Friday, April 25, 2014

Working and planning the Akot Medical Missions in the early days, before Mustard Seed involvement. Since Bill Deans closed the facility we built, the area is returning to these very difficult times. Very sad. Many will die.

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Thursday, April 24, 2014

Anyone know what this animal is? Found in South Sudan near Akot.


Wednesday, April 23, 2014

The Day I Touched Jesus. Notes on South Sudan

The Day I Touched Jesus

Jeffery L. Deal, MD, FACS, MA, DTMH

From Narrative Inquiry in Bioethics, Volume 2, Number 2, Fall 2012, pp. 81-84.10.1353/nib.2012.0051

She deserved better. They all do.
I met her early on a morning that promised to be hot and wet, as Sudan tended to be at that time of year. Hot all the time. Hot and wet in the summers. I touched her for the briefest of moments, felt her leg move against my hand and caught a fleeting glimpse of a foot that was barely the size of my fingertip.
Her twin brother was born eight hours earlier, somewhere around midnight. The birth attendants managed the delivery as well as could anyone in the same situation. The last time I had attempted to manage such a problem delivery was almost twenty years earlier when I had been a Navy Lieutenant fresh out of my surgical internship on temporary assignment to a Marine Corp battle group in the Philippines. On that deployment, a corpsman brought me to a grass hut where a woman who looked barely more than a child herself labored against a breach delivery. I spent the day examining her while her family brought me things to eat that I do not believe should be eaten. After six hours of no progress, I radioed for a helicopter to take her to Clark Air Force base where they had operating rooms and obstetricians. In South Sudan, we had no such resources.
My oldest daughter, a premed student at the time who had worked with me in Sudan on other occasions, sat in the corner with her classmates and watched as I put my hand inside the Dinka mother. She was a large, robust woman who sweated profusely and occasionally caught her breath, but otherwise seemed unmoved by the pain of delivery. Fluids gushed over my gloved hand and the students gasped. I felt the baby’s leg retract slightly as if she resented my intrusion. I could not get past her hip and she was wedged tightly in the uterus. I had some medicines that were used to hasten delivery and, not really knowing if it was the right thing to do, I gave the mother some through her IV. Still I could not dislodge the child. I told the students and birth attendants that we would give her one hour while I rounded on the other patients in our remote and poorly equipped clinic. If she did not deliver by that time we would take her to a facility run by a Catholic relief agency several hours drive from us-- a drive that due to war, weather, or mechanical problems we could not always complete.
I saw the rest of the patients in a hurry while browsing through all of the medical texts and the few books we kept at the clinic. This child’s only hope of surviving was for her mother to have a cesarean section, and as quickly as possible. After determining that none of our other patients were in imminent danger, we loaded the mother, the first born twin, and the grandmother into our vehicle for the long ride. One of the medical students who at the time of this writing was completing her residency in obstetrics and gynecology asked me if I shouldn’t pray for the woman while we drove. I felt guilty for not praying out loud without being prompted, so I reached back and placed my hand on the mother’s abdomen and prayed while I drove. I felt a slight movement that I could not be sure was not the mother or the road, but I believe to this day was the child again. I would not feel her again. I drove as fast as the rough, bomb-cratered dirt road allowed.
Mother and unborn child were doing well when we finally arrived three hours later. I knew the facility and many of the workers so I drove past the guard and directly to the obstetrics ward. Two nurses rushed out to meet us with a gurney and whisked the patient into a delivery room, a dusty place of peeling paint and old, powerless lights. They told us the surgeon was nearby and that they would take care of her. The rest of us left to find something to eat and to purchase supplies. We were gone for a couple of hours. When we returned, we found the head nurse.
“The baby has died,” she told me with a professional mask of seriousness. “We felt the baby’s leg and thought we could make the delivery. The child died while we were working.”
We asked to see the mother and were taken to the ward next door. The mother we had worked with so hard sat upright in the bed with a sheet over her lower body. Amazingly, she still did not look tired. Her Dinka name, my wife reminds me, was Adut which means “Replacement.” It is a name given to the next child born after the firstborn dies. Adut cradled the twin brother in one arm and stroked his cheek. The mother nursed the child and gazed at him with the look that only a mother can have—one of love, adoration, and hope. My daughter stood beside me while we spoke briefly to the nurse and to the mother. Adut did not seem troubled that we did not save her other baby and was content with the life she held to her breast. I had feared she would hold our failure, my failure, against us. When my daughter and her friends had left, I asked the nurse a question to which she responded, “It was a girl.”
I kept my face turned from the others as I got into the truck.
The ride back was mostly silent and seemed to take forever. Darkness had fallen over the flat land by the time we made it back to our tent camp. We all drank our filtered water, spoke encouraging words to one another, and went to rest for the coming day.
I have worked through epidemics of cholera, malaria, and meningitis where we lost scores of people each week and those hard days remain a distant and yet troubling memory. Something about the one, tiny being I encountered that day haunts me in ways that I cannot easily explain.
How low can a person be when she can die having never been held? Never been stroked or fed by someone who loves you? How low must a person be to die without a name in a place that will keep no record that you ever lived and where your own mother does not mourn your passing? It is hard for me to imagine anyone of lower standing than the girl who I touched ever so briefly that hot morning in Sudan.
Jesus spoke passionately of His desire for us to care for the poor and downtrodden in His stead, none more poignant that when He said “Truly I say to you, to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to Me.” The partially born girl that I touched that day had to be the least of the least. In retrospect, I could have administered enough local anesthetic to have surgically removed the child through a few incisions, but it had been years since I had done or even assisted in such an operation. We had no lights, no cautery, limited instruments, and no sterile rooms. Even had we had gotten the child out, we had no way to manage the bleeding and would have had to pack the wound open and rush her to the same hospital. It would have been like performing a cesarean section in your garage without electricity. Perhaps I should have tried. Perhaps I could have made the decision to drive her to the hospital earlier and she would have lived. Perhaps, perhaps, perhaps…, but I am not sure of any of that. Of one thing only I am certain.
She deserved better. They all do.

Tuesday, April 22, 2014

Videos of the celebration of opening the Akot Medical Mission. The facility was recently closed by Bill Deans. Very sad ending to a great effort by so many.

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Abraham on Prostitution and AIDS


(JLD) Does the word prostitutes mean something to you?
(AM) Yes. A prostitute is a lady who divorce with her husband. Prostitute also is very bad among the Dinkas. When a lady makes herself to be a prostitute it is not good. No one can marry her.
(JLD) Is she always a divorced person?
(AM) Yes. And when she made a prostitute way, no one can marry her. If she go and stay at the house quietly someone will come and marry. If the wife maker herself a prostitute lady, no one marry her. She just goes and makes tea for sell in the market and sleeping under her tukel (Swahili word for hut or house) and doing something what she like.
(JLD) Are there prostitutes in Akot?
(AM) Maybe. [1] (with a laugh). All the villages, all the towns there are prostitutes. I don’t know the number of them. I hope the town have no prostitutes. If it is a very small town, prostitute may not stay there. Many of the prostitutes make some of them, the tea, the beer, or alcohol, the tea… making food in the kitchen or in the hotel[2], that is their work.
(JLD) There are people who come to our clinic with diseases that are transmitted by sex. How do you think they get it?
(AM) Some people  they get it from the wife. Many others they go and have sex with others. Many people they go in the town and leave their homes they can mate with others. If another women comes to the village and mix with the others, that is another way to get diseases.

(JLD) Have your heard of HIV/AIDS?
(AM)I heard about that and I don’t know way of it. I don’t know the sign and symptom of it.[3] When you marry and the wife have no children, you have the permission to marry.
You keep the first wife and home and you agree with her to have marriage another wife. You do not send her back. You can treat her like the way you treat the wife who having children. You give them two houses to let that wife have her own children and the other her own children. If they (the wives) have a good relationship, they can help each other. It is the way of the relationship.
(JLD) Once I met a woman whose child was dying of malaria. She said she was so upset for fear that if another child died the husband’s family would not let her back because .
(AM)It is difficult with another people. If you know God is the one, the only (one to) have the power you can stay with your wife until God bless you to have your own children.



[1] The entire market place in Akot is situated along a single dirt road and is less than 100 meters long. Abraham was also born, raised, and still lives in Akot. He spends a great deal of time in the market socializing and drumming up membership in the local Baptist church. It seems, therefore, highly unlikely that Abraham is actually unaware of who the prostitutes are in such a small place.
[2] Hotels in this area simply mean a stopping place where travelers, almost all men, are allowed to put up their nets, sleep the night, and purchase food. They are not in this area structures as one might think of in
Western cultures.
[3] Abraham has worked as a translator at many of our remote clinic sites. He almost assuredly picked up this terminology during this work. He has no medical training of his own and makes his living as an evangelist paid by US Southern Baptists. 

Saturday, April 19, 2014

Review of the novel, The Mark: A Novel of Dinka in the Time of War.

"The Mark is a harrowing and beautiful story of a young man in the Sudan, a Dinka tribesman set in the midst of unimaginable turmoil; it is genuinely frightening and genuinely revelatory. Jeffery Deal has caught a true voice here, and the book's tone and texture make his hero, and the whole of his culture, matter to us immensely. I recommend everyone read this book."

Bret Lott. bestselling author of fourteen books, most recently the nonfiction collection Letters and Life: On Being a Writer, On Being a Christian (Crossway 2013) and the novel Dead Low Tide (Random House 2012)

Available on in paperback or Kindle format from Amazon US at the link below.
http://www.amazon.com/The-Mark-Novel-Dinka-Time/dp/149521155X/ref=tmm_pap_title_0?ie=UTF8&qid=1397935253&sr=8-3

Available on Amazon UK at the link below.
http://www.amazon.co.uk/Mark-Novel-Dinka-Time-War/dp/149521155X/ref=sr_1_1?s=books&ie=UTF8&qid=1397935498&sr=1-1&keywords=the+mark+dinka



Friday, April 11, 2014

"If a bomb drops in Sudan and no one hears, did it make a sound?" A newspaper oped I wrote several years ago. I think it applies to today's situation as well.

If a bomb drops in Sudan and no one hears, did it make a sound?
On November 15th, a friend of mine in South Sudan sent me a message that on the previous day, bombs had been dropped on several sites near him, one wounding a United Nations observer. I searched the US news websites and none of them mentioned the bombing. Three days later, another acquaintance told me that bombs were dropped near their orphanage resulting in unknown casualties. The orphanage was undamaged and the children were safe. Several African papers ran the story which was picked up even by Aljazeera, but as I searched for any US or western reports of the bombing again I found nothing In a country where the temporarily suppressed civil war has lasted longer than the average life expectancy of its inhabitants, where upwards of two and a half million people have been killed and millions more displaced into abject poverty, and where life in the best of times hangs by the slimmest of threads, war seems to be so much a part of normal life that it is no longer newsworthy.
On January 9, 2010 the most important event in Sudan’s history is scheduled to take place. On that day, in keeping with the Comprehensive Peace Accord forced upon the central government by the previous US president, the people of South Sudan will vote on whether they stay a part of a greater Sudan or they will secede from the union. By all accounts, the South will vote to secede. By the majority of accounts, the mostly Muslim central government will then resume its war upon the largely defenseless people of South Sudan. Last week’s bombings appear to be a prelude to this war.
Before its partition, the modern borders of Sudan make it, by area, the largest country in Africa. Northern Sudan, which includes the states of Darfur, has come under increasing Muslim influence while states in the southern regions have resisted such changes. The regime in Khartoum is recognized by the United Nations, the African Union, and the United States as the only legitimate government. It is also led by the only sitting head of state to be indicted by the World Court for crimes against humanity and to have an outstanding arrest warrant still in effect. Since obtaining independence in 1956 the northern central government and rebel forces in the South have maintained separate legislative bodies, armed forces, cultural identities, and economies. Sudan, therefore, has functioned in effect as two separate nation-states whose interactions have been characterized primarily by conflict and not cooperation for the good of its citizens. The result is the longest running civil war in modern times.
South Sudan experiences crippling conflicts that overlap and perpetuate one another. Family feuds erupt into violence often years after the initiating events. Clan wars expand to involve tribes. Tribal wars expand to involve government forces. Multiple rebellions trigger disproportionate retaliation from the central government that escalates to genocidal levels. International intervention is hampered by complex loyalties and agendas that treat human life as a commodity to be bartered. The discovery of oil in South Sudan may not be the blessing that many hope as it raises the stakes in a global economy where human life, especially life so different from our own, appears cheap and expendable. China already develops, exports, and protects the oil interest while providing weapons to the central government which are in turn used exclusively against its own people.
Brutality, mass rape, slavery, and genocide fill the history of this region where traditional African societies interface across a harsh landscape with Muslim/Arab societies. The region also lacks a history of successful peacemaking devoid of external involvement. Often the struggle for survival has forced ethnicity onto people who are not well served by modern political or cultural boundaries. Theses identities can turn with disturbing rapidity to a type of ethnic-bound loyalty which expresses itself in the recurrent retaliatory massacres, Darfur’s ongoing genocide, and the wholesale rape and enslavement of women and children—often with senseless violence and disregard for human life so horrible that the senses numb. Sudan is truly a country of extremes within extremes, but inhabiting these extremes are a highly marginalized people who deserve recognition and a voice. They are not, as I have heard them described, a “primitive people”, in any way except that they lack most modern technologies. They possess intricate relationships, a rich and complex culture, history, and sophisticated philosophies—in many ways more so than those found in Western urban cultures. In a word, they are humans whose similarities with the rest of us far outweigh their differences and whose worth is equal to our own. I am blessed to have known them during my time with them as both a physician and an anthropologist. I would plead with Western powers, including our president, to commit whatever resources are required to make known to Khartoum that we will not sit idly by as another generation of Sudanese are again ravaged by their own government and by neglect, by ours as well. If AP, Reuters News, CNN, and all of the major US papers and networks did not hear the sounds of bombs dropping it was only because they (we) did not listen.