Down to Juba

Tuesday, 8/9: I've sat down to my tasty breakfast (one fresh pita with eggs, one fresh pita with butter and jam – hard living, I know), when I notice, out in the yard in front of me, Thomas (the medical head of the project) talking animatedly with someone on the phone. A minute later, he says “Okay, I understand,” hangs up the call – and walks straight over to me. Hmmmmmm – this could be interesting.

In short order, he tells me that the anesthetist in Juba has gotten sick, and that they need to send me down there as soon as possible to take over on the project started about a month ago to tend to people injured in the recent political violence. “Today?” “Well, that would be ideal, but it’s probably too late to get you on a flight – and since there is no flight tomorrow, it probably means Thursday. But get your things packed so you’re ready to go, and wait to hear more from me.”

To tell the truth, I was still kind of pissy about the theft the previous week, and I think more stressed than I realized by the confined and unchanging work/life situation up there, so I had a very brief thought along the lines of “Yeah? Well what if I don’t wanna?!?” But I said yes – not being willing to go to any more-or-less normal place they want to send you seems contrary to the whole spirit of the work. And, besides – in a minute or two, I realized how nice a change might actually be.

I went and threw my stuff into my suitcase (given the shampoo I had used, the treats I had eaten, and the stuff that had been stolen, I had plenty of room), then headed in to work. A standard-issue day of changing children’s dressings – although, in something I will have to remember the next time I do this, the very short fuse I found I had that morning was a clue that I need to figure out good “mental-health activities” on jobs like these. (I tend to think of myself as stoic and imperturbable, but I think in fact I may be rather more prone to stressing out than the average person.)

Around 10:00, however, we got a call from the OB – the woman with the ruptured uterus, who had never recovered from surgery, for reasons the OB could not figure out, was coming back. She had gotten sicker and sicker over the week, and he wanted to look in her belly again as a kind of shot in the dark, a last-ditch, desperate attempt to see if there was anything there he could fix or improve. We started setting up for this delicate, probably unstable patient (happily there were three of us that morning), and had her in the room when the OR supervisor said someone in the hallway wanted to speak with me. And there was Thomas, with the news that, indeed, they had managed to get me a ticket on the flight out, and I was leaving in an hour.

After confirming with Nicola and Hassan that they were okay taking care of the ruptured-uterus patient (so nice to have good colleagues!), I changed and ran out to the car, which took me to the compound, where my suitcase was already loaded into another vehicle. I said a quick goodbye to whoever was there, turned over my “security money” (the stuff you always carry with you to have something to give to someone if they want to rob you), and jumped into the new car. And that was the last I saw of the Aweil compound or any of its denizens.

Half-hour ride to the air field through the beautiful-but-unattractive (well – to me) South Sudanese countryside – bright green and clay red, but unremittingly flat, scrubby, and monotonous. Brief horn-locking with the official who wanted to know why I was there 20 minutes before the flight, not two hours (he did not make me put my carryon in the little measuring box, however). Short flight to Wau, where we had to disembark for three hours as they waited for connecting passengers. Hideous, humid waiting room whose essence combined a little of the sauna and a little of the urinal, and neither of whose large and promising floor fans worked.

We were told we could leave for a little while if we wanted to, and, as I was ravenous, I headed out across the neighboring dirt patch to what appeared to be a line of shops. I wasn’t sure what MSF policy said about this little foray, and, as I walked along, in addition to the normal stranger-in-a-strange-land apprehensions (Will I be able to identify what they are serving? Will I be able to make it understood what I want? Will I be able to find out what it costs? Will people stare at me the entire time I’m there?), I had visions of being kidnapped and held for ransom. However, as almost always happens, it turned out to be lovely. Largely because when I got there, I ran into Moses, the guy responsible for biomedical equipment at the hospital in Aweil, whom I had seen several times but never actually met. He is one of those people who, quite literally, the moment you lay eyes on him, you feel “I am in good hands.” What is it? What information are we picking up in those split-seconds, and is it in fact accurate? (And does it have anything to do with the fact that he is rather shockingly handsome?) He stood me to a delicious meal of beans and bread (wouldn’t hear of me paying, despite the fact that my annual salary is probably about three orders of magnitude higher than his), and we were back on our way, in much better moods.

The flight from Wau to Juba is longer, and I spent much of it listening in on the conversation of a bunch of “lifer” aid workers sitting in front of me. I think they were all associated in one way or another with FAO, the UN food organization. Such a lesson/reminder of how anything can become normal if you do it for long enough, of how any of our conversations can be cruelly turned into a bunch of clichés by a bad-natured outsider, and of why I never wanted to do this full time. Yes, Mary is in this boarding school – it really is the best one. No, we were in Rome then, it must have been some other time that I saw you. Yes, yes, but was that before or after we had to evacuate Mogadishu? They say that someone who was a total mediocrity in Brussels could go to the Belgian Congo and suddenly become a king. I know NOTHING about the skills or qualities of my fellow passengers, but – it’s always seemed to me that one has to work very hard not to more or less repeat that process today, in the modern age of aid.

Finally in Juba. Funny, when I first came through, it looked like a dusty and disordered frontier town, and now, after Aweil – why, it’s the metropolis! Once I’m settled in in the guesthouse, I get a detailed briefing from the medical director and from Dave, the surgeon I will be working with. More or less as I understood it: Many people were injured in the flareup of violence in early July – mostly gunshot wounds, but also the odd machete slice or RPG gouge. And medical care was scarce or undependable, especially – a point I will come back to in a later post – if you happened to be Nuer instead of Dinka. Meanwhile, the International Medical Corps (IMC), another NGO, already had a medical center in the Protection of Civilians (POC) camp inside the UN base, where Nuer have been fleeing for safety since the start of the current hostilities in December, 2013. So MSF “borrowed” one of IMC’s Quonset huts to set up a surgical hospital to deal with all these wounds. Everyone has already had their initial, stabilizing surgery; now we just need to finish up as many of the additional surgeries as we can before turning the whole ward back over to IMC on Monday (8/15).

The situation is, in fact, a good deal more controlled and predictable than Aweil, largely because MSF has decided that we must be out of the POC by three o’clock, at the very latest, every day. (I ask why that time, in particular; apparently, it is a compromise – any earlier, and the day becomes unworkably short; any later, and the concentration of “drunk soldiers” on the street becomes unworkably high.) So we are NOT on call, which – even though the work in Aweil, where I was on call 24/7, was never overwhelming – is surprisingly relieving to learn. Also, Dave already knows all the patients well, so what we have to do each day is defined. And in some way satisfying, too – setting bones that we expect to heal, covering huge open wounds with skin grafts that, if everything goes well, will give the person back more or less normal function. Aweil was often a holding pattern – we can’t actually do a skin graft to close this huge burn wound, or massive snakebite necrosis, so we’ll just try to keep the wound from getting infected while the body does it’s months-long work of closing the wound off with scar tissue. You were never sure the patient was getting better. It was vital work, as far as the kids were concerned – a large number of them would almost certainly have died without it – but doing something where you can actually envision the arc of healing – there is something about it that, for me, anyway, is more immediately gratifying.

Dave, an ex-Army surgeon (but not at all in the macho mold that I – not, in fact, knowing anyone in the army (!) – assume for the military), strikes me as super, awe-inspiringly competent. I’m looking forward to the next day.