Notes from the field

David Kapla, January 2014

"Life goes on"

Old Fangak has a community that, as angry as they are over what is happening, wants peace in their town. Old Fangak has local people working very hard, in big and small ways, every day to achieve and maintain that goal. My sister, Dr. Jill, is working 19 hours a day treating a steady stream of wounded and displaced... coming from far places, some of them walking 3-7 days to get here, some coming on trader boats filled to the brim. They come here because they have family in the area, they come here because there is no fighting, they come here because of the clinic.

 

The clinic staff, approximately 50 local men and women, has been inspirational. Everyone here (everyone in South Sudan, on both sides of the conflict) has lost family, they have brothers trapped in the UN compound in Juba, mothers missing in the country. Sadness and depression has been the rule of the day, but despair is not an option. 

 

Life does, and will, go on. Malaria must be treated, and not allowed to take away someone too soon. Gunshot wounds must be cleaned. Destroyed fingers must be amputated. Solar panels must be washed to keep feeding power to the lights and lab equipment. And rather then running off to avenge the deaths of their brothers in Juba, the men of the clinic choose to stay in Old Fangak and continue working to heal the sick and bring real change to this suffering country.

 

And life indeed goes on.

 

This morning, two gorgeous babies were born in the clinic. One girl, one boy. There is a chance that they may go to school one day. There is a chance that they may live to see their 20th birthday. Dr.Jill, George Kam, Peter Sunduk, Michael and Jian and Gordon and Lam and the people in Old Fangak are hoping they get that chance… and working to make that chance happen.

 

My brother, Stephen Ayul Jak, is one of the finest human beings I have known. He could teach the Dalai Lama things about loving thy brother, and dedicating yourself to actually working to improve your brother's condition, not talking about it. Every day I have spent working with him over the last 5 years has, at some point, included joy, and included learning.

 

My brother is currently living in a UNICEF tent with his wife and children, across the Nile River from Malakal. He took his family and ran, fleeing in a canoe on Christmas Eve. As he told me that night on the phone, "Do not worry, my friend, I am strong, God is with me, I have done this before." Christmas Eve found me sitting on a balcony in Nairobi, staring powerless and impotent at the cell phone in my hand, as my friend set up a tent in the bush, and told his children they would be okay. I have faith in his destiny, and vast confidence in his abilities. These things, and the blackest of humor, keep my own despair at his situation at bay.

 

Yeesterday, a cease-fire was agreed to, hopefully tomorrow will find it signed and in place. And the day after that, or the next day, or the one after that… will find me helping my brother to move his family and begin re-building what was lost.

 

Until THAT day comes, what the hell am I doing in Old Fangak, when you're supposed to be done and traveling and vacationing you ask? 

 

The usual. Being a shoulder and chef and repairman for the Jill. Building shelters for the mass of patients and IDP's (Internally Displaced People, UN-speak for "refugees in your own country" ) that have flooded Fangak County. Repairing water wells (just fixed one here and one in the nearby village called Chotboro) so people don’t have to drink Bilharzia and Giardia-laden river water. Driving the boat to shuttle patients back and forth to the dirt air-strip for evac or return flights between us and the surgical clinic that Doctors without Borders operates in Leer, a 20 minute flight (or 3 day walk) away. Building incinerators to deal with the massive amount of medical waste an over-loaded clinic generates. Killing cobras... again... two the first day the Jill and I got back... caught a mating pair in a clinic storage building, they were as surprised as we were. None since then, thankfully. Helping the young men who work with A.S.M.P. continue working and training amidst this madness. This last one being probably the most important thing I've done over the last week.

 

Like every country at war, like every army in the world, the majority of it’s cannon-fodder is made up of 16-22 year old young men, and South Sudan is no different. Assisting ASMP apprentices to work on improving their community keeps them out of the line of fire, and alleviates the pressure their society is putting on them to grab a gun and join the battle. When people see them repairing a bore-hole or building a shelter, they will stop telling them that their duty is to fight.

 

Life goes on. Water wells are drilled. Babies are born. Houses are re-built. Friends return safely, or are mourned. Gardens and farms, producing fruit and vegetables that supply a market that has seen no outside re-supply for 40 days are tended. Kids are out laughing and playing under the full moon tonight, a certain sign of a peaceful village.

 

Do not worry for me, my friends. The Jill and I are not foolhardy, we are not blinded, we would not be here if it was not safe to be. If events occur to make us doubt that safety, we will be exiting long before any danger can reach us. We have both seen far worse days in Old Fangak than the current ones, and have no desire to repeat them.

 

At the moment I am sweaty, and tired, and smell like the guy you don't want to sit next to on the bus... and very, very happy to be utilizing my abilities to their full potential in a place that dearly needs and appreciates them. Be happy for me as well.

 

Now, I'm going to go take a shower.

 

Love and appreciate you all for enabling this life of mine, more than you can know."

 

 Elyze Wermel, December 2013

“Eye for eye”

This week brought death and continued life.  

One of the local little girls who had been suffering from measles and kala-azar took a turnfor the worse. Despite resuscitation efforts she passed away. (Thankyou to AMR for the IO needles.)  She had been in our care for severaldays on an outpatient basis. Her family did not recognize her worseningcondition in time. The preventable deaths are the most painful.

On the flip side, a very ill kala-azar patient who was in heartfailure drastically improved after two blood transfusions!

Engineering Ministries International (EMI) dropped in for a visit thisweek. They have partnered with Food for the Hungry to mitigate floodwaters in the area. It is always nice to have visitors!

On the second night of their stay, one of the team members came backfrom the latrine saying "I think there is a komodo dragon in thelatrine."  Whaat? He wasn't kidding! One of the monitor lizardshad fallen into the latrine and was clinging for his life with hisclaws barely hooked and the tip of his nose above the waste. I amsure, had his face and eyes been visible, sheer panic would have beenevident. Patrick (a team member from Kenya) took a long tree branchand gently placed it under the belly of the lizard. The lizard,immediately recognizing his salvation, clung to the branch as he waslifted out of the latrine. His exit into the swamp following theextrication was swift and smelly.

That doesn't happen every day!

Last week there was a conflict in a neighboring village that ended inone man suffering significant spear wounds. The victim had to beflown out for further surgery and treatment. (He is doing well in ahospital Malakal.)  Equal retribution (eye for eye, life for life) isthe standard repayment for wrongs done another.  Most of the villagehad no desire to see further injury and employed one of the elders ofthe village as a mediator promoting verbal conflict resolution versusviolence.  The wronged parties did not favor the suggestion and thusspeared the mediator. He arrived two days ago in the early hours ofthe morning with part of his large intestine outside his body.  Notonly had the abdominal wall been penetrated but the colon itself hadbeen pierced, thus preventing us from putting the colon back into thebody and suturing the wound shut.

EMI graciously agreed to take him to Malakal hospital on their way outof town. This saved us chartering a plane to fly him out!  Hereceived surgery that same day and is expected to fully recover.

We received the barge with most of our building supplies this week!Whenever a boat or plane arrives, it feels like Christmas!

A new volunteer doctor arrived as well.  The bulk of her experiencecomes from her work in Haiti.  She is rugged, tough, and loves toteach. I have learned to suture. I am learning much about ultrasound(her specialty).

"I will lie down and sleep in peace, for you alone, O Lord, make medwell in safety." Ps 4:8

 

Todd Hardesty, “Guandit,” December 2011

“Hunger is their shadow”

Today's the perfect day for a walkabout. Not too hot. Maybe 80 with a light breeze. I'm heading toward Nunamesh.  It's one of Old Fangak's neighborhoods, just up river from the town center. The path goes past the military encampment. To help create a sense of security, a permanent camp of soldiers are here.

They are allowed, and probably requested, to bring their wives and children. Their mud huts are a bit smaller than the locals. Of course they don't have cows and goats to take care of. At least not that many. Since arriving eight days ago, I have seen the men march through the village one time. Singing as they go. Like military men everywhere I suppose.

Leaving town the trail weaves along the edge of the marsh.  In another month this whole area will be dry and cracked.  But there's still a small pond which I have to skirt.  As I walk along I'm joined by a young man.  His English name is James.  I can't understand nor pronounce his Nuer name.  Although later Jill tells me his name means "rain."  Definitely born during the rainy season.

James is about six feet tall.  Thin like most here.  He's wearing a button down red and blue shirt.  Same design as you might find in Hawaii. On his feet yellow sandals. In broken English he tells me he is 18 years old.  He has a fourth grade education. Wants to be a doctor. James lives in Nunamesh and offers to take me to his home.

"My father died last year," James tells me. "Of kala-azar."  A year ago Old Fangak was in the midst of a kale-azar epidemic.  The clinic was caring for one thousand patients.  James' father did not get
treated in time. I can't detect any emotion in his voice. Just a fact.

James leads me to the Nunamash Presbyterian Church. I peak inside the church. Made of mud with a thatch roof supported by tree branches, the inside is cool. It's also where a bull is resting out of the mid-day sun.

Outside the church a group of children are playing in the shade of a tall tree.  When they see my video camera that all ask for their picture to be taken. "Sura, sura." An Arabic word for picture.  I ask James to tell them that I will take their picture if they sing a song. Two young men pick up their drums. The group forms a semi circle. The song begins. It is a song of South Sudan. They all know the words.  The five year olds and the teenagers alike. The melody feels like a cool breeze. It is comfortable. Welcoming.

James family homestead is a collection of four tukols. Three are for the family and the larger tukol for the cattle. His mother comes out to greet me. Since his father died, James' uncle has come to live with them. He is blind and walks with a cane.  Extending his hand he greets me as well.  "Malle."

The whole family gathers for me to film them. Brothers and sisters. Mom and uncle. Toddlers and young adults.  More than a dozen live here. I am panning across the family. This is very likely their first family "video portrait" ever.  Once done, I play back the footage and show it to them. They are animated and excited.  Pointing at their own image and laughing.  A dozen voices at once.  Grandma is in the back and she just smiles. Proud and knowing. Just taking it in as I am.  We exchange glances.

Before I leave though, they have all held my hand. We've laughed and played. James takes me past his sister's home.  Three of the younger children are hers. We're heading to the river.

As we continue our walk I ask James about the food shortage in Old Fangak. "We are hungry. There is very little food." He tells me they eat two times a day. Maize and  sometimes fish. They've long ago run out of sorghum. "I am always hungry," says James.

We're not talking. Just walking. I really can't remember a time when I've been starving.  Hungry because I didn't eat lunch or worked into the evening, of course.  But not the hunger that lingers here day in and day out.  Hunger is their shadow. Hunger is like the sun which is setting in an orange sky behind the reeds.  It will rise again tomorrow. Every day hungry.

 

Jason Hahn, December, 2011

 

“Blood, Sweat and Tears”

 

Day three in Old Fangak starts like the others: crawling out of the tent at sunrise, firing up some hot water on the Coleman for the French Press and some oatmeal, getting the backpack ready for they day, pouring a cup of coffee, pouring a second cup of coffee, taking a malarone, discussing the days plans, pouring a third cup of coffee, and venturing off to the "compound," our fenced yard of Connex containers, tools and Steven Ayul's sleeping quarters.

 

 

 

Steven, a Shilluk and ASMP's star employee in Old Fangak, has been running our water pump micro-loan program along with his welding, construction, and mechanical repair duties. Today we would take a half-hour ride down the river to check on the gardens of the farmers with our pumps including brothers Tai and Tayek, two of the first recipients of pumps from our program. A couple pumps are needing repair at the farms along the river, and we were going along to swap out or fix pumps and check out the status of the farms.

 

 

 

I find it amazing that the Nuer people live on the fertile banks of the Nile and do not have thriving agriculture. The reasons are many and beyond my comprehension, but revolve around the fact that they have been cattle people for thousands of years, have never been trained in agriculture, and lack technology to do so. However, Tai, Taiyek and the other farmers have poured their sweat and love- and some Nile water- into their farms over the last couple years and the results have been astonishing.

 

 

 

As the boat pulls up on banks of Taiyek's farm, we immediately see the remarkable results: rows of tall corn, trees budding huge bulbs of papaya, green tomatoes, ripe eggplant, short mango trees that will bear fruit in couple of years, big onions popping out of the ground, and even carrots.

 

 

 

While his garden flourishes, down the river the people in Old Fangak are still starving. A massive flood preceded by raiding has stripped them of there normal small rations of food. The markets are empty; patients can no longer make the long walks to Dr. Jill's clinic due to malnutrition and their need to forage for food; even Dr. Jill has little food to feed her patients.

 

 

 

The gardens are a spark of hope that need to be turned into a fire. We need to loan more pumps; the farmers need to learn better techniques; they need more seeds. Almost all of our farmers have already paid back their micro-loans and are interested in investing in new equipment like roto-tillers.

 

 

 

With two pumps on board, we take the boat back to Old Fangak, passing by villages of waving children, fishermen in dugout canoes, and the gorgeous marshland scenery dotted with fish eagles, herons, doves and the thousands of other species of birds searching for food along the Nile.

 

 

 

Once back in the compound, we set about repairing the pumps along with the other generators and drilling equipment we need to finish the new medical clinic, rehabilitate a water well, and begin to drill for more water. Rob is sweating over a pile of drilling tools, Denny is fixing a generator, Steven is welding beams for a new recuba dwelling, David is carrying concrete floorboards to the clinic. The days are filled with sweat, dust and a sun that relentlessly beats down. We down Nalgene bottle after Nalgene bottle of water. Progress can seem slow without all of the proper tools and a daytime sun that never lets up. We push ahead, always with good humor and the sense that we are privileged to be doing what we are doing.

 

 

 

As the sun goes down we head back to camp. I detour behind our camp hut to the outhouses and am suddenly greeted by a long black being that turns and raises his head to show his yellow hood. A cobra. I hightail it as he turns to do the same. I would later be chided from others in the camp that I did not get a stick to go back and kill it. The cobra will remain waiting in the marsh for a further encounter.

 

 

 

The nightly routine runs in reverse of the morning. As the temperatures cool we throw on a layer, rub on our bug dope, build a fire and assign someone to cook the nightly pot of grub, usually camp chef extraordinaire David, who can whip up a mean Italian dish with some pasta, canned tomatoes, fresh onions from the market, and a line of spices on the shelf that have accumulated over the years.

 

 

 

At every meal we are keenly aware of our full plates of food in a starving village. We do not flaunt it, we eat modestly and we deal with it in our own ways. We live among the people of Old Fangak, but in reality we live a world apart.

 

 

 

We wait for our food around the fire and the full moon casts a bright glow on the campsite and we barely need our headlamps. This night we have a "special" treat, a round of cans of cheap Filipino malt liquor called Red Horse from the market. It is our first adult beverage in the village and it goes right to our heads. 

 

 

 

We notice an eclipse beginning on the bright full moon. We get up to take photos as Jill walks by, noting: "Oh great, if it keeps going the villagers will get in a frenzy because they will think that the dragon is eating the moon."

 

 

 

After a few snapshots the dragon retreats and the moon is saved and Jill is walking back to camp from the clinic. At that minute an explosion and flash of light is heard nearby in the village. A bonfire suddenly lights up the buildings and the outline of Jill as she is rushing towards me. She is concerned- but not about the fire. She has a patient who has just arrived from another village and needs a blood donor- what type of blood do I have? As an O-, I am the universal donor and will gladly oblige. But first, the storage room with the blood bags is locked, the clinic director must have accidentally walked off with the keys, we need to find some screwdrivers to break the lock.

 

 

 

With a frantic calmness we search for screwdrivers as her patient lies in the clinic waiting. Jill says that she is anemic with a blood pressure of 60/30, her eyes are white, there is not enough blood in her for her to talk, stand or hear. She is clinging to life. I run to grab David to find screwdrivers. As we get ready to break a lock, someone finds a blood bag and I rush to the clinic.

 

 

 

Headlamps light the inside of the dark old colonial brick clinic building as Gretchen, a doctor from Australia who came to help Jill, greets me and sits me down. They are awaiting permission from the family. Locals often have superstitions about receiving blood from kuwajas-foreigners- but in this case the family knows how dire the situation is and solemn nods of the head are the all the approval that we need.

 

 

 

I tell Gretchen that there is some Red Horse in my blood. "At this point I don't think it will make much of a difference," she responds. The patient lies feet away from me on the bed, she must weight about 80 pounds. Nobody is quite sure what is wrong with her- a few family members and her 2-month old baby are the only ones in the clinic. As the headlamps of Jill, Gretchen, David and myself dart around the pitch black clinic I catch glances of the family. Nobody is shedding a tear. I have yet to see a tear in Old Fangak.

 

 

 

My blood drips slowly into the bag. Jill squeezes my arm a bit, trying to draw out every last drop. It is the patient's only hope at this point. I would later learn that she had undiagnosed kala-azar, and after the transfusion and with more treatment, she would probably pull through. Her name is Nyakuele.

 

 

 

As Gretchen pulled out the needle, it all hit me at once: the loss of blood, the adrenaline fading, the fatigue from the day, the dehydration, the Red Horse. I get dizzy and see stars as consciousness starts to fade, David and Gretchen lay me down on the bench to get the blood to my head. 

 

 

 

I look up at David; he hovers over me and with a smile says: "We are living, my friend." I instantly understand what he is saying... in so many ways.

 

David Kapla, 2010

“This truth breaks my heart.”

About a year ago, I began to work with the Alaska-Sudan Medical Project….and last November, traveled to the village of Old Fangak, to assist in the drilling of wells, and the construction of new medical clinic facilities.  I lived and worked in Old Fangak for 3 & ½ months, departing the Sudan in mid-February.

 

That is the text-book explanation, a dictionary definition of my activities over the winter season…. but life, surely, is no text-book… and even the OED has limits in it’s descriptive powers… as I know my own do….

 

It is difficult for me to write anything shiny or happy about Old Fangak, for the truth is that it is a brutal place… life in Africa is harsh… life in the Sudan is very, very harsh.…..

 

But if you’re reading this letter, you’re aware of the brutal truths and the bleakness…so in an attempt to avoid such maudlin indulgences, I’ll allow myself a text-book approach to recap some of the work done in Old Fangak, and hopefully, some story will come through….

The first team of ASMP volunteers, including myself, arrived in Old Fangak November 4th… the well was successfully completed, a new hand-pump installed, and the volume of clean water available to the people of Fangak was immediately tripled… the opening of the well also involved construction of fences and brush-clearing, finishing the concrete foundation pad, and spraying kids with a hose…

December was spent doing materials preparation for the new clinic building; and many, many equipment breakdowns and resurrections… December also brought the holiday season, the fervor that accompanies it, and it’s transformative effect on the village… a 25th like nowhere else on the planet, without doubt…

 

January brought the arrival of the second team of ASMP volunteers, and the construction of the new clinic building began in earnest… with the insane efforts of many hands, beams & frames were welded, walls were raised; the highlights of January were seeing a woman from Alabama and a young boy from the Sudan pulling together (literally, on a rope) to help place a frame section of the new clinic..

 

So… efforts were output, investments of time, money, and energy were made… and much was accomplished… yet there is so much more to be done… the need, and the stakes, are too high and the situation is too desperate… there is no greater return on investment relative to the effort than the work that can be done in the Sudan… when life is this harsh, this brutal, the simple problems….water and health… must be solved first, and as soon as one of those elements is improved in any way, the effect is immediate and geometric … people stop dying.

 

Why return?  ….because in December I saw an 8 year old Sudanese girl trying desperately to convince a woman who lay dying to accept a blood transfusion, and evolve beyond her racism and tribal fears of the modern medicine being evil, because she, the 8-yr old, received a transfusion 2 years before, and look at how strong she was….

 

Because in January I saw Nuer and Dinka and Shiluk tribesmen in Old Fangak working together to ensure the safety of patients and aid workers, while Dinka and Nuer killed each other in tribal fighting 50 miles away…because almost every single day I saw a kid die who really, really didn’t need to…

 

This truth breaks my heart.

 

And until those odds improve, there is work to be done.

 

Molly Bartel, 2009

“Immunization."

I loved the day we did immunizations.  Kristin, Summer and I traveled half an hour by boat up river to a neighboring village carrying basic childhood vaccines such as polio and hepatitis.  Stepping off onto the mud bank we saw a crowd of villagers starting to gather; trickling in from random paths cut out of the fields and brush.  The crowd grew and we started to hear children singing. 

 

Our translators led us into the crowd, saying we need to have church before starting the immunization clinic.  The village was holding a special service that day outside under the trees by the river for Palm Sunday.  The congregation was split, with the women and children on one side, and the men on the other.  We were seated on the male side as the priest made his way to the middle and began Mass.  Three Alaskan girls in a sea of Africans.  At one point in the service the village thanked us for coming and prayed over us. What I remember most from that service was the choir.  A group of children with green vests on, arms swinging, singing the most amazing music I have heard.  I remember Summer and Kristin and I just listening in awe, thinking about where we were, half way around the world.  Incredible. 

 

After church we spent the rest of the day immunizing the village.  Working with the our translators we checked in families, documented who received which vaccine, drew meds as fast as we could, and held countless little squirming, wiggling bodies. One of the biggest challenges was space.  The Nuer and Dinka don’t have the same concept of personal space as we do in America.  The crowd constantly collapsed on us, practically sitting in our laps all day regardless of how many lines we drew in the sand. 

 

The heat, the flies, the nervous faces on the kids, the fast pace of giving shots…left us all exhausted by the end of the day.  I remember the welcoming sound of the boat arriving at sunset to pick us up.  We eagerly piled in for the pleasant trip downriver to regroup with the rest of the team.  Definitely a day the three of us will never forget.”

 

 

 

 

 

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