Nov-Dec 2012 Letters from Old Fangak by Dr Gretchen Neumann-Stone MD.

Gretchen who currently works in Scottsdale Australia, has had long-time involvement with the Sudan Medical Relief Project and took a month in Old Fangak, South Sudan, to work with Dr Jill Seaman. The following is her writing -

23 November 2011

Sitting in the open-air lobby of Juba International Airport, waiting for a charter in to Old Fangak.  Jack Hickel and Todd Hardesty, a doc and videographer from the Alaska Sudan project, are flying in too.  It’s good to have company.  Jack is trying to book his ticket to fly back from Malakal to Juba in 10 days, but you can’t buy it in Juba.  You have to pay cash in Malakal—which is a day’s trip upriver, and costs about $600 in fuel just to get there.  Credit cards are not a go in Juba.  Phone numbers have changed since independence in July, so the numbers for Mission Aviation Fellowship charters don’t work.  Todd spoke with a man who looked official, and advised us to be patient.  Good idea.

Joseph, a Kenyan man who does work in Nairobi for the Alaska Sudan project met me at the airport about 4 pm yesterday. We hit rush hour heading back into Nairobi, with stop and go traffic, and plenty of diesel fumes.  He headed off onto a dirt road that runs alongside Nairobi National Park.  Traffic was slow there too, but we could see antelope, ostriches and water buffalo in the park—lots of antelope.  Folks were walking along the dirt road, several carrying chairs upside down on their heads. Joseph found out that the road was blocked because the government was knocking down a shanty town which had mushroomed on fields that used to be the airport.  Thousands of people inhabit shacks of corrugated tin, plywood, and whatever else they can use to throw up a shelter.   Joseph said that the government was building better housing for them, but who knows where they will stay meanwhile. 

24 November 2011

Typing from Jill’s tukul, happy to be in Old Fangak.  I flew in yesterday with Jack Hickel, a doc from Anchorage who worked in Swaziland for 16 years, and Todd Hardesty, who makes videos for a living.  Dave Kapla (the Captain) had arrived from Malakal the day before.  He delivered a boat which the World Health Organization donated to Jill, complete with a shade roof—very flash.  As we circled over the village, we saw them hop into the boat to cross the river to the airstrip.  Then hugs all around.

It is so different being right on the river!  As we made the short trip back to the compound, with blue water, lush greenery on the banks, and purple blossoms on the water lilies, it looked like something out of a travel brochure.  Flooding destroyed a lot of the food crop, but leaves everything much greener.  The weather is actually lovely, and chilly enough at night so that one blanket may not feel like enough—even for those of us who are not stick figures.  Right now, the breeze is blowing through the tukul.  It is much less dusty than it was in Keew both because we are right on the river, and because it is earlier in the dry season.

A group from Stop Hunger Now had been here for a few days, and departed on the plane we flew in on.  One of their goals is to get an open air school built here, with a metal roof to keep the elements at bay.  They reckon they can provide food for the kids, to encourage them to attend.  There is so much hunger now because of the flooding, I am sure adults would be happy to come too.

A young man from the education ministry was with them, dressed in a suit and tie.  Suits seem out of place in this environment, when it is so hot and dusty. People around here barely owned clothes 20 years ago, let alone business suits.  This man has been really helpful to Jill in getting us certified as a community agency, which gives us tax-exempt status and other benefits, doing it as a volunteer.  Turns out he is also receiving a salary to teach in Old Fangak—which he has never done.

There are so many undercurrents here that influence what works and what doesn’t.  The cost of living here is actually quite high, compared to people’s income.  Jill and I walked over to the market this morning and bought some fry bread for breakfast.  We watched the Ethiopian man slip discs of dough into the hot fat, and spear them with a poker when they were cooked.  They cost about 30 cents American each.  Hard to imagine how many local folks could pay that kind of money for breakfast.  But some must; otherwise he wouldn’t be in business.  He also had a big pot of hot cereal for sale.

We were discussing appropriate salaries last night.  Our chief medical officer, Peter Sunduk, attended 4 years of school (financed by the project) and then returned to work here.  He is really good: a solid citizen, committed to working in the area he came from, and with high standards of practice.  He gets paid about $500 monthly.  Stephen, who works with the Alaska Sudan folks to get the hospital up (and weld, build tukuls, etc), gets paid about $400 monthly.  When the Stop Huger Now team asked about building a simple school, Stephen said that an outside contractor would probably charge $3000 US, but he could do it for half that.  But that is only 2-3 weeks’ work—which then throws the pay scale of the area way off, and creates jealously, and the idea that all our staff should have their salaries doubled or tripled.  Even the guy from the ministry of education, who has helped Jill for free, then decided that he should receive a generous salary.  Ouch!  (Later—this has been worked out.  Reason and  commitment prevailed.)

Meanwhile, the kwaji (literally white folks, but ex-pats of any shade) were discussing this in the large tukul, eating popcorn, and drinking gatorade.  The Alaska folks said that last year they had counted on food being here that wasn’t, so ended up buying goats and chickens to butcher. This year they brought freeze dried meals—and also peanut M&Ms, coffee, tuna in foil packets, etc.  Jill has always flown most of her food in, since there is very little for sale, and you don’t want to compete with local folks for food.  The standard of living for ex-pats has gone way up since I was here in 2004, partly because we are right by the river, with a market and plenty of water, and partly because the Alaska folks have been here for longer periods, and set up their own systems for higher class eating.  It is still very simple living compared to what we are used to at home, but conspicuous consumption by Sudanese standards.

Jill has been introducing me as Katie’s mum, which causes rows of shiny white teeth to spring out of dark faces as they break into smiles.  Katie tutored one of the health workers in math last year; he is eager to have me carry on where she left off.  One of the staff just came in with a report on how much plumpy nut (the high energy peanut paste that we give to malnourished patients) we have used in the past month.  Turns out there is only a week’s supply left—partly because the nutrition worker has such limited math ability that it is hard for her to count how many have been distributed.  UNICEF is providing it this year, but has no way to get it here at present.

Todd is shooting a video, which he will send back to Alaska in time for the Thanksgiving evening news.  It does seem like a rather huge community of expats at the moment: six of us.  Patient numbers are down.  Perhaps it’s a smaller kalaazar epidemic this year; perhaps it is because there is so little food.

25 November 2011

Yesterday arvo, Ann Evans (a nurse practitioner from Alaska) and I met with a bunch of women who wanted to talk about finishing the roofless building that was intended to be a women’s center.  Rumor has it that the contractor was paid for the whole job, but got mad about something and stole the rest of the materials.  Now the 5 room brick building has no roof.  Weeds grew through the would-be floor, as tall as the women’s heads.

Seventeen women showed up, each carrying her own chair.  One of the male nurses translated for us, since none of the women speak much English.  They want a place to gather, sewing machines, a way to earn some money.  Maybe a feeding center for the kids, since there is so much hunger this year.  At one point, one started clapping, and the rest joined in, then burst into song.  That’s my kind of meeting!  Most of the women looked to be in their 20s; all of them were married and had kids.

So this morning, there we all were, chopping down the weeds with machetes and lugging them out of the building.  It was done in an hour.


27 November 2011

Sunday is different - no regular morning clinic.  We booked a thumb amputation for 7 am.  The silly soldier was drunk 2 weeks ago, and decided to use his hands to fend off a puff adder.  It bit his right thumb enough to kill the tissue, and his left hand was puffy as well. He was worried about how he could shoot his gun if his thumb went missing. The thumb was mushy—obviously dead tissue.  To demonstrate that there was no hope of it healing, he pulled on the nail and slipped all the skin off his finger like a glove, leaving what looked like an overripe banana.

We used ketamine to put him to sleep.  It’s a great anesthetic, since you don’t need gas, but it sometimes gives people weird dreams. After surgery, he started getting stiff and agitated, and trying to climb off the bed.  Jill sings to babies while she starts IVs, to calm them.  So I started singing to him in Spanish.  Right away, he lay down and waved his hands to conduct the music.  Everyone else in the ward who was mobile strolled over to watch.

This afternoon, I went with folks from the Alaska Sudan Medical Project up the river to a farm they helped establish.  ASMP was founded to build a hospital in Old Fangak, but they also work on wells, fences to keep the cattle out of the hospital, etc. (Our satellite dish quit working because cows thought it was a perfect spot to scratch their itches.)  Old Fangak lies on a tributary of the Nile, called Bar El Zaref.  Tooling up the river in a speedboat makes you think that our next project should be ecotourism.  It is so lush, with floating islands of water lillies, and banks of green reeds camouflaging the dry earth only a few meters away.

Hunger is a huge problem for our patients.  Floods destroyed much of the sorghum crop in August.  The World Food Program donates food, but it is never enough to feed patients and their families while they stay in Old Fangak for a month of treatment.  So ASMP is encouraging farming by selling water pumps and rototillers to those who demonstrate that they can grow veggies at least 6 inches tall. These folks traditionally focus more on cattle herding than gardening, so there are new skills to learn.

We visited a family that bought the first pump 3 years ago.  Now they have an incredible spread, with at least 40 papaya trees, mangos, tomatos, beans, eggplant—and on and on.  The farmer’s elderly mother sleeps at the edge of the garden to ward off a hungry waterbuck that emerges from the river at night to munch. (You should have seen the sign language involved before we sorted out which animal she was complaining about!)  She asked where they might buy a tent so she could move her shelter.  The farmer was able to pay off his pump as soon as his first tomato crop came in.  You can see the difference in his 6 kids, who just sparkle.  The fat, sassy baby is named Brett, after the man who delivered the pump.

Oh, yeah—I came here to practice medicine. 

A snapshot of our practice in Old Fangak:

We have major treatment programs for kalaazar and tuberculosis, infectious diseases that kill lots of people, especially those weakened by malnutrition.  Since Jill is the only doc for miles around, and does not charge for patient visits, she sees anything  that comes up the pike.  All but two of the Sudanese clinical staff are male; women don’t have much chance to attend school or learn English, the official language of Sudan.  We do have one young woman community health worker who has studied in Uganda and speaks good English.  The second female CHW has a new baby, so Jill is working on arrangements to have her study abroad next year, with her mother along to look after the baby.  That takes some commitment!

Women carry loads around here—there are no wheeled vehicles or beasts of burden.  So we hire women to carry 40 litre (5 gallon) water containers on their heads from the well, to stock both the hospital and our home.  When some of the Alaskan guys tried to carry water last year, they were soundly scolded for being so inappropriate.  Even when they carried water after dark, word got around.  But they are allowed to lift the full bottles to pour them into the water filters, inside the house.  Jill and I can’t hoist 40kg that high by ourselves anyway.  I haven’t even tried getting one onto my head.

Our “inpatient” ward consists of those who need IV medication, and those who are too weak to walk.   We have 11 metal bed frames, seven of which are blessed with mattresses.  A few patients sleep there overnight, but most stream in around 9 am for their IVs, and sleep in mud huts overnight.  The hospital floor was tiled at one point.  It’s like an archeological dig.  You see the layer with green and white lino, then layers of bricks where the lino has worn completely away, and only dirt in the areas where the bricks have eroded.  That’s where the nurses squirt their excess IV fluid, as well as other moist substances that they want to dispose of. 

Last night, we admitted a young mother, a TB patient whose kidneys were shutting down.  Her breathing made you think that she was not likely to survive the night; her blood count was about a third of what it should be.  Her sister in law stuck out her arm for a blood donation, and the patient got it in short order.  That helped. 

We were delighted to find her still alive, and improving, come morning.  But she deteriorated over the course of the day.  She died just after Jill rang a doctor friend in the US for advice. 

And the flip side of that coin is that a heck of a lot live when we might not expect them to.  One emaciated baby with kalaazar has had pneumonia, heart failure, and 2 blood transfusions in the past 4 days—and looks like he is going to make it. 

Most of the kalaazar patients are adorable babies with big eyes—although sometimes you discover that the breastfeeding mom is the patient instead.  Because we have so little food this year, and the World Health Organization is giving us the Cadillac of kalaazar treatment at no cost, we are treating more patients with IV meds. That means they only have to stick around for 11 days.  Our national staff finds counting pulses quite challenging, but they can whip an IV into a dehydrated baby in no time flat, and organize the blood transfusion.  Yesterday I watched Jill start an IV, squatting on the floor beside the mum, with baby in her lap.  I fall over when I try to squat for long, let alone starting IVs in that position!


7 December 2011

Thinking of you, but not doing much about writing.  Our solar power and internet have both been having issues.  David, a homesteader from Alaska, farms peonies in the summer, and has volunteered here for the past 3 Alaska winters.  He is a lovely man who can tinker with things until they work.  Most useful in a place where so many things don’t.

There is a genuine famine going on here.  Sorghum is the staple food, along with milk and occasional beef or fish.  The sorghum crop failed due to flooding this year—as well as all the issues of war, displaced people, rats, and so on.  There is so little food; lots of shops in the market have shut down.  The World Food Program is supposed to be providing 1900 calories daily for a lot of our patients, but it has not been delivered since February.  And yesterday a boatload arrived! We got 1600 kilos of beans (Sudanese are not in the habit of eating beans, but it’s food), 625 kg of salt, and a bunch of oil.   Plus some high-energy biscuits that you can crumble into water to make porrriage without having to cook it.  Today the patients carried next month’s 50 kg bags into the food storage area, and then the beans were distributed.  Women do most of the carrying, and most of our female patients weigh less than 50 kg.  Someone helps them hoist the bag onto their heads, then off they go.

Jill has spent hours every day on e-mail and satellite phone, trying to get the food organized.  She has been told that it was already delivered to us (hah!), that it had  been delivered to a town 2 hours up the river, that we were getting sorghum, that we were not getting sorghum, and on and on.  The surprise yesterday was that Mission Aviation Fellowship, who fly the charters that bring folks in and out of Old Fangak, had heard of our plight and arranged for Save the Children to donate a bunch of high-energy peanut butter glop—without even being asked.

On the medical front: kalaazar numbers are way down this year.  Now that food has arrived, we expect that patients will follow.  Kala azar patients have to have enough to eat during  two to four weeks of treatment, and TB patients stay for 8 months.

Today Jill was on the phone, when our lab tech told me that a woman had walked in ready to deliver.  I ran over, and there she was, surrounded by 10 or so women who had accompanied her, someone who was already in the room waiting for a wound dressing, and the 12 year old sister of another patient with her baby brother on her hip.  The woman was kneeling on the dirt floor to push, while her friends chatted and laughed.  I KNEW I had seen umbilical cord clamps around somewhere, and located them in the pharmacy.  Jill popped in, told half the bystanders to get out, encouraged the woman to lie on the bed so she wouldn’t arch her back so much, and out came a beautiful baby boy.  I popped him right onto his mom’s tummy, but was told that it was proper for friends to cuddle him until the placenta came out. 

In Australia, women get a $5000 baby bonus when they deliver.  Here, they get a mosquito net and a bag of iron tablets.  I did bring the lady some water in a plastic cup, since she had lost a fair bit of blood.   Then they all walked home.

I continue to be amazed by the fact that here, with intermittent solar power and no soap in the inpatient ward (because it always gets stolen), Jillruns a referral hospital.  Last night, a soldier presented documentation that he had been granted leave to travel to Old Fangak for medical consultation. It was handwritten on a sheet of graph paper, with all the official stamps.  He had suffered with numbness in his feet for a few years.  Today I was flagged down by the parents of a 10 year-old boy whose eyes were not focusing—looked like he might have had a seizure.  Turns out that one half of his visual field was not there--and he is the only surviving child of parents who look too old to have any more.  None of the possible diagnoses we came up with have good outcomes.

We had a baby several days ago who did have seizures.  She was swollen and puffy from malnutrition.  Jill thought there was no chance of getting an IV in her, since we could not see or feel any veins.  I did 4 or 5 blind sticks, checking my own arms to see where veins should run.  No luck.  Next thing I know, the nurse had one in, and we gave her a transfusion.  Mind you, several of our nurses can’t tell you the difference between the circulatory and neurologic systems, since the word for them in Nuer is the same.  But they’re dynamite at starting IVs! 

When my daughter Katie was here almost 2 years ago, she helped one of the young male nurses study math.  Diu is still eager to learn.  I spent an hour with him yesterday on his new workbook, and suggested a couple of pages for homework.  Today he showed up half an hour early, and had done 5 pages.  Tomorrow we start fractions.  Diu did one problem right to left, and commented that that is how you would do it in Arabic. He also speaks Dinka, Nuer, some Shilluck and adequate English.

Several folks have asked if they could contribute financially to this work.  You can guess my answer!!!  The address for (tax deductible) checks is

Crosscurrents International Institute
7122 Hardin-Wapak Rd
Sidney, OH 45365

Or online at Sudanmedicalrelief.org.

As they say here, Malay—which means “peace”


12 December 2011

Another exciting day in Old Fangak.

The highlight of evening clinic was a laughing woman in her 40s, with a letter from an MSF surgeon to whom Jill had sent her—emergently.  The letter reported that he had repaired a hepatocutaneous fistula—a hole through her liver that was spilling bile out onto her belly.

This lady had been attacked by a crazy man wielding a spear.  One wound went straight through her liver, from front to back.  She then walked for several days to get to Jill—who started IVs and paid $1500 for a plane to fly her to the surgeon.  The surgeon’s letter commented that her husband had donated a unit of blood, and, thanks to the grace of God, she was being discharged.

Yesterday presented us with a dental challenge.  A man who smelled of alcohol walked in with a bloody gap where his 3 upper front teeth belonged.  A drunken soldier had hit him in the mouth, for no good reason.  We washed the teeth, debated how much of the tobacco stain we should try to scrub off, and reinserted them so that they looked pretty good.

One of those coming-of-age customs here is that many males have their lower incisors knocked out (by people who love them!) when they are around age 7.  That makes their upper incisors flare out over their lower lips, which is considered attractive.  When my son Woody had his upper incisors knocked in by a baseball years ago, the dentist used “fishing line braces” to hold them in place.  Inspiration!  We had just imported fishing line to give the staff for Christmas.  My efforts to weave it around the 3 teeth and anchor it to his ears did not go well.  So I stuffed gauze where his lower teeth should be to keep the upper ones in place, and obtained his permission (through an interpreter) to give him IV fluids and tape his mouth shut.  When I turned around to get the IV pole, he pulled the whole works off.

Thank heavens for IV valium!  When he was nice and sleepy, we wrapped his jaw up like a mummy.  The next morning, a sadder but wiser man learned to drink through a piece of IV tubing, since straws are not available in Old Fangak.

As we finished dinner around 10 pm, a man walked up to our tukul, calmly asking for a stretcher.  Not an auspicious sign.  They had just arrived on the trader boat.  His wife was barely conscious, and had not been able to drink or talk for 2 days.  She had been seen in a clinic downriver, where they sold her medication for Kala azar and referred her to Old Fangak.

She had no pulse, and barely any blood pressure.  She needed blood.  Someone had apparently taken the hospital keys home after clinic—no blood typing supplies available.  Fortunately, one of the Alaska team that is working on our new hospital building was willing to share his O negative.  David hovered nearby, hatchet in hand, in case he needed to break down any doors that we did not have keys for.  Clinical officer Peter Sunduk got out of bed to translate and help the family understand what was going on.  After one bag of blood, we syringed super-sweet tea into the woman’s mouth, and then she was able to drink a bit.  The next day, her hemoglobin was still less than 4 (the lower limit of what our machine will report—about a third of what she should have).  At least half of her blood supply must have come from Jason. 

Another member of the resuscitation team was “Snake Bite Man” whose thumb we amputated a couple weeks ago.  He has become quite fond of hanging around the clinic, sometimes being useful.  Turned out he was the drunken soldier who had punched out the other man’s teeth.  He said this guy had taken milk from a child, and Snake Bite Man wanted to teach him a lesson. 

The World Health Organization now donates essentially all the meds for kalaazar treatment.  Since kalaazar is one of those diseases that mostly affects poor people in developing countries, it is not high on the list of pharmaceutical research priorities.  Clinics that receive donated meds can charge for administering them—but the health worker downriver had just sold the patient a bottle, without much in the way of instruction on what she should do with it—or even the syringes to inject it with.  She probably can’t read anyway.

She is still terrifically weak, but she should make it.   Her 2 month old son arrived with a bottle and formula-- the first kid I have seen with a baby bottle in South Sudan. 

The despicable medical treatment that our patient got downriver lets me appreciate once again what we are trying to achieve here: delivering the best health care we can manage in a place where so little goes according to plan.  Doing it ethically goes without saying—until you realize how many folks don’t worry about that.

Good night to you all,

15 December 2011

I just re-read my last letter, with the comment at the end that so little here goes according to plan (along with the comment that now sounds sanctimonious about despicable care from the guy who sells donated meds).  Jill greets me this morning with the news that, while I can get out of Old Fangak on a charter tomorrow as planned, I may end up spending a couple days in Juba before getting to Nairobi—thus missing the flight back to Australia tomorrow at midnight.  What will be, will be.  I guess.  We are researching options.

Two days ago, Jill put the water on to boil in the morning, and then disappeared.  She and Sunduk had heard that the troops stationed here were being moved out to a conflictive area a couple hours downriver.  Sunduk and Jill figured they had better remind the commander that, according to Geneva Conventions, sick and wounded soldiers are considered civilians; their medical needs take precedence over military priorities.  He readily agreed to leave the 3 who are in kalaazar treatment, as well as Snake Bite Man, who needs wound care and eventually a skin graft.

During inpatient rounds, a Big Man (literally as well as figuratively) was trying to borrow Jill ‘s satellite phone, so he could negotiate with the next level commander about troop movements.  Jill did a tactful job of explaining that, while she could phone to check our security situation, we are not really in the business of negotiating troop movements for other purposes.

A couple hours later, Snake Bite Man showed up to say goodbye-- ammo belt strapped over his orange T-shirt, wool beanie on his head.  The dressing on his half-thumb must have been freshly changed; it almost glowed.  A higher commander had decreed that all the troops would move.  They could be assessed in Phom for kalaazar (by the guy who sells donated meds) and shipped back to us if necessary.

So Jill fired off an e-mail to the World Health Organization, copied to RiekMachar, the vice president of Sudan, who visited our project in 2009, and understands the politics of health care.  When we opened e-mail the next morning, the WHO head had written to the UN, calling Old Fangak  “one of the busiest and largest kalaazar treatment centers in South Sudan, if not the region”.   Both the Ministry of Health and the UN Office of Humanitarian Affairs are hearing about this “violation of patient rights.”  Good to know someone is listening to the humble rural doctor.  In the meantime, we hope the soldier/patients haven’t passed out from marching in this heat.  Untreated kalaazar is usually fatal.

Sudan is nominally not at war.  The BBC had a story the other day about South Sudan (which only separated from Sudan 5 months ago) being on the verge of declaring war due to border conflicts.  North Sudan is dropping bombs on refugee camps.  Lots of tribal conflicts and cattle raids take place; it’s hard to know what is political and what is merely opportunistic.  We get security inquiries or updates several times a week, and always have a running bag in case we need to clear out quickly.  But most of the time, the dramas are just everyday things, like who has the right to which cow.

Speaking of cows—an interesting conversation when kalaazar admissions were slow the other night.  The nurse was talking about his 2 wives, and how many cows he had paid for each (FYI—the first was 28 cows and the second only 17.)  I told him that in my country, men are not allowed to have more than one wife at the same time.  He laughed, and asked, “WHY?”  I was hard pressed to answer.  Yeah, I know it’s against the law, but why?

Jill’s answer, from her college religion course, was that Jesus was an advocate for the poor, and thought that poor men should be able to enjoy family life too.

One of our nurses, a very nice guy, had to leave for a week to avoid divorce.  His dad had died of kalaazar, so a cousin or uncle or some relative paid cows when Tito got married.  Now that the relative has 2 wives and wants a third, he reckoned he could take back the cows and force Tito into divorce against his will.  Tito travelled to his village, where the chief decided in his favor.  He returned to work, with hugs and the Nuer equivalent of high-fives all around.

When we admit patients to TB treatment, they are required to stay for 8 months of observed therapy, in order to avoid multi-drug resistant TB.  That is a pretty big commitment, and the major reason that many NGOs figured TB was not treatable in Sudan during the civil war.  Our patient consent says that anyone who defaults before completing treatment will be fined one cow—probably a holdover from when the program started 11 years ago, before this area had a cash economy.  We debated telling the VP that his officers owed 4 cows, since they had forced patients to default, but decided that sounded too cheeky.

Yesterday was spring cleaning at the hospital.  Dust covers everything on a daily basis; rats and spiders also leave evidence of their visits.  A geologist from Alaska who is here digging wells hooked up his big hose so it would spray water from the river.  The patients moved out to the yard, and the staff went crazy.  When I arrived, one nurse was standing on a bed frame spraying walls and ceiling.  I thought how much my sons would have enjoyed the scene, and how I would have yelled at them (as I did at the nurses) to take care, while water gushed through the filthy window screens onto boxes of sterile-wrapped supplies. 

Good night, and thanks for reading my ramblings!


16 December 2012

After hours of negotiation that started a month ago, Jill secured a seat for me on a diverted charter from another organization, to leave this morning.  Yesterday they gave ETA of 0830.  This morning, when she called to confirm time and tell them that the dirt airstrip was landable (Spellcheck always wants to change that to “laudable”, but it really is LANDABLE—meaning adequate visibility, reasonably dry, and someone there to chase cows and goats off the runway), the company said, oh, didn’t the other NGO tell us that they couldn’t divert to pick me up after all? 

Jill remained polite.  We had gotten up at 6, taking advantage of the early-morning quiet to enter kalaazar data, which is a 2-person job.  We knew the  morning would be a 3-ring circus.  Then a woman disturbed our peace with the news that her friend was trying to have a baby and it was not coming.  An American ER doc and eye surgeon wanted a 10 minute tour of our hospital before taking a 1 year old to another village for cataract surgery, and Jill had begged them to see a couple more patients while they were there.  The UN was supposed to send in a plane to pick up surplus polio vaccine this week, but was not telling us when.  When I said goodbye to Tall Peter, the nurse in charge of the tuberculosis program who has worked with Jill for 15 years, he told me that we really need another full-time Kawaji (literally, white person) here, because when Jill is by herself, she sometimes gets crabby and expects them to work too hard.  Imagine!

20 Decemberv 2012

Events like cancelled charters happen for a reason; it could have been a sign that I was meant to be the second long-term Kawaji in Old Fangak.  But the American docs offered me a ride out on their charter, (stopping for bush cataract surgery on the way), I got the last seat on an overbooked flight to Nairobi, and made it home to my patient husband on Sunday morning as scheduled.  It’s kind of pleasant to be back in the land of hot showers and grocery stores.  But I miss Jill, and working in a place where small efforts make bigger differences.

Last night I was awakened by a raucous noise beside my bed.  I grabbed the offending object, could not figure out what to do with it, and threw it across the bedlike a hot potato. Turned out it was the hospital ringing my call phone. . .  In Sudan, the night watchman walks to Jill’s tent to tell her when she is needed.

My month in Sudan is over.   Good things must come to an end.

Jill and her Dutch friend Sjoukje, on the other hand, have been committed to this work since 1989.  That sort of longevity develops cultural wisdom, medical expertise, and the trust of the community.  It means progress can happen in spite of the daily hassles, and the larger tragedies of war and poverty.

This work is worth supporting.  If you feel moved to be part of it, or if you would like to honor friends by telling them that their holiday present has just saved a life (which may well be true!), please send contributions to

Crosscurrents International Institute (with “Sudan” noted on the check)
7122 Hardin-Wapak Rd
Sidney, OH 45365

Or online at Sudanmedicalrelief.org

Many thanks,






Website by Jeff van den Bosch