Life in the day of a desert nurse

The light is soft and the dawn air cool; this is the only time of day that the sandblown town of El Geneina is a pleasant place to be. In the thorn trees a thin chorus of desert birds begins to sing. Its litany is suddenly augmented by the chanting of the children in the Koranic school next door. It is 6am.

Ann Dalrymple-Smith, the senior Oxfam nurse in the Darfour region of Sudan, has been awake five minutes. She switches on her shortwave radio and the bare African room is invaded by the alien accents of the BBC World Service. Sarah Barnes snuggles obstinately into the bed of rope and wood which she bought in the local market along with the gaudy dress material which has become her sheets.

Ann, one of Oxfam’s most experienced nurses, is soon up and dressed. She shoves a mug of coffee into Sarah’s hand. ‘We don’t often get coffee – the supplies aren’t very regular in this part of the world’, she says with early morning understatement. Three million starving Darfour peasants testify to the irregularity of supplies in this forsaken desert. They are as far from the Red Sea ports (and the food piled there) as they are from the Atlantic coast.

By 6.30 am they are in their Land-Rover having exchanged several volleys of good morning salutations and observations about the goodness of God with their Muslim driver, Ibrahim.

Their first stop is the refugee camp at Azerney. The rains have eased up recently and, though the sands are still as sticky as mud flats, by 7.30am they are in the feeding centre watching the Sudanese relief workers ladling out a pinkish grey sorghum porridge to hundreds of children sitting in long rows.

‘When we first set up these centres we get up even earlier to be here at the start. Our basic job is to set up the systems and see that the local staff run them efficiently. We set very high standards because they always slip later.

‘You teach by example; you walk along the lines and pick out those who aren’t eating. You offer the child food and if it rejects it you inspect it. Often it is just thirsty, so you try water. It may have a raging fever, which you can treat. But most often it has the anorexia of starvation and no appetite. Then you have to force-feed it and encourage the mother to do the same.

‘If a child doesn’t want to eat, an African mother will just put the spoon down. You have to persist, spoon by spoon. Then, of course, the child vomits and the mother says ‘told-you-so’. Then you have to start all over again. But eventually it works and then you feel fantastic.’

In Ethiopia, and in Sudan as well when the programmes first began, Ann and Sarah did this type of feeding for two hours solid, five times a day. Here in Darfour their job is to teach these feeding techniques and diagnostic skills to the Sudanese staff of the Islamic African Relief Agency.

‘The main problem is dehydration – a lot of children die from it. It’s easy to prevent and yet it’s the biggest killer. Diarrhoea, fevers and chest infections all cause it and they are caused by dirty water, malnutrition and lack of personal hygiene. There is an enormous amount which can be done just through education.

‘Our main problem is rush. In a hospital in London you’d feel overworked if you had five children to look after; here 50 means a quiet time.’

The staff at Azerney are now well trained and all the nurses do is troubleshoot. ‘We go out on the tractor to find the water or firewood when it hasn’t come. It’s good for the tractor man to know how what he does fits into the general scheme of things.’

Today’s problem is in the kitchen where staff who cook the porridge in hugh oil drums are worried that they are shedding rust into the children’s food. ‘Scrub it with wire wool and if that doesn’t work we’ll sort out something on our next visit’, says Ann.

Tasks are handed out. ‘Now remember about the firewood, the kitchens can’t work without it’, says Sarah from the seat of the Land-Rover as they prepare to leave Azerney.

‘I will do it, inshalla’, says the smiling woodman. Inshalla means, in literal terms, ‘if God wills it’; in practice it more often means ‘if I get round to it’. ‘No, not inshalla’, says the nurse with a look of mock ferocity. ‘Definitely. One hundred per cent.’

‘OK. Definitely. One hundred per cent – inshalla’, replies the smiler, after the vehicle has begun to move. The nurses laugh.

At the camp’s next feeding centre they concentrate on seeing that the children wash properly before eating. Ann helps with the water supply, Sarah wanders through the queue.

‘You get to know them, of course. Not by name, but you recognize them by their clothes. There’s one here we call the caterpillar because he wears a striped Babygro sent out from England. I have my favourite babies that I have special cuddles with.’

But if there is room for affection there is none for sentiment. Nearby is a clinic run by the German Emergency Doctors. The different philosophies of the two groups cause tensions. Three of the Germans are gathered around a stretcher bed which holds a painfully thin child. They are trying, without success, to find a vein which has not collapsed in the child’s body so that they can insert an intravenous drip to replace the lost body fluids.

Ann leaves their clinic with scarcely-disguised exasperation. ‘This is ludicrous. That child will be dead by tomorrow anyway. These people think they are still in Europe. All that nonsense about intensive care while they ignore the 30 children outside who could be saved.’ In Africa today, succour sometimes seems as much about death as life. Sarah’s views have been moulded by working in Thailand, Nepal and Ethiopia. ‘We often see children who aren’t going to make it. A lot of it is about letting the child die without fuss. Often you are working hard and a mother will ask you to stop; she will take the tube out of the child’s nose and close its eyes. Then you have to think what is best for these people and not salve your conscience with aggressive treatment.’

The child dies. Death is followed by lunch in the straw-fenced compound of one of the Sudanese workers. A liver is cut from a newly-killed sheep and fried. A tin of tuna is mixed with local lentils. Tomatoes and onions from the local market are chopped together. The nurses and their driver eat with half a dozen locals before leaving for the next feeding programme, two hours’ drive away, at Kerenek.

It is 7 pm before the Oxfam team regains its little bungalow after a brief stop in the market place for food. Sarah buys six eggs – individually from different traders – and a few tomatoes. Back home there are tinned sardines and a tub of local halva, the sweetened residue of sesame seeds crushed to extract the oil.

It is too late and too dark for their usual bath (a bucket emptied over the head), so they eat straight away.

Over supper they talk of the situation which is deteriorating throughout Darfour. ‘Just as people warned it would’, says Ann glumly. The mood is despondant rather than despairing. ‘It’s not got to the stage where we’re wasting our time, so long as there’s even a bit of food we can do something.’

The weather breaks. Flashes of sheet lightning illuminate the sky and fearsome wind, a haboob, rattles through the little house scattering papers. The air fills with sand.

‘The haboobs are the things that really get me down here’, says Sarah. ‘Sand gets everywhere. Everything you eat, everything you drink has sand in it. You begin to sweat a lot and it pours off you in rivulets of mud. That’s what I hate most, that and the flies.’

Before sleep she listens to a Sony Walkman and writes to her husband, Simon. She is 25 and they have been married for two and a half years, during which she has seen him for only two weeks every three months.

‘He’s a mature student, doing his Part IIs in law. He’s a kept man, he doesn’t get a grant, we live off my salary’, she laughs. ‘I write to him every night. After his exams he’s coming out here to visit. I shall try to find something useful for him to do.’

As 11 pm approaches she is in bed reading the last few pages of The General by CS Forrester. ‘What is it about? I’ll tell you one thing, it’s not about Africa. You need a bit of an antidote’, she says and blows out the lamp.

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