti roller!) We have been getting chickens every second night, and we are trying to negotiate the purchase of a small cow too. We are making due, but I feel a South Sudan Weight loss program starting (that's not so bad, I'm usually the fattest guy around any­way.) As for alcohol, all the other beers went pretty quickly, and the wine Dennis brought from Holland too. The staff here keep sneaking to our office these bottles of Ethiopian Ouzo, I never liked Ouzo, and here is no exception.

Well, that is a week in S Sudan. Tomorrow is Sunday, maybe a walk around town (I am trying to get someone to make me a pipe, similar to the ones the old ladies use) also a nice sleep in, and maybe some reading too. If it is sunny out, we will get a good charge on the battery and can have music for the day too.

Good night, lots of love,

Steve

P.S. Mom, or Jen, or any other cook out there: If you have any good simple recipes to do with flour, salt, sugar, (no yeast, no baking powder, no baking soda, etc) please let me know. Chapattis are great, once or twice a day, but not too much more... I'll be at this email address until the 19th, (hopefully not much longer.)

Message #13 November 20, 2003


Hi Dad.

Yes, I got your previous email; it was forwarded by someone in Kilo1.

Your email identifies a lot of questions I am asking too. Yes, what are people's motivations when working with us in Lankien. I started asking that sort of question a little more, instead of instinctively answering it, with my limited knowledge of Lankien. Here is a couple of things I heard.

Lankien didn't exist 15 years ago, as it is now. It is actually a mix of people from different clans, coming together because NGO's have been dropping food and aid there. There are 6 different chiefs there, 4 of which head 4 displaced clans. If you took any two people, chances are, they are not from the same clan, and therefore, they are not the same people. So, I think more people work for MSF (from Sudan) as a job, rather than other motivations that drive us (expats). As such, I think it is easier to walk out on a job, if it is just a job, and not walking out on your people (as we bitterly first felt they were doing.)

And it is a job. To most of our staff, this is the first job they have ever had. We pay them money, the local authorities take some, and there are hours for them to work, that sounds like a job to me. (Just like any Doctor or Nurse strike in Canada).

Your email also points something else out that I had to read a couple of times before I got, what I think you were saying.

"It must stimulate questions about the nature of giving and love, e.g. do these concepts have to have conditions attached, like gratitude? "

I think many of us expected that our nature of giving did have an attached assumption we would receive gratitude or at least reassurance that it is wanted, and when people walked out on us, that was stripped away. It points out to us, "is that a reasonable thing to want?" I think we were asking, "If they walk out, should we walk too?" One wants to feel like the work they do is wanted, and they are not just keeping themselves busy. Maybe the gratitude I receive just reassures me that the work I do is wanted, and therefore I continue. I would hate to go on a crusade of work on a project that no one really wants.

I read about an engineer who looked into the lives of some people in Sierra Leon, and of their hardship crossing a river. So, he decided to build a bridge for them. He found the funding, and spent some months building a beautiful bridge. The day after he built it, the locals torn it down. The next year, he visited the site, and was distraught that his bridge was destroyed. With renewed energy, he found more funding and explained to the locals how good the bridge would be, then he re-built it again with their assistance. Two days after he left, they destroyed it again. When he returned and questioned people what they were doing, they said they didn't want a bridge (the evil spirits couldn't cross the river, until the bridge was built), but he was so excited and happy about building it, they let him build it, and they just would destroy it once he left.

Anyway, I would not like to be doing something like that, and I think a show of gratitude may be my reassurance that people want us here. And if they don't, PLEASE LET US KNOW!

As for the question of eating frogs, I don't think they eat them here. There are so many, and so many people are hungry, I don't think they are good to eat. To give you an idea of how resource deprived they are... There are two main foods, maize and shorgum (if you have a job, sometimes you can buy some meat, but that is about once a month or less). With the maize, one can grind it and make a type of tortilla, or with more water, a thinner roti, or add more water and make a porridge. With the shorgum, same thing, a tortilla, roti, or porridge, but also they distill it to make a shorgum wine (it tastes pretty bad) or distill it further and make a shorgum spirit (it smells really bad, and I didn't taste it after that.) That is about it for the food. We pay labour partially in salt, and they add that anywhere they can, it is a delicacy.

This week here in Wudier, we bought a cow (our food supplies had almost run out), and we invited over all our staff and some local authorities (about 25 people in total). Everyone ate like it was the best meal of the month (or maybe even the year). I think if frogs legs were roughly edible, there would be no more frogs in Lankien. (The cats don't even eat them.)

David Miller as Mayor eh? How is he? Has he firmly placed his foot in his mouth like Mel so frequently did? (I liked Mel, he had an energy and honest ignorance I like in politicians. I don't know how he was as a mayor though.)

Bill Bell is still around, good to hear. I never met him, but I've always heard good things about him. (Mostly from you I think.)

Your books are ready. I would like to read the rest of the Metaphysics one. Is there a chance I can get one here for x-mas?

And Santa is bringing Mom a laptop, that's good. Is it still a Mac? Christina has a Mac laptop, and it is very slow. It shouldn't be, Macs should be faster, having two processors and all, (but then why aren't they selling better?)

Oh shoot, some donkeys are eating and knocking down our fence. (Shorgum fence, not just a good breakfast cereal, but also a good fence.)

Sorry to hear about Granddad’s hip. Please pass on my best to them.

Well Dad, thanks for the update on Toronto and the family. That news is the stuff I miss most. I'll be out in a couple of weeks (on R&R).
I'll be heading to Nairobi, then on to Mombassa for a break. Some other people are heading to Zanzibar, but the plane ticket there is a little much for a short R&R, so I'm going to take a train to the coast instead. I'll also try to give you and Mom a call once I get to Nairobi (around the 27th or 28th).

Looking back at this email, I don't know if you want to send it out or not. I'll leave it up to you.

Cheers, lots of love,
Steve