The following is a letter a friend of mine wrote about her first experiences as an obstetrician and surgeon working for Doctors Without Borders in South Sudan. Her letter gives the reader a good sense of the state of medical care in some of the harder hit areas of central Africa. D.H. Lawrence is said to have written about new places before he knew anything about them. He was more concerned, he said, with the freshness of his impressions than with their accuracy. In the case of my friend, her thoughts reveal both a freshness and an accuracy. She remains in my thoughts.
Philosophy flourishes in gardens. It can only begin once the hands are free and the belly is full. A good plant rises up to the liquid sky; so does a good life.
Note: Names have been left out, changed, or removed for security reasons.
Dear friends and family,
I have arrived in South Sudan and finally have a free afternoon to sit down and write. I’m doing well and adjusting to life here about as quickly as can be anticipated. It’s been a busy and full couple of weeks, partly due to all of the traveling (it’s quite a lot of work to get this far into the middle of Africa) and partly due to a high work volume—also, everything always takes longer when it’s new, regardless of where one is or what one is doing.
After finally arriving in Uganda, where I spent a few days briefing, I flew by commercial air to South Sudan. The MSF [Doctors Without Borders/Médecins Sans Frontières] field operations are run from here (coordinating supplies, people, paperwork, etc.). Here things are bustling with a sense of their own newness. Here the pride and anticipation felt among the people after the Comprehensive Peace Agreement was instated in July is palpable. After a night in X, I flew with a MAF (a Christian aviation mission that MSF has a contract with) to Y. On the plane were 6 people and boxes and boxes of supplies. We each had to step on a scale with our luggage (they even weighed my yoga mat) so the appropriate flight calculations could be made. We didn’t have enough weight allowance for gas to make the 4 hour flight to Y so had a lay-over in Z to refuel and then another hour or so to our final destination. The landing strip in Y is just as you’d imagine: a red dirt strip with potholes worse than a midwestern highway in the wintertime and lined with grass-thatched huts and teeming with children running out to meet us. A white Land Cruiser (the ubiquitous vehicle in these parts) met us and drove us through town to base.
The town here seems to be quite impoverished. People live in mud huts called tukuls with palm-thatched roofs. As far as I can tell from a few walks about the city, there are groups of a half dozen or so tukuls with a community fire pit and some sort of latrine and city blocks are made up of 6 or so of these communities. Outside of the market (which sells very little), there is essentially no commerce and very little agriculture as the people in this area were ranchers and herdsmen by trade. In the town, electricity and running water are rare (making the stars shimmer at nighttime!) and plumbing appears to be sparse.
Our compound is not bad at all. There is a large mango tree (sadly, it’s not mango season) in the middle of our tukuls and there are small patches of flowers. Everyone has her own tukul and there is plenty of filtered water and lovely showers. There are 20 or so of us who live here plus the 20 national staff who work as security guards, drivers, cleaners, and cooks. The living area is directly adjacent to the offices, which have moderately reliable and fairly speedy internet access via old school Ethernet. And there is a volleyball court as well. We’ve played every Sunday and I have two skinned knees (cement chips hiding in the sand) to prove it!
The food is pretty bland – nearly every meal gets a healthy dose of a spicy Thai chili garlic sauce that’s imported from Paris. And every meal is the same. Breakfast is surprisingly good – a piece of bread flavored like a pita but fluffy like ciabatta with Kenyan peanut butter (or, for the more adventurous, Happy Cow cheese – that stuff is everywhere! – or Nutella, the other ubiquitous flavor sensation) and of course, Kenyan coffee. Definitely my favorite meal. The beer fridge is the only thing that is reliably full. We mostly drink a Kenyan lager called Tuskar.
Our compound is about a 10 minute walk (or 10 minute drive in the Land Cruisers) from the hospital. The hospital is quite well-equipped with its own clean water supply and generator. There’s a very reasonable selection of medications and all necessary supplies such as suture, IVs, and the like. There is as little portable ultrasound that is quite nice but no EKG or x-ray and minimal lab tests available. The main hospital is maternity and pediatrics and there is a special section of the hospital reserved to treat malnutrition both for inpatients and outpatients. As you might imagine, the beds are nearly always full, sometimes with 2 patients sharing a bed and make-shift beds on the floor. The maternity staff consists of me, 2 ex-pat midwives (one from the West Coast and the other from Australia), 6 “medical assistants” (who are more like midwives or interns), a handful of “nurses” (who are more like nursing assistants and have never actually gone to nursing school), and plenty of interpreters (mostly Dinka but some Arabic as well). I’m mostly responsible for gynecologic problems and surgical or more complex medical obstetric problems. In addition to more basic cases such as cesarean sections, I’ve had at least one fairly complicated surgical case a day including a ruptured uterus and a ruptured bladder (both from prolonged labor) as well a finger amputation on a little boy (axe accident) and a reattachment of a finger on a little girl (hoe accident). Who knew I’d be running a pediatric hand surgery practice! Oh yes, and I can’t forget to mention the gun shot wound to the back and the innumerable malaria cases. It’s been a crazy couple of weeks.
There are about 16 or 17 expatriate staff working here. Most are in their 30s and 40s. There are 5 doctors – a Family Medicine doctor from Vietnam, a Pediatrician from Japan, an Intensivist from Czech Republic, and an Internist from Kenya. The others are nurses, midwives, logisticians, a pharmacist, and an administrative person. There are 4 Americans here and 4 French, but everyone else is from around the globe. Much of our evening conversation consists of traveling and favorite foods!
So hopefully this gives you some sense of what my life for the next few months will be like. I’ll be sending updates as often as I can. Your emails and letters are always appreciated!
Adam Hyde, “After South Sudan: Integrating Africa,” Open Democracy (August 22, 2011).