Six Months in Sudan (6 page)

Two of the Land Cruisers pull away. Nyala sits in the passenger seat of the third. She leans out the window.

“I can give you a ride, if you want,” she says.

“I don’t know where I’m going,” I answer.

She laughs. “Abyei’s not that big.”

There is no sign of another car.

“All right. MSF compound. Thank you.” I throw my bags through the rear door.

We bump across the landing strip and enter Abyei. There appears to be one red dirt road. After a few hundred meters on it, we stop. On a grass fence is a red and white door, and in the middle of it, a small MSF sticker.

“Here you are,” Nyala says. “Welcome home.”

“Thank you. I don’t know what I would have done.”

“No problem, James. I’ll be seeing you.”

I take my bags, and her Land Cruiser drives off. I knock on the gate. It creaks open. A tall, thin Sudanese man steps out to greet me. He’s holding a radio.

“I’m James. The new doctor.”

“Welcome, welcome.” He gestures me in, closes the door, then turns and sits down on a wooden chair, perched in the shade of a grass awning.

I walk past him. To my left and right are two huts with grass roofs. I can see no one in either of them. I continue on. The ground is dust. I pass a large white canvas tent full of tires. Beyond it is a square brick building, and inside, an African woman is making food. I wave. She waves back, turns towards her pot, stirs it.

In the middle of the compound, flanked on all sides by half a dozen huts, is a tin-roofed house with no walls, a gazebo. Chairs are scattered around on its floor and a makeshift couch sits at one end.

I walk to it, to get out of the sun. I take my bag from my back and throw it on the floor. It lands in a puff of dust. I look around.

Where is everyone?

Bang.

(Blink.)

What?

(Blink.)

knockknockknockknock.

“Yes …”

“James? Sorry to wake you. There’s been an accident. We need you at the hospital. James?”

“Yeah. Okay.”

Whatthefuck.

I open my eyes. Mosquito net. Grass roof. Right. Abyei. Made it.

I lift off the corner of the mosquito net and a fine cloud of dust descends. I swing my feet to the cement floor and stand up. My back is wet. My mouth tastes like ashes. I’m dizzy, just for a second. Then, a headache. I sit back down, lean my head on my hand.

What happened last night? Oh yeah. Party. Someone was going away. Or a birthday. I can’t remember. Nyala was there. Who else. Some of the team. Tim. Smoked a hundred cigarettes. And then what. Sick. Diarrhea. I lay by the latrine until dawn. What time is it now? Ten. Whoa. Ugh.

Hospital. Right. Accident. Cotton. My head’s cotton.

I look around the hut. Tim, my Swiss tukulmate, is gone. I reach underneath the bed for my stethoscope, searching. There it is. I stand, take the MSF shirt dangling from a rope strung between sticks in the grass roof, look around for my shoes, then slide into them.

I open the low door, bend underneath its frame, and clip my head on the beam of the awning.

“Motherfuck.”

I rub my head. Paola, the Italian nurse, is standing right outside.

“Sorry, James, but we need you at the hospital. Car accident. Sandrine is already there. So’s Bev. I think there’s quite a crowd,” she says.

“Okay. No sweat. I gotta get some water.”

“They need you right now.”

“I’ll drink it on the way.”

Paola leads. She and I met two days ago, on my arrival. Young, cute. Boyfriend. I walk into the small brick kitchen and grab a plastic Coke bottle filled with warm water, then jog into step behind her.

Glug-glug.

I am having a tough time drinking water and keeping up. I’m spilling some of it on my shirt. We walk out of our gate, turn right, then right again at the tire half buried in the red dirt.

Okay, this is our compound to the right, behind the grass wall. Glug. Compound, compound, compound. On the left, another grass wall, huts behind it. Sixty paces and the grass walls end on both sides. To the right, a football field-sized flood plain, and at each side, football goals. Empty. Too hot.

Coming up on my left is a military compound surrounded by barbed wire. Which faction? Government, I think. SAF. Bev told me on my second day. Yesterday. Wow. Seems longer. Difficult to keep it all straight.

We sat for an hour in a hot hut. As the rest of the team talked in the gazebo, we hunched over maps as I recorded a list of names and acronyms. She told me who I should watch out for, who was best to avoid, and ended with, “Just leave it to me.” That sounded fine. When the time came for Sandrine, the departing doctor, to show me the patients she was leaving me, Bev suggested that my time would be better spent going on an early-evening tour of Abyei. We bumped across un-tracked ground, past half-built huts until we had done one large circle. It took about fifteen minutes. I was to meet with Jean, the logistician, to get a technical and communications briefing. When I poked my head into the logistics tukul, he was deep in conversation with one of the mechanics, both their hands black with grease. “Tomorrow?” he said. “Or the next day? Oh, one thing. Handset. We use channel 5. Don’t be without one.” I took it from him and put it in my tukul.

Shit. It’s under my bed.

Paola and I pass the military compound. Inside, some soldiers are washing their camouflage uniforms. A goat has climbed to the top of a mound of rubble, and another circles him, waiting for his turn to be king. In the corner of the compound, facing the juncture of the road I’m on and the approach to the hospital, sits a howitzer. I duck underneath its barrel, which appears to be aimed towards the great nothingness that surrounds Abyei, and turn left onto the hospital’s driveway.

In it sit three cars. One of them, a white Land Cruiser, is ours. The other two are military green. A crowd is gathered at the small entrance.

Paola pushes past and I follow. Inside the hospital, people are milling, pushing, yelling, straining to see what they can of the action. A little girl sits on the ground between angles of legs, crying.

I don’t know the hospital yet. It seems huge. I don’t know where I am supposed to be. There’s Bev. Her eyes are wide, her thin frame tight with stress. She is hurrying towards me.

“What’s going on?” I ask.

“Bloody rollover. Military truck ran into a car, then turned on its side. Six soldiers in the back. They’re mostly just banged up, but one of ’em’s got a big gash on his arm. Sandrine is in the tent with a civilian who got run over. I’m crowd control.” She turns away.

I edge through a group of women, babies on their hips, and walk towards the tent. On my way, I glance into the tiny emergency room. It is filled with soldiers.

In the tent, a man is lying on a cholera bed, grimacing. Sandrine is bent over him, listening to his lungs.

“What’s up?”

“Oh, James. Sorry to get you, but there’s just too many people. Mohamed is in the emergency room with one of the others, and this guy, I don’t know. I think he got run over. I started an IV and I’m giving him a bolus. Pressure’s okay.”

His shirt is off, but his pants are still on. Coarse tread marks march over his thighs.

“His lungs are good? What about his belly?” I ask.

“Seems okay.”

I feel his abdomen. It is soft. I put one hand on each side of his pelvis and push down. He screams.

“He’s probably got a pelvis fracture. We should cut his pants off. You log-rolled him?”

“Not yet,” Sandrine answers.

“Let’s do that. We should give him some morphine first.”

We turn him on his side, one person holding his neck steady, two others pulling him over. I feel along his spine. As I get down lower, he shouts in pain.

“Maybe a lumbar fracture too,” I say. “Seems to be moving his feet okay. That’s good.”

“Transfer?” she asks.

“I don’t know. What do you think?”

“We can.”

“Maybe it’s all from his pelvis, I don’t know. It feels stable, but if not, the guy needs to be in traction or have surgery. Is there an orthopod at that other hospital, whateverit’scalled?”

“Heglig,” Sandrine says. “Don’t think so.”

“X-ray?”

“Yes.”

“Well, it’s probably worth a transfer, then,” I say.

“Okay. We’ll do it.”

“Are you cool here, Sandrine? Should I go help Mohamed?”

“Yeah. That’s a good idea.”

She leaves tomorrow. She is an infectious-disease specialist and has been here three months. Today she is on call. Yesterday we were both pulled in so many different directions, we had little chance to speak.

On a nearby veranda, two of the rollover victims are lying on the ground, each attended to by soldiers in green fatigues. They are moving. I consider that a positive sign and walk past them to the emergency room.

It is full. I can barely squeeze myself inside. On each of the two beds lies a soldier. One of them has a clean piece of gauze on his head. I pull it aside. An abrasion. I turn to the other bed and see Mohamed
holding a cloth firmly down on the upper arm of the second patient. He and I met briefly during my whirlwind day. He is the other doctor in the mission, recently graduated from a medical university in Khartoum. He is young, brown skinned, with a smile full of bright, white teeth.

“Mohamed, you okay?”

“Oh, James. How are you, man?” he says, grinning.

“Good. What’s up with this guy?”

He takes the cloth away, and blood starts shooting from a large gash in the patient’s upper arm in a thin, red stream.

“Okay, okay. Got it.”

“I think it was the glass from the windshield,” Mohamed says.

I feel the pulse in his wrist. It’s strong. “Hey, can you ask him to wiggle his fingers.”

A flicker.

“Make a fist.”

A bit.

“Thumbs up.”

Nothing.

“Ask him if he can feel me touch his hand.”

No.

“Radial nerve. His arm is fractured?”

“Seems so.”

“Any other injuries?”

“No, I don’t think so,” Mohamed replies.

“Well, I guess we’ll have to wash it out and sew it up. Splint it. I’ll look for the nerve, I guess. We have ketamine, right?”

“Yes.”

“If you get me some, I’ll start. It’s going to take a long time.”

It does. Over an hour. His arm is broken in half. Thin spicules of bone keep snagging my glove, ripping it. I can’t find the nerve, can’t see enough of the bone to trace its route. I am reluctant to cut any farther. Sweat drips down my forehead and into my eyes. My stomach cramps, and it makes me feel nauseated. I wash out the wound, cut
away the black pieces of crushed tissue, sew his triceps together, then close the skin. Lastly, with Mohamed’s help, I put him in a long arm-cast.

I finish wrapping it and open the door. A man in military fatigues pushes quickly past.

“Doctor. Tell us what is wrong.”

“Well, sir, this man has some scratches on his head. He is going to be fine.”

“Good.”

“The other soldier has broken his arm, and has a large cut in it, at the break. I have cleaned it out and sewn it up. It’s possible he cut the nerve as well. Right now, he can’t move his hand. That might recover, but possibly not. Time will tell.”

“You must take him to Khartoum.”

These guys must be SAF.

“Sorry?”

“You have to fly him to Khartoum. He is one of our soldiers. He needs an x-ray.”

“He doesn’t need an x-ray. The bone’s broken. I can see it. The rest of his arm is okay. These fractures usually heal very well.”

“You said he can’t move his hand.”

“I know. The nerve has been bruised or cut. He could use a neurosurgeon. But not urgently, not today. He can wait a few days.”

The patient starts to groan behind me, his anesthetic worn off.

“You must fly him to Khartoum.”

Another soldier enters the room.

“Listen. We don’t have a plane. We have a Land Cruiser. We can take people as far as three hours from here, to a bigger hospital, but only if it is going to save their life. And there is no neurosurgeon there. And we can’t take people to Khartoum. We simply can’t.”

“Why are you refusing? I know you are going to take the civilian who was run over. Why won’t you help us?”

I need to get out of the emergency room. I need some air.

“Excuse me, excuse me.”

I push past and step into the courtyard. The scene has settled. Bev has done her work well and only a few mothers of children in the feeding center remain. One of the injured men on the veranda is gone, and the other is sitting there, his leg bandaged, sipping tea.

The soldiers follow me out.

“Doctor, I don’t understand …”

“I’ve explained things as clearly as I can.”

“I think it would be best if you took our man somewhere he could get better help.”

“I agree,” says a man who has come to join us from the veranda. His hair is gray, and he is wearing a large white tunic. “I think you should listen to this soldier here. You’re new. I understand that, and you don’t know me yet, but I am one of the leaders around here, and …”

Bev turns the corner.

“Bev. Can you help me out over here?”

I take her by the shoulder, lead her a few steps away.

“I mean the guy needs a neurosurgeon or an orthopod I’m not sure maybe a general surgeon can handle it but he would have to dissect the triceps away look for the nerve sew it up but it’s not that straightforward maybe in Khartoum I don’t know and these guys they’re all—”

“James. I’ll take care of it. Gentlemen, come with me.”

And with that, she leaves. The soldiers follow. My anxiety quiets. I walk back to the tent. Sandrine is scribbling out a referral note.

“You okay?” I ask.

“Yeah. You?”

“Yeah, I guess. Some drama. Is it always like this?”

“Not always.”

“Wow. Anyway. I think Mohamed has taken care of the rest of the patients. I’ll make sure. If there’s nothing else, I’m going back to the compound. I feel kinda shitty. I’ll write orders for the guys in the emergency room.”

“See you back there.”

I stop in the nursing room and find an empty chart. I am not certain what drugs we have, or how best to order them. I grab a chart on
the desk. It looks like the system is to make a full circle, or half-circle, depending on the dose, and draw them on a line that marks the time of day when I want them given. I turn to the cupboards, find some antibiotics and some morphine, and hand the rest of the orders to one of the nurses whose name I don’t remember.