There aren't terribly many flights to Nairobi, and if I miss mine, I'll also miss the flight to Sudan. It flies at most once a week to a USAID/NPA airstrip next to small village of Akot, where the clinic in which I'll be working is located. However, the flight arrives just in time, and since I didn't exactly wear heels to fly to Africa, I have no problem trotting across the airport to my next flight, which is far less eventful than the prior one. Nairobi is an archetypal third-world metropolis, with copious pollution, gobs of traffic, and absolutely no regard for traffic conventions. There are red lights, but no stopping for them. I like it immediately despite all of this (those with allergies are less forgiving), but am anxious to get to the clinic in Akot. The plane we fly to Sudan is an old DC-3 of the World War II era. Africa is a graveyard for aircraft cast aside by the more developed world – but the DC-3 is a champion capable of carrying a great deal of weight (in this case, people and medicine) and, more importantly, landing on short dirt strips rife with potholes and cow dung.
My first few moments on the ground are an adrenaline rush until the heat seeps into my consciousness. It's extraordinarily oppressive, even to my South Carolina- and Texas-tuned senses, and the ward I'm sleeping in (part of the inpatient facility of Mustard Seed International's Akot Medical Clinic) raises the outdoors at least ten degrees. The clinic is the only accredited medical facility for about a two-hour drive – or day's walk – in any direction. Our compound neighbors that of the Norwegian People's Aid, which is a contractor with USAID and the UN World Food Programme and does their food drops in South Sudan. The clinic is independent, but receives some support from WHO and UNICEF, the former of which provides HIV and malaria test kits while the latter entrusts us with the distribution of mosquito nets impregnated with insecticides. The bednets add to the heat, but even though I have anti-malarial medication buddying up to my red blood cells, I'm grateful to be sleeping under one. Besides malaria there are yellow and dengue fevers – both hemorrhagic fevers mechanistically similar to Ebola in their more serious forms. The medical director of the facility, Dr. Jeff Deal, says that the creature he fears most here is the mosquito – and I see his point, but have a pretty healthy fear of snakes as well, especially after a green mamba is killed two feet from someone's head, another is found in our showers, two try to attack us while we are on a remote clinic in a refugee camp (one actually leapt twice its body length!) and I almost step on a cobra (little, and of the spitting variety, so my windshield sunglasses would have been useful.) But this fear, like the discomfort of the heat and pit latrines, fades as time passes and I fall in love with Southern Sudan and the Dinka.
The Dinka are a people torn by war for the past 50 years. They are tall and very dark-skinned – so even with the beginnings of a marvelous farmer's tan, I stand out. I find that my blondish pigtails are a novelty and thus a good distraction for babies I am vaccinating since everyone keeps his or her hair quite short, in part due to tradition, in part because of nutrition, and partly to discourage lice. My first day, we vaccinate a couple hundred people at a well about five miles from the clinic. My second day in Sudan, one of the Med students and I trudge about two hours with needles, syringes, gloves, sharps containers and vaccine coolers on our backs and give vaccinations for several hours, then hike back. I have learned to maintain sterility (or as close to it as is possible under the conditions) while joining needle to 1-mL syringe, to reconstitute the vaccine with a saline-buffer solution, draw up half a cc into the syringe, plunge the needle into either arm musculature for adults and bigger children or derriere for babies, aspirate to make sure I haven't hit a blood vessel, depress the plunger, remove the needle and deposit it straightaway into the sharps container. Aspirating is necessary because it's impossible otherwise to make sure one doesn't hit a vein or artery, and the vaccine has to be injected intramuscularly; if it gets into the bloodstream the liver will filter it out before the immune system gets the chance to develop antibodies. I will aspirate blood only once the entire time – but every time I draw back the plunger to check, I hold my breath, hoping I won't have to stick my patient a second time. Most of the time, our patients don't bleed from their shots, but when they do, we have to change gloves, disposing of the dirty ones as carefully as we do the dirty needles. Although all of us have had every hepatitis shot available, not every HIV test we do on patients is negative, and we can't be too careful. Full sharps boxes are banished to the depths of the latrines each evening.
Our vaccination plan calls for us to hit locations where people congregate regularly, so we visit school after school, churches, prisons, army barracks, wells and even an IDP ("Internal Displaced Persons" – ie, refugees) camp.
Meningitis spreads by fluid contact, so the risk of contracting it is highest in groups of people, and although no census has been done with any accuracy in the region we are working in, we hope that our strategy will confer a degree of herd immunity. Soldiers and released prisoners are very mobile and prime spreaders of disease. Schoolchildren are not only more vulnerable because of younger immune systems, but also come into contact with many more people than their parents simply because they are at school while their parents work the fields. Wells are points of contact for all the people of the surrounding area – a day at the well ensures that most people within two-three mile radius are vaccinated.
I receive a marriage proposal accompanied by a dowry of a hundred cows. Cattle are currency among the Dinka – 100 cows translates to roughly US$80,000 – and despite efforts by the government to enforce use of the Sudanese pound, it falls a distant third to the Kenyan shilling and the glorious cow. Most of the cows appear to have a bovine version of dysentery based on the liquidity of their patties, but that doesn't stop the Dinka from combining the dung with weeds to fashion tobacco. It's quite a generous offer, 100 cows, since I'm very short and wouldn't guarantee tall sons, but it comes on the heels of my victory in a dance-off with some Sudanese women at a remote clinic. Sudanese dancing consists of jumping up and down, neck bobbing and feet tapping precisely with drumbeats. I am tired long before my opponent, but have a streak of stubbornness that keeps me going even though I am wheezing and my dueling partner's mother keeps trying to push me over when I land between hops. Plus, it is entirely possible that she let me win. I wisely choose not to mention the nuptial offer to my father in my emails home – 100 cows is powerful temptation!
Neither do I tell him about the signs that warn of land mines. I just stay on paths and try to understand the context of ever-present war that permeates every aspect of the lives of my friends here – South Sudan was the victim of atrocities like those now being committed in Darfur. I know I can’t even begin to comprehend the impact the conflict has had in shaping their psyches, but it makes me ache a little for them, especially since they’ve told me they don’t think the fragile peace with the North will last. Most of the people I talk to say that they expect Khartoum to rig the independence referendum scheduled in 2011. Whether it does or not, if people suspect that and the South doesn’t gain independence, there is a lot of fear that war will break out again. Southerners point to Darfur and to recent drops in their share of oil revenues that they feel have been inadequately explained in order to raise questions about Khartoum. I don’t know what’s really true, but it’s scary and at the same time exhilarating to feel in the middle of it – scary because it seems like anywhere I look there is a boy who is younger than I am brandishing a Kalashnikov, and exhilarating, because here I am in the bush, at a hand-pumped well, discussing UN policy and competing national interests when I’ve finished with vaccinating. I feel like we’re doing something that matters, and I’m certainly gaining a new perspective.
One day we feast on beef from a cow killed by the local dignitaries in honor of the clinic’s recently constructed new facility. The sacrifice is an elaborate ritual – it takes most of the day and involves chasing the doomed bull all around the clinic compound and baking loaves of bread in pits in the ground covered with burning coals. I struggle to accept the cultural differences that prevent any of the women from eating with the men, who are served first. The women, who have been slaving over hot fires and serving the men tea sweetened by 100 kilos of sugar specially and expensively purchased for the occasion, eat hours later – the cooking pots are only large enough to cook three-quarters of the cow, perhaps a calculated move as the men consume everything from the first batch. The women are left with the cow’s insides and least choice cuts of meat, and the whole day are essentially ignored by the men. It bothers me so much I have trouble going to sleep until one of the female medical students and I have a murmured discussion about it back in the ward.
Even more privileged than the men in the village are the soldiers. Even though the dearth of resources dictates that each man is assigned only one bullet, an assault rifle as an accessory lends a certain spirit of power and arrogance. Chalky lines encircle trees, reserving their shade for members of the Sudanese People’s Liberation Army. Still, my Dinka friends are very gung-ho about the SPLA. A rally is held in Akot village so the surrounding populace can register as members of the party and receive surprisingly high-tech identification cards with holograms and bar codes that remind me of my driver’s license. That day, wary of trouble from so many men with guns collected together, we stay on the clinic compound and keep a low profile.
The days start to run together, as we vaccinate, draw blood to test for malaria and HIV, treat cases of typhoid fever, tuberculosis, tetanus, meningitis, guinea worm, leprosy, and many other tropical diseases. I work in the pharmacy, see patients, give shots and help in efforts to coax babies into swallowing oral rehydration salts, which I agree taste nasty, but also save lives as supportive care not only for cholera but with far more minor diarrheas. I stupidly, but intentionally, dehydrate myself one day to avoid having to go to the bathroom while we're at an IDP camp and suffer a headache and dizziness quickly ameliorated by rest and gallons of fluid. Lesson learned. My most precious commodities – the Gatorade powder and Nutella spread I brought from home to give my taste buds a vacation from lukewarm but thankfully-filtered water and the staple rice and beans, are disappearing quickly, especially since I share the chocolate spread (less vulnerable to melting than a Hershey’s bar.) Punctuating the routine is a trip to the nearest surgical unit, a Catholic hospital in the town of Montpardit. There is a large school there, so in an exhausting day we give almost 1,000 shots – by far the most of any day. We also pick up a man who needs a procedure too complicated for the primitive conditions of the Montpardit surgical unit to be airlifted from our airstrip to a hospital in Khartoum. He bounces up and down, prostrate in the back of our truck, for over three hours of excruciating pain.
I grow used to being in Sudan – taking my turn filling up the barrels with water to start filtering, scrubbing down the pit latrines with bleach, becoming used to the heat and familiar with the medicines prescribed for the more common ailments we see in remote clinics – and even more accustomed to vaccinating. One day, we travel to Rumbek to vaccinate children at the two large schools and prison there and I have my worst toilet experience of the trip: a pile of feces surround the pit in addition to being in it, with maggots crawling around (although some friends had an even worse experience.) My stomach squirms a little, but my tolerance for inconvenience has expanded just as my waistline has shrunk with all of the walking and the fairly basic diet.
9,000 vaccinations later, I’m packing the trinkets I’ve acquired – a bracelet cast from spent AK-47 shells left over from the half-century of conflict, a ceremonial dagger and shea butter – made from the avocado-like pits of Sudan’s ubiquitous lulu fruits and the South’s only considerable export; it is the product of a cottage industry run by Sudanese women with support from Catholic missionaries who provide sites and presses for extraction of the butter. The DC-3 flies us back to Kenya, and security in Nairobi is so lax that all the passengers are detained for questioning at our connection in Amsterdam and my bags are re-screened. Since the Southern Sudanese government doesn’t have the infrastructure necessary to stamp passports, I have to bring out my separate SPLA visa and explain why I seem to have disappeared by exiting Kenya and not having an entrance visa in my passport again until reentering Kenya in transit to fly out of Nairobi. It’s strange to see so many people, but not be greeted with cries of “Kawadja, Kawadja!” (Foreigner, Foreigner!) everywhere I go, and even stranger to use a flush toilet in a sanitized stall. Immigration in America is not exactly welcoming, as my Customs official interrogates me after seeing I’ve been in Sudan, but I enjoy a huge burger at Fuddruckers in the Detroit airport, finish a book and walk through each of the airport’s terminals with a new appreciation for air conditioning as I wait 10 hours for my connection back to Charleston. Somehow, when I get home to the bed I grew up in, I can’t sleep, even though it is far more comfortable than the cot made from PVC pipes I’m used to. I’m jet-lagged, of course, and I feel immeasurably older. I have Africa in my veins, and now, almost two months after I have returned, I cannot wait to go back. I didn’t catch malaria, but I did catch a very persistent fever: work like I did this summer is what I want to do for the rest of my life. I’ve never felt so significant as when helping others. I’m good at science, and I actually liked Organic Chemistry – but serving people is the reason I stay up late to learn the habits of electrons and importance of protein tertiary structures, why I memorize amino-acid characteristics and hormones secreted by the endocrine system. I’ve been searching for the most meaningful way to maximize my application of both the molecular biology knowledge The University of Texas at Dallas imparts to me and the leadership experience of the McDermott Scholars Program.
I’m grateful to have found it.
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