Series: 11-FEB-D-5

February 24, 2011

It is fairly far into the week of what we had hoped to be two sites of work in CAR as we left PiBor on Monday and it is already thursday as we have migrated slowly toward the CAR which has been our target for the patients with whom our CO-trainee Ambroise is waiting in Obo. I heard that a colleague was making the phone call to the UDPF command in Kampala which ordered us to be taken on the MER-8 Soviet era chopper to Obo as soon as it flies, which I now learn will be this afternoon. That still leaves unresolved the matter of the airplane, with Jon Hildebrant on the ground with the aircraft, which is both secure and also without fees since it is in a military base at Nzara, where the UDPF has now an even greater reason to cooperate with us, beyond Isaac Mwira’s personal inclination. If orders from HQ were not enough, we had also invited them to come to us at the Naivasha Hotel last night. I was not out and about when they did so, since I was struggling with the laptop that had caused the entire product of my evening to go poof, which was then re-done in its entirety if not a cheerful repetition. They took full advantage of the open bar we had invited them to so that the amounts of Bell’s lager comes up to almost the same as our hotel stay in several rooms. But, they will be picking us up in the same military pickup trucks later toward noon, for the same high speed rush down the wash board roads.

I wandered about before anyone got out of bed and saw the usual scene of African women bending over at more than 90 degrees from the waist, sweeping to the dust the compound with a short broom made of a bundle of twigs. I just thought that it most closely resembles the broom that is the ‘motorbike equivalent” for Harry Potter as the twin grandsons are riding it around the house in their “stupefying” contests they have absorbed from the Harry Potter DVD. As I watch them in their classic African boy form—e. g. our waitress Remy has the steatopygia and breast accumulations of body fat leaving the rest of her lean frame free of any insulating body fat so that they can tolerate the high temperature baking that occurs each day at this time in the tropical dry season. The people here are adapted to this environment. And in Yambio at 686 meters elevation, there is also a bit of relief despite the 4 degree North latitude making us as close to Equatorial as we can get in a state named West Equatoria. We will not have the advantage of that bit of altitude when we arrive in Obo where it will be beastly hot from the moment of our arrival at a lower altitude in the same Equatorial climate. There are big trees in an amazing variety around me including very big and impressive mangoes. The mangoes are seen to be in two halves, since this is a “monecious” tree—that is, both sexes are living “in the same house.” The female side of the tree may be in full flower as the male side of the tree is dormant, since they are out of phase so as not to self-fertilize. So the big trees are abundant in their species and varieties, but even the common mangoes are in different phases of their reproductive cycle, a perpetual harvest time of fruit bearing on the Equator.
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Filed under: News, Personal Reflections, Sudan by William on February 24, 2011
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Series: 11-FEB-D-4

February 23, 2011

No one would believe where we are and what we are doing just now; I am in a tent in the military camp as a guest of Commandante Stefano—a burly fellow who is the chief of the camp here set up to pursue the Number One Bad Guy in all Africa—Joseph Kony—hiding out in the tropical bush all around us here in which his scattered guerillas are allegedly on their way to Darfur to join the forces of the GOS—an unusual alliance for a fellow who is claiming to be Messianic. The large unique vehicle that just rolled up is a Military mule with a machine mount on the top. The solders have all saluted us as they went out to set up a large tent next to the airstrip. It is an unusual setting for a lunch offered by the Commandant, who offers us tinned Argentina Corned Beef and tins of dried biscuits with bottled water. As we are here “our chariot awaits!” The options for aircraft? A forty four year old Soviet era Antonov AN-2 (fourteen generations before the current AN-16) and maintained by the Ugandan Air Force and flown by Ukrainians and registered in Lithuania that gives its number “LY-12” for…Lithuania.

Our alternative aircraft may be a large Soviet MER-8 helicopter. It just rolled up in a cloud of dust. The third—and it appears to be least likely—is our own 5Y-PAP (A Kenya registry) Caravan owned by AIM Air which so far has not received the clearance to land in Zemio, the small glitch in a single letter that has kept us two days and nights on the ground in Werkok and now has had us waiting in Rumbeck for hours, and now all afternoon in a border town air strip further west than Jon Hildebrandt has been so he is in unfamiliar country also, as we edge out of the barren Saharan sands of the Nile River floodplain, we are edging on into the rainforest of the Central Africa—the terrain I know of CAR and DRC and The Sudanese border—the territory for which Commandant Stefano is responsible. He said to us he knew a “church woman” once in Zemio, he was not sure whether Catholic or Protestant, but her name was……I asked “Did she ride around on a motorbike?” Yes, Wendy Atkins! Oh, tell her from me that her friend Stefano is wishing her well!
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Filed under: Personal Reflections, Sudan by William on February 24, 2011
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Series: 11-FEB-D-3

February 23, 2011

We are still at Werkok. The plan is to take off and get closer to CAR and gather up the calls and permits the closer we get to the border, but awaiting the contacts that have been made with multiple sources to clear the logjam on this ridiculously small glitch.

Two major events happened on our departure plans as we waited: one was the final tutorial and the wrap up session at Werkok led in all the important points by the Sudanese. The second was the vitriolic post to the TR Blog of a poison pen note accusing TR of being a crazy Paramilitary group of the Christian Right which was messing around in an area in which it had no business since a very well established and big NGO had already set up for many years in that area and had those problems exclusively under its control. It was written by an MSF sympathizer who was obviously stung by the small and agile group coming in and rendering services for which there was a great need while a large and well-funded and supplied agony had done little detectable services for the Murle people in the assessment of those most closely able to judge that—the Murle health officers and representatives of the people themselves.

As an organization to “bear witness” the MSF had obviously been stung by our arrival at the request of the Murle community since they had great needs which were not being addressed. In the opinion of the District Commissioners, two paramount chiefs, seventy eight sub prefecture chiefs and the County Health officer Juono and most of all the Murle SALT community leader Bishop Oruzu had called upon me to help address unmet health needs, and even pledged to forgo violence and abstain from retaliation if they could get some hope of health care where none was apparent to them. These direct quotes from those closest on the ground may have been the greatest stinging rebuke to the complacency of the MSF which has the Murle and the matter of their health care under control, especially since they were evacuating all emergency cases to Juba or to Bor for management. This might even fly if it were not for the fact that I have seen the Bor facilities, and know that they are less well equipped than any other to handle the kinds of emergency surgical aid that MSF alleges to deliver by transfer of patients to them. Just how apparent this is to those in the community was made even more appetent late when the report from Dr. Ajak, and the Director of the Bor Hospital and the Governor whom he reported are very grateful for the arrival of our container and are coming in a body on Thursday to MCH to claim a donation since Bor Hospital has no sutures! This is the referral center to which MSF transfers all patients needing operation! And this is the only service they can render since MSF leadership declines to allow any operations inside its rather commodious facilities and denies the opportunity of its very eager personnel to come to our group for such training. They have discharged their responsibilities with a claim that they have a limited mission and serve the people here within strictly narrow limits, which have been invisible to the leaders of the Murle which I have just cited. Rather than get angry at the Murle for blowing their cover, they have sent an inflammatory post to TR as the small and agile group who has actually come in to deliver services and also bear witness that this “emperor has no clothes.” (more…)

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Filed under: News, Personal Reflections, Sudan by William on February 24, 2011
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Series: 11-FEB-D-2

FEBRUARY 22, 2011

Good morning from the familiar and comfortable setting of MCH in Werkok! We slept out in the open in our bug tents, after going to the local Werkok pond, where the “Jesus Film” was shown. This is a two hour film on DVD that had been dubbed into lip synch in one thousand of the world’s seven thousand languages. This one was in Dinka of the Bor variety, and there are several other Dinka dialects in which the movie has been dubbed as well. I took a couple of pictures of the crowd watching the film, based in the book of Luke with direct “” from the Scriptures. The movie stopped with pixelated break up periodically, but no one left as they all watched patiently as they made an effort to go through the story again from the front and fast forwarded to the point of breakup.

We may have a bit more leisure than we would like for a slow morning start. The sat phone to CAR tells us the several people, including the British High Commissioner in the capital of Bangui are all working on our permit to land directly in Zemio, but the capital is two more time zones west and another number that counts is three thousand dollars more for our trip. It is going to be prohibitively expensive and time consuming to have to fly to Bangui to reverse to Zemio, which is what everyone else must do. Because of Wendy Atkins continued efforts, AIM Air is the one and only group to have permission to fly directly into Zemio, but that permit is good for only six months and needs renewing each six month interval. IT turns out that this was just a week ago, and now it is found out that the permit states what the CAR president has decreed—all incoming flights must come through the capital, and this “oversight” is the problem. So we have sent out a message which will have to go all the way to the CAR president this morning, and they are two hours later than we are. Conceivably, we could take off and start moving westward toward the Bangui capital, but divert to Zemio if the permission comes through. But, this would set a precedent for further AIM Air flights in which in the future all will be told—“See? You came through the capital as everyone else must! So from now on everyone will do just what everyone is required to do in the first instance!”
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Filed under: News, Personal Reflections, Sudan by William on February 22, 2011
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Series: 11-FEB-C-6

FEBRUARY 21, 2011

Each night as I have been in my small sleeping net and listening to the sounds of the central African night around me, usually the flutter of bats, the occasional howl of yipping jackals, or the chirp of unknown bugs or birds outside, I had heard the unmistakable keening wail of women and their ululating cries—another discovery of a death in the night, often children. There are a lot of children here, even though the chief complaint of many of the women we see each day in the clinic is that they have been pregnant several times, and after the birth of a living child who died at age six months, they have not been able to get a live child, and they have fallen in esteem and social position as much as if they were barren. In church yesterday, we saw the overflowing right side of the church with the colorful women in their gowns, and loads of kids in the center and right sections, but few men up against the wall on the left side. The scarcity of men does not indicate their less religious status but their loss in perpetual war over the last several decades. The “lower intensity wars” of the rivalry between clans has been the largest loss of men and boys, from the cattle raids and the child stealings to make up for the complaints we have seen all day every day from the women.

THE STORY OF THE CHRISTIAN TRADITIONS OF MEDICINE AND THE MURLE AND THE WONDERFUL DOCTOR WHO STARTED IT ALL SIXTY YEARS AGO

After I had tried to use the time I was on post-op recovery room duty yesterday afternoon to spellcheck the chapters I had sent out yesterday through the BGAN, I took a walk through the acacia gum trees to see if I could learn more of the Murle area which we have come to recognize as one of the more destitute spots we encounter, completely marginalized by the war and tribal hostilities and imprisoned in the cattle culture dead end for fertility and tribal survival. It is also one of the more heavily Christian areas since the evangelization sixty years ago of a physician, Dr. Albert Graham Roode from Pennsylvania who settled at PiBor and developed a home and Hospital. He was beloved of the Murle people and they gave him a new Murle name, Lakunga—the grey color of the crocodile in the river Lilly in front of the great house he built, and also the name of his big bull of the same color. So the hospital he built is called the Lakunga Hospital, and it functioned from 1952 through 1964 when it was looted and destroyed following the Missionary Edict by the Khartoum GOS Government, which in 1964 expelled all missionaries in an attempt to found an Islamic state of Sudan. Thus were sewn some of the seeds of the long conflict I found represented on the ground at my feet today in twenty millimeter cannon cartridges from the ire directed at these people in thatched tukuls from Antonovs supplied by the Russians in equipping the GOS with Air Power—against peasant pastoralists armed with sticks.
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Filed under: Personal Reflections, Sudan by William on February 21, 2011
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After a hard day of clinic work, Josh Webster was overcome by malaise and fluid loss.  Firefighter/Paramedic Zach Smith inserted IV, administered course of antibiotics, and an oral rehydration solution.

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Filed under: Photos, Sudan by Brittany on February 21, 2011
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The Pibor clinic pharmacy window.

Josh Webster checks a young girl’s lungs for pneumonia.

Dr. G and Josh Webster assessing a young boy’s gate.

A female malaria patient resting in the shade of a tukul (hut).

Fourteen year old typhoid patient being held by her mother.

Zach Smith saying good bye to his friends in Pibor.

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Filed under: Photos, Sudan by Brittany on February 21, 2011
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There was some tension in the air on Thursday in Werkok as we discussed our plans to go to Pibor the next day.  South Sudan is made up of tribal networks, the big ones being Dinka, Murle, and Nuer.  These tribes are traditionally at odds with one another over resources, namely cattle.  Dr. Ajak, and Werkok hospital administrator Jacob Gai are Dinka, and they take a big risk by going directly to the heart of Murle territory.

We all nervously flew to Pibor on Friday morning, along with Jacob and Ajak.  While the Team Rubicon members knew we were taking a risk, we also understood the ultimate risk was taken by Ajak and Jacob.  Upon landing in Pibor, we were greeted by government soldiers, checking to make sure we weren’t arms dealers, and by reverend Oruzu.  Reverend Oruzu is a community leader in Pibor with a lot of clout.  We piled into the back of his pickup and drove to his compound.

We quickly stashed our bags in a tukul, and drove a short ride to the the government clinic that serves the people of Pibor.  As we turned the corner on the dirt roads delineated by corrugated tin sided shops, we saw the crowd of patients.  Hundreds of them.  The team quickly got to work.  We set up four stations and started seeing patients right away.  American and Dinka doctors working side by side to treat Murle.  It was a great show of force, and a powerful image to the Murle, who were excited and appreciative to receive care from their rival Dinka.  The walls of animosity crumbled.

During our time in clinic we found some patients that required surgery, a man with an inguinal hernia, and an elderly woman with an enormous ventral hernia…basically a knobby mound of intestines hanging out of her mid-line gut held in place by nothing but skin.  Now, the government clinic is a small three room bat infested shanty.  For our clinic  sessions, we opted to see patients outside under a tree.  But now we thought, where to operate?  We ran by the MSF compound, impressive buildings with electricity and clean water, but they deferred our request to someone else higher up to eventually refuse.

So…we took our patients back to our bunks at Rev Oruzu’s compound.  Now, this compound is less than ideal for day to day living much less an operative suite.  Every night as we filter our water, we watch the cage match ensue between swarming scorpions, tarantulas, snakes, roosters, bats, mosquitoes and of course their human prey…us.  However, we’re resourceful and we brought a lot of medicines and supplies with us.  We cleaned out our sleeping quarters, set up an old wooden table as an operating table, organized a sterilization corner and an anesthesia table, and hung our fold out medical bags with all our medicines and supplies on the wall.    We brought our surgical patients from town in the pick up truck, did pre-op evals including IVs and pre-op antibiotic administration outside under a big neme tree in our compound, and performed successful and curative surgeries in our revamped operative suite.   As I write this now, our patients are resting comfortably in our sleeping quarters, without hernias anymore.  We are able to keep a close eye on them tonight, as they are sleeping right next to us.  “Grand-Mamma…is that you?  Do you need more pain meds?  Need assistance getting to the bathroom, let me help you.”  Really the ultimate in concierge care, sleeping next to your surgeon, anesthesiologist and entire operative team.

Finally, I have to talk about the weather last night.  I remembered from my trip to Old Fangak South Sudan in 2005 that it can get hot, but last night was ridiculous. The sun went down, and the intermittent slight breeze that had existed up to that point stopped.  Zach, Brittany and I stayed up late as it was impossible to sleep…just too hot.  We passed the evening time stomping scorpions, joking about how tired we were but couldn’t sleep, and Brittany prayed for a breeze. Well Brittany, God was listening…about 2AM out of nowhere the wind whipped through with the sound and force of a freight train.  Sand, dust, bugs, trash , chickens, etc… flying everywhere.   Thunder and lightning in the dry season?   There it was.  Then the rain, leaking through our tin roofs.  It was quite comical as we blamed Brittany for bringing on such a destructive force through prayer.  And when the storm passed, it was hotter still…

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Filed under: News, Personal Reflections, Photos, Sudan by Brittany on February 21, 2011
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While conducting the daily clinic at the Pibor hospital, one of the team members came across a middle aged man with a hernia. The man had traveled seven hours to reach the clinic after hearing of Team Rubicon’s arrival. He was eager to have the team remove the hernia that was causing him a great deal of pain. Rubicon had done a few other hernia operations while in the Sudan and had the surgical supplies on hand. The operation was the first surgery ever to take place in the city.

The PiBor clinic is small and dark and not a good sterile environment for an operation. So, the only other option was to do the operation in TR’s sleeping quarters. With the beds pushed against the wall and our host Rev. Orozu’s kitchen table acting as an operating table, the team got to work sterilizing the area. The patient was given a spinal epidural by Josh Webster and the operation began with Dr. Ajak as lead and Zach Smith as assist. The operation was a success and, in order to monitor the patient’s progress, he spent the night with the team.

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Filed under: Photos, Sudan by Brittany on February 20, 2011
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Series: 11-FEB-C-5

FEBRUARY 20, 2011

We had another full day of outpatient in the “clinic under a tree” and concluded with an afternoon of our “OR in our sleeping quarters.” We had a start with the visit to the church, as we were dressed down to do our clinic duties in the hot sun. We came in to sit in the church at the back of the packed mud earthen church but they would not hear of that. We were invited in typical African fashion to the front of the church and sat at the platform next to the choir and the elders and the pastor at the fore. Overhead were what looked like leftover New Year’s Eve celebration party favors, including tinsel wreathes and a few glittering wall hangings. We sat near Pastor David who had come to visit me in Clinic yesterday getting treatment for his eyes. But today he was sporting a black suit and tie as the local Pastor. Since Rev Oruzu was the overall Bishop of the area, he was the one to do the introductions especially since he was the first Murle ever to visit America, and he pointed out that the whole area was Christian which started with the American missionaries on the station on the other side of the river. I had attended that beautiful site for a mission station, with the “hospital” in ruins and the old outpatient clinic being used as a small church for those people who cannot get across the river to PiBor during the rainy seasons. The magnificent mission home, is roofless, and has smoky fires of the cooking that many of the women had clustered around to do as we were walking through. It had looked like a warm and welcoming home high up on the bluff overlooking the Lily River, where Sandy Bixel was born. Her father was the doctor after whom the mission station is now named—in ruins. Sandy Bixel is the wife of the engineer who had asked me pointed questions about what I was doing in trying to take over PCC Sudan before he was convinced that I am not a big organization that funds me generously to claim other people’s effort s and that I was genuinely trying to help the people of this field and then get myself worked out of this job. Sandy Bixel and her husband are now members of the PCC Sudan board, and whose dearest wish is to see the hospital their father had built re-built. That was much of the theme of today’s session in church interrupted often by applause, as a potential pair of rival Dinka were there to say they were brothers trying to help them. I said that in heaven there would be no Murle and there would be no Dinka and there would be no Americans but we would all be brothers and sisters and we might try to get started in this here in this church right now. We pointed out that I had been here last year when the chiefs and commissioner pledged non-violence and as a condition of that they might have their health care redeveloped—and here was a pledge on that delivered through the leadership of Rev. Oruzu, and Ajak and Jacob who would see that the materials we had promised to redevelop their hospital were delivered along with the patients we said we would care for in Werkok in an exchange that would bring back to them the supplies that Ajak and Jacob here present would be guaranteeing for them.
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Filed under: News, Personal Reflections, Sudan by William on February 20, 2011
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