I am writing from a town called Muhajariya, population 36,000, a
significant proportion of whom are displaced refugees within their
own country. Here we run a clinic where we are the only medical and
surgical referral centre in this region, attending to the needs of
a wider population of 200,000 people. Life is far from easy here,
but the happiness and sheer enjoyment of living today that
envelopes and dissipates the ever-present fear here, would
certainly make you think otherwise.
Enigma
I can't really talk about the clinic without telling you first
about the people of Sudan. They are such a conundrum. On meeting
them, you'd be astonished by their generosity of spirit and open
heartfelt welcome. If they see you enter a restaurant, they have no
hesitation in buying you a drink, even if they barely know you. And
this isn't just a perk reserved for foreign doctors, it's an
ingrained custom. But smothering all this kindness is the total
senseless killings that are happening all around. No-one would dare
steal from you here, but militias drive around town with rocket
launchers hanging off their shoulders on the back of converted land
cruisers.
Abnormal lack of fear
As you sit under the tea sellers' tree, outside the hospital, a man
armed with a machine gun and belt of bullets will sit in the seat
next to you and smile a greeting as he sips his hibiscus tea, his
eyes hidden away by sunglasses. Men armed with swords and AK47's
are so common, they barely merit a second look these days. In fact
it’s only writing this now that I realise how abnormal my lack of
fear really is. I guess you do get used to anything given enough
time.
Hectic and unreal
Days in
the MSF clinic can veer between hectic (seeing hoards of
outpatients - over 4000 a month) and unreal (truck upon truck of
patients with gunshot wounds arriving within hours of each other).
But the staff we work with here, who have unfortunately seen this
all before, carry on with such continued compassion and
determination that one can only feel strengthened by their
example.
Biggest challenge
The biggest challenge I've faced so far has been with the
acceptance and stoicism of the people of Sudan. Recently I saw a
boy of 13, with a horrendous dilated cardiomyopathy (disease of the
heart muscle) who I could only encourage to go home and enjoy what
remained of his life. The difficulty came after the consultation
when he stood up and smiling bravely shook my hand and thanked me,
as did his slightly older brother.
Scream and shout
So many people here have suffered so much, they take everything
life throws at them and just carry on. I wish at times they would
just scream and shout with the unfairness of it all, but in fact
they probably do this as well, though surreptitiously, via
complaints of chronic backache, loin pain, chronic headache or
night fever irreproducible during daylight hours.
Truly amazing
I hope the above doesn't sound too negative because some of the
things we have done here have been truly amazing. Last week, I had
to use a pinnard stethoscope to listen for foetal heart sounds on a
lady who was experiencing an obstructed labour, for only the second
time in my life. All the women here are circumcised and this often
leads to difficulty for the baby when negotiating the birth canal.
Thank god I heard a heart rate of 140, and the surgeon went on to
do a caesarean and deliver twin girls. I can only hope the rest of
my time here see this luck hold out.
Silent tears
In the past
month I've seen terrible injuries, scores of gunshot wounds,
parents whose children have just died, auto-amputations and
assaults, but only one person over the age of five has cried
audibly. Plenty have shed silent tears, but for a sound as natural
as laughing, its absence only became apparent 2 days ago. A
45-year-old lady had a huge stroke and died the next day.
Undoubtedly a cultural phenomenon, the mourning daughter, whose
uncontrolled wails made us all stop our activities, and my hairs
stand on end, was quietly ushered away.
Grief versus energy
Whilst laughter here is as unrestrained and enthusiastic as I've
ever seen, the polar opposite holds true for grief and sadness.
Children's eyes will glaze over and slow salt-water drops will be
the only evidence of pain as an abscess is drained without
anaesthetic. Maybe there is just too much real grief here and too
much energy that would be expended were it to be expressed in full
every time.
February 2007