One Summit County doctor’s view from a foxhole in Sudan
June 11, 2014
As may become clear if you continue reading, I'm a doctor not a writer. However, just as I was compelled to return to a war zone in the Nuba Mountains of Sudan, I am compelled to write and tell the story of what is happening there.
I think of myself as a generally positive person and this is a very negative situation. The closest I can come to framing this in a positive way is that humankind has an amazing opportunity to learn how to end war. This is a relatively small place. The Nuba Mountains are roughly the size of my home state, Iowa. We, the 6 billion people on Earth who are not living on a dollar a day, can do this! World War II ended just 70 years ago and now most of the world lives in peace.
We must figure out a way to protect innocent people who just want the same things we all want — the freedom to pursue happiness. If the Khartoum government would stop aerial bombardment, the Nuba would return to their subsistence living and begin to develop their resources, which are many, and quickly become a self-sufficient partner in the world. It should be noted that the president of Sudan, Omar al-Bashir, is an indicted war criminal at the International Criminal Court (ICC) as a result of the genocidal activities of Sudan in Darfur. The world has a mandate to intervene.
I first heard of the Nuba Mountains in 2007 from a Nuba physician working with me at a refugee camp in Darfur in the west of Sudan. The government of Sudan continues to arm an Arab militia known as the Janjeweed, which means "men on animals with weapons." Somewhere on the order of a million black African farmers have been displaced to massive refugee camps and still live in fear of attack and famine.
The Nuba by nature are a joyful people. I have been fortunate enough to observe the rich culture of Nuba singing and dancing at every occasion. I also witnessed the heroic stoicism of patients smiling up from hospital beds despite missing limbs, lying for weeks in traction, having lost family members and all their possessions. Their spirit is strong and will eventually overcome the suffering that is being brought to them by an unjust government.
Restoring peace to this area will not be easy. The Nuba Mountains of Sudan area just north of the new boundary between South Sudan and Sudan where oil fuels both economies. It lies between the world's largest desert and the world's largest swamp, where rock outcroppings and slightly higher ground allow a sparse population to subsist on goats and sorghum. Most of the population live in stone and grass huts. Even before the current conflict, the rates of women's deaths during childbirth and of infant mortality were among the highest in the world. Malaria, leprosy and exotic diseases developed countries eradicated decades ago are as prevalent as the common cold.
Since May 2011, when the government in Khartoum launched a campaign "to exterminate the Nuba people like bugs," the civilian population has been subjected to daily aerial bombardment and has been denied access to humanitarian aid. Unable to plant crops, people are surviving on bugs and grass, risking death to venture outside their caves in search of food and water.
The one civilian hospital in the entire state had been spared bombardment until last month.
Journal Entry for May 2, 2014
Yesterday morning waiting to go to outreach clinic, Ingrid just told me, "No driver or car means no trip today"… I was walking between the hospital and the outpatient clinic when I heard the jet. I was unafraid and looked up curious how close it would come. Within seconds it was on top of us, people screaming, running, I remembered the instructions — "DO NOT RUN!" I dove to the ground and covered my head as a very loud explosion came from very close — wind, sand, dust from the area of TB/leprosy village. I looked up. People no longer screaming — or I just couldn't hear yet — but running in every direction — I saw the pharmacist run with purpose so I stared in her direction. Then she tripped and fell over a wire fence I'm sure she didn't see, then scrambled into an overfull foxhole. I turned my head the other direction and saw another volunteer, also moving with purpose, who happened to be the director of emergency response, so I sprinted behind her a couple 100 yards through the gate to the doctors' compound and into an empty foxhole 6-by-6-foot square, 3 feet deep. We waited … not long — 5-10 minutes and again LOUD jet, very fast and close, lie flat, cover head, seconds, moments later even louder explosion, near, but probably just beyond compound. Wait, wait, wait — 10 min. Out and back. That's it. Jet is done. Time to go to hospital to help with casualties. I could see Dr. Tom enter children's ward from the North… NOT OVER! No time, jet upon us, flat in fox hole body to body in a line women and children one mass of quivering humanity; moments later another explosion, again close by but not in our foxhole. No one moves, children are quieted, our collective hearts pounding, my head on the scarf of the woman behind me, my left elbow under the head of the woman in front of me, a custom-fit puzzle of necessity. We knew the jet would be circling back. A few rapid breaths and an eternity later, here it comes, VERY close, closer and louder than before. I would die in an instant if we were struck … or survive. There was nothing more to do. I accepted that reality and felt a great calm. The noise got louder then just faded away. I never heard that explosion if there was one.
The rest of yesterday was spent inspecting the damage and cleaning our rooms. The second missile struck 35 yards behind our small doctors' quarters. The ground was a thick solid mat of shredded leaves, the back fence destroyed, a crater 6 feet across and 1 foot deep, metal shards of shrapnel had the force to take off 8-inch limbs from trees. Lucky, LUCKILY! The only loss of life was one goat when the same jet attacked the next village. Not a single significant physical human injury. Psychologically, however, everyone to some degree or another is shaken. The rest of the day was quiet. Most patients left the hospital, unless paralyzed or in traction; they were out in the rocks and caves. The roof in our quarters is damaged. We cleaned Tom's room, which looked, well, like a bomb had gone off, his room has a back door which was blown in. I don't know or really want to know the physics of that. Over a warm Russian beer, over dinner, walking to and from the hospital, everyone was telling and retelling their own experience, cheering, encouraging each other that it would not come again… until today, 10 a.m. during rounds on men's ward we heard the low distant rumble of an Antonov high-altitude bomber. Tom said, "Too far away to worry right now." Then, quickly, when we could perceive and comprehend, no, in fact it's getting closer. "Move everyone out!" then, "No time! Just lie down!!!"
Flat on my belly, eyes clenched shut, hands clasped behind my head, ears covered by my upper arms — BOOM BOOM! Ground shook, dust flew, VERY loud, but ½ minute later, get up and look outside, debris still falling from across dry riverbed ½ mile away. I joined mostly old men and one nurse, Anna, who was crying and wanting to go home to her baby — we got into a proper foxhole knowing the plane would be circling back before she could make it home — I helped lower a patient into the foxhole who was on crutches already having lost a leg when an Antonov attacked his village. We kept our heads low to the ground. BOOM BOOM! The return pass again missed by ½ mile. We waited — it circled back two more passes — four more bombs — eight total. Only one casualty. A man who sought shelter inside a hollow baobab tree was struck in the foot by shrapnel that had penetrated the 6-inch outer trunk of the tree.
The second day, back to back, did leave psychological casualties. "Is this a pattern?" " Will they return every morning?" " Will they come at night?" There's enough work to focus on that these thoughts don't stick, but they do come back. I am surprisingly calm. I am not proud or ashamed of that, because I didn't do anything to be calm. I just am for now. Right now, actually, I'm just very sleepy — even that is all luck. I will enjoy a sound night's sleep and see what tomorrow brings.
I don't think of myself as a brave man for helping those in need, but I do feel bold in writing this story and hope those reading it will have the courage to tell others — a friend over coffee — sign a petition, or call their government representatives, or just be a little nicer whenever you see the chance.
There are still some small parts of the world that need really big changes. How exciting will it be to participate in that change? That joy is what will bring me back to the Nuba Mountains.
Again, I'm a doctor, not the president of the United States. Not many of us consider ourselves community organizers, political activists or having the power to change the outcome of situations as complex and generally awful as that in the Nuba Mountains.
But, if we do nothing, we can be absolutely sure we are not helping.
C. Louis "PJ" Perrinjaquet, MD, MPH, is president of High Country Health Care and practices family medicine in Breckenridge. He is also Medical Director of Doctors to the World, Honduras / Nepal / Cameroon / Haiti / Darfur and Nuba Mountains — The Sudan (not to be confused with Doctors of the World; our group is a small U.S.-based NGO). For information, search "Louis Perrinjaquet" on Facebook or contact him directly at firstname.lastname@example.org.
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