A/N - I can tell my brain isn't always in gear at the moment. I meant to say on the previous chapter's authors note that some of the descriptive to do with African countries is taken from the real experiences my Father had from over ten years working in Africa (mostly North Africa, but on occasion Uganda and Kenya).
As for MSF, some of the information is taken from their website, some from a friend who helped, although not in Africa, and as she said, her time wasn't under the same extreme conditions she knows happens there - and some is guess work, which I hope isn't too far from the truth. My apologies to MSF if it is. I think their work is absolutely incredible and vital. Finally - The information about the loss of two MSF members in Mogadishu, is true and they have had to pull out of Pibor County, Jonglei State, and had two out of three camps ransacked there. Truly desperate times.
Chapter five
Maura pulled out the band she had in her hair, dragging her fingers through to untangle it a little, before pulling her hair back into a new pony tail. She then sat down on the small fold out wooden chair, that was placed alongside a small folding table, obviously part of a set. Her task now that she had completed her rounds was to write out her report for the day so far, as dust swirled around, already falling on to the log book she had open. She blew on the page gently to dislodge what was there, before pulling out her favored ink pen, slowly unscrewing the cap off. The log book was part diary for Maura, part record for those on site. She used the notes here to write up more formal reports, separate to the already meticulous medical notes that were kept, when she needed to.
I have no idea whether this is being reported on the news yet, but we've just entered a particularly difficult time here. I knew this was the most volatile area when I arrived just a couple of weeks ago, but no-one imagined how it would grow as out of proportion as we're facing in such a short time. The camp is now operating well beyond its capacity and has been for a number of days, and the numbers just keep on increasing. Whereas there were ten of us, plus around one hundred and fifty locally drafted workers for around twenty thousand, of which around three thousand were children, and a couple of thousand elderly, we are now looking at ten times that number, but with the same number of staff. We have the emergency team set up as recommended when dealing with situations like this, and I cannot praise them enough. Without the work they have done, the chaos would be unworkable.
Maura paused to take a small sip of water out of a bottle that was on the table, as she peered through the flaps of her tent, watching as people walked around, dust being kicked up with every step they took. The sounds of people talking, shouting, pots clanging around cooking fires and children crying was the background noise that rarely changed, even at night. Maura tapped the page again with the end of her pen, tipping it at the slightest of angles, to make sure it was as clear of fine particles of grit as possible before she set about writing again.
Sometimes it is frustrating when we are having to work with minimal water supplies, spaghetti every day made from local wheat, with dust particles as much a part of their makeup as the flour, and working flat out seven days a week. However, I know I will be returning to a place where water usage isn't a problem, where shelter is a solid home around me. Where I will have no oppressive heat, or dust that invades everything you do. Let alone no threat of rape, torture or bullets. It's those reminders that keep me, and I know, the others going. I will admit though, these are by far the toughest conditions I've faced and I know, those like me who have experience with MSF, have said the same.
The majority of our population are women and children, and our biggest problem, other than overcrowding, has been to get women to be admitted in to our hospital as an inpatient. It's become clear that when they have a number of children and/or elderly relatives that they are solely responsible for, their distress and refusal make sense. When they share the high energy food we give to those most severely malnourished, because otherwise their children would go hungry, you have to cede to their wishes. Because this is a problem we are facing more and more, we've decided to set up a more informal area in the camp, whereby we hope it will encourage the women to remain with us in treatment, but with facilities for the children to stay with them. It hasn't been easy, because it takes up valuable room in an already packed arena, but we felt the benefit far outweighed the problems caused. So far, although it's only been running a few days, it's been a huge success.
Food supply is now becoming an urgent issue because of the sheer number of people who have descended upon us. We can only supply limited amounts, none enough to fully feed the people here, and I know a request has been placed for this to be addressed as soon as possible. I can only hope we don't have to wait much longer.
Maura stopped again as someone poked their head around the entrance way.
"Sorry Maur... But we need you." Alice, another American from New York, and the head nurse working immediately under Maura looked and sounded apologetic, and Maura simply gave her a tired but understanding smile.
"I'll be right there." Maura then carefully closed the book, having once again blown across the pages gently. Partly to help the ink dry, as well as to remove the ever present dust, before standing up, stiff already, but ignoring the burn in certain muscles. She picked up her bottle of water, stethoscope and small medical bag, before heading outside, where Alice was waiting for her and they began to walk towards the hospital building that was in the middle of the camp, as Alice explained the problems.
Maura walked into the small, crudely built building, and into the small intensive-care space which could only house three beds. It was as far removed from an intensive care unit you might find in most Western hospitals as you could imagine. From the main hallway there was also two separate wards, one for critical and severely-wounded patients, the other for less critical and walking wounded. All beds were full, and some gurneys with people lying on them were now also spilling out in to the corridor. Maura frowned as she pulled her stethoscope off her neck, hooking it in to her ears, and began to listen to the patient Alice was most concerned about. She made a mental note to discuss the overspill issue once she was done here. It looked as if they were going to have to set up tents to cater for the numbers and use gurneys as makeshift beds. Far from ideal, Maura knew, but preferable to the alternative, which was in effect nothing for these people.
Maura finished her examination of the child that they wanted her to check in on, and looked back at Alice, who had taken the time to check IV's and charts of the other two patients.
"We need to call in Michele Ledecq. Tell her I'll get the theatre ready and be her number two." Maura knew almost immediately this was beyond her scope, she needed Michele as the resident surgeon to come in and operate.
Alice nodded and disappeared from the room to use the radio to call in Michele who was currently just outside camp in the mobile unit they had. Maura walked out, and strode through the hospital to the small staff room at the far end, and opening the door was relieved to see Stefan, the young Austrian anesthetist who was on staff. He looked up from reading a book when the door opened and Maura saw his face change, as he knew she would only be there if she needed his services.
"We need to take Pal back in to surgery. I've called Michele in from the field. I think there is still an internal bleed that we've failed to get first time around." Maura explained, as she moved towards the kettle and quickly put it on before making herself a tea, knowing she had a little time before she would have to go to the operating theatre.
Stefan stood up and joined Maura in making his own tea, as they both then sat down on the hard unforgiving chairs. ""I hear this is your second time around for MSF." While Stefan had worked often with Maura in such a short space of time, this was the first occasion they had spent any time alone together, and this woman intrigued him.
Maura nodded, already noting the worn out features on the young mans face. He had been there for a couple of months and it was his first time volunteering, and Maura could tell it was already taking a toll on him. "I did some work with them before I went on to become the Chief Medical Examiner for Boston."
"I heard you did something like that. Seems like a big change, to come back to something like this? You either stay with MSF, or like me, and I think you as well, you join when you first qualify. Not many come back like this for a second time." Stefan said, his voice low.
Maura glanced across the rim of her mug at him, not sure how much information she was willing to give out. "Let's just say I had personal reasons to do this again."
That seemed enough to satisfy his curiosity and they finished their tea in silence, before heading out to prepare to operate.
Maura and Michele both instinctively ducked as they heard the gunfire coming from somewhere in camp.
"Keep going." Maura asked, even though it felt as if her heart was beating out her chest. She could see the fear she was feeling echoed across the eyes and faces of everyone in the operating room, even with masks on, hiding most of the face. It took all her concentration to not be transported back to Boston, and the shooting at the precinct, to the pavement, to Jane.
Doors could be heard banging, and shouting was coming from all directions. Michele bent down, determined to somehow keep her concentration, as Maura continued to assist. Alice stood at the foot of the operating table.
"Can I go and see what is happening?" Alice asked, her eyes meeting Maura's for a split second.
"Stefan, do you need Alice?" Maura's voice raised, partly in fear, partly so she could be heard above the ever increasing cacophony of sound. Hearing his 'No' being yelled back, Maura tipped her head up enough to see Alice already leaving the room.
"Michele, how much longer?" Maura asked, worried they were about to get caught up in something that was about to become dangerous to them all.
"Ten minutes, perhaps. If we're lucky." Michele's heavily French accented English as distinct as the woman herself. Tall, close to six foot, with striking piercing blue eyes, the likes of which Maura had never seen before unless the person was wearing colored contacts, which Michele definitely wasn't. She had long flowing blonde hair that would fall down to her waist, which was currently pulled up and hidden under a washed out pale green surgical hat.
Michele wasn't someone you forgot in a hurry, and was one of the best field surgeons Maura had witnessed, even surpassing Ian's skills. Her calm exterior was often matched by Maura's own, even if they both knew internally they were scared, making them a formidable pair when working together. Their working partnership had already become the stuff of legend within the ranks of workers on camp, and even further afield, unknown to either woman. That Maura could speak fluent French only helped cement their growing friendship, as well as the working relationship.
Maura knew that luck wasn't going to play a part, and if Michele said ten minutes, she would work as much as possible to pull it off. Dust suddenly began to drift down from the ceiling as something hit close to the building, exploding, causing even the usually mellow Michele to swear under her breath in French. "Merde!" her eyes shot up towards the ceiling, seeing how much dust was coming down, and trying to work out the risk to her patient.
"Shit indeed." Maura said, as she splayed her own body across the torso of Pal, trying to protect as much of him as she possibly could until they felt the air was clear enough to continue. While they were used to operating in very basic, sometimes less than ideal conditions, especially with the mobile units, the last thing they needed was for Pal to have some sort of post operative infection due to the explosion. Just as Maura moved back off Pal, and Michele started working on him again, a very flustered Alice came back in to the room, pulling on fresh latex gloves as she did.
"We're being ransacked and looted." Alice said without preamble. "Armed men, I'm not sure how many..." Alice stopped as another explosion rocked the building, and Maura, Michele and Stefan all breathed a sigh of relief that it didn't dislodge any more debris from the ceiling.
"Are we letting them take what they are after?" Maura asked, her voice still raised. The command that had been drilled in to every worker before being allowed out on the field was clear; if they found themselves under such circumstances, don't fight back and allow them to take whatever they need. Medical supplies could be replaced, lives counldn't.
"Yes. I made sure that the order to unlock medical supply cupboards was issued." Alice replied, before moving back in to position to help finish up, as Michele began to close the incision with quick, practiced movements. It wouldn't be her neatest work, but it would suffice.
"Good. What about..."
Maura didn't get a chance to finish as another explosion hit, only this time, a small section of the external wall bowed in towards them, and the roof timbers began creaking.
"We need to get out of here now." Michele said, as Stefan was already sorting out from his end, so they could get Pal on to the gurney and out of the room. Maura had moved and was pushing the gurney to set it alongside the operating table, while Alice and Michele prepared to move him, which they did in a practiced motion. Within seconds he was on the gurney and they were wheeling him out, as far away from the damaged area as possible. They got in to the corridor, only to be greeted by chaos, as people were rushing around, trying to help those who needed it, others who were mobile enough taking the decision to get the hell out of there as quickly as possible.
"Take him out to one of the Land Cruisers." Maura shouted. "Time we got out of here."
Michele, Alice and Stefan all nodded, as Maura broke away from the group, shouting orders to evacuate to all the staff she could find as quickly as possible, with the most critical patients to be stowed in the Toyota Land Cruisers that had been adapted for just such a scenario. She then ran, dodging panicking people, heading towards her tent, only stopping long enough to grab a small rucksack she kept for such possible situations, the log book and satellite phone so they could call back to Juba and appraise them.
Maura never thought she would ever have to abandon a camp like this, despite having been trained with full evacuation procedures on both times with MSF. Sure, she had to run a few times from villages or area's that didn't take kindly to western interference as they saw it, and had even been involved in a camp evacuation on her first MSF voluntary period; but this was the first time that she would be the person issuing the order to abandon the camp, and many of the people housed within it. She then flung herself to the floor, as gun fire once again erupted around the camp, and peered up enough to see dust and dirt being kicked up not too far from where she was, as bullets hit the floor. She crawled along, and finding a wall of one of the other smaller buildings in camp, stood up and using that to shield her, she made her way back to where the Land Cruisers were parked.
Maura had never been so relieved as she was the moment she broke cover from the building to find one of the Land Cruisers heading her way, Michele in the drivers seat, leaning over, and opening the passenger door, slowing down only enough so Maura could scramble in, throwing her rucksack and book in ahead of her. Maura then twisted around and pulled the door closed, before collapsing back in to the seat as Michele picked up speed, mindful of the scattering, frightened people around them.
"Exciting, yes?" Michele said, with a small smile on her face, as she began to accelerate, the way becoming clearer of people and obstacles.
Maura changed position and looked back, to see Alice tending to Pal. "How's he doing?" she then asked.
"All things considered, he's doing okay." Alice said, looking a lot less tense as they finally left the confines of the camp, as she adjusted the oxygen flow from the mobile tank they had. "He'll be coming around soon. Stefan was driving one of the other Cruisers with Subin in the back, and Jean Paul as the nurse."
Maura nodded and turned back to face the road. "Exciting is one way to describe today's events. It certainly wasn't what I had planned when I woke up yesterday morning. So, there are five of us accounted for, I'm assuming the others are in the two other Cruisers?" Maura finally answered Michele, whose beaming smile was enough for Maura to break out in one of her own, out of sheer relief that had got out unscathed.
"As far as we know, yes. Some of the local people were going to sort out the patients we've had to leave behind before making their own way out of camp. So, where to?" Michele then asked, unsure where they should go.
"Gumruk, the clinic there won't be up to taking patients except on a temporary basis, but unless they have also been attacked, it'll give us a chance to regroup and call in to Juba. They are the nearest as well." Maura picked up her rucksack that she had put down in the foot well, and pulled the phone out where she had stowed it seconds before leaving her tent. She was relieved it appeared undamaged so she carefully put it back inside the rucksack for use later.
"Sounds good." Michele agreed, as she shifted gear, avoiding a massive boulder that suddenly appeared out of the sand with the ease of someone used to driving in such challenging conditions. "We have diesel in the cans, so we can go a long way before having to stop. Also plenty of water. If we have to, we can go straight on to Juba."
Maura nodded, knowing each Toyota carried additional cans strapped on to various points outside the vehicle for additional fuel as well as plenty of water. Everyone knew if something happened, those were the two most important items they could possibly have on them. There was also a small tent available for them if needed. As well maintained as the vehicles were, breakdowns, punctures and similar problems were commonplace, and could potentially leave them stranded for a long time until help could reach them.
"You should sleep." Michele suddenly spoke, looking across to Maura briefly, concern showing. "I know you've been up all of the night as well as yesterday. Take this chance to recover. I did get sleep last night, so I can drive as long as possible."
"I'll try." Maura didn't want to tell Michele, that no matter how tired she was, she often found it difficult to sleep in a moving vehicle, but knew she could at least try to meditate and rest. She opened the rucksack, and pulled a sweater out from it's depths, which she then bunched up, and placing it between her head, the corner of the seat and window, she tried to settle down. She closed her eyes, and began one of her meditation routines.
Maura woke up, surprised to find she had fallen to sleep, and she moved, putting a hand out on to her neck, which felt like she had a crick in it. She closed her eyes briefly, as she rubbed to try and ease the tension there.
"Did you sleep well?"
Michele's voice was welcoming and soothing, and Maura moved so she was sitting upright in the seat properly, trying to get her bearings. "It was... needed. How long have I been asleep?" She then asked, noticing dusk was fast approaching. She also then noticed there was at least one other Cruiser in tandem with them, it's tail lights showing up a short distance ahead.
"A couple of hours." Michele replied. "Stefan caught up also."
"So I can see." Maura pointed out towards the windshield to show she'd spotted the lights. "We should be getting in to Gumruk soon then." Maura turned around to see Alice was sleeping, and Pal was awake, albeit obviously not fully with it. Sending a smile his way, which he saw, and smiled back, she looked across at Michele. "Status?"
Michele knew it was Maura's way of asking how Pal was, without alerting him to the fact knowing he could speak some broken English. "Good, stable. I told Alice to also catch up on sleep."
Maura settled back in her seat with a sigh. "God what a day!" earning a chuckle from Michele.
"Always one for the understatement, no?"
Maura chuckled as well, "I don't know quite how to describe today. I always hoped we would never face something like it, but at least we've got out without injury or seemingly loss of life."
"That much is true." Michele acknowledged, as both women reflected silently over the people that had been left behind, knowing that there was little they could do to change the situation, except potentially get hurt of killed themselves. It still upset them both though, even if neither was willing to show that for now.
"So, what do you plan to do once we get to Gumrak?"
"Call in to Jubar, and get a change of clothes if at all possible. I've been in these scrubs for two days and they are frankly rather rancid." Maura replied. "I guess we'll then be called back to Jubar once we've got patients settled. Always assuming of course that Gumrak is stable enough to leave them."
"Let us hope we can get back to Jubar with little trouble then." Michele said, her grip tightening on the steering wheel ever so slightly, the only outward sign of her worry and tension.
Maura wasn't looking forward to a drive to Juba that she knew would take around five hours over roads that were barely recognizable as being highways at all. While the distance to travel was only around two hundred miles, it felt a lot longer because of the poor road surfaces, or at the beginning, like now, no real road at all, but track ways that they had to follow. She sighed heavily, as she looked out of the window, watching the sun beginning to set. At least the sunset and sunrise's here were beautiful as the they went from vivid oranges, to deep reds and on occasion, purple within minutes, color swirling around an otherwise barren sandy landscape.