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Letters from Old Fangak, Southern SudanLetter # 10 Three slow admission sessions hinted the epidemic was decreasing; then two boats brought thirty new kala azar patients, a number of them quite ill. We worked late into the night. The weakest ones came with walking sticks or supported by a family member. The five-year old jaundiced child was admitted for IV treatment of Ambisone; he is really frail. He just had his second blood transfusion. Jill asked me to get blankets for the four sickest admissions, the ones who would stay overnight. But the in-patient worker said we needed six—the two snake-bitten men needed blankets too. Blankets are few and precious, so their distribution is a serious issue, it calls for high-level decision-making; hence Jill intervened. I wondered which data would be most compelling; both men looked entitled to me; but what do I know. Jill surveyed the scene and made a decision. The snake-bite man lying on the wire frame without a mattress gets a blanket; the other snake-bite man has the luxury of a mattress, so there is no blanket for him. Fortunately, he has a thin wrap. And he isn’t skinny like the kala azar patients. I wake wondering if snake-bite-man-with-the-mattress, but no blanket was cold last night. The temp was in the mid 60s—cold for people accustomed to 90s and 100s. I struggle to grasp the concept of a single blanket being a luxury item; but it is here. Rationing blankets is one issue; rationing food another; both are painful and complicated. Yesterday a mother requested more Plumpy Nut—a high-energy peanut butter product with vitamins and minerals added. Her moderately malnourished child received 35 packets two days before; no-way the child ate that many in two days! The family was traveling ‘home’, home where there may be food for the family. Their World Food Program rations ended when the child’s kala azar treatment ended two days ago. ‘Food insecurity’ as it is called, is widespread; many people just don’t have enough to thrive. Rats got into a couple packets of Plumpy Nut; I cut around their nibbles and give the rest to two of our skinny children. Rationing food is both a head and a heart ache. Maybe we should give enough food for the journey home; but can we do that? Will our supply run out? We check the bags remaining; many have rat damage—mostly holes through which the grain or beans escape. We add the good bags and the rat bags together—not enough. Last week the staff forgot that double drug therapy shortens the treatment course, which diminishes the food ‘entitlement’. They gave out ‘too much’; our supply dwindled even more. The Plumpy Nut child is now at 80% of standard nutrition so she isn’t ‘entitled’ to more Plumpy Nut, according to UNICEF guidelines; she gets a little extra anyway. And today the child with necrotizing fasciitis gets some Plumpy Nut to help her heal, and another packet went to the small crying child with relapsing kala azar, diagnosed by needling two lymph nodes in the groin. I’m happy for our donor-funded stash of Plumpy Nut that permits discrimination and avoids the distribution regulations and reporting hassles that come with the UNICEF supplied stash. Our Paromomycin may run out today. A supply sits in Malakal awaiting transport. It would be easier to get it if in were in Juba where an over flying plane might drop it off. Without the Paromomycin we are back to single drug therapy and 30+ days of treatment; a situation that will further affect our World Food Program rations. Every day it is something new, another wrinkle, another problem, or two, or three or a dozen to solve. Some are bigger and harder to solve than others. For instance, Jill’s hard drive crashed, taking all of her kala azar data, email addresses, contact information, photos, collection of forms and everything else digitally available and important. The computer would not boot, in spite of multiple attempts, local assistance, on-line trouble-shooting, and a middle of the night lengthy and expensive satellite phone call to the help center half-way across the world. Jill sends the dead hard drive to the US; but nothing is unrecoverable. Knowing my own failures to back up my computer, and what such a loss would mean to me, I state that I probably would have cried; Jill said that wouldn’t help. Maybe not; but still seems like a reasonable first action—cleans out the channels, makes room for the next step. Jill sighs and goes on. Jill and I talked about a new computer this summer, one with a longer battery life and more storage. I lobbied for a new one—a donation to the project. Jill, being the ever-frugal person she is, even with other people’s resources—wanted to squeeze another year out of this one; big mistake! My statement that computers outdate in three years met visible and voiced annoyance. “It’s the rapid development of technology; not a conspiracy”, I argue. She scowled, attributing short computer lives to planned obsolescence, a marketing ploy. Three years for a computer is probably even a stretch in this unforgiving climate and primitive conditions. I say this as I type in a mud hut with sky peeking through the grass thatching. My new laptop has a six-week dusting of Sudanese mudding, thatching, rat tracings and other deposits. So far, the mustard, oil, peanut butter and jelly have kept their distance, even though a rat knocked over the oil one day. I was happy the spill missed my computer. I placed the oil in a container; the rat knocked that over too; I add rat poison to the Nairobi shopping list but regret that I’ll be gone before the results occur. Maybe Jill will send a picture… Progress here is slow; but it happens often enough to keep one hopeful if not optimistic. The Alaska team’s barge with two containers of equipment and supplies finally arrived, two months late and absent the materials for the incinerator that is desperately needed for the hundreds of syringes we go through each day. The incinerator materials are in another container, one still stuck in Nairobi—who knows when that one will arrive. Of course, the arrival of the barge with two ocean transport containers was a very big deal, drawing the whole village out, not to help, but to watch. It was a great show, particularly the part of off-loading the containers and rolling them into the Alaska team’s compound. The military used their clout and guns to ‘recruit’ the helpers, few of whom understood when to push, pull or stop doing either. David said it was a good day, for no one died, lost a limb or even lost a finger. Life is good, indeed. With the new supplies, the Alaska team got to work putting up some metal poles and welding on tin roofing—the beginnings of racubas that will shelter some of the displaced people. Local volunteers brought big sticks to make walls for the racubas. A lot of mud is needed to ‘mud’ the four large structures. The traditional way of scooping it up from the riverbed makes for very slow work, so a few mud holes are planned; the Alaska team will pump river water to them. A new drill rig replaced the broken one. And Jill just gleefully announced that the new well—Gatmai’s well—is working; she drank from it; a little sandy, but it should be good by the end of the week! After two failed attempts in this ‘black cotton’ soil we breath a sign of relief. This soil sneers at well drillers, delights in collapsing walls in the last few feet of drilling, just when you think you are almost home. Friday I leave for Nairobi, then Sunday for Alaska. The contrast in temperatures will be just one of many extremes. Sand blows into my tent; a minor issue compared to the earlier infestation of fleas. It took days of tedious observation, annoying bites, and great patience to eradicate the mass of leaping black spots. Sand? Not a problem! The snakes, however, are a serious potential problem. A puff adder met its demise, under the policy of ‘kill it first’ and identify it later; but the six-foot cobra, spotted three times around our camp, managed to escape unscathed, in spite of our search-and-destroy mission. And the scorpion that I found inside the door of our ‘office’ tukel won’t bother anyone else, ever. This has been a semi-violent experience, if you add up all the dead fleas… On the other hand, we’ve banned the children with spears from our yard, a decision that the local dogs seemed to have grasped. The military gave the children spears so they could kill or torment the dogs—I’m not sure which; but I’ve heard lots of yelps and the population of canines is as robust as ever. I took a picture of ten of these lean animals lounging around Jill’s tukel. The sound of the camera clicking made them rise up growling and advancing toward me. Fortunately, a few sharp words sent them scattering; but I made a mental note never again to photograph a large group of stray dogs. Today a baby breathes more easily than yesterday, its heart rate slowed to normal after receiving a unit of ‘kuwaija’ blood. The mother was not a match for the baby; she agreed to the donation; but I wonder what the mother really thought about that… I watched the baby go from listless to active, now eagerly breast-feeding, as the iron-rich blood did its magic—what a joy to behold. A small quantity of blood, not even missed by the donor; but the difference between life and death for the baby; miracles actually happen in Old Fangak. With the holidays almost here, I think of the shopping excesses that often mark the season. I certainly have much more than I need; I want for nothing. For years we’ve worked on ‘unplugging the Christmas tree,’ diminishing gifts to each other, shifting the focus outwards. Having become a supporter and an unabashed beggar for Jill’s project, I heartily recommend donations to Sudan Medical Relief, and the practice of giving until it ‘feels good.’ May your holidays be filled with happy times with friends and family, and may your generosity bring you peace and joy. Blessings to all and gratitude from Old Fangak, ann CrossCurrents International Institute, a 501(c) 3 organization, generously volunteers their time to manage the donations and pay the bills for Sudan Medical Relief. All expats volunteer their time so 100% of donations go directly to saving lives by purchasing medicines, supplies, transporting them in, and paying a very small salary to the national staff. Checks should be made payable to CCII with SMR written on the lower line; then mailed to CCII at 7122 Hardin-Wapak Rd., Sidney, OH 45365. On-line contributions can be made at crosscurrentsinstitute.org. More information about SMR is available at sudanmedicalrelief.org as well as crosscurrentsinstitute.org. ann evans |
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