Wednesday, June 8, 2011

Sudan - Level One Threats

My first night in Sudan I lay on my cot at midnight, jet-lagged and wired, smiling ironically.  Mission control had briefed me in Brussels:  keep security cash and passport on my person at all times, water and flashlight in a daypack at the ready for urgent evacuation.  Coming here was a calculated risk; now I was re-calculating.  My risk scheme ran from threat level one to five.

The smell of burning garbage occasionally overpowered the squat latrines of our compound.  I lay there, breathing more and more shallow as the stench worsened.  What vapor came from burning batteries and water bottles, I wondered.  Eventually I passed out from hypercapnea or was anesthetized by vinyl chloride or whatever.  I awoke when feral cats entered my tent. Blind in the darkness I waited for them to leave.  They found my stash of cashews and a spinning, slashing fight ensued.  So I emerged from my mosquito net and hissed them out.

I smiled again. Weirdness with a touch of danger were what I’d signed up for, in part. I was overdue to escape the overcomfort of suburbia and hang in the Nile riverbed among the world's most sonorous infectious diseases: kala azar, malaria, trachoma, bilharzia.
A flashlight then shined in my face. The anesthesiologist:  Come quickly.  

A baby was stuck, butt-first, in mid-delivery – mother needed a crash cesarean section.  We woke the on-call logistician by radio:  Fire up the generator for our operating light.  
This was my hospital orientation. The patient was nowhere near our inflatable operating tent.  She was crouched in a dark corner of the female ward, pushing at the nurses’ bidding.  I begged them to stop. (A C-section was a little out of scope for a general surgeon, but I was more comfortable with a scalpel than a breech vaginal delivery.)  The nurses knew better, I suspect. We still had no lights, scrub tech, etc.
The baby moved a bit and I changed gears – I would deliver my first child since med school.  I hooked two fingers at the flexed hip and pulled.  She slid!  Her body was now on the cold cement floor.  I pulled her little blue legs as the mother pushed.  Baby’s head was stuck.  My heart pounded as diagrams from fifteen years prior flashed in my head.  I pulled her, spun her, hooked a finger in her mouth, pulled some more, yelled for mom to push, shoved a hand in mom’s belly, and pulled more.  How much could I pull before..?  Good god, could I separate the..?  Please, no.
And she came.  Lifeless.  Onto wet cement.  The nurses performed a cursory resuscitation and put mom on a cot.  I listened and listened for heart tones, rubbing and pinching the little girl.  The nurses reassured me they’d never heard the infant’s heart beat on arrival, so don’t take it hard.  I was dumbstruck, ill. I’d forgotten how much suffering came to Africans.  And I realized, too, that medicine had changed for me since having my own baby girl. I cried.

On my second night, I zipped closed my canvas tent to keep the wildlife out.  I still hadn’t slept since arrival.  I lay on my cot a few hours then got up to find a core of our mission drinking and chain-smoking.  I estimated the second-hand smoke to be a level one threat, and I joined them for a beer. Then because I was on-call, I refused the second beer.  Instead, I covertly poured an inch of whiskey into a tea-cup and got some sleep.
In the morning, chicken-sized grasshoppers in our mess tent, plump frogs grazing on flies in our latrines, noxious burnt-garbage fumes, and ever-present cigarette smoke all faded to background. I sat in the mess tent waiting for hot tea water. The cook came in, shook rat turds off the tablecloth and returned the same cloth to the table. I ate my toast without mentioning the level-one threat of infectious scat to my colleagues, who I presumed were accustomed.

In a short hospital day and a quick walk about town, I learned how war turns poverty into abject devastation.  People bathed in and drank from Nile. On the wards most of the adult patients were malnourished and had been shot with high-velocity rifles. The children's ward was all pot-bellies, stick legs, flies and diarrhea.  I learned that no virtually no food is produced in an area the size of England – a whole generation of farmers was lost before passing on their knowledge to the next generation. There was no water, sewage, or electrical service. The only concrete structures were our hospital, aid organizations, and a police station.  Thousands of displaced refugees were spontaneously building a haphazard city of tin and tents on the flooding banks of the Nile.  Who is in charge? I wondered.

Next - Threat Level Two

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