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Dr. Glenn Geelhoed’s journal from his last trip to South Sudan in January 2010 (part 2)

These two journal entries were posted because they uniquely describe Dr Geelhoed’s medical peace initiative and what’s at stake in South Sudan. We encourage you to read them in their entirety.

10-JAN-A-15

I AM STARTING OFF ALOFT, IN TYPING FROM THE AIM AIR CARAVAN WHICH IS CARRYING ME AND THE EMISSARIES OF A PEACE OVERTURE OUT OF WERKOK AND INTO PIBOR FOR A DISCUSSIONWITH THE MURLE ABOUT A MEDIATED PEACE ACCORD TO ENABLE OUR MEDICAL MISSION TO BRANCH OUT INTO THE OPPONENT CATTLE RAIDERS—WITH AJAK, DESPITE ALL THE OTHER ISSUES IN TURMOIL IN IS LIFE—IN EQUANIMITY AND GRACE UNDER PRESSURE AT THE “EDGE OF THE WEDGE” IN OUR NEGOTIATIONS TO STOP THE FRATRICIDE AND PURSUE BOTH MEDICAL MISSIONS AND PEACE; WE DEPART AT WERKOK BEFORE THE LONG, WEARISOME, AND EXPENSIVE FLIGHTS FROM WERKOK TO LOKI TO NAIROBI AND CHECK IN AT MAYFIELD FOR A PRE-DAWN DEPARTURE “ON SAFARI”

January 14, 2010

As hard as it may be to believe it may actually be happening, I am at 12,500 feet in the AIM Air caravan flying into enemy occupied territory for the purpose of offering a peace negotiation. I have already witnessed the rivalries of the clans and the friction between adjacent cattle culture tribes, so much alike that they are at each others’ throats constantly in bloody struggle for access to grazing, water, nubile young women, and fighting extinction of their tribal history by trying their best to extinguish individual enemies who are going for the same limited resources. Have I not had almost enough of that in close range witness to the negotiations on Ajak’s behalf?

I have had with me otherwise neutral observers—the film crew led by Michael Skinner, not a typical rabble rouser. I asked, “Is it any wonder that there are cattle wars here? We have just been engaged in a “friendly negotiation” over cattle and the obvious intent of the one group is to drive a superior win/lose bargain to the extinction of their opponent with “demands” that they told us as outsiders “You must meet.” I had recounted our first six days here with twelve casualties of the cattle traffic and rustling—eight of those are dead—under our direct observation. THIS is the LEADING CAUSE OF PREVENTABLE DEATH in my considered opinion as a practicing epidemiologist, and why should I work any harder to prevent deaths of lesser causes by mere germs, to get health survivors to impale or shoot each other in a direct application of all their best wiles in man’s inhumanity to man to further the worship at the cattle fetish?

And now, with a takeoff weight designed to get us off the ground in Werkok (there was a still persistent confusion from AIM Air last night which had insisted that they would return the plane to Werkok to drop off the returnees from PiBor but insisted that all the others of us should truck on down to Bor yet again to be picked up there, because of its longer runaway! This is because of a persistent confusion that we were adding people in Werkok and luggage as well which would make our second Werkok takeoff weight heavier than the brief excursion to PiBor.

In fact, I am the ONLY one landing in Werkok on this return except for Jim and Reini the pilots who will be leaving and the three of our film crew and David Bowman and Ajak and Jacob, our negotiating team and two others—Aaron Bogg and a friend Matt who just arrived and has never been in Africa wants a sightseeing flight. With the exception of Matt, we are all on board, and when we return we pick up the other six of our team so we will actually be LIGHTER going out of Werkok the second time —we drop off seven and pick up six, and I remain—plus, we will have burned off more fuel! This was impossible to get through translation so there was a still persistent order to pile everyone at Werkok into a vehicle to go to Bor with luggage, and only on the Werkok strip did I get the final worked out by toting up body weights s and luggage, all of which puts us well under the 700 kgs I had estimated since we came in with a twin at 100kgs and have jettisoned four hundred kgs in Werkok. The AIM Air 206 will return for the three film crew and Ajak to go to Old Fangak on 1.22 for his further extension out from here to Upper Nile. We will be departed by that time, the team all home telling their stories, and I starting all over again in The Philippines.

And now, we are on a glide slope into PiBor to find out God only knows as our reception among the brothers who have been killing the Dinka in turn for being killed by Dinka raids on the same worthless “attractive nuisance” of their brazen cattle.

PIBOR
AN INAUGURAL EXCURSIONINOT THE HEART OF MURLE COUNTRY
PIBO= 06* 48.19 N and 33* 08.48 E
BORT= 116 miles @ 249*
DARS= 1,031 155
DUKP= 121 292
HKKG- 5,450 22
HOME-6,906 312
KIGA- 1,082 155
KIL= 752 159
LOKI- 116 249
OFAN= 220 315
WERK= 107 252

ASSESSMENT OF THEIR PROBLEMS—A 75% INFERTILITY RATE!

The meeting in a tense time and across a lot of boundaries could not have gone better, largely because of the two factors of a needy people—the Murle are hurting and there is NO health care facility there, except for the bombed out and abandoned shell of a clinic in a very pleasant.ly situated location up high under neme trees on the River Bank—and a County Commissioner who did not first list a series of demands for hat we had to do for him and give over to them, but said that they were so eager for help that they were volunteering up front all the labor and all the materials that could be gotten locally (sand, rock wood, etc), and they were not asking us to give them anything except help and teaching with the support to get supplies that they could not provide. This is the right start. And there is no question that this is the community feeling as well—right down to including the volunteering of all labor, since they were working on THEIR hospital not ours. And they would bring a sheep or goat regularly to feed their people which were all volunteered by the chiefs. Each chief here, including the paramount chief, were representatives elected by their people so it was obvious that this should be the will of the people.

Our tour began colorfully enough. I gave an introductory speech at the side of the airplane after the landing on the somewhat rough strip of PiBor along a river that is a branch of the Nile that can get boat traffic all the way form Akobo on the Ethiopian border. We were met by the Rev who had met Dave Bowman at an evangelical mission conference in Louisville, Rev Lucero, who took us around the colorful riverbank souk where they were selling fuel by the half plastic bottles sitting in a row on the river bank in the hot sun.

Standing or sitting in drowsy torpor on the river bank are unloaded packstock that made me do a double take. These are NOT donkeys! The larger blonde and more horse like creatures I had instantly recognized as familiar to me from the Himalayas where they are in high altitude and desert environments and are skittish wild animals only a bit domesticated. These are ASSES! They look like the original ass from which almost all of the equine stock have been differentiated. The closest thing alive except those that are now bred as packstock is the Przbelski’s horse-said to be the persistent proto horse, the Ur Equus, also Asian. Many of the cattle that Bantu are killing each other over are also Asian particularly the drought resistant Zebu or “Brahma Bull.” The Bantu cattle culture tribes are those that came down the Nile, and are frequently linked in “Nilo-Kordufan Linguistic groups” but the Bantu tongues are mutually unintelligible. When we had gathered at the plane under the wing and I had turned to Jacob who translated for me to the crowd he spoke Arabic from my words in English.

Then as I turned it over to my “boss leader” Ajak, he ALSO spoke in English, rather than choosing Arabic, since he certainly did not want to talk to them in Dinka. He said he knew only one phrase in Murle, and he gave the greeting he had rehearsed which caused a bit of hooting. But on the other side of the river is the Murle Clinic built and staffed by Presbyterian Christians which was burned pillaged and the patients killed in their beds by cattle raiders set on a terroristic avenging of similar cattle raids. That these raiders were Dinka is not disputed by any side. There is nearly no atrocity worth disputing here since they are all probably true, and if not so will be by their very suggestion. We are standing in the epi-center of a civil war smoldering a long time which seems to have been fanned to flame coincident with my arrival here, in advance of the sample election after the census and in advance of next year’s plebiscite which is fixed in the terms of the CPA (Comprehensive Peace Agreement) six years ago Saturday. Even the outside world media are picking this up as was reported by the CNN headline that the South Sudan is poised again on the brink of all out civil war. It would not take a news analyst to discern this pattern from the crossfire where I have been standing and watching the exchange. The tall Murle who responded to our airstrip greeting looked at me and (seemed to relate directly to me as—if not the white man, at least the non-Dinka—even when I deferred to Ajak as the leader of our delegation who might be back unaccompanied by me on the next one and if all went well in continuing peace, then I would come to assist him as I had in Werkok as the model for our second order assistance to self help.

The women looked tall and stately with a good deal of facial ornamentation as well as jewelry and plastic beads inserted in their tattoos. The souk looked like Akobo or Timbuktu or any desert market on a river which had water only because it fell someplace far away. We would get acquainted with it directly, since we were threading our way through the river in order to cross to the ruins of the clinic. We forded it in a splash and fast forward to get cruising speed to make it across to eh scrub forest opposite side with thorn trees and what looked to be an orchard, with huge bird nests in the trees—possibly storks.

We had already washed our wheels—well near up to the windows, so I do not know how they get across in the wet season—as we passed through this almost orchard like flood plain of the River, which I now learn is named the “Nghama River.” As I was at it I got the right spelling of the Rev Orazu Lokine, who had facilitated our visit and arranged for the agreements of all the chiefs and commissioner to join with us. Hakim Hyandoya was the translator who had brought me around and showed me some patients as well as the relics of destroyed buildings as I admired their situation high on a river bank and under the neme trees. A rather pretty woman named “Alizabeth Abraham” of about twenty six years of age was crawling forward to us in a graceful side-seated gait. She had had polio and has about 65* contractures of her knees and hips having never walked or stood since the polio. She has muscle wasting and extended small feet. One thing she has going for her over most other Murle women–she has a husband and four children! This is in distinct contrast to the many barren women and disastrous marriages which end in one of three ways as described to me later. But the simple number to explain a lot of what has been going on is the number 75%. That stark number is the infertility rate among Murle women! She is beyond the age for tendon lengthening and does not have enough muscle form the lower motor neuron disease to make a trial of tendon transfer worthwhile. But she could have a hand cranked wheelchair cart supplied for free by a Holland based company that makes them, but her particulars are needed so that they are not just giving them out to someone whom wants spare parts. I took pictures and her name and talked with her husband and told her what it was that I hoped to do and see if I could get one as carryon luggage at next time and have Ajak be the one to make delivery on such a short trip (107 miles by air) to PiBor which is also accessible by that river..

The secretary of PCC Sudan at Grand Rapids is a woman named Sandy Bixler who is the daughter of the physician who had the clinic built here at PiBor and it was the place she grew up. The home is in a stately prime position, with a commanding bluff over the river, and a “ventilated veranda.” It looks like it is of stable good construction with women now gathered under the neme trees sitting by smoky fires in the shade all around the house. The clinic looks like all the worst news of Sudan: a stable well built tropical building, with ruins for walls but still standing and a superstructure of fixed steel still standing and not crushed. We had brought Aaron the builder with us and he said it could be used if fixed and patched. I told them I would be willing to conduct “theatre under a tree” if they could not get the inside cleaned to the point of a delivery suite and an OT space.

We saw the inpatient facility now used as a small ersatz church. The “Missionary Expulsion act of 1982 (?) had been the end of the support to the clinic and since then during the war the MSF had been here but has pulled out and left only a vestige of primary care. Rev Eruzu says there is no way that the government can bring peace, but only the church. They asked in the last (unfortunately rainy season) meeting in which five Dinka pastors came to Murle land and a second meeting in which five Murle pastors were coming to Dinka land “How is it we are the same color and worth, worship the same God and are sworn enemies? That is good that they are asking that question, and not just we at last night’s “wrap” audio recording of the conclusion of our Werkok as well as our entire African experience except for the transit out of Africa through Loki and Nairobi.

I thought that we were coming to an end when we forded the river on the reverse pass, spreading hammerkopf and sacred ibis. But it was the beginning of the “formal part” of our session in which the “Inshallah Time” predominated. We were going to the Headquarters of “SALT- Serving and Learning Together.” This organization was in Khartoum during the war, and has a couple of places in the south. They have three objectives: 1) Literacy programs, now up to 40%, 2)Adult Education, and 3) Agriculture training—desperately trying what our discussion was all about last night—converting a cattle culture of pastoralists into framers. The problem at present is that they have a high endemic PID rate and no treatment. In the Murle culture, a barren union is a non-natural one, and in the extreme if a man has no offspring to carry forward his name, he commits suicide. There is a crisis in the Murle population and the suicide is one of the problems, abandoning wives or husbands is anther (after all without medical testing the either side can accuse the other of being the problem) and child stealing is the next consequence/. So, in no small way, the cattle rustling that has left so many dead behind in Werkok is the direct outcome of PID and infertility.

Formerly if the Murle became ill, they were to travel to Bor for health care such as an operation. Because of the ill will of Dinka and Murle from cattle raids and deaths past counting, the mix in Bor was not good for the Murle. They were way off base far from Murle country when revenge was called for. Neither was it good to be in Murle land since Murle were killed in their clinic before it stood empty in ruins. Even if there were safety in being there, getting there is dicey since older people have an eight day walk compared to the young who do it not stop in four days, hiking all night. No acute injury survives to arrive where health care is.
They are not happy that they have no health care and want to attract a group like us to come to help them and as soon as the commissioner had gained a quorum of many people, he said to my own long applause: “We don’t want your fish; we want help with the nets and how to use them!” He promised all labor, building materials and supplying the system for the whole families.

It was an impressive gathering all under the lights and microphone boom of our documentary team. We saw every local chieftain filed in as well as the paramount chief and the County commissioner and several church leaders. It was a meeting without a “Gimme list.” I made introductions and then said we will show by results of what can be done when you are the ones who take the initiative. Dr. Ajak has been in Werkok only two years, and he now operates in a hospital which was a green field two years ago. Jacob is the hospital administrator and takes care of all the business of the MCH and he has arrived less than six months ago, and they have treated sixteen thousand patients and have done over six hundred operations in a self-sustainable system that will be run by and owned by the indigenous medial leadership.

The meeting was dignified and could not have gone better from my perspective suggesting to them that I was a very happy assistant to Dr. Ajak, and much the same kind of support that has founded MCH under the PCC-Sudan, through what Dave Bowman calls the miracles such as his finding me, even when he was told that we refused to come to Werkok after we were on the airstrip awaiting pick up and they decided immediately to come to Duk Payuel to meet me instead. We have made many tenuous connections that have forged good partnerships. This one may be built on such a model but few more important for what they might bring about since we predicated all of this on peace. They assured us that within their power to control anything they would come together with our help in peace, and restraining those by internal discipline (I will not even ask how) those who persist in killing their brothers.

I am now back in the air. I am leaving from Werkok after picking up my residual team after I alone except for the pilots stay with the plane. It has been an eventful day. I have said farewell to Ajak, Jacob and John on the airstrip and our clinical officers, John, Gabriel and Aret. We then all lined up under the Cessna Caravan wing for our last (and first!) group photo of all the pictures that have been taken in four 4 gig cards full. The film documentary team are now arrayed along the air strip to take the photos of us bumping along as we take wing in the AIM Air Caravan as they are toting up numbers in a large envelope named “GEELHOED” with pilots Jim and REINI who agreed to our much reduced estimate over the much higher body count they had been given by AIM Air scheduler, (they still have David Ludwig listed on the passenger list) especially now that we have jettisoned most of our baggage, three of our passengers, and two hours’ flying fuel load.. We are heading on and a half hours back to Lokichoggio for re-entry into Kenya our entrepot. We will have a regrouping time that will be brief as we gather at Nairobi two more hours away from the probable hour or two of on the ground Loki time and the formalities of our re-entry on multiple entry visas. They will then bill me for the AIM Air caravan traffic that I had been planning on all along with seven of us gone Werkok to Nairobi, and get a hot shower tonight in Mayfield for an early morning pickup for a game drive in Nairobi National Park as I sit on my onward luggage, since I will be dropped in Kenyatta for my round the world extension as they go back to Mayfield for lunch and then shopping at YaYa Shopping Center and the final packing up as they go back home.

It has been a very exhilarating trip that has been already described as a highly successful one by the outside observers as Dave Bowman already reports, and as those who count most have testified—the staff and patients at Werkok of MCH.

I will have a circumnavigation to think about these further details and ramifications of what we have continued in some sites, begun in others, and made plans for in still others. If I were a betting man, I would call any one of these long long shots, and here I am, again, riding high in the AIM Air Caravan on return with a very mixed team. The most junior member of our “pre-medical team” had written a brief journal entry yesterday and read it as her last word on the trip she had just shared as a full partner with the team she has got to know and trust in a very foreign environment in which she has felt so very comfortable and worthwhile. It may be a simpler expression of what I have tried to explain in a shorter version of the chapters herein, but it will be an original from a first timer, who is just now sitting in front of me in the “smallest airplane she has ever been on” in the grand total of three flying trips of her life—so this trip may have stretched her as much as any of us.