Drømmen om et simpelt liv / Dream of a simple life

“Settling into a new country is like getting used to a pair of shoes. At first they pinch a little, but you like the way they look, so you carry on. THe longer you have them, the more comfortable they become. Until one day, without realizing it you reach a glorious plateau. Wearing those shoes is like wearing no shoes at all. The more scuffed they get, the more you love them and the more you can’t imagine life without them.”   (Tahir Shah: In Arabian Nights)

Et år er gået, og min tid i Sudan er ovre. Noget af det jeg finder mest belønnende ved at bo og arbejde  under fremmed himmel, er at få lov at opleve at livet kan leves anderledes, at vi ikke nødvendigvis har den eneste løsning på hvad livet bør indeholde. Det er ikke nogen hemmelighed at vi hvad angår velstand, uddannelse, fred, og valgmuligheder er meget forkælede i Danmark, ihvertfald hvis man sammenligner med Sudan.

Jeg har brugt meget af min tid i Bushen, i små landsbyer hvor folk ikke er så eksponerede for udvikling. Mange kender end ikke Khartoum eller Juba, deres egen hovedstad. Og livet leves som det altid har været levet, generation efter generation. Og det har slået mig at folk faktisk er tilfredse med dette. En kvinde bliver gift som teenager, hver tredje år får hun et nyt barn, hun træder ind i rollen som Mor og hustru, og hun brokker sig ikke, men regner sig selv blandt de heldige. Hun taler heller ikke  om hvad hun kune have drevet det til hvis blot...Her er ingen selvrealisering nødvendig.  Man er kvægavlere, dyrker lidt afgrøder omkring sin hytte, snakker med de andre kvinder når man sammen henter vand ved brønden, og man er tilfreds, for man kender ikke et andet liv.

Også tænker jeg på mig, og mine veninder derhjemme. Vi har haft talrige valg. Vi har valgt uddannelse, karriere, mænd, og nogle mænd er blevet fravalgt igen. Vi har valgt hvor vi vil bo, vi har valgt at flytte væk fra Danmark for en tid. Nogle valg har været nemme, nogle har nærmest indtruffet uden at vi har tænkt over det, og andre har været vanskelige, nærmest umulige. Og hvergang vi foretager et valg, er der en svag stemme kaldet tvivl der hvisker i baggrunden: “har du nu valgt rigtigt?” “ ville dit liv se bedre ud hvis du havde valgt anderledes?” “Hvad nu hvis?” 

Og mens jeg skriver dette melder en tanke sig: “Ville jeg være lykkeligere hvis jeg ikke havde alle disse valg, hvis jeg ikke havde muligheden for at foretage et galt valg, hvis jeg var født i en lille landsby i Sudan?”

English:

A year has passed and my time in Sudan is gone. One of the things that I find most rewarding by working and living under foreign stars, is being given a chance to see that life can be different, that we do not necessarily have the one solution to what life must be like. It is no secret, that when it comes to wealth, education, peace and choices in life, we are very spoiled in Denmark, at least if you compare to a country like Sudan.

I have spend a remarkable part of my time this past year in the bush, in small villages where people are not exposed to development. Many do not even know Khartoum or Juba, their own capital. And here life is lived, as it always has been lived generation after generation. And I have been surprised, that the people actually seem content with this life. A woman gets married as a teenager, for every three years that follows she gets a child, she step into the role of mother and wife, and she does not complain, but count herself lucky. She also does not talk about what she could have made it to, if just... Here is no need to realise your self potential. People are herds-people, they grow a few  crops around the house, talk to the other woman while fetching the water from the bore hole, and she is content, as she does not know of a different life.

And then I can not help thinking of me and my girlfriends at home. We have multitudes of choices. We have chosen our education, our careers, our men, and some men have be de-selected again. We have chosen where we want to live, some have chosen to move away from Denmark for a while. Some Choices has been easy, some have almost taken themselves without us thinking about it, and yet others has been difficult to make, almost impossible. And every time we make a choice there is a possibility that a small voice called doubt will appear, whispering in our ear: “Did you make the right choice?” “Would your life look better if you have chosen differently?” and “What if...?”

While I am sitting here typing, a thought catches me: “Would I have been happier if I did not have the choices, if I did not have the chance of making a wrong choice, if I were born in a small village in Sudan? “

Hverdag i Jiech / Everyday in Jiech

De seneste par måneder har mit arbejdsliv udspillet sig i Jiech. Som et respons på det øgede antal patienter smittet med Kala Azar, har vi i Medair startet en klinik for Kala azar patienter. Området er svært tilgængeligt, isoleret halvdelen af året grundet regn, og nu hvor det er tør-sæson  kan man på 9 timer i raskt tempo gå til nærmeste markeds-by. (Ayod) Mange af de menesker jeg møder der, har aldrig været længere hjemmefra en Ayod. Kvinderne forventer at jeg taler Nuer, da det er det eneste sprog de nogensinde har hørt talt. På grund af isolationen har det ikke været muligt for dem at få hjælp tidligere. Der er ingen sundhedsklinikker i byen udover den lokale troldmand., og den nærmeste klinik er i Ayod. Da der ikke er nogle biler i området er den eneste mulighed for at få folk til lægen at bære dem.

I løbet af kort tid har vi 300 patienter i behandling, som alle kommer dagligt for at få injektioner. Vi træner de bedst uddannede i landsbyen til at arbejde i centeret. De har måske hvad der svarer til en dank 4. klasses niveau. En tager sig af register bogen, da der skal føres rapport over de behandlede patienter, 4 oplæres i at give indsprøjtninger. Det er svært når man ikke har nogen sans for hygiejne. I Jiech er der ingen der har fortalt børnene at de skal vaske hænder efter at de har besørget, og derfor er der heller ingen voksne der har kendskab til denne praksis. Man drikker vandet fra den lokale vandhul, og tager bad i samme vandhul, og køerne gør det samme. Vi har været heldige at få en laboratorie-assistent der kan udføre testene (forgår lidt som en graviditetstest, blot med blod istedet for urin) og en CHW  (Community health worker - har 9 måneders træning i sundhed) som kan dele piller ud men har svært ved at vurdere en person er syg eller ej, og leverer en noget rusten oversættelse til den stakels læge (læs mig)

Som i nok kan forestille jer er der nok at se til. Over jul og nytår var jeg den eneste uddannede sundheds personale på stedet, og det føltes nærmest som at arbejde i døgndrift. Mange af patienterne er rigtigt syge, og når man samtidigt skal supervisere alt det andet der foregår i centret, skrive rapporter til chefen, sørge for at vi har et tilstrækkeligt lager af medicin og kanyler (vi bruger ca 900 sprøjter om dagen) så har jeg strukket mig så langt som jeg kan. Vi giver som regel indsprøjtninger om formiddagen, og har konsultationer med de patienter der føler sig syge, samt udskriver dem der har fuldført behandlingen. Om eftermiddagen ser vi nye patienter, tester for Kala Azar og malaria, og indlægger og skriver journal hvis de er positive. Det er normalt med 20 nye indlæggelser om dagen. Dertil kommer der alt arbejdet i vores hjem, som at instruere vores kok i hvilke dåser hun skal åbne og mikse, købe brænde, skælde vagten ud da han igen har forladt sin post det meste af en dag... Jeg går som regel død i mit telt omkring klokken 9 om aftenen.

Når en 8 ugers rotation er overstået er ferie meget tiltrængt.

English:The last couple of months I have spend much of my time in  Jiech working on setting up a new Kala Azar treatment centre, as a response on the increase in cases seen from the area. The area is difficult to reach, half of the year there is no roads due to rain, and the people live in total isolation. Now, while it is the dry season there is 9 hours walk to the nearest market in Ayod. Many of the people living in the area has never been further away from home than Ayod. The woman expect me to speak Nuer, as that is the only language they have ever heard spoken. Because the place is so isolated, it has been impossible to get treatment previous. There is no health-center in town, only a witch-doctor, the nearest clinic is in Ayod, and with no cars the only option of getting some one sidk to the doctor is to carry them.

We very fast get 300 patients under treatment, who all come everyday to have injections. We train the best educated people in the village to work for us. They properly have what is equal to a danish 4th grade in primary-school.  One is fillig in the registration-book as we need the information for the weekly reports send to donors and MoH, 4 is taught how to give an injection, which is a challenge in a population that has no knowledge of hygiene. Here the children are not told to wash their hands after emptying their bowels, and as they were not taught as children, the grown ups does not know this either. You drink the water from the water-hole, where you also bath, and the cows do the same. We have been lucky to employ a lab-assistant to carry out the tests for Kala azar, and a community health worker, who has 9 months education in health, and who can count the tablets, but not carry out consultations on his own. He does provide a poor translation for the poor doctor (read me) .

THe witch doctor

as you properly can imagine there is plenty to do. Over Christmas and New years, I was the only trained health professional there, and it felt like I was working 24-7. Many of the patients are really sick and need attention. At the same time it is necessary to supervise everything else going on in the clinic, write reports to the boss, make sure that we have sufficient amount of medicine and equipment in the storage (we use 900 syringes a day). At the end of the day I have been stretched as much as I can. We give the injections in the morning, do consultations of the ones feeling sick, discharge the patients finishing treatment. In the afternoon we see new cases, test admit and take up a medical file. It is normal with 20 new admissions a day. On top of that there is the daily work in the house, like telling the cooks which tins to open and mix to make a meal, buy fire-wood, tell the guard off for leaving the compound all day. It is quite normal for me to fall asleep in my tent as soon as I enter it a t 9 o’clock. After a 8 week rotation, a break is very much needed.

Afrika er gravid / Africa is pregnant

Er der noget der i høj grad har præget dette år jeg har tilbragt i Syd Sudan har det været forventningerne til folkeafstemningen. Der har været nervøse forventinger: Vil afstemningen finde sted, bliver der uroligheder op til afstemningen, kan det overhovedet gennemføres til tiden, vil vi kunne udføre vores arbejde, eller bliver vi alle sendt på en måned lang ufrivillig ferie, bliver valget retfærdigt osv.

Men for folk i sydsudan har det også været en dag der er længe ventet. Siden uafhængigheden fra kolonimagten i 1956 har syd og nord bekriget hinanden. Syd-Sudaneserne har ikke følt at de hørte sammen med nord, hadet er vokset frit grundet krigshandlinger og de har haft svært ved at se fordelene i at være en nation. De har drømt om at have deres eget land.

Derfor var det en stor festdag da valget startede. Jeg befandt mig i Jiech, som er en lille flække, stort set bare et administrativt centrum for to payamer, med enkelte hytter, 2 boder der udgør markedet, og en landingsbane. Stort set alle der var registreret til at stemme mødte op på første dagen, iklædt deres pæneste tøj. Talrige medlemmer af Parlamentet i delstaten kom forbi, og lagde vejen forbi vores compound, for at høre om vores arbejde. Selv “the minister of interior affairs” kom forbi, med et TV-kamera, og benyttede sig af lejligheden til at få mig til at give en udtalelse om Kala Azar situationen i området. Sange blev sunget og trommer slået.

Det var glade dage. Folk som kom til klinikken viste glade deres farvede finger frem, som tegn på at de havde stemt. 

Og resultatet er klart (selvom det ikke er endeligt offentliggjort endnu) 99,9% har stemt for selvstændighed. Med andre ord Afrika er gravid, hun har undfanget et nyt land, og har termin om mindre end et halvt år. Det bliver ikke en nem start, udfordringerne er talrige, ressourcerne få. Men jeg glæder mig over at have fået lov at dele dette øjeblik med befolkningen, og jeg håber at en fredfyldt nation vil komme til verden.

The referendum centre in Jiech

English: Is there something that has greatly influenced this year I spent in South Sudan, it has been the expectations for the referendum. There have been nervous Expectations: Will the vote take place? Will there be riots prior to the referendum? instability? Will it be implemented on time? Will we be able to work, or will we be force on a month long holiday? Will it be a fair referendum?

But for the people of South Sudan, it has also been a day that has been anticipated for a long time. Since the independence from the colonial powers in 1956, South and North has been engaged in a civil-war against each other. The South Sudanese people has not felt that they belonged with the people in the north, hatred has grown due to acts of war and has not been able to see the benefit of being in the same country. They have been dreaming of having their own country.

Therefore it was a big day of celebration when the first day of the referendum appeared. I was in Jiech, a small nowhere, basically jest an administrative center for the two bordering Payams, a few cottages, two stalls that makes the market and an airstrip. Almost everyone that was registered to vote came on the first day of the referendum in their very best clothes. Members of the local state parliament showed up, and also came to see us in our compound, to hear of our work while there. Even the Minister of Internal affairs came by, bringing a TV-crew, insisting on me giving a talk on the dire situation of Kala Azar in the area. Songs were song and drums were beaten.

It was happy days. The patients in the clinic proudly presented their stained finger as a sign of them having cast their vote.

And the result is clear (though not yet final) 99.9% has voted for independence. Africa is Pregnant, she has conceived a new nation and is due in less than half a year. It will not be an easy start, the challenges are plenty, the resources few. But I am happy to have been given the chance of sharing this moment with the Sudanese, and I hope that a peaceful Nation will be born

Om Køer / On Cows

Forestil dig et liv hvor alt gøres op i køer. Sådan er livet i Jiech, og mange andre steder i Syd Sudan. Efter at have arbejdet blandt Nuer-folket i flere omgange, er jeg ved at forstå systemet. En ko er det mest værdifulde man kan eje. Har man mange køer er man en heldig og vigtig mand. Man slagter sjældent en ko, det er den for værdifuld til. Men man kan drikke mælken. Langt de fleste slagsmål mellem klaner og stammer drejer sig også om køer. Om at stjæle køer, eller tilbage stjæle de køer der blev stjålet fra en ved tidligere lejlighed. 

Det koster 25 køer for en mand at få sig en kone. Køerne deles ofte mellem alle pigens slægtninge, da man må bestikke onkler og tanter til at godkende ægteskabet. Hele familien spæder nemlig også til hvis man er en ung mand der skal giftes. Man er således heldig hvis man føder et pigebarn. Det er nemlig lig indkomst. Piger er ofte omkring 14 år når de bliver gift, mændene ældre. Gifter man sig med en kvinde som ikke bliver gravid, kan man levere hende tilbage, og få sine køer igen. Dør kvinden uden at have fået børn, får man også sine køer igen. Hvis man bliver træt af sin konen, og vil skilles, får man sine køer igen, minus 4 køer for hvert barn hun har født en (og manden beholder børnene)

Hvis man kommer til at dele leje med en anden mands hustru, og bliver grebet heri, skal man betale kvindens mand en ko, og ægtefællen beholder konen. Og hvis man skal tro historierne der fortælles, så er der par der spekulerer heri, for det er jo en hel god forretning. Historierne går alle om mænd der sender deres unge smukke konen ud for at forføre de rige og betydningsfulde mænd i byen. Kvinden fortæller så sin ægtefæle hvor hun skal mødes med elskeren, og vupti han dukker op, tager dem på fersk gerning og har skaffet sig endnu en ko. -Hvis han laver det nummer 25 gange har han råd til at skaffe sig endnu en hustru til samlingen.

-Så hvordan fungerer det i Danmark?

-Når en mand ser en kvinde han gerne vil giftes med køber han en ring til hende

-En ring? her er ringe lavet af ko-horn og ikke af en særlig værdi.

-Altså det er en meget speciel og dyr ring!

-Og hvad med familien, får de ingen ting?

-Nej de er ikke en del af handlen

-Og hvis kvinden forlader manden, får han så sin ring igen?

-Måske... Nogle gange beholder hun ringen og får den smeltet om til et andet smykke.

-Hvad hvis hun dør uden at have givet dig afkom? 

-Så græder du

-Og hvis du sover med en anden mands kone?

-Så kan du få hende gratis, ægtefællen vil ikke have hende tilbage.

Jeg ved snart ikke hvilket system der er bedst....

English: Imagine a life where everything is counted in cows. That is how life is in Jiech, and many other places in South Sudan. After having spend considerable time working among the Nuer-tripe this last year, I am getting an understanding of the system. A cow is the most valuable you can own. If you have many cows, you are a lucky man. You seldom slaughter a cow, it is to valuable to be eaten on normal occasions. But drinking the milk is okay. Most of the fights between clans and tribes is also about cows. About stealing cows or stealing back your cows that was taken on an earlier account.
It costs 25 cows for a man to get a wife. The cows is often shared among the family. you need to pay of the aunts and uncles for them to accept the proposal, as marriage is a family affair. All of the family will also help gathering the necessary amount of cows if a young man from the family wants to marry. In this way, you are lucky if you give birth to a girl, because that equals income. Normal age of marriage for girls is 14 years, the men are older. If you marry a woman who does not conceive, you can take her back, and you get all your cows back. If the woman dies without giving you offspring, you will also get your cows back. If you are tired of your wife, and want a divorce, you will get back your cows minus 4 cows for each live child she has given you (and the man keeps the children)
If you by accident ends up sharing a bed with a woman who belongs to another man, and are caught doing so, you pay a cow to the spouse, and the husband keeps the wife. And if we are to believe the stories told, there is couples who takes advantage of this system. The stories are about men who send their young and beautiful wives out to seduce rich and influential men in town. She tells her husband where she is going to be meeting the lover, and “bam” he shows up out of the blue, catching them in the act, and has earned a cow. If they do that 25 times, he can afford taking another wife.

-So how is the system in Denmark?

 -Well when a man has laid eyes on a woman he wants to marry, he buys her a ring.

-Just a ring? (here rings are made of cow horn and not that expensive)

-Well a very special and expensive ring.

-And the family, do they not get anything?

-No they are not part of the trade

-what if the woman leaves the man? does he then get his ring back?

-Sometimes, other times she keeps it and has it melted into some other jewellery

-And if she dies without giving birth?

-Then you cry

-And if you sleep with someone else's wife?

-Well most likely you can have her for free, as the husband would not like to have her back.

I am just questioning which system is the best?

Rhoda Nyakan

Rhoda Nyakan har endnu ikke fået sit navn da hun først kommer til mig. Hendes bedstemor og far kommer med hende da hun er blot 5 dage gammel. Hendes mor havde Kala Azar og døde kort efter fødslen. Familien aldrig hørt om et barn født for tidligt, men det er tydeligt at se at Nykan ikke er født til termin. Jeg vurdere at hun er født omkring 30 uge, og vejer blot 0.9kg da jeg ser hende. Jeg forklarer familien at moderen var så syg, at barnet kunne mærke at det måtte komme ud før tid, for ikke at dø sammen med moderen. Hun er lille bitte. Alt er småt på hende, og familien har haft problemer med at få hende til at spise. De medbringer en  sutteflaske der er alt for stor til hendes lille mund. Vi blander mælk til hende, og bedstemoderen lærer at give hende mælk på en ske, som hun fint drikker de første par dage. Men efter 4 dage vil hun pludselig ikke tage mælken mere. Hun er også kold, og jeg vurdere at hun kan være løbet på en luftvejs infektion. Jeg anlægger en sonde, og vi oplærer bedstemoderen i at give hende 10 ml mælk hveranden time i sonden, og hun får antibiotika. Hun retter sig på behandlingen, og efter en uge begynder hun så småt at drikke mælk fra skeen igen, og begynder at tage på i vægt.

Det så så godt ud, men ville virkelig have været et mirakel hvis hun kunne overleve så tidlig en fødsel, i en landsby hvor der ingen kuvøser er, ingen special afdelinger for fortidligt fødte. men 14 dage efter jeg er rejst fra landsbyen omkommer hun, da hun påny får lungebetændelse. Men bedstemoderens omsorg for dette lille væsen der trods alt fik 4 uger her på jorden var stor, og den indsats hun lagde for dagen for at holde liv i den lille størrelse var stor. Hun havde et navn, hun var.  Jeg ville ønske at vi kunne gøre mere, men nogle gange så er det utroligt hvad man kan gøre med de få midler man har til rådighed. 

English: Rhoda Nyakan has not yet been named when I see her the first time. her grandmother and her father has brought her to me when she is 5 days old. Her mother passed away short after giving birth to her, she had Kala Azar. The family has never before heard of a child born to early, and just consider her very small. I is quite clear that this child is pre term, properly around 30 gestation weeks, only 0.9 kg’s when they come. I explain to the family that the mother was so sick, that the child could feel that it had to come out if it should not die with the mother. She is tiny. Everything is small on her. The family has had trouble feeding her. They bring a bottle, but the mouth of the child is simply too small. I teach them to feed her on a spoon, from which she is joyfully sucking the first couple of days. But after 4 days she stops eating. She has also grown cold and passive, and I start treatment for pneumonia and have to give her a N-G tube for feeding. We teach the grandmother to mix and give her 10 ml’s of  milk every 2 hours, and she gets better on the treatment, starts to gain weight again and after a week she can again take part of the food on the spoon.

It looked very encouraging, and it would have been a miracle if such a small child could have survived in the bush where there is no incubators, no specialised wards for pre term babies. But a forth night after I have left the village, she again catches pneumonia and leaves this world. But the grandmothers care, and hard work for this little being gave her 4 weeks on earth. She had a name, she was.

i wish that we could do more, but sometimes it is amazing what can be done with the few remedies available. 

Deng

Deng er en helt normal 13 årig dreng. Men hans liv er ikke helt normal. Også han er fra en af de mange landsbyer der er hårdt ramt af Kala Azar. Begge hans forældre er døde, han er ene barn, og tilbage har han blot en bedstemor, der tager sig af ham. Desværre bliver også han bedstemor syg af Kala Azar, og da der kun er hende og Deng tilbage, må han træde i til og tage sig af hende. 

Da de ankommer til klinikken, kan hun ikke gå, og hvordan han har fået hende fragtet den 8 timer lange tur til fods er et mysterie. 

Fra starten af er Deng meget om sig. Så snart jeg viser mig på afdeling for at gå stuegang, griber han min hånd og fører mig til sin bedstemor, for at sikre sig at hun bliver set. Hvis han er den mindste smule bekymret henter han mig, og gør med tegnsprog og en blanding af arabisk og nuer forståeligt hvad problemet er. Engang i mellem giver vi ham lidt penge så han kan købe brænde og mad og tilbrede et måltid til ham og hans bedstemor. Det rører mig dybt at se denne knægt tage så godt vare på sin bedstemor, og heldigvis kommer hun sig hurtigt. Efter et par uger er hun igen i stand til at gå en lille tur rund om klinikken, støttet til sit barnebarn, da vi deler myggenet og tæpper ud sørger Deng igen for at hun også får sin ration. Og når vi skal have båret borde og stole og andet materialle fra vores lager, er han der staks for at give en hånd med.

English: Deng is a normal 13 year old boy. But his life is not normal. He is from one of the villages that have been hit by the outbreak of Kala Azar. Both his parents has passed away, he is the only child, and left is only a grandmother, who is taking care of him. Unfortunate also she falls ill of the Kala Azar, and as it is only the two of them left, he has to take care of her. 

When they arrive at the clinic, she is not capable of walking, and it is a mystery how they have reached the clinic, as it is 8 hours away on foot from their village. 

From the beginning Deng is very aware of his grandmother making sure she gets the best treatment. When I arrive to do the rounds in the ward, he is there immediately, pulling my hand to his grandmothers bed, making sure she is seen and gets the best treatment. If he is worried, he comes and finds me, and with a mixture of sign language and arabic / nuer makes it understood what his worries are. Once in a while we give him some money to go to the market to by firewood and food to make a meal for him and his grandmother. I am deeply touched seeing this kid, taking so good care of his grandmother, and luckily she quickly recovers. After a couple of weeks I see her and Deng walking around the clinic arm in arm, and when we do a mosquito-net and blanket distribution Deng is there making sure his grandmother gets what belongs to her. And when I need help carrying tables and chairs to our storage he is there giving a hand with the work.

Nyajang

Nyajang, while being feed in a tube

Hun kommer sammen med sin mor. Hun er 2 år gammel, hendes kjole er beskidt, det er hendes eneste kjole, moderen er gravid igen, og har et trist glimt i øjet. Pigen er syg. Hun er ramt af den Kala Azar epidemi der fortiden hærger dette hjørne af Sudan. Hun er også svært underernæret, og har der til tabt et halvt kilo siden hu besøgte klinikken sidste uge. Hun er lilla om munden, ikke på grund af vejrtrækningsbesvær, men fordi hun har fået Gentian Violet på de sår der fylder hendes mundvig. Savlet står ud af munden på hende, og hun nægter at lukke munden. Da jeg kigger i munden ser jeg at hun i også har svamp.  Jeg insistere på at se hende spise en pakke plumpy Nut, vores terapeutiske føde-produkt, og da jeg tænker at grunden til hendes vægttab sikkert skal findes i de smertefulde sår der fylder hendes mund. Jeg får ret i min mistanke, Pigen vil ikke spise. Jeg forsøger nu at overtale moderen til at lade mig give barnet en sonde. Med en vægt på nu blot 5.8 kg, og intet væske eller fødeindtag, er det væsentligt at få noget i ernæring i hende hvis hun skal overleve. Moderen er skeptisk, synes ikke det er en god ide. Her er døden noget man er vant til, og moderen har allerede opgivet. Men min tolk er lige så insisterende som jeg, og under skrål, og nogen kamp lykkedes det at få anlagt en sonde. Jeg blander og giver mælk, bandagere barnets hænder med gaze for at hindre hende i at hive sonden ud. Og efter at have fodre barnet 2 gange, giver jeg moderen lov til at gå hjem. Hospitalet er alligevel øde om natten, ingen af de ansatte syes at have vagt. Jeg tvivler på at jeg får dem at se igen, for moderen er stadig meget skeptisk. Men næste morgen dukker de op igen, jeg blander mere mælk, giver barnet mælk flere gange i løbet af dagen. Og efterhånden som barnet bliver mere aktivt, begynder moderen at smile til mig. Hun kommer trofast til alle aftalte fødetidspunkter, og en gammel bedstemor fortæller os, at uden vores hjælp var dette barn ikke i live, hun var allerede død, men nu er hun i live. Efter fem dage på sonde mælk, og behandling af mund infektionen fjerner jeg sonden, giver dem 3 små poser med Plumpy Nut og håber at hun vil få nok appetit til at spise dem når hun kommer hjem. Og det gør hun. Da de kommer tilbage, kommer Nyajang gående imod mig med strakte arme for at blive løftet op.

Jeg så hende igen  3 uger efter første besøg. Nu vejer hun 7,3 kilo, er stadig meget tynd, men helt sikkert stærkere og gladere.

Nyajang 3 weeks later

English: She comes with her mother. She is 2 years old, her orange dress is dirty, it is the only dress she has, her mother is expecting again, and she looks sad. The Girl is sick. She has been hit by the Kala azar outbreak that currently ravages this corner of Sudan. She is also severely malnourished, and has lost half a kilo since she visited the clinic the week before. She is purple around the mouth, not because she suffers from difficulties in breathing, but because she has been given gentian violet on the wounds that surrounds her mouth. When I look in the mouth I see that she also has oral thrush. I insist on watching her eat a sachet of plumpy nut, the therapeutic food we use, as I am thinking that the reason she is loosing weight is properly related to the painful wounds in her mouth. And I am right, the girl will not eat. I try to convince the mother to give permission for a feeding tube. The girl is weighing 5.8kg, and not taking food or fluid, it is therefore essential that she get some nourishment, if she shall survive. The mother is sceptical, she does not like my idea. People here are used to death, and the mother has already given up. But my translator is as persistent as I am, and while the child is screaming and fighting me, I place a N-G-tube, mix the milk and start the feeding. And after feeding the child twice with a couple of hours between I allow the mother to take the child home. The Hospital is without staff at night anyway, so it does not make sense to leave the patients there. I am doubting that I will see them again, because the mother is still not happy, and asking if I can remove the tube. But next morning they show up, and the following days the child is feed 4 times a day in the clinic. With time the child becomes more alive, the mother starts smiling to me when she arrives, and she shows up faithfully when ever we have an appointment. And old grandmother tells us, that without our help this girl would not have been alive, that she was already death, but now she is alive. After 5 days on milk in the tube, and treatment of the infection, I decide to remove the tube to see if the child can feed on plumpy nut, giving her 3 sachets to bring home. And she eats. When she returns, Nyajang comes walking towards me, stretching out her arms to be lifted up.

 I saw her again 3 weeks after the first visit. She is nowI 7.3 kg, still thin but a lot stronger and happier than she used to be.