The Power of Uncertainty

In South Sudan, I’m still trying to get used to the emotional extremes. On a good day, the sunrises hold promise, the kids laugh a little brighter, and the air feels cooler. Some mornings, I have these moments of immense gratitude when I’m running through the bush and it hits me that I’m incredibly lucky to be where I am, doing the work I love, and living out my purpose. On a good day, I don’t even smell the rotting cow by the side of the road, mind the midnight drumming, or turn my nose up at the rice and beans I’ve been eating twice a day for over four months now… But on a bad day, the sunsets look sinister, the kids’ cries sound louder, and the sun beats down until I’m level with the ground. On those days, I wonder what I’m doing as a 32 year old woman living in a tent, far from friends and family, with a goat named Majak as my closest male companion. On a bad day, I get under my mosquito net at night and struggle to ignore the bites on my ankles, the pounding in my head, and the bugs chattering away in my belly.

The tricky thing is that sometimes I don’t even know whether it is a good day or a bad day until it is over.

I had one particularly extreme day like that at the end of June. I was heading out to a village called Pulawar to do a rapid protection assessment with another NGO and the local governmental authority. Pulawar was about 45 min by road from Mingkaman, followed by a harrowing 45 min drive through the bush. We had heard that the residents of the village had been attacked by anti-government forces in January and had been suffering ever since, but we weren’t sure exactly what we would find when we got there. Just when we were about to reach the village, I saw two men emerge from behind a clump of trees. I knew from their indigo robes, circular patch of hair on their heads and rubber anklets that they were from the cattle camp. They caught my attention because they were carrying a sack of something that was suspended from a stick between them. As we got closer, I noticed two little feet poking out out of the sack and realized they were carrying a child. That is when it hit me that it was going to be one of those days….

We stopped to ask them what was happening and learned that they were planning on carrying the child – a young girl – 20 km through the bush to the hospital in Mingkaman. They said she had gotten sick the day before and worsened through the night. The team expressed concern, but thought that we could continue to do our assessment and then bring her to the hospital a few hours later. No one seemed to be moving with urgency, so at first, it seemed like a reasonable course of action. However, as I took one look inside the sack at the little girl, I knew we were dealing with an emergency. Her eyes flipped back and forth between staring out blankly in front of her and lolling back in her head. Her lips were drawn back in a permanent grimace, almost like an animalistic snarl, and her hands were pulled up into little claws on her chest. Something really isn’t right here.

We drove another couple of minutes to the village so that we could talk to the community health worker. He said that the girl had had trouble breathing the day before, so he had given her a series of drugs and multi-vitamins by IV through the night. I scrambled to write the names of the medicines down phonetically so that I could tell the doctors at the hospital in Mingkaman. Oftentimes, patients are given completely the wrong drugs by untrained local health workers and it is difficult for the doctors to repair the damage later without knowing what is in their bloodstream…

I left my staff with the assessment team and decided to use our car to transport the girl and her family to Mingkaman – immediately. The parents, the little girl, and her baby sibling and brother piled into the back, along with a local who could help direct our route. He said he knew a shortcut to take and I agreed, thinking it would get us back as quickly as possible. Unfortunately, much to my dismay, after 45 minutes we were still in the bush. Turns out, our shortcut bypassed the main road entirely, meaning that we were on a harrowing trip straight through the bush – we had no reliable way of knowing exactly where we were going or how long it would take us to get there.  I tried to avoid slipping into full panic-mode by talking to the family through our driver, but his ability to understand English was limited. I learned that the little girl’s name was Mary just before she started quietly vomiting all over herself and her father, who was cradling her and trying to straighten our her claw-like arms. Our small chat stopped after that. The smell inside the car became unbearable in the heat, but we couldn’t roll down the windows because of the danger of branches, sticks and other sharp objects that were slapping against the side of the vehicle as we raced through the bush. I focused on breathing slowly through my mouth, but I could taste the smell of vomit in the air.It was the longest drive of my life. I gripped onto the handle above me inside the land cruiser and told the driver to speed up, but it was impossible. The brush reached above the hood of the car at time and we couldn’t even see what lay ahead. I had no way of stopping the questions from bouncing against the top of my skull and ringing in my ears. What if we get a flat? What if we get lost? What if – god forbid – she dies in this car?  I must have checked my watch a hundred times. Please, please, please, let us make it to Mingkaman. After an hour and 15 minutes, we emerged onto a dirt path. I quickly recognized it as one of my regular running routes next to the market.  Just a few minutes to go. We pulled up to the Medecins Sans Frontieres hospital (which was a tent in the bush) and I ran around to grab Mary from the back. Her father was moving slowly – was he sick too? – so he just passed her right into my outstretched arms without saying a word. She was covered in dried vomit and stiff as a board. Almost there, Mary. I carried her through the gate  and was immediately ushered into the emergency room (tent). She was extremely weak and barely conscious. What’s wrong with her? Is she going to be okay?  The doctors diligently started their work and informed me, apologetically but firmly, that they wouldn’t know anything until they conducted some tests. I knew that my presence there would not help anyone work any faster, so I stepped just outside the tent to sit with the family.  And to watch.

Within minutes, we had a diagnosis: cerebral malaria.

Cerebral malaria. The most severe neurological complication of malaria. It has a high mortality rate and some patients who survive suffer from long-term neuro-cognitive impairment. It’s something I’ve heard about, of course, and I knew it existed… but I’ve never actually seen it.  Is she going to make it? I naively expected the doctors to say something comforting (not just to me, but more importantly, to the parents). Instead, the informed us all that we just had to wait and see.  Sometimes it is just too late.

I told the family I would be back in a couple of hours and went back to my tent where I broke down in sobs. Actually, I started sobbing in the car (much to the bewilderment of my driver). I wished I could maintain more of a professional distance. I wished I wasn’t so affected by this little girl I had just met. I wished I hadn’t asked the doctors if she’d make it. I wished they could give me a better answer. I went back to visit Mary twice more that day, where she was hooked up to IV in the ICU (another tent). Her temperature was almost 39C and she wasn’t responding to the drugs yet. The doctors had given her an anti-convulsant, which was helping with the tremors, but no one was sure what would happen. Miraculously, by the morning, Mary’s temperature started to come down.  By the next day, she was sitting up and talking.  I could not believe it. She went from near-death to looking like a normal, happy kid within 48 hours. The doctors said had we not gone to Pulawar that day, Mary surely would have died while being carried by the cattle herders through the bush. Holy. Shit. 

It was a good day in the end – a really, really good day – but it very easily could have been the opposite. The difference between a little girl living and dying was a random encounter in the bush. The thought that we might have done the assessment to Pulawar on Friday instead of Thursday, that we could have gotten a flat tire or that the cattle herders might have taken a different path carrying Mary is just too horrible to bear. The unpredictability of South Sudan, like any country embroiled in conflict, is sometimes hard to take. The unanswerable, open-ended questions are endless. But instead of looking at the uncertainty of each day as a negative, I’m trying to view it as a positive. Uncertainty means that there is still space for hope. Uncertainty means that a bad day can become a good day. Uncertainty means that there is a reason to keep trying.

Perhaps a good lesson to learn in running too….But I’ll leave that one for another day. At the moment, I’m certain if I don’t get to bed then tomorrow will be a bad day!

Happy trails from South Sudan.