Chapter 2

That following Monday, Paul began taking three weeks of seminars and classes on MSF procedures and company rules and policies, and everything else from what to expect and operate in a M. A. S. H. [Mobile Army Surgical Hospital] unit to what clothing to pack. After the Christmas holiday and New year, Paul landed in the capital city of South Sudan, Juba, on January 4^th. The weather was typical of Sudan. January, the same as December, in Sudan is another hot winter month, with temperatures in the range of an average low of 15.6°C (60.1°F) and an average high of 30.7°C (87.3°F).

The introductions were made after arriving at the PoC [Protection for Civilian] camp in Bor, in the Upper Nile area of Northeast South Sudan. The chief surgeon and head of the medical MASH unit was Dr. Abdul Kareem Abdallah, a Muslim doctor from Jordan. Next, the second surgeon was Dr. Gupta Singh, from India followed by Celeste DuBois, a French nurse and Dashiki Dimka, a Swahili nurse. They had two Sudanese nursing assistants who were very dark, but Paul had seen darker African Americans. he had yet to see any of the “ink black Nuer” that Sally made such a fuss about.

Paul had just sat my bags down when Dr. Singh vigorously shook his hand and said, “Hello, Dr. Paul! We have been anxiously awaiting your arrival. You will be much pleased to know that you have been appointed head of labor, delivery, and pediatrics. Isn’t that wonderful?”

Paul looked heaven-ward and said, “Jose Ramirez, I’m going to bitch slap you if I ever see you again!”

Dr. Abdallah quipped with a smile, “Is there anything wrong, Dr. Whittaker?”

He had such an innocent smile, Paul simply shook his head, chuckled, and replied, “No, Sir, nothing at all.” When he looked at Abdallah again, they both burst out laughing.

Abdallah said, “We are overtaxed with war wounds: hacked limbs, gunshots, and stabbings. Unfortunately, there are a lot of very young girls giving birth in this area and they are too young or small for a vaginal delivery and need C-sections. Your expertise and skill in this area is desperately needed”

Paul sighed and replied, “I’ll do my best, Sir.”

“I’m sure you will. Your credentials are outstanding, and we are very proud to have you with us.”

“By the way, may I call you Paul?”

“Yes, Sir.”

“I’m just either Abdul or Abdallah. Either one I fine. I am afraid that you will be terribly overworked here in the next 12 months. There are 4.3 million displaced people in South Sudan. We’ve made 71,341 outpatient consultations, of which 107,115 children under 5 years old. We have hospitalized 16,769 patients, of which 7,694 children under 5 years old. We have performed 6,679 operations of which 6,077 were deliveries. We’ve had 6,784 children treated for malnutrition, of which 1,896 were hospitalized. So, you can see why they were in such a hurry to get you here.”

“Wow, Abdul, the scope of the need here is so overwhelming, I can’t fathom how you folks did it.”

“Well, with you here, it will certainly be a lot easier.”

“I promise, I will do all I can to carry my share of the load.”

Over the next two months, Paul had performed sixty-two deliveries of which 48 were C-sections. The average age of the young mothers was 13.8 years old. Most of his infant and child cases were malnutrition and with the latest outbreak, malaria.

From what Paul could ascertain, regarding sexual, gender-based violence, 1 in 3 women experienced physical or sexual violence in her lifetime. 19.7 percent of women suffer some form of sexual abuse before age 18. 24,900 patients were treated for sexual violence by MSF in 2018

Late one night in mid-March, a late-night raid by the Janjaweed resulted in twenty dark-skinned Nuer and Dinka murdered. Paul’s midwife assistant was among the victims. Paul never knew her name because she looked like Mammy from Gone with the wind. She was heavy and wore a neckerchief on her head like the black actress did. Since she’d helped deliver babies, she was proud of being called “Mammy.”

The real issue with finding a Sudanese replacement was the fact that most could not speak English well enough to relate with medical terms and procedures. Then one day about two weeks after the late-night raid, A young Nuer girl walked into the MASH unit. She was ink black. She was so black, it was hard, at first sight, to make out some of her features. She first approached Celeste and said, “I would very much like to help deliver babies.”

At her very clear English, everyone turned and looked to see who was speaking. She was young, Paul initially thought she might be fourteen or so. She was completely nude except for the traditional wire and beaded belt, necklace, and bracelets of the Nuer. The only piece of clothing she wore was a pair of camp-issued flip-flops. She was small, standing about five feet tall and about ninety-five pounds or so. From what he could tell, Paul noted that she had a light dusting of black pubic hair with the plump, full labia of a little girl. Her breasts were about a large A cup or a small B that were cone-shaped and protruded straight out from her chest like the Dagmar bullets on the bumper of a ‘52 Cadillac. She had large very pronounced bulbous, puffy nipples that were as black as her skin tone. To top it off, she had the most perfectly shaped round, little teardrop derriere he’d ever seen. Paul had never seen anyone ― either in person or a photograph ― as dark as she was. There was only one word Paul could think of to describe her ... beautiful. Her eyes were black and sparkled with the vibrance of life, and her smile was bright and gentle. She appeared to be very humble and meek.

Celeste pointed to Paul and said, “See that doctor over there. He’s the baby doctor. Talk to him.”

All eyes were on her as she approached Paul timidly and stopped in front of him with her head down and her hands folded on front of her vulva. Paul extended his and directed her to sit in the chair next to his desk. She sat with her hands folded in her lap. Paul asked her, What’s your name?”

“I am Nadia Juma, Doctor Sir.”

“Nadia? That’s a Russian or Ukrainian name.”

“My mother named me after the nurse who delivered me.”

“I see. How old are you, Nadia?”

“I am sixteen, Doctor Sir.”

“Just call me doctor is fine, Nadia. You don’t need to ne so very formal.”

“I much sorry, Doctor. I meant no disrespect.”

“You speak English very well. Where did you learn it?”

“I am learn fast. I follow workers from MSF in Malakal and learn to speak good. We be there six month.”

“Have you just arrived in the camp?”

“Yes Doctor, we be here two weeks. Right after the Janjaweed come here and kill black women. We hide in riverbed, cover ourselves with sand.”

“Do you have any brothers or sisters?”

“No Doctor, it just mother and me. Father and sister dead.”

“I’m very sorry to hear that. Now, why do you want to help deliver babies? Have you seen a baby being born?”

“Many times. I want to be nurse.”

“You say you learn fast. May I test you?”

Nodding, she looked a little skittish, but replied, “Yes, I can do it.”

Paul stood and asked her to follow him. He led her to the autoclave where they had some instruments that needed to be sterilized. He picked up a scalpel and said, “This is a scalpel.” He set it down and picked up a clamp and said, “This is a forceps or a hemostat.” He then picked up another instrument and said, “This is a retractor.”

He set it down and asked her, “Are you ready?”

Nodding, she smiled and replied, “Yes, Doctor, I ready.”

“Okay then. Hand me a hemostat.”

She picked up the clamp and handed it to him handle first. Paul nodded and smiled. He then asked, “Hand me a scalpel.”

Nadia picked up the scalpel carefully and gingerly handed it to him so as not to get cut. He gave the girl a definite nod and said, “Excellent! You passed with flying colors! When can you start work? Now, you know that this is volunteer work, don’t you?”

Nodding, Nadia replied, “Yes, Doctor, I understand. I will learn very fastly and obey you in everything.”

“Alright. I’m going to give you your first lesson. This machine is called an autoclave. Say it.”

“Ah-tow- clay-vvv”

“Excellent.”

“This machine sterilizes instruments and makes them germ-free. Now, watch what I do. Now there are two kinds of baby forceps. One is called the Simpson forceps. They look like this. They come apart into two parts. The other pair is called Elliot forceps. Can you guess what we use these for?”

Nadia cocked her head a few times looking at their shape. She put her hands around her head and said, “To pull baby out of baby hole.”

“Correct. Very good girl! Now, we put these two pair of forceps into a tray and then wrap and tape it so that no germs can get in. Then, we put it in the autoclave and turn it on. But first, I think we need to have an anatomy class.”

“What is this anatomy class?”

“Do you know all the parts of a woman’s body down there?” Paul asked pointing to Nadia’s groin.

Nadia shook her head no.

“Well, if you’re going to be a nurse, you need to know all about the human body, right?”

With an affirmative nod, Nadia smiled and replied, “Right!”

“Okay, let’s go back to the desk.” He pulled out a medical book and marked the section for her and asked, “Can you read?”

“Yes, I read okay.”

“Okay, what does this page say? Read it to me.”

“The vulva is the part of your gen- ee-talls on the outside of your body — your lab-aha, clee-tow-ris, vagg-i-nn-al opening, and the opening to the er-eth-RAY- (the hole you pee out of) ―”

“Stop there. Let’s go over the pronunciation of all these words. Paul then began to explain in detail how to pronounce each word. Within thirty minutes, she had memorized all the parts of the female anatomy.

“What you can do, is to take this book home and find all of these parts on yourself. Where are your labia? Where is your vagina? Where is your clitoris” Find all these body parts so that you know where they are and what they do? Tomorrow, we will go over them and see how much you have learned. Okay?”

Nodding she answered, “Yes, Doctor, I obey completely. I learn everything you show me today.”

“Good girl! You have done very, very well today! I am very proud of you! I’ll see you tomorrow morning. You can go with me as I make some rounds, and then when we have time, we’ll go over everything you learned. Be here at seven am. okay?”

“Yes, Doctor, I will obey.”

Paul handed her the book, and she beamed a smile from ear-to-ear and pranced out the door like she owned the place. Abdul stepped alongside Paul as they watched Nadia leave and he said, “You sure put her through the paces. Don’t you think you were a little hard on her?”

“No ... no. That is one very smart girl. She had an eye for detail and a razor-sharp memory. The faster she learns the more we get done safely and the closer she gets to becoming a full-fledged midwife.”

Dashiki [dah-SHEEK- ee] quipped, “It looked like the little beauty has her eye on the young doctor, doesn’t it, Celeste?”

Celeste nodded and joked, “Did you see her give him the coquettish look out of the corner of her eye? Little Mama is on the hunt!” They both giggled, Singh smiled and snickered quietly.

Paul retorted, “No way! This girl is all business. Besides, there could never be anything between us. She’s just a child.”

Celeste shot back, “Child my ass. Besides, we all saw your eyes pop when she walked in the door. At sixteen in Nuer culture, she’s a single, old maid.”

Paul kept his mouth shut but couldn’t hide the reddening flush come over his face. Everyone just chuckled and let him save a little face.

Nadia was sitting on the ground waiting for Paul when he arrived at seven am sharp. She had her legs pulled up and held the book between her and her thighs, close to her chest. Paul was going to offer his hand to help her up, but thought he’d better not touch the young woman. Being young and agile, she stood without any trouble at all and followed him into the unit.

She followed him like a new puppy dog. He almost bumped into her when he turned to talk to her. “Oops!” Pointing to the coffee pot, he said with a smile, “First things first. I need some coffee to get started.”

She watched intently as he made a pot of coffee. When the pot was finished, he made himself a cup with three sugars and two creamers. Nadia watched the entire process from start to finish carefully. Paul offered her a cup, but she politely refused.

They went to his desk and they sat like the day before. She handed Paul the book and said, “I learn everything good. I know where all parts are on my body. I have question, but am ... how you say ... embarrass to ask.”

“Nadia we are both professional medical people. I am a doctor, and you are a nurse-in-training, right?”

“Right!” “Then, there is nothing embarrassing about the human body. Whatever your question, aske. Okay?”

“Nadia nodded, but still looked down as she quietly asked, “When I try stick my finger in my vagina, I touched something stop me and it hurt a little. What was that?”

“It was your hymen. It is a piece of skin that covers your vaginal opening. To protect you from getting anything inside of you. When you were a baby, you wore diapers and maybe got poop all over that area. As a little girl, you sat in the dirt or played in the mud. That skin kept you from getting anything dirty inside you and giving you an infection. When you have intercourse with a man for the first time, it will break.”

“Oh, when I make baby, he break it?”

“Yes, then you will not be a virgin any longer.”

“Oh, I know that word. It mean I not be with a man.”

“Yes.”

“I now understand. Thank you much for telling me.”

“You’re quite welcome”