"you always think it can't get worse, and it always gets worse"

a search for blood donors



milena doing blood typing


mohammed prepares the car for an emergency transport to el geneina


after the bed collapsed beneath us


and again, where to start, where to start....
the day started slowly, with all of us sitting silent and bleary-eyed at the breakfast table. the night before, the dogs of habillah- every single one of them- had held some sort of dog symphony and we were all awake much of the night. by early evening we were splayed across the livingroom, each of us with our individual ipods blaring with earphones shoved in our ears, each pretending that no one else in the room existed. someone heard the radio and carmenza took the call. when she came back into the livingroom we removed our earphones long enough to ask what was up. she said that it was the hospital and that 7 patients had just arrived from Gobe. we wondered aloud what sort of fiasco could have resulted in 7 casualties that had to be referred from Gobe, and the only thing we could think of was that it was soldiers who had been injured fighting. we all got up and decided to join carmenza, partially out of a desire to help, partially out of curiosity and partially out of pure boredom. as we pulled up to the hospital someone pointed out that there was a huge truck in the courtyard. we got out of the car and entered one of those situations that causes you to look around for the cameras because you think you've stumbled into a scene from a movie. it was pouring rain and, thus, there was no moonlight. our hospital has no electricity, so we arrived to find a huge crowd gathered around the truck trying to unload patients by the light produced by weak flashlights. i was holding a fairly powerful lantern so i stood in the middle of the crowd and held it up over my head à la statue of liberty so my team could determine what the hell was going on. the truck that had backed into our courtyard was a huge flatbed truck, and the back of it held 6 patients, soaking wet, shivering, wrapped in large, bloody bandages. carmenza and milena started to order the men to carry the stretchers to the small, dark hall between the dispensary and the dressing room to get the patients away from the curious crowd and out of the rain. we asked the staff to ask the people what had happened and to translate for us. they told us that the patients had been at a wedding in gobe when someone had unleashed a hail of bullets into a crowd of dancing women, killing a woman who was 8 months pregnant and wounding 6 others. there's no time to really think about that, it's time to make sense of the chaos. triage begins: vitals are taken, i.v. lines are started, tetanus vaccinations are given, patients are sedated, wounds are unwrapped and exposed. at one point i looked over and watched milena crouched in a small, dark corner, trying to start an i.v. line on a little girl who had been shot, with only the light of a fading lantern, and all i could think was "this is insanity". the wounds were unbelievable. one small hole where the bullets entered and complete and utter destruction where they left the body. kalashnikovs. two of the patients are seriously injured and we know we need an emergency transport to el geneina, but the roads have been closed to us after too many attacks on ngo's. a couple of days ago an ngo about 140km away was attacked and one of their staff was killed. you probably didn't hear about it because it was "only" a sudanese national staff member. after an extremely long night that involved far too much carnage, the patients were as stabilized as they were going to get. finally we went home to try to sleep for the few remaining hours until daylight, when we could transport the patients. i think i managed to sleep for a couple of hours, and then i heard my radio. i curse the world and get up for the delivery. the delivery took awhile and then, at the last minute, the baby went from 'head visible' to 'head out' in about 10 seconds. the 4.2kg sumo baby tore his mother, in spite of her having had 3 previous deliveries. after the delivery i went to examine the tear so i could determine whether or not hawa could suture it, or if i was going to have to break down and do it myself. i opened the wound and cursed the world again- the woman had torn through her anal sphincter. i radio carmenza as i'm not trained to suture tears that serious, and she comes to join me. with carmenza and i busy in the delivery room, and gustavo meeting with local security people to determine just how high the risk was to travel, milena was left to prepare the patients for transport. once my patient has been sutured, we join milena who is frantically taking blood types from the patients relatives in order to send a donor with each of them. in the craziness carmenza cuts her arm open on one of the doors and needs stitches. gustavo is about to leave with the patients and none of us are allowed to go as he is not willing to put any of us at risk. he is going to take the patients halfway, to mornei, and then one of our cars from el geneina will meet them there and take the patients the rest of the way. i take off my St Christopher necklace (patron saint of safe travel) from sarah gem and hand it to him. he thanks me and slips it into his pocket. carmenza needs someone to suture her arm- gustavo the doctor is leaving, milena puts her hands in the air and says "i'm a nurse", and i say "well, it's not exactly the tissue i'm used to suturing, but i can do it". we go into the dressing room and i am so tired i can barely keep my eyes open. i set up the sterile field and i'm about to start suturing and carmenza stops me, saying "maybe i'll just clean it before you start stitching". i had been about to suture her arm without first CLEANING the wound. suuuuuuuuuuch an idiot.
finally we head home for breakfast, then it's back to the hospital to see patients. my national doctor went on holidays two weeks ago, then decided to stay home for an extra month and a half, which means that i see her patients all day long, then i'm on call for deliveries every night. when gustavo heard that i had been called to a delivery shortly after getting home the night before, he remarked "i think they're trying to kill you". i reply "i think they're pretty close to succeeding". i get home for lunch and i find carmenza at the table eating, and i see milena on her bed in the livingroom, facing the wall. it looks like she's listening to her ipod, which we all employ as a polite way of saying "pretend i'm not here", but when i look closer i can see that she's sobbing. i go lay beside her and throw my arm over her. it's the first moment that i've seen anyone show any emotion over what the previous night had entailed. somehow in the moment we had all turned off. we dealt with the injuries, not really allowing ourselves to acknowledge that 4 of these patients were little girls, that somewhere in gobe there was a dead, pregnant woman who had left 4 children behind and that someone had shot them with a kalashnikov as they danced.
milena is still crying when suddenly she yelps "there's an ant in my ass!". she jumps up, whips off her pants and starts frantically searching for the offending agent as carmenza and i take pictures of her. now we're laughing. the moment passes and she sits down and starts to cry again. i pull her towards me and she lays her head in my lap. i motion for carmenza to sit on the other side of her and she comes from the table and sits down. and the bed collapses beneath us. she says "i told you i gained 2 kilos on vacation". now we're laughing again. we get up and decide to eat lunch. as we're eating they tell me that the car from el geneina hasn't made it to mornei, and no one can reach them by radio. the required contacts are every half an hour and they haven't been heard from in 2 hours. we spend the afternoon tensely waiting for news. i pray that they were just robbed but that they're ok. we talk about the night before and milena says "you always think it can't get worse, and it always gets worse". she starts to cry and carmenza tries to comfort her, saying "only a week left for you". milena says "and a lifetime left for them". carmenza tells her that she can't let herself think about it, she can't let herself think like that or it will be too hard. too late. now carmenza is in tears. me? i'm far too tired to cry.
finally there's news. our car from el geneina was stopped by 4 gunmen who shot warning shots into the air. the staff pull over and are ordered out of the car. one of our staff is an arab and he is confronted by the men. they ask him why he is helping the "hawagas" (white people), who only help the masalite and not the arabs and they accuse him of working for the UN. he tells them that he is working for msf because msf helps everyone, including the arab nomads. they tell him that he should join them and he politely declines. they say that they'll be taking his driver and car but he asks them to allow them to continue because there is a medical emergency. they beat our driver for not carrying enough money and demand to know what tribe he is from. apparently his tribe has no problems with the nomads, so they stop beating him. they cut the radio; tell the men that they will let them go this time, but that next time they will kill them and release them. the staff make it to mornei where it is decided that everyone will stay until the situation has been assessed. the little girl, our youngest victim at 10 years old, starts to crash and needs to get to el geneina for surgery or she likely won't make it through the night. the drivers decide to chance it, and they transport the patients back to el geneina on the same road where someone had just very seriously threatened their lives if they were found on that road again.

and that, my friends, is enough.