First Rain

West of Sudan -Rigl El Fula-Kordofan

Transformation & re-birth-after the first drop of rain:

It is impossible to describe to a British or European, whose land is always green, the miraculous and magical transformation of the land from barren desert to a magnificent multi-color green within seconds of the first drop of rain. The seeds and plants seem to be impatiently waiting to come alive after so many months of drought.

The painting (First Rain) captures this moment of exhilarating feeling, of astonishment, amazement and joy watching the magical transformation after the first drop of rain reaches the ground.

The rainy season in the West is in July and August. The dramatic transformation to green is breathtaking, joyful and intoxicating with a sense of something washing the soul & mind and everything inside and outside.

The Form and Content of the painting:

The Cubist or more accurately ‘trianglestic’ form of the painting was inspired by the peculiar triangle shape of the local cows that are very tiny and bony, literally half the size of European cows. Looking at any part of them from any angle, their bodies looked to me as if constructed of triangles. It gave me great pleasure watching them running around.

The vibrant green and sudden change was overwhelming. Even the sky seemed green! Amazing varieties of wild flowers of different shapes and colors sprung from nowhere. Colorful African birds, flocks of metallic blue starlings with bright red eyes and yellow weavers, multicolor bee- eaters and birds of prey filled the skies.

The sounds of migrant wild geese, ducks and cranes filled the skies celebrating the turn of the rain. People too are equally desperate waiting for the rain to cultivate their land with the most amazing varieties of fruits and herbs.

 The West of Sudan is famous for its charismatic (Tebaldi Trees- Baobab trees). These produce large fruits with hard woody conical shaped shells that contain hundreds of seeds covered with a lemony ‘sweet and sour taste’ loved by both animals like elephants and monkeys as well as people. 

The tree is devoid of leaves all summer until the rainy season comes. A full grown tree is massive; seen from a distance in the desert it looks like a fossilized dinosaur. Apart from its fruits, it used by people as water tank, to store precious water in autumn. Its trunk is very soft so people dig inside the tree to create a big hole and fill it with water for the long drought.  

I painted First Rain in Rigle El- Fula.  My compulsive desire to paint was urging me to start but as there was no color, paint or any artist materials to be found in that remote place I used local wall paints. I made my own canvas from a piece of cotton cloth.

Khartoum University Hospital-1968-1969:Favoritism in training and lost chance to perform caesarian Section?:

I finished Medical school in Alexandria, Egypt 1967. My first assignment was in Kharmuz Hospital a very poor and rough part Alexandria. Then I was transferred to Ameriea Hospital in the Western Egyptian desert. I had excellent training in all aspects of general surgery and medicine. After 8 months in Egypt I was informed that my training in Egypt would not be recognized in Sudan so I returned to Khartoum and worked as House Officer in Khartoum University Hospital for a year. I received a good training in all aspects of medicine and surgery except for obstetrics and gynecology where a colleague Hashim Ziada and I , both Egyptian graduates, faced some discrimination from our registrar. He favoured Khartoum university graduates so gave all our ‘chances’ to perform cesareans (under supervision) to his friends! We were effectively deprived of performing (caesarian section) operations, an important and essential training to prepare us for the next stage in our medical life that is working in the   hardship areas as part of doctors National Health Service! This caused me a great deal of anxiety later!

Immediately after I finished my training in Khartoum I was promoted to DS as medical officer & transferred to Al-Obied Hospital in the west of Sudan.

Heavy Work in Al Obied Hospital and the discovery of  Psychiatry

I worked in Al-Obied Hospital in Al-Obied City for about 7 months. Al Obied citizens are the most hospitable, friendly, and extremely generous people you can ever imagine and very pleasant to strangers. They always invited the junior doctor to their homes, weddings, and for Ramadan breakfast. I enjoyed working there.

However work in the hospital was extremely heavy mainly because of the shortage of doctors. To ‘spice’ up night duties a little, some citizens who have insomnia, come for a chat with the ‘duty doctor’ late at night as their favorite pass time hobby! 

Two other aspect of my work there was quite disturbing and unpleasant:

Infant Mortality:

Working in the children’s department was very depressing and distressing. Infant mortality rate was extremely high. Most babies are brought in from villages from around the city, sometimes from very far places, either on foot or on donkeys travelling for many days. Many die before arriving and many babies arrive dehydrated and too late to be saved. It was a heart breaking experience and I hated it.

Forced to attend hanging

Another unexpected and bizarre work that was forced on doctors, that I never thought has anything to do with medicine is to attend hanging, to examine and ascertain that the hanged man was dead! The Prison car usually came around 4 o’clock am to take the doctor to witness the death sentence and examine the body hanging from robe. I did it twice and hated it.

The Discovery of psychiatry:

In a strange way this heavy night duty was responsible for my falling in love with and eventually becoming a psychiatrist. I took my enormous workload in the Hospital as a matter of course, and was not thinking, let alone planning a way out of it. So one day when I was in the SMO’s office, I jokingly said, “I wish I can work only ‘by day’ like most people in Sudan and do no night duties!” He surprised me, by jumping out of his chair as if bitten by a scorpion or perhaps had discovered a Eureka moment. He shouted, “Yes there is such place! Dr Sheik Idris, the Psychiatrist, was begging for months to have a junior doctor to work with him but no junior doctor wants to do psychiatry. They all think it is a waste of time!”.

 At that point I asked what was Psychiatry and who Sheik Idris was!  He twisted his finger around his ears in a typical movement, meaning he was the mad doctor who treated mad people. I actually finished medical school without even realizing that psychiatry was a branch of medicine. We had not had a single lecture on the subject! Actually I was quite astonished that it was a branch of medicine at all! 

I went to work with Dr Sheik Idris with only one objective in mind… that is to have a rest from on call duties and enjoy some quite time. But as it turned out, the man was an amazing psychiatrist. He was also… a working machine and that was a bit embarrassing for me! He didn’t seem to need any breaks, no tea or breakfast or lunch breaks!

Soon I was sucked into that electric atmosphere. I was shocked and amazed and I became extremely excited and interested in psychiatry and did not want to leave the clinic.

For the first time I saw patients suffering from strange and unique symptoms never seen or taught in medical school.  I saw people actually talking and listening and responding to voices and having long full conversations with them. It raised profound questions and curiosity about religion and science and philosophy and history. Where did the voices come from?  Were angels or devils or even God talking to them or were these voices from within their brains? If so what was the mechanism?

I had studied neurology and had dissected the human brain but no one had spoken about voices or how the voices were generated? A question after 40 years in psychiatry still not fully answered or understood!

A door opened in the search of philosophical, religious, scientific and artistic expression. I wanted to know more, so I chose to study  psychiatry. The images, thoughts and emotions as well as suffering expressed by patients needed to be expressed in some artistic way and needed some scientific understanding.  

From then on I talked and talked about psychiatry and of my amazement in this subject which has never subsided 50 years after specialising in it. I still think it is the most exciting branch of medicine.  We are beginning to learn more about the complexities in terms of understanding human brain, behaviours and emotions.    

Rigle Al Fula (Hardship area) and my Anxieties regarding Caesarian Sections

After working in Al-Obied City for about 7 months, I was suddenly transferred to Rigle-Al-Fula Hospital, a hardship area. Rigle Al-Fula is a 30 bedded hospital covering a huge area. I was to take responsibility for all medical, surgical, gynecological etc on my own for the first time! For Good reason, my only worries were caesarian Sections!

The little story about corruption & my sudden transfer

Actually there was a little story behind this sudden decision.  As a doctor I have never opened a private clinic; I was against private practice mainly because of the serious corruption I witnessed. However, when I was approached by a charitable organization and asked to run ‘their clinic for the poor’ for free, I accepted.  They provided the place, a nurse and medication, and I was the doctor. With great effort it was a success. In no time people flocked into the clinic as it was also very cheap.

Unfortunately this upset many doctors with ‘private clinics’ and my clinic was seen as competition to them and in particular one senior consultant. He actually started threatening me with comments which I ignored. However immediately after that the  Senior Medical Officer of Al-Obied hospital who happened to have a private clinic in the area, informed me they took  a decision to transfer me immediately to Rigle-Alfula  Hospital,- a hardship area about 4  days drive from el- Obied! I knew why but did not contest it. In fact I did not mind at all. It was a dream for me going around to ‘wild Sudan’ and to experience its rich diversity of culture and terrain. I was on top of the world; I agreed immediately.

The Meaning of Hardship Medical Service :

 Hardship areas are villages and small places in the periphery of the Sudan’s one million square miles. They are areas that normally suffer from deprivation of services; they lack roads electricity, running water and of course medical services. I thought it was a good and fair policy to make it compulsory for doctors to work in these areas as it was the only way for the deprived to get some medical services.  However doctors dispatched to these areas are almost always juniors with very limited training and experience as consultants usually remained in Khartoum or big cities.

Unfortunately, even some junior doctors found ways of avoiding this service…. if they had the support of an important official or relative and can remain in Khartoum or another city so as to get the best training and scholarships and specialization abroad. The junior doctors who go to hardship areas are those with no support from an influential relatives or officials!

However, for me, I have always dreamed of travelling around those little areas in Sudan. These areas may be poor in modern facilities but very rich in nature and culture. I found village people better humans and highly civilized compared to those   living in the cities!  

Working in Al Obied and Rigle Al Fula was a life changing experience for me. I gained huge experience and confidence in myself as a doctor.  And I discovered psychiatry for the first time.

 

Travelling to Rigl-Al-Fula:

 Rigle El-Fula Hospital is a small 30 bedded hospital about 200 miles from El Obied City and a 3- 4 day drive depending on the encountered difficulties on the road, in particular during the rainy season. I was driven in an old English ‘Comer lorry’ driven by an elderly experienced and very pleasant driver named Ibrahim Abu-Kinga.

Rigle El-Fula was inhabited by the Meseria nomadic Arab Tribe… the Meseria were also called the Baghara i.e. Cow boys because they mainly reared cows… their very funny cows with their strange (triangelistic) appearance that inspired my painting! 

Apart from my medical responsibilities as the only doctor there, I was responsible also for the administration of the hospital budget and also the supervision of seven medical out-stations manned by experienced nurses. Babanosa, El-muglad, Lagawa are some of these outstations I needed to visit to check the running of the service.  

The depressed Colleague!

The Driver finally stopped in front of a house and knocked at the door. A young man came out but he did not greet me or invite in as expected in the Sudanese culture but briskly went inside, came out carrying two big bags, loaded them in the car with the help of the driver and ordered the driver to take him back to the el-Obied City!?

The driver introduced him as Dr. Abdul Gahder. He smelled strongly of alcohol and looked very unhappy. I asked him politely to officially hand over the hospital, as was the practise. He walked few steps on to the road and pointed to a building at the end of the road and sarcastically said that that was the hospital and, “take it!”  He jumped into the car and was about to leave!

At that moment I remembered ‘cesarean Section’! and my anxiety surfaced. I always felt that it was probably acceptable in a primitive and deficient medical environment to lose a patient if he died as the result of, say, injury or loss of blood, after making all the efforts to save him but what was totally unacceptable to me, morally, ethically and psychologically, was to lose a mother or and a baby a caesarian, because of my lack of experience or training.

I felt I would not have been able to live with myself and would definitely have stopped practising medicine.

So I asked Dr Abdul Gahder to stay for few days to help me orientate myself to the place and just in case I had a caesarian and needed his support.  He strongly assured me that caesarian sections were a rarity and he could not remember the last time he had operated on one.  He lied.

He was just depressed and fed up of the place after spending one year and was desperate to leave.

The House of Horror:

Following that strange encounter with Dr Abdul Gahder the driver dropped me in front of another big house, and told me that it was ‘the doctor’s house’ and they both left for Al-Obied.

The doctor’s house I soon discovered was a huge derelict unfurnished dirty place. There was no electricity or running water. I realized later that the place was endowed with a huge variety of insects and poisonous snakes like side winders and rattle snakes, cobras and an enormous species of scorpions! I was stunned as this was my first hardship assignment in running a hospital on my own! I was horrified as I did not even have a bed!

 I stood gazing in shock trying to think of what to do. Suddenly two men with the typical Sudanese jelabia (long white male dress) shyly and hesitantly approached me. The first one introduced himself as Mr. Ahmad Al-Awad the head of the Majlis i.e. The Council, and Mr. Faisal, his assistant. He simply asked me to stay with him in his house.

He spent a great deal of time and effort trying to convince me to stay with him! He said, “I am a bachelor, like you, I have furniture in my house, and an extra room with a nice bed. I have a fridge where you can keep cold water, and  oil lambs that you can use and we can keep each other company as I live in my own …..”. Gazing into the abyss of that horrific house, that was an offer I could not refuse and I did not need any more convincing! It was like manna from heaven; I gratefully accepted with no hint of hesitation and never looked back.

 My stay with Mr. Ahmad Al-Awad and Mr. Faisal was the most amazing experience and friendship.  It had turned my hardship work to real fun and a great experience.

The Luckiest man in Rigle-Al Fula- with Snakes:

As for the snakes it seemed that Mr. Ahmad was the luckiest man in encountering snaky wild life experiences twice in his own house, one in his bed room and one in his bathroom with disastrous effect on his furniture!

One after noon, I woke up with to a loud screech and breaking noises. It happened when Mr. Ahmad who had just woken up from his afternoon siesta half awake looked under his bed and wondered, according to him, who put this beautiful bicycle chain under my bed, and as it looked tempting to touch, he did just that; the bicycle chain moved and Mr. Awad panicked. In trying to defend himself he smashed almost everything that could be smashed. The bicycle chain was the lovely pattern on the back of a side- winder!

The second time was in the evening, when he had just come from a visit to his family in the Lagawa Area and wanted to have a refreshing shower. Now we had a wet bathroom with a drainage hole. Frogs for good reason love to be in wet areas in desert places. And off course snakes tend to follow frogs…

 Mr. Ahmad went into the shower carrying an oil lamb and   locked the door. It was dark so he needed few minutes to adjust before hitting the panic button when he discovered he was not alone in the bathroom. He screamed and screamed in terror, smashing his wooden Donkey, a piece of furniture used to hang clothes while taking a shower. This time the snake was a cobra but thank God, both Mr. Ahmad and the snake managed to escape unscathed.   

My first Caesarian Section:

The next day I went to the hospital. I was taken around by the senior nurse only to discover that there were two women who had recently been operated on. The very next day I had to perform my first caesarian operation! To add to my anxiety she was the daughter of the Sultan of Rigle al-Fula. Her name was Sirror.

A further complication, she was a primi-para i.e. her first pregnancy. She had a contracted pelvis, that is a small pelvis that would not allow normal vaginal child birth!

I kept remembering the notorious Mr. Murphy who predicted that anything that could go wrong will go wrong… simply my fears and nightmares perfectly materialized. To make things worse, I was assisted by only two nurses, one to administer the anaesthesia, and the other, the surgical assistant.

The anaesthetic used at that time was open ether. Ether is a highly flammable gas, administered directly using a mask that covered the patient’s mouth and nose. The patient would breathe the ether and air through the mask and fall asleep. Off course because there was no electricity, we had to use a special oil Lamp (Petromax) that was extremely hot, while administering the ether to see what we were doing! That off course increased the risk of explosion and fire! A further risk to patient, apart from the inexperienced doctor, there were no facilities for blood transfusions in the hospital!

My fear and anxiety of the caesarian was such that I kept thinking to myself  that if the mother or the child died because of my incompetence or mistake, I promised  to stop practicing medicine altogether. 

 I had witnessed the operation performed even though had no firsthand experience so I read about how to perform the operation a few hundred times before entering the surgical theatre! And I brought all my surgical and obstetric books with me in to the theater… just in case I needed to open and read them!

A pleasant surprise was waiting for me; the two nurses were highly experience in their work and very confident and relaxed. So I felt quite relaxed and I did not need my books. I just used my experience in anatomy to guide me. The most difficult moment for me was when I picked the scalpel to cut the skin. It was a strange feeling of violating another human’s body, but this did not last long.

Once I opened her up, I proceeded step by step and I did not feel the passage of time, until I had the baby was in my hand.

Now I faced another unexpected problem… trying to close the wound. Because muscle relaxants were not available and not used, once the effect of the anesthesia waned, the abdominal muscles started to contract vigorously and rigidly pushing the content of the abdomen out!  It became quite difficult to get the intestines in and close the wound, so we had to add more Ether, with the increased risk, to put the patient to sleep and finish!!!

Eventually I closed the wound and mother and child was alive and well. However my anxiety and worry continued; what if something else went wrong like bleeding? So I spend the rest of the night sitting in a chair near the mother’s bed measuring her BP every half an hour. At around 8 am the mother woke up with a big grateful smile. I was exhausted.

She named her child Taha after me. I went home but I could not sleep. I was excited and to some extent elated with my success in having performed my first Caesarian section. Few days later another patient needed a cesarean and then another and I remembered my friend The Liar!

 

Forensic Doctor by force:  Autopsy under acacia tree ?

One last bizarre event took place Rigle Al-Fula that is worth mentioning. One day I received an order from the local judge to do a post-mortem on a young teenage girl who was found hanging on a tree. The police suspected that the girl was killed because she became pregnant i.e.  (Illegitimate Pregnancy) and she may be killed by her relatives (Honor Killing) or that she hung herself.

I protested to the police and the judge as I was not a pathologist or forensic specialist but to no avail.

 Now the question was where to do it? I asked the experienced nursing staff. I was told this had never been done in the hospital before. I was given all the necessary tools and a special gown but there was no special place in the hospital to perform the autopsy. The senior nurse suggested doing it outside, under a tree, as the hospital grounds were full of trees. He erected six medical screens creating a room under a big acacia tree and brought the body on an old hospital trolley. It was an awful and horrific scene. Her body had been left in the sun for few days and was swollen.  As I did not have a clue about how this, I knew it was going to be a very messy job. I did not know where to start. Finally I gathered my courage, picked up the scalpel to open the swollen abdomen that I was dreading. Suddenly I heard a thunderous sound of steel objects knocking just over my head and turned to look. I was surrounded by over 100 angry men all carrying swords, knifes, and spears waving over my head!

An older angry bearded man waved his sword in my face and said, “I am her father. If you touch her with your knife I will take your head off !”. I was completely astounded. I was totally alone without any protection! That was persuasive enough for me to instantly throw my tools and gloves on the ground and walk away. In a way I really felt relieved!

The family took the body home to bury it and the police did not dare stop them.  Justice of course was not done. We will never know the truth about the girl’s death, suicide or murder.

I realized after that I was put in an extremely dangerous position recklessly by the local police and the judge. I could have lost my life in an instant. Unfortunately this incident also throws light in applying justice in those hardship areas.

  After four months in Rigle-Al-Fula I returned back to Al-Obied and discovered my next assignment to another, even more dangerous hardship area, The South of the Sudan, where a civil war was raging since 1955. I was on top of the world! I had gained priceless experience in hardship areas and I had met amazing friends, seen amazing cultures and returned with more confidence and I was happier with myself!


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