Dr P. J.’s Nuba Mountains Journal entries from October, 2011

C.Louis Perrinjaquet, MD, M
Reports from a Clinic in Kauda
Sudan Journal entries from October, 2011

…difficult to arrange flight from Juba into Nuba Mountains because Sudanese
Armed Forces (SAF) keep finding out about flights and bombing landing strip as
the plan tries to land…
Oct. 8. Mother of Mercy Hospital in Gidel… horrible “Antonov” wounds, at
least one child dies of malnutrition every day, osteomyelitis (chronic draining
infection of exposed bone)…
Oct. 12. Heard my 1st Antonov. Dr. Tom Catena pointed it out over sounds of
fans, anesthesia machine, oxygen concentrator & people talking. “You hear
that low rumbling sound?”  Then back to surgery…
Sister Mary Carmen from Mexico remembers going to meet an airplane [in Kauda
last summer] and running away from airstrip, diving to ground as bombs landed
behind her, three times running with another sister who was crying that she
couldn’t run, lying on the ground praying “God help us.” Still those memories
are so terrifying she trembles when she hears the Antonovs.
… many children dying of malaria because of lack of medicine because of “denial
of access of humanitarian aid” war tactic of the North Sudan.
Traction pin placed through young man’s tibia for femur fracture when Antonov
bomb blew off his left buttock. Eight of us worked to construct a 2-part
mattress to allow access to dress the wound. Now he has to lie on his back in
traction and the nurses have to get underneath him to clean and dress the
massive wound down to pelvis, whole left buttock gone.
Oct. 17 Two children die during morning rounds today. Less than 1 year old
child in feeding program past week, fever, not doing well, gave few agonal
breaths as we entered ward, his mother already sobbing and holding scarf over
her face and the father rocked the baby.  Soon after – called to 6 or 7
year old boy, admitted unresponsive last night, seized as we were called to see
him adjusted Quinine dose and later a crowd was gathered outside and his bed
was empty.
Oct. 20 Togor (3 1/2 hour drive north of Kauda) Save the Children built the
building. Fighting now in Dalami.  People are fleeing from there to the
South and the caves along the way.
Clinic Administrator, Abass, “No medicine. No gauze. Solar fridge needs
battery, kerosene fridge not working. No truck for transport. Monitoring
children under 5. Advising people from outside this area to travel to refuge
camps in south – Bentiu – many days or weeks walking.  Also has inpatient
ward. Only one person now because of bombs people are living in rocks and caves
near here. [just 50 yards away from clinic they showed me the bomb craters
where shrapnel injured] Two sisters, one lost right hand, mid-forearm, one
sister wound to her side. Staff working free since May – 13 staff including 2
guards and 2 cleaners.
12:30 Sabat – Nuba Community Clinic. Nice set of buildings, well maintained…
no patients, no medicines, no supplies for months except few packets of ORS
(oral rehydration salts) so most patients just come for referral or guidance on
where else to seek care which everyone knows is too far away if you are sick.
Spend night in Lamba, my guide’s family home. We heard Antonovs twice today.
They were far off, but still people ran for the caves.
I speak to a man, Jibril, from village of Omhitan, Oct. 1 walked 9 hours with 2
women and 13 children here to Lamba.  They heard the SAF was planning an
attack on their village, only civilians, no SPLA there and that day and many
days as recently as yesterday the Antonovs dropped 6-7 bombs each time. Two
were injured physically , everyone frightened – terrorized enough to leave
their homes – all their crops, cows , goats, all their wealth to run with their
families in hopes of finding a safer place.  Those who chose to stay are
hiding in the rocks, caves, forests. Those who stayed in villages have been
beaten, jailed, raped, houses burned.
As I spoke to Jibril, we looked up and saw an Antonov silently passing high
overhead to West heading South. Some stood and pointed, some gaped open-mouthed
frozen in their places.
A second Antonov, this one louder, close enough to photograph with my little
point and shoot jungle camera, not close enough to run to a hole, but we
discuss where to go if/when the planes circle back if they are closer.
SAF soldiers could run here in 2 hours.  The locals hope rumors of SPLA in
the mountains will keep the SAF away from this area.
“They are doing exactly same thing here as they did in Darfur – raping killing,
transfer soldiers from Darfur here and Nuba soldiers in SAF to Darfur.
It’s unbelievable.  They force soldiers to kill their own
parents and children.  It’s really horrible.”
Oct. 22 Kauda – Speaking with Nuba Relief, Rehabilitation and Development Organization
(NRRDO) Internet Manager and Media Coordinator.  1) Expect Hunger. People
weren’t able to cultivate, especially the “far farms” due to many being killed
from bombing and ground fighting.  The Antonovs are most terrifying.
Whenever people start coming down, more bombing and people run to caves
and rocks again.  2) Blockade of medicines and supplies – even UN not
allowed.  Now end of rainy season lots of malaria and no medicine.
3) Dry season when roads are dry the Nuba fears ground attacks and when
“green cover” gone, trees no longer hide villages and easier to burn to the
ground all crops and villages.  Unbalanced attacks of civilians.  SAF
knows where SPLA are and they are not attacking the army.
Already 30-50 families daily are coming here for food from NRRDO and they have
none.  There are large fields in central Nuba Mountains that normally grow
enough for all Nuba area and even export to Khartoum, but that large area is
not able to be cultivated now.
Oct. 23 Kurchi – Everyone is friendly, cheerful and alert to sounds of Antonovs
in the distance.  As soon as we arrived they showed us where the holes we
are to run to are if we hear planes.  “Snakes, bombs or bullets”.
May be bitten by snakes if run to caves to avoid bombs and may meet
bullets if leave the area for help. I get a walking tour of the area. “First
attack in July.  15 killed 56 injured here in Kurchi.”  “My father
died of hunger,” he said with sadness, but no more than if he’d said, “My
father died of cancer or a heart attack.”  I’ve never had someone tell me
their father died of hunger.
Oct. 24 Kurchi Clinic 8 staff, no medicine.  Nurse, “We may see 40 – 90
people per day walking up to 3 hours.  Before war 45 min by car to
Kadugli. Now totally cut off. They have instruments to suture wounds and
dressings. Psychological effects rarely bring patients to clinic, but obviously
is has it’s effect.  Also more skin problems since war – poor hygiene,
running and living to caves, sleeping on ground, ticks scabies, scorpions,
snakes. More first trimester miscarriages, malnutrition in IDP’s in surrounding
area >40,000 IDP’s in Kurchi area, some in camps, many dispersed in homes
and caves. Watery bloody diarrhea, poor water and sanitation and crowding ,
pneumonia , meningitis, etc…Staff are committed to work even without pay as
long as possible. (Malaria = genocide by disease) Malaria medicine is priority.
Telabon Clinic – up to 250 patients per day. No medicine. Malaria especially
young children – no medicine except some ORS. “3 hours footings to get here and
go back with zero.” Staff sacrificing to serve people and not working for
Limon Clinic – 75 patients per day total , majority are malaria, 30 – 40
inpatients, only has 1-2 more days of quinine. “Psychologically the people are
strong. Wondering how long this will go.”
Oct. 25 Gidel noon. We left Kauda at 8am finished rounds w/ Dr. Tom then
assisted removing rotten, decayed baby 3 weeks after ruptured uterus – opened
abdomen – foul gas blew out like opening a tomb – the baby skull came out in
pieces… I plan to donate blood for 15 year old woman with 2 week old ankle
injury “blown out from Antonov.” We’ll amputate tomorrow… Malaria cases grow –
other clinics are coming here to Gidel asking for supplies of meds – crisis ,
disaster, warfare – not too strong of words.  2:30 Wow – I just gave the
stuttering nurse tooth puller named Monday all my dental instruments, some I’ve
had for > 10 years.  Monday said he agrees to stay and work at this
hospital and use these tools at least 15 years – until he retires. 4:45 Three
pickup trucks with wounded SPLA soldiers arrived.  We had just finished
amputating a guy’s right leg below the knee.  He has spinal anesthesia.
He couldn’t feel pain but was awake and talking about home though the
sounds of sawing though his tibia that shook the whole table.  We had
earlier amputated a man’s right arm above the elbow, the forearm blown apart,
packed with dirt and burnt flesh.  Did an exploratory laparotomy because
of shrapnel entering abdomen tearing a whole the size of my thumb – luckily Tom
only found small fragments and no bowel perforation.  He’s still at high
mortality risk from infection.  Put chest tube in sucking chest wound 3
rib section of flail chest ribs 4,5,6 broken in 2 places. Tom’s pretty quiet,
sick himself with a bad cold, hoping it isn’t another attack of Malaria
Oct. 26 No bombs or
bombers today. Donated blood again, something concrete I can do. I feel fine
even giving 2nd unit in 11 days… removed 5 fingers from 4 peoples hands –
2 patients had gun shot wounds, another patient was an old woman with
leprosy, and the last a young woman with gangrene from traditional treatment of
stuffing wound with leaves…  as leaving dinner with sisters SAF soldier
from yesterday’s battle was found and brought here by SPLA. He had gunshot in
and out thigh shattering femur, not bleeding, good pulse, fever – probably from
malaria and not the wound.  Tom plans to put in traction pin tomorrow.
Lots of people in courtyard shouting  about this enemy soldier but SPLA
who brought him asked he be treated well – not like the brutal SAF treatment of
their prisoners.
Oct. 29 Yesterday we amputated 15 year old girl’s right leg above the knee.
Her ankle had been struck by an Antonov. The second unit of blood I
donated was running in her arm as I filed smooth the freshly sawed end of her
thigh bone.  She felt no pain. The spinal anesthetic worked well for that,
but she was wide awake and we made eye contact as I looked over the surgical
drape to make sure she was OK.  Sorrow and relief.   After the
rounded stump was cleanly wrapped and the surgical drape lowered she raised her
head to see her future and her lifeless leg lying on the operating room floor.
I tried not to project my own sadness onto her own emotions.
I am overwhelmed by the injustice suffered by these innocent people, “ The
enemies of Omar al-Bashir” as Dr. Tom refers to his patients who have suffered
his senseless violence.
End of
Sudan Journal entries.  Time to get on a plane.

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