When I hear the news of Somalia, I think of the Sudan in 1984.

That was the year of a great drought in the Horn of Africa. The combined stress of famine and the civil war in Eritrea (northern Ethiopia) forced thousands of Eritreans to flee their homes. Many died before reaching the refugee camps in the Sudan. Suffering in the region attracted the attention of the world. We responded with government aid, private aid, food shipments, TV cameras, and rock concerts, as our hearts opened and our generosity flowed.

After a while, our attention turned to other crises. But the Eritrean refugees remained in the Sudan with nowhere else to go. Food rations were cut as aid dwindled. Conditions deteriorated after two military coups. In Eritrea, the fighting still raged after twenty-five years of war. And here in the West, the situation rarely made the news.

Already in Somalia, the Marines are leaving and the TV reporters are following close behind. Relief will eventually dwindle as the West realizes that after all the flurry of money and concern the problem still remains. Children who were fed will become malnourished again or be killed by warring gangs. And relief workers will begin to wonder what they’re doing there.


I live in Wad el Hileau, an Eritrean refugee camp two hundred miles due east of Khartoum, the capital of this God-forsaken country. I know that when I go back home after completing my work here, the insidious haze of nostalgia will steal in. I will remember the nomadic women in silver-studded black veils, the mournful cry of the muezzin calling the people to prayer before first light, the faithful laying out their mats and bowing toward Mecca, the shimmering mirages and dust devils dotting the unbroken horizon, and the camel herds silhouetted against the setting sun.

While I am here, I write in my journal to preserve the record of what living and working in the Sudan is really like. It will tell another truth.


In Arabic it’s called a haboob. The three-day desert dust storm saturates the air with fine sand dust, filtering the sunlight. The Sudanese walk with their veils and turbans wrapped tightly around their faces, while scraps of last month’s uncollected garbage swirl around their feet. Scrawny stray dogs lean sharply into the wind.

Every few hundred feet is another deserted building, twisted metal rods protruding from the topmost floor. It’s hard to tell whether the buildings are going up or crumbling down.

Khartoum is number one on the U.S. State Department’s list of hardship postings for international diplomats, and it pays a 25 percent bonus on top of their salaries in compensation for the rigors of living there. There’s no extra stipend for volunteers like us, though — just an extra allowance of griping and grumbling. For the Sudanese it’s just the way it is, and they say ma’alesh, which means never mind.

As I ride through the midday twilight of the haboob in an air-conditioned car with the windows sealed and a Beethoven symphony on the stereo, I feel like I’m sitting in a comfortable theater seat watching a post-nuclear science fiction film — until I’m jarred into reality when the car hits another pothole.


In the countryside, Sudan is a land of monotonous brownness — brown dirt, brown huts, brown dogs, and brown people. The sun burns away all frivolity, leaving only the people’s instinct for survival. Nothing vulnerable could survive more than a moment here. It takes the most incredible strength to laugh, to build, and to bring children into an otherwise barren land.

I stared at him unbelievingly: I had never seen a child die before. Children don’t die in American emergency rooms just because they stop breathing.

Tonight I was called by the midwife at our clinic to see a woman who had just given birth. When I arrived, she was unconscious in a fever while the fat, rosy newborn lay wide awake and kicking on a nearby table. Three women wrapped in bright veils, with intricate facial scars and nose rings, hovered over the patient and asked me repeatedly, “Kayf hassa?” — How is she now?

“Who will feed the baby?” I asked, after ordering medications for the mother.

“The mother, of course,” came the matter-of-fact reply.

All three women set to work squeezing her breasts to see if there was milk. There was much consternation when the first breast had none. But the second one yielded a few pearly drops to their inquiring fingers. The newborn was laid next to the productive breast, and she latched on without coaxing, sucking hungrily. The mother, who previously had made no response to the women calling her name, the painful injections, or the milking of her breasts, now softly moaned in response to her nursing child. At first, I was afraid the newborn would sap the mother’s already meager strength. Instead, she responded to her child as if by instinct.


I came to the Sudan because I wanted to help people and provide medical care to the underserved. But mainly I came because I wanted to experience life on the edge. I wanted to escape the numbness of living in America, where everything comes easy.


Outside in the moonlight, on the way to the latrine, I notice that the high clouds of the last couple of days are clearing, and I can see the constellations: Cassiopeia, Orion, the Southern Cross, and Scorpio. My heart sinks as I realize that tomorrow will be yet another sweltering, sunbaked day in Sudan.

Inside the latrine, I’m reminded that someone before me felt the same way about Sudan and attempted to stave off the oppressive brownness with buckets of multicolored paints. She painted an imaginary shelf of books on the wall, with titles like The Diary-R Of Anne Frank, and a scoreboard of the hits and misses of previous residents. Someone recently had a miss in real life — diarrhea is smeared down the back wall of the hole.

I avert my eyes and watch the antics of copulating cockroaches on the wall instead. The “Far Side” cartoon mocking our repulsion at bugs is too curled-up and faded to read, but I know it by heart, and it offers a fleeting, humorous perspective. Sudan is a showplace for the horrors of the insect world. There are worm bugs, which are bulging orange larvae with wings, and blister bugs that burn a painful red blister wherever they touch the skin, and stink bugs that release a skunk odor when squashed.

Last month was cockroach mating season. I went to the latrine one night, and more than a hundred of them, each two inches long, covered the walls and were running in and out of the hole. At least half of them were stuck together and couldn’t even get coordinated enough to scurry away when the lights came on. They had completely taken over, so I gave ground gracefully. I peed behind the hut instead.


Living on the edge means that many people slip over. The Sudanese and the Eritreans accept it as inevitable. In time, maybe I, too, will learn to say ma’alesh.


Making daily rounds with Habte is frustrating because he has the weakest skills of all our Eritrean medical assistants. At the same time he is one of our nicest employees — always happy and ready to help out — so I haven’t had the heart to demote him to a position he can more capably handle.

Midway through our ward rounds this morning, he presented the case of a boy admitted half an hour earlier with malnutrition and malaria. That history fit nearly every patient on the ward. But when I turned to examine the child, I was horrified to see an emaciated two-year-old gasping for breath. There was fear in his wide eyes as he writhed on the bed. His muscles were too weak even to lift his head, which made his flailing all the more pathetic. According to the mother, who looked concerned but calm, her son’s condition had gradually worsened over the past week.

I knew he needed oxygen, a ventilator, and a chest X-ray. All of those things were out of the question in our thatched-roof clinic with grass walls that went only halfway up the sides. Still, I needed to do something — anything — fast, so I decided to start an IV. You always need an IV in an emergency.

I concentrated on starting the IV, wondering how the mother could stay so composed as she watched her son’s torment. It wasn’t until I had taped the IV in place that I realized the child had become quiet — deathly quiet. He was no longer gasping, but was lying still with a fixed gaze.

I stared at him unbelievingly: I had never seen a child die before. Children don’t die in American emergency rooms just because they stop breathing. We resuscitate them and put them on ventilators to at least simulate life for a time.

I was still transfixed when Habte took over. He scooped up the boy, handed me the IV bottle, and ordered me to come with him. We carried the body to a little room off the nurses’ station, where he began wrapping the child in the traditional way. I sneaked a look down the boy’s throat at the epiglottis, still trying to make a diagnosis, before he wrapped gauze around the chin to keep the mouth closed and the spirits in. He covered the face with cotton, tied the thumbs together, and connected them with a length of string to the big toes. Then he wrapped a blanket around the body and tied it securely. Meanwhile, the mother was squatting outside on the floor of the nurses’ station, wailing. The other women gathered around, silently watching her.

Within minutes of the child’s death, the body was prepared, and Habte matter-of-factly carried the bundle to the pickup truck and put it in the back. The mother climbed in with it, and I drove the dead boy and his wailing mother home to their hut.


Wherever I go, my white skin stands out like a signal flag of wealth and privilege. I want to be a part of the community, but to those who live here I will always be a khawadja, a foreigner.


I live trapped in the khawadja compound. As soon as I leave it, people yell “KHAWADJA!” at me, as if I need to be reminded that I am an outsider. Sometimes it’s shouted as a greeting, but more often it sounds to me like a taunting accusation. For the children, it’s a game. They twist the word into four demonic, singsong syllables, “khaa-waa-jeeee-yaaaaaaaa.” Inside our compound, I can usually escape into privacy. But for the moment, I can’t even do that, because our grass fence is being repaired. Sections of it are down, and people gather outside to look into the forbidden, walled-in place where the strange foreigners live in brightly painted huts with a generator and a latrine.

Last night I dreamed about our neighbors on the south side of our compound, just across the fence from my hut. I can hear them all day long but never see them. In the dream, they were standing outside a dismantled section of fence — all men in turbans and white jalabiyas lined up shoulder-to-shoulder, yelling “khawadja!” and menacingly pointing spears at us.

On my first Friday night in Wad el Hileau, I went with other clinic workers to a concert in town. Teenaged boys threw rocks at us hard enough to bruise my leg. Our truck’s windshield is broken because children yelling “khawadja” threw rocks at it in the refugee camps. Are these kids just troublemakers, or are they actively expressing what everyone here is thinking?

We must be resented because although we are the largest employer in town, with over one hundred employees at our clinic, the wages we pay locals are too low to maintain a family at subsistence level. Our organization is “humanitarian” and apparently feels that our employees should be humanitarian, too: we expect them to work for the common good of their fellow refugees, with no regard for their individual personal needs. We Americans are volunteers, receiving room and board but no salary. Yet our pocket money is more than the salaries of most of our employees, who are the sole breadwinners in their families. I feel like I’m making a sacrifice because I’m a doctor living in a mud hut, making only twenty dollars a month. But I’m rich compared to the people who call me khawadja.


When our living conditions deteriorate, the gap between us and them seems to narrow. But then something happens that shows me it is even wider.


Everything was difficult before the military coup last month, and now it’s worse. People stand in endless queues for bread, sugar, and flour, only to be eventually told they’ve run out. There’s no diesel fuel to run the trucks that bring fruit, vegetables, and canned goods to the market from Khartoum, across the sandy desert. The restaurants are closed for lack of food and fuel. Shops close mid-morning for lack of stock. The market, usually a bustling hubbub of activity, is desolate and deserted.

We khawadjas are faring better than most during this time of hardship. Unlike the locals, we’re able to get fresh-baked bread daily because the army commander representing the National Salvation Revolution in Wad el Hileau thinks we are important enough. I think the people here have forgiven us for having bread, because being influential is respected in this culture, and preference for friends, family, and the powerful is expected in the policy of any worthwhile government official. But I don’t think they’ll ever forgive us for having sugar.

Sugar means more to the local people than it does to us. They won’t drink tea with less than four teaspoons of sugar in each four-ounce glass, and their culture revolves around tea. Usually, the market is full of stalls overflowing with turbaned men in white jalabiyas lounging and drinking tea. Tea is served every time you visit someone’s house, a government office, or a shop, and it’s considered impolite to be too busy to sit and drink it. At our clinic, the most popular spot used to be the tea shop run by a refugee woman. Every morning, she would bring charcoal, a teapot, a tray with ten glasses, a canister of tea, and a bigger canister of sugar from home. She did enough business to support herself and her two children.

But since the coup, sugar has disappeared. You can’t buy it anywhere — not even on the black market. The tea shops have closed. The tea lady at the clinic stays home. Visiting, negotiating, and shopping languish, and people complain all day of headaches that they attribute to the lack of sugar.

When our living conditions deteriorate, the gap between us and them seems to narrow. But then something happens that shows me it is even wider.

But we khawadjas have sugar. For a while, the army commander gave us a two-kilogram ration every couple of weeks. One day, two of my favorite staff members, Afeworke and Tadesse, came to our compound soon after the two kilos had arrived. It was all on the table in clear plastic bags. I tried to joke about how big the pile seemed when it was all together like that, but they couldn’t tear their eyes off it; there hadn’t been any sugar in their households in weeks.

I told them I wanted to give them some to take home, but I was afraid word would get out and the rest of our employees would demand a share too. But that was only part of the reason. The truth is, I wanted every grain of that sugar. I craved it. At home I don’t even keep sugar in my house. I don’t take it in my tea or coffee. But in this hellhole of heat and dust and bugs, that sugar held all the sweetness of life within it. I clung to it as one of the few things that stood between me and the destitution and degradation of the people here.

Finally even the army commander ran out of sugar. But it was still available at the American dollar shop in Khartoum for those rich and influential enough to have foreign currency. At one dollar a kilo, we bought forty kilos, shared some with our khawadja friends, and stockpiled the rest. But water finds its own level, and we had dammed up too much of it. Our compound was broken into while we were out last night. They stole some of our money — and all of our sugar.


I know it’s wrong to have so much more than those around me, yet I’m unwilling to give up what little I have and be cast into the ocean of suffering that threatens to swallow me up.


I escape to caviar and freezer-cold Russian vodka, my rations from Julian. He feels that all of us here are refugees — cultural refugees — and that his mandate from the United Nations High Commissioner for Refugees extends to us, as well.

At Julian’s, there are no camel spiders or worm bugs. There is twenty-four-hour electricity, with generator backup. He has a CD player and acoustically perfect speakers. We drink Tanqueray gin instead of bootleg Ethiopian firewater smuggled over the border on camelback. At Julian’s, I can forget that I am in Sudan. It’s even better than home; I’ve eaten more caviar here than I’ll probably ever eat again in my lifetime.

Ethical dilemmas and hardships are left at his gate. The only rule of the house is to enjoy yourself to the fullest. Self-restraint is superfluous in Sudan, where life imposes more limits than necessary by its very nature. There is respite in Julian’s oasis. I can stuff myself with delicacies and wear my finest clothes, and for a short time the poor, the hungry, and the downtrodden struggling to survive outside in the desert don’t exist.

Tonight, the dinner party turns into a dance party between the hors d’oeuvres and the main course. A sheep’s head is the macabre centerpiece of the buffet, and the chocolate cake is garnished with a locust. Paul is thrown in the pool along with his chair and cocktail. Dr. Pierre hangs from the rafters sans pantalon. When Nino, holding a video camera, asks me what I have to show, I bare a breast from under my swimsuit. Ma’alesh.