South Sudan Journal, Parts 23 (of 29)

Message #23 March 30, 2004


Hello Mom and Dad.

Well it is the end of March, and once again this has been an eventful month. I wrote before of the fire and insecurity, but maybe I'll summarize a little and bring you up to date.

Tuesday, March 2nd: shooting in Lankien. Decision to evacuate reconsidered after brothers of killed person give guarantees of security in Lankien.

Friday, March 5th: Fire in compound, destroying lab, office, 6 storerooms, 2 latrines, 3 expat living tukels and much fencing. No one was injured. Thought to be accidental. Many unaffected stores and guard tukels were looted in the confusion.

Sunday, March 7th: Team pulled out for a break, with a relief team put in for the week to sort some of the mess out. Arjan, our head of mission, asked us to come to Nairobi for the week to relax, however with the difficult situation in Lankien, we decided to stay in Loki and prepare for our re-entry and continuation of the program. We had almost 300 patients (all on treatment for terminal illnesses) watch us as we left a still burning compound for Loki. We gave our best re-assurances of a quick return, but we didn't know how many would believe us, and hold hope.

Sunday, March 14th: After a week out, and some much needed rest, the team was brought back in. Within three hours of our arrival, some men entered the clinic, looking for people from the family that killed their brother on the 2nd. One staff member was threatened, but not taken by them. Again, serious meetings with Isaac the counterpart followed. That night the decision was made to evacuate the next day, since the previous guarantees on the security of our staff, patients and clinics were not honoured.

Monday, March 15th: Team evacuated to Loki less than 24 hours after arriving the day before.

Wednesday, March 17th: We all arrived in Nairobi. This time Arjan didn't ask us if we wanted to come to Nairobi, tickets were booked for us. I agree with that decision, now. In the face of the latest stressful situations, it is difficult to notice how tired one becomes.

Friday, March 19th: After doing the work that couldn't wait till later, four of us were sent on to Mombassa to find a beach and supervise good food and cold drink intake for a while. A small group of the team was held back to go back in on the Sunday to bring more food and drugs. We were very concerned about patients defaulting. By taking on treatment of diseases like TB, we take on the responsibility to get around all obstacles to
continue treatment to conclusion. If partial treatment happens, then the patient leaves, drug resistance can occur in the disease. In such a case, our drugs will no longer be effective in the treatment. As such, we need to get around insecurities, fires and lootings, if we are going to do treatment in Lankien. And common thoughts have it that there is still enough security for us to try, and with no where else for people to go, there is reason too.

Saturday, March 20th till Thursday March 25th: Diani beach, just south of Mombasa. We stayed at a nice cottage right on the beach, where the palm trees meet the sun and sand. In the mornings men would walk by trying to sell their morning catches of lobsters, calamari, prawns, fruits and veggies too. We had a kitchen in the cottage, so it was time for a feast; and we did.

Friday, March 26th: Back to Loki, meeting up with the rest of the team, and getting ready to go back in again on Monday. They had gone in on Wednesday as well, but not much changed in the security situation, so upcoming plans were just to visit, re-stock food and drugs, and leave again.

Monday, March 29th: Visit to Lankien. Still some staff members were missing (run away due to insecurity specific to them, because of relation to the family that did the killing on the 2nd.)

With the current situation, we will continue these visits. Our next one is on the 4th of April. We are waiting on a meeting to finish off all the chiefs and headmen, as well as some SPLA commanders. Once this meeting is over, more authority will be back in the area, and we can discuss the terms of our return. For now though, we are in Loki for a longer haul. For me that is alright. With the fire destroying almost all of what we had, there is much planning and ordering to do. For our medical staff, they are going out to some outreach locations to continue work there.

So that is the short story of how the month has gone. It has been an interesting one. Maybe to give you a better picture of it (and I'll have to do more of these written pictures, since my digital camera was looted during the fire) here is a day in the life of yours truly.

Monday, March 29th: Going back into Lankien for the day.

0515 alarm goes off, my ears hurt a little. The next 45 minutes are filled with shower (why bother, I'm going back into the dust) prepare some eggs for lunch, gather some money from the safe (staff payments today, if there is time), dress, pack lots of water, pause for a moment to listen to the call to prayer (there is a mosque nearby), mumble the two words, "goodmorning," and, "how'r'u'doing?" to those mumbling back to me. Climb into the back of the landcruiser with the rest of the team (there are 7 of us going in today, Evert, Sammy, Hannah, Mary, Lindsay, Charlie and myself), and bump along the road to the airstrip, in the Loki morning air.

It hasn't rained that much lately in Loki. I think the last time it rained, you could count the individual drops as the heavens tried one last time to squeeze the last out of the clouds. The time before that, it was December. The road is dusty. The side of the road is black by the light, but under that, I know it is dusty brown too. Even the thorn bushes are dusty brown. Our landcruiser bumping along the road leaves a wake of dust too, but just a drop in the bucket.

In the pre-dawn light, you could see the outlines of the Turkana (native people to this area) carrying water and coal to town. The men ride bikes with three jerry cans on the back, the women carry one jerry can on their heads, and the children kick jerry cans along the ground. I often wonder about the medical implications of any repetitive strain injuries caused by kicking a jerrycan along a road for a kilometer, two or three times a day. As the dust wake is blown towards them, I see them lean into it. Again I am reminded of my fortunate life.

We clear customs (what a joke, but they are getting more serious these days) and then get driven down the airfield to where our plane sits. We pass 5 large Hercules airplanes, run by WFP (World Food Program), they do the majority of the airdrops in South Sudan. There are a few buffalos (I still cringe when I hear them taking off over the MSF compound in Loki), some smaller Antinofs, (spelling?) then an array of caravans and twin otters.

In the corners of the airfield are the skeletons of airplanes past; remaining in Loki for the right purchaser, spare parts, or just neglect of a wreck.

We arrive at the plane (a Casa 22, pride of Turbine Relief Flight Operations), and greet Shane and Nirov, our pilots. Shane and Nirov have been flying us almost exclusively, and as such we have a very good relationship. Our morning conversation is a little more extensive than before, but still under 20 words. We pile into the plane and take our seats. Shane turns around to see how people are doing. Charlie grabs a handful of earplugs and hands them out, and I open the cooler to see what food will be served today, (Ah, samosas, I love those little things.)

The take-off is smooth, (Loki has a tarmac runway) and after 15 minutes we are beyond the lower altitude turbulence. I get out the stack of money and staff salary sheet. There will be some people laid off today, so I split off that amount to make it smoother. With that done, time for a break. Evert and I head to the back of the plane where there is a load of 50kg maize bags; perfect! With a little adjustment, two bed size clearings are made on the soft load, and two people lying down in them. The drone of the engines lull me to a slumber.

In what seemed like a minute or two, my ears were hurting a little. Just as an alarm clock nags me every morning, the plane descending for the landing wakes me from my maize bag bed. I look outside and confirm, we are low. The different sounds of the plane tell me as well, we are approaching. That sound is when they lower the flaps 40% and that sound is when they slow the throttle, soon there will be a slight turn to the right as we line up to the airstrip.

I move forward in the plane to the front where I can see out ahead of the plane. In the distance, there is the white landmark of a plane at the end of our airstrip. I look downward and see the loose maze of footpaths, and random grouping of tukels and wonder how old someone is when they first see something straight. (A straight path, a straight stick, a straight anything.)

The airstrip is clear, so there is no need to overfly it. We slow and makea final approach. In the plane we have cold drinks, warm food andcomfortable seats. Just ahead of us now, is Lankien, where everything isdifferent. There is an anxiety that floods through me on the approach and landing in Lankien, and other places. I don't know what it is, but it is happening every time I arrive. I know it isn't the flying, because when I am heading out of Lankien, or out of other forgein places, I don't get it, but entering into the unknown brings an uneasy feeling.

The landing is smooth, one of the smoothest I think Nirov has given us yet. We taxi to our unloading area. (That sounds so formal, an "unloading area," it is just a place in the clearing that is wider than the rest, and therefore a good place to park a plane.) The back of the plane opens, and I'm back in Lankien.

I know I'm back, by the smiles of the people greeting us. A lot of the staff have become friends. Sure we don't share much, (traditions, values, problems, habits, goals, etc.) but what we do share, there is plenty to go around, (respect, greetings, happiness in each other's presence, etc). I have gotten into the habit when out on R&R, to save my empty water bottles to bring back for them. These are so valuable for them, but tossed out back home. I think I embarrassed Christina a little when we were coming back from Zanzibar, when there was a little crunching noise from my pack. Our talk went something like, "What is that?" "Just some water bottles." "How many?" "12 or so." "You're crazy." "It seems odd, but there are two places where a crazy man is normal, one is the circus, and the other is where I choose to work, Lankien." The Loki customs guy found me out too, but he gave me a look like I wasn't the only one that does that. And besides that, I have bought Math and English books for them too. For $1, you can get a small exercise book. After one of the guards showed me his English book, all dog-eared and worn from use, and in broken English asked me for another one, I found a couple of dollars I wasn't putting to much use. When I first arrived, I was overwhelmed by all the asking, but now I have been able to pick and choose my small extra efforts.

There is John Lul, my Logistic Supervisor, smiling ear to ear. I like John, a lot. I can't trust him, (he suffers from the same hardships as everyone else in Lankien, and therefore everything MSF owns, is an opportunity), but he is a hard worker and good man. There is Big Issac, the huge man that lost my wire cutters and broke out in tears when he told me about it. And there is David, the brother, or cousin, or I don't know who, but he is standing in for someone else, but has proved to be a great worker, and I think I'll keep him. The carpenter, David, also a little quiet, I think he is sober today.

Greetings are a little difficult. Two people approach each other, right hand extended, and palm forward. When they get close, they put their hand on the other's chest or shoulder, and lean into each other, then stand up more and shake hands and begin the verbal greetings, "Ma-le me lim lim," (sweet greetings) "Ma-le me guire," (big greetings) "Ma-le me di," (nice greetings) "Ma-le me gua long" (good greetings) "Ma-le me gua long a long a long," (very very good greetings) Unchecked, this could continue all day, with frequent parting of the hands to again touch the chest or shoulder, then as a signal to get ready for some more good hand shaking, one person extends their hand back and aiming for the other person’s lazy hand hanging in the air, "slap" back into the handshaking and more greetings. Then, as that finishes up, there is a crowd of 20 others to greet in a similar way.

I keep remembering back to a little session I had on cross culture awareness, and how the speaker was talking at length about the value of a handshake. More importantly, he expressed the vital detail of not leaving anyone (of importance) out of a handshake. Once again, the difference between a good theory and a practical difficult situation is realised in the classroom, "Lankien."

As the cargo comes off the plane, I hand over the waybill to John with some instructions, then head off to the compound. It is 0900 by now, and the sun is starting its tricks again. Meetings are moved to under trees, and bags are left in the shade too. (I froze my water bottles the night before, but I doubt by the end of the day it will matter.)

The compound is in good order, cleared from the fire. The fence has been re-erected (we tore down large sections during the fire, to put fire-breaks in the fire's path), but all other construction has been left. With the recent insecurity, we are holding off all non-essential operations. It is kind of a game of poker, with high stakes, and little hope on our part. A pilot told me once he was talking with a commander about evacuating a team. The commander said, "you'll be back." The pilot replied, "not with this security situation, and lack of community help." "You'll be back. You Kawagas always come back. Me, I can sit under this tree and watch people die, you kawagas can't sit in Loki knowing people are dying here. You'll come back." Right now we are visiting, and holding off re-construction, but I think that commander’s words ring true to us too, we will come back, this isn't the first time the clinic burned and people looted it, and yes, we do have a hard time with the people dying too.

Soon we will be called on our bluff. The rains will be coming in a month or two, and we need to build before then. Maybe we have a couple more weeks that we can hold off, but then we need to commit to something and build a lot.

I finish greeting people, remembering as best I can everyone's name. Fortunately, most of the ladies are named Rebecca, Sarah, Mary, or Martha, and the men are mostly John, David, Moses or James.

I check out the new pharmacy and things look in order. Usually when we leave, we give the keys to James, but he has run away, so Samuel took over, for the first time. The math in the stock cards is completely off, but he is willing to see that he can learn from the mistakes and we agree on some homework for him to improve things a little.

One of our cats is under a shelf. I know that one, it is Liz's favourite cat, but it isn't moving. I hope it is still living. I call it, and it slowly moves it's head. Ah good, Liz would be mad if we let her favourite one die. It is very skinny though, I guess the rodents have gotten faster, and our supplement is appreciated. No time to deal with it, I'll mention it to someone else, and maybe we can get some food to it. (Tricky thing to leave food for the cats with the guards, when it is better food than they get. Today I found out one of the pilots has been taking food in for the cats.)

I arrange some meeting with John, and some other key people. We have 6 hours on the ground, and much to do.

1000, John and I discuss some work, and also discuss with him about not buying any more materials without me or Charlie approving it. He spends money quickly, and doesn't get the best price around town. This makes me quite frustrated, but he continues to do it. I think this time, I will wait on payments until we return. After we do some small talk, we discuss reasons to hold off construction, and when we are in a quiet corner of the compound, he tells me that he does not feel safe in Lankien, and would like to finish with MSF and move back to Pieri where he is from. My breath slows. On the one hand, that is the best reason for him to go, I wish him the absolute best, but on the other, he is a cornerstone to the logistic running of the clinic and it is a mess without him. We agree that he will wait till later, and plan to move when things are somewhat under control in Lankien. He isn't threatened, but rather he just doesn't like Lankien anymore.

I finish with John, then on to another staff member who also states that it is still not safe for some of the national staff in Lankien. These are the brothers and other relatives of the man who killed someone on the 2nd. In the Nuer culture, the security to you and your family, is to revenge any killing of your family. This revenge threat is not only to the killer, but to kill any member of the family, of a similar status. If the family does not agree with the actions of a family member that kills someone (or they do not want an overhanging threat in their lives), they can pay cows as compensation for the killing. 50 cows is the settlement for an average killing in a fight. If it is a respected person that was killed, it is worth two people (100 cows) and an assassination is also a raised amount (+50), further, the SPLA authority court collects 10 cows for administering the settlement. Right now 160 cows are owing for this killing. With that amount of cows coming from a clan, it will go quite hungry.

1100, start paying people. There is a new salary scale, so increased payment, but lots of questions and comments. Mostly smiles though, everyone like a pay raise. The trickiest part of the payment, is the signing the payroll sheet. I block off other lines with paper, I put the pen on the line, I push the pen to the right spot, I block other areas with my thumbs, but consistently people try to sign on other areas. I know this is the once in a month opportunity for half of them to hold a pen, and there is pressure to get it right, but it takes a long time for people to put their unique dot on the line.

I like the staff paying. It is a good chance to say hello to everyone (in case I didn't say "hello" enough in the morning) but also we depend on these people for the clinics, our compound and sometimes for our security. I cannot give them more than their salary, but I can give them 2 seconds to say hello (Ma-le) and how are you (gin-ni-sin?). I think they appreciate the small verbal appreciations, just as I do in my life. There are a few jokes and they laugh at hearing my impression of Nuer numbers (Jen-douk weda kel, rew, douk, wan, de-ich, 30, 31, 32, 33, 34, $35).

1400, finished most of the salaries. Others will have to wait till next time. Not a perfect way to do it, but we do what we can. Back in the pharmacy, getting an idea of what drugs to bring next time.

The plane lands again, (it left to pick up a lady in a place called Cue.) I ask about fuel, and send some labourers to roll some barrels to the plane for re-fueling.

The storekeeper brings his stockcheck of other stocks, patient foods, blankets, mosquito nets, etc. I file it in my pocket, it will be handy later.

1430, Evert comes by, "we leave at 1515." Good to know.

1500 a little more planning with John as I pack my books, remaining money and last litre of water (slightly cool still). Damn it is hot! The temperatures are now mid 40's. Sure it is a dry heat, so that should be better, but I can feel my body de-hydrate quickly. I drink about 4-5 litres of water a day, unless I'm active, then more. Standing in the sun is hard work. After the fire, many of our prized trees lost their leaves, so shade is harder to come by; this is a hard place. Today, we are lucky, we will go back to Loki and enjoy cold Gin and Tonics with ice.

1510, back at the plane. The patients we are taking with us are loaded back on the plane, one engine started as I finish the last handshake then board the plane. I slump into a seat and lean back. This visit was only 6 hours, I hope I am ready for coming back for good soon. I look back, the rest of the team are settled, and the patients briefed on the little plastic bags for when the plane bumps around. Why do we bother? I have seen many patients sick, but I have yet to see one use a bag. Optimism I guess.

I wave to the guys outside. They are smiling, but I know they are wondering if we will ever return. I wonder that too. I also secretly thank my maker that I have a return ticket. "Some days you are the fly, some days you are the windscreen." Well, some days you stand outside the plane, some days you sit inside.

We were bringing some patients from Lankien to Pieri who were finished their treatment, and also bringing one patient to Loki for some surgery. I don't know the medical terms for this case, but here goes. This lady tried to deliver her baby a few days before, but was obstructed and the baby died. She needed it to be taken out. There was much trauma in the last few days, and she would die soon if not helped. There is a network for getting patients like her to Loki where ICRC has a surgical hospital, but it isn't easy. This patient was suppose to go the last couple of days, but the flights didn't work out for one reason or another. Fortunately today she could come. In the back of the plane, without the sacks of maize, there is a wood and metal floor where you can lie down.

In Pieri where we were dropping off a team and some patients, we hung a drip for her, and Hannah did some magic medicines for her. This lady was getting some of the best treatment in the area. In a place where there are thousands of people per doctor, this lady had our Dr. Hannah's full attention. Wow, that is funny, "the best treatment" in practical terms means: with no clothing, wrapped in a urine soaked mosquito net, lying on the metal floor of a cargo plane, getting the full use of the medical kit we carry with us (in a small back pack, with just a handful of injectable meds and some emergency fluids and dressings.) From our own packs, we were able to find some space blankets to keep her warm, for when we were higher and colder in the air. One of the pilots was asking Hannah about this patient, and I think her answers put out his optimism a little. "What happened?" "Baby couldn't come out, and it died inside." "My God, how common is that?" "This is the second one I saw today, but usually not that common." "And the other mother?" "ICRC took her already but couldn't take this one. The other one will die probably." "Back home do mothers die like that." "It is very uncommon to have a baby die inside in the UK for this reason, and if it were to happen, the mothers would not be at muchrisk. We have a thing called surgery." "Will she live?" "Probably not,but we'll try all we can."

In Lankien, the other pilot, Shane, picked up a bird that was wounded. When we were flying, I saw this beautiful bright green bird spread its wings as it sat in the palm of Shane's hand. He put it down on his cooler, and the bird shifted to its side and lay down. He picked it up again, but it was dead. I looked back at the lady, on her side, and said one more prayer, "please don't die."

We arrived in Loki by 1800, and an ICRC ambulance (Landcruiser with a red light on top) was there to greet us. There was a miscommunication and they were ready for a sitting patient, and as such no stretcher. We all gathered and carried her roughly off the plane and into the cruiser. She woke with a pained expression, but in their culture, to show pain is not tolerated, so it was restrained. Also, there were no attendants, so Hannah and Sammy stayed in the ICRC cruiser and Evert and I went to the airport to clear customs. "Good luck" I whispered to her as she was taken away.

Name:
Passport number:
Date of Entry:
Reason of Entry:
etc etc,

Time to think about satisfying customs agents.

"Are these your bags?" he asked waving to Hannah's and Sammy's packs. "Jambo, (Swahili, "hello") Yes" "What is in this one?" "Clothes, books, you know, the usual," I said as it always is. As he opened it, and I noticed it was the medical runaway kit, "...and some meds." "Sawa sawa, goodbye." "Sawa sawa, asante sana, (Fine fine, thank you) see you next time, bye."

Our driver was there waiting for us, already loaded the bags, and off we went to pick up Hannah and Sammy.

Hannah stayed a while at the hospital, hoping to see the operation, and the rest of us went back to the compound.

That night, we went for those Gin and Tonics and Ice. Nice. Hannah stayed at the hospital to see the two operations. (The two mothers brought in that day.) One died, one was still alive afterwards, for now.

An early night and off to bed. I have been sleeping outside these days, since the rooms are too hot, and the evening air is much cooler. Armed with a mosquito net and mattress, I set up on a wooden platform that looks over the whole compound. It is a nice cool breezy place. I suppose if I can see the whole compound, the whole compound can see me, but I have long since exchanged my dignity for comfort.

So that is a day in South Sudan. Some days are better than others, this day was roughly in the middle.

For the next couple of days I will be in Loki doing more orders for burned/looted items, then I may go to Western Upper Nile on the 2nd for a 4 day trip, to see the hospital project there. On the 6th I'll be back out for a logistic meeting here till the 10th, then ??? who knows. We may be back by then, or we may be holding out for more. Just tonight we heard reports of military movements in other places. Some of these reports are starting to line up to patterns. It will be interesting over the next month or so if the peace talks continue. They have been delayed a little, and with the new movements there is a concern that it won't hold. Sammy, our Lab technician (and wise man) has a theory about fighting and this time of the year. They can only fight for another month or two, because after that, since all the young men are out at night, with the sandfly (transmitter of Kala Azar) soon they will be coming to our clinic for treatment, and not fighting. Apparently he has seen a trend over the years of young men coming in, in waves at the beginning of the Kala Azar season, and the fighting slowing down. We'll see what happens.

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I guess there is some more to this story... Anyone still awake?

I have decided to extend my contract for another 3 months, so I will be finishing in September.

Of course there are many reasons for doing this, and many more for not, here are the big ones:

I am just starting to understand things here. It is much different from anything I have seen before, and I would like to continue learning and applying what I have learned. Expats are often criticized for coming in, messing up stuff and then leaving. I have seen this, and do not believe that I’m above that. I would like to be on the more beneficial side of the spectrum though.

I have believed that I want to do this, (partially), for the good of others, and I guess that means doing it too, and not just talking about it. So that means doing it for a long time too. There is a balance though, between benefit of others, and problems for myself. This is a stressful job, and I would like to ensure I don't take too much on too quickly. So, for now I'll take on another 3 months and stop it there. Sudan will always be there, so I can get back in later if I choose to.

Also, I am learning very much about myself and my life here. I love it, and I hate it. Those are both emotions I want to explore more, and this is a very good classroom.

It is also good for the project, of course.

I'm also getting into more coordination of the project, as Evert has been away at significant times over the last month. I would like to continue this direction too.

I do often complain about non-community involvement, but I'm starting to think about what I'm doing about it. When was the last time I got involved in the community, outside MSF? That is another reason, (challenge) to stay, I would like to try to get involved a little more. I identified Isaac, our counterpart, as a tutor in Nuer culture and traditions. I bought him a map of South Sudan and a dictionary. I would like to try to free more time for that too.

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So that is about it. I have passed 6 months here, so I think that means I'm doing all right. I miss home and everyone there, but I am with you in spirit. This has been a hard time, but a good time. There still is energy at the end of most days to smile, and there are good people here to smile with. As for doing meaningful work... I am more confused now than ever about what that... means. But I am enjoying this work, so that is enough to keep me doing it.

Take care, lots of love,

Steve

P.S. Joe: The package you sent me, I still have.
Mom and Dad: The soup mixes were looted, but other books and photos saved.
Bread recipes saved, but any material that would have been an oven, have been looted.
Kevin: Still have the book and package you sent.
Christina: The hat is gone. I'm most certain it went in the fire.
To everyone else: Maybe it best not to send anything of value, except for letters and emails. It would be good to hear how you are.