E-newsletter Issue 43 | March 2006
Letter Home: David Friend in South Sudan
New Zealand doctor David Friend recently left Australia bound for South Sudan on his fourth mission with Médecins Sans Frontières (MSF). In this Letter Home he shares his thoughts on what it’s like to arrive in Africa and reflects on the challenges that await him in the primary health care clinic MSF operates in the town of Akuem.
Lokichokio is a town in northern Kenya, created out of the bush, close to the Sudanese border, almost entirely to service various NGO's working in southern Sudan. There seems to be nothing for miles in any direction. On arrival, the thermals from the baking ground create a gut-swooping descent and landing – it’s good to be on terra firma. The Hercules is the main transport aircraft which does the food-drops for OLS (Operation Lifeline Sudan). But we soon realise all is not well as it is unclear how much reaches those who need it most.
The town is frequented by the wonderful-looking Turkana people – mostly nomadic pastoralists – dressed in reddish cloaks over one shoulder with many layers of brightly coloured beads around the neck. The men all carry a stick with a "business" end and a small wooden stool which they can either sit on or use as a neck rest whilst sleeping. Some carry a knife in a leather scabbard on the forearm. Their huts are hemispherical woven thatch and some small encampments can be found in town. They drive their herds of goats out of town to grazing areas and have cattle somewhere too. Cattle rustling is said to be rife and gunfire can often be heard in the hills at night.
It’s an odd sight to see the noble and timeless Turkana people going about life, surrounded by Landcruisers, satellite dishes and aircraft roaring overhead. Is one more representative of the real world than the other? Which of the two will prevail? As a degree of peace has been reached between northern and southern Sudan, relief work is being shifted to Juba, the capital of southern Sudan. Mentioned in Carre's book, The Constant Gardener, Lokichokio may soon return to the bush and dust from which it arose.
A further two hours flight brings you to Médecins sans Frontières’ hospital at Akuem. Paul, a pilot originally from Feilding in New Zealand, has flown small aircraft everywhere and does lots of charter flights for MSF, flying patients and staff in and out of remote spots. He informs me that he won’t be able to find his way by looking at the ground as it is flat and looks the same for hours on end. A reassuring set of GPS systems keep him and us on course. We soon learn that a low level pass over the runway is required to view the windsock, clear the area and, "anyway", as he says, "it's fun!"
We do a low level pass alright. A herd of goats scatter in all directions; bicycles and people head off at speed for the runway's edge. MSF's Landcruisers drive up close and staff immediately hammer iron rods into the ground stringing red tape between, as a hundred local folk of all ages crowd around to see who’s arriving. The doctor I am to replace is in tears and obviously distraught to be leaving. Before I’m even able to pass on greetings she and another nurse going on leave are bundled on board, leaving us standing in a cloud of dust.
After weeks of planning, it’s a joy to be here, even despite the realisation that this is the remotest place I have ever been. The team lives in a tented compound and we have a tent to ourselves. They’re a good size and I can easily stand up. A wooden slatted bed, folding chair and wooden shelf complete the furniture. No candles are allowed in the tents as one had almost caught alight. A somewhat fruity long drop (the kind with "starting blocks") and shower are 50m away. The tent is way too hot to be in during the day and any rest time is spent under any of several canvas shade areas.
The bare ground is like concrete with ruts and old footprints baked into it from the previous rainy season. A pair of rubber boots was kindly left by the previous occupant of my tent – an essential item, I am told, when the compound becomes a quagmire in several months time! The general recommendation is to keep the tent zipped up as snakes and scorpions have a tendency to come and visit, though I have not seen any yet.
The compound is surrounded by a woven thatch fence, with a ring of thorn branches laid outside that. The night sky is spectacular as are the sunsets and sunrises. At present, it is not light until 0700, so there’s no time for a morning run before work at 0730. On Sunday, I headed for a trot around the airstrip, much to the amusement of a group of women going to a nearby borehole, one of whom jogged along for a while, chortling with laughter.
Evening time, for exercise, I do a bit of cycling with Martin, the Malawian TB (tuberculosis) nurse and Charles, the Kenyan laboratory technician. The old black Chinese bicycles have long since lost their brakes, but this is no problem as there are no hills, no cars – nothing but soft sand. Local folk decorate their bicycles with great bunches of plastic flowers and sometimes several rear view mirrors. Sick patients are often brought to hospital on a bicycle. A full size wooden chair is attached to the carrier for the patient and if necessary someone goes alongside for support.
There are no roads as such to run along, only single lane dusty tracks, which the occasional WFP (World Food Program) lorry uses. Other lorries are bringing back returnees from northern Sudan. I have not seen any cars here and it has taken a week before I realise which side of the road vehicles drive on, as MSF has some left and right had drive Landcruisers and we rarely meet anything on the road!
Most of the materials get flown in as there isn’t much in the local markets. No good source of wood, no bricks and even getting sand and gravel is hard. It was a pretty hot area during the civil war and much of the population fled to other parts of the country. Many are coming back now which is good. There is very little infrastructure of any kind; the last rainy season was poor and harvests limited. It seems a most inhospitable place to eke out a living. But the peace in this area seems stable and I feel safe.
There is likely to be a food shortage during the year and as roads become impassable, MSF is getting the next year's food in place now. 20 lorries are arriving from Nairobi in coming weeks with the "Unimix" and other therapeutic food and tents. Even at this time of year, it took a week for the lorries to cross a nearby river. One got stuck halfway but was eventually retrieved. Medical life here gets very busy during this period with seasonal epidemics of malaria and malnutrition.
I am still very much getting to know the Dinka people. They are very African looking and not at all Arabic. The men are very tall, wiry and hardy and tower over me. They have obviously endured years of hardship and survived. Men can frequently be seen carrying a couple of spears. The women are also tall and have lots of "beauty scars" on their faces. Usually lines of scarring, curving over the eyebrows into the centre of the forehead and sometimes on the cheeks or radiating from the corners of the eyes. I am looking forward to learning a little Dinka. They seem a friendly people and I am happy to be here. The needs in every facet of life, not least of all health, are huge.