The Letter from Khartoum

I had been in South Sudan for four months when Samuel arrived at our clinic. Our facility was a collection of canvas tents and corrugated metal structures about twenty miles outside Juba — a field hospital operated by Médecins Sans Frontières that served a catchment area of approximately 200,000 people with a clinical staff of twelve. We treated everything: malaria, tuberculosis, obstetric emergencies, trauma from landmines, malnutrition, cholera. We did not have a CT scanner. We did not have an ICU. We had a portable X-ray machine, a basic lab that could run CBCs and malaria smears, and a pharmacy stocked with essential medicines. That was it.

Samuel was twelve. He arrived on a Tuesday morning, walking into the triage area alone except for a small girl — his sister, he told us — whom he was carrying on his back. She was maybe five or six, listless, with the telltale signs of severe malaria: fever, anemia, altered mental status. Samuel himself had a visibly deformed right leg — a femur fracture that had healed at an extreme angle, probably from a fall months earlier. He was walking on it. He had walked thirty miles on it, carrying his sister.

We took the sister immediately — IV fluids, IV artesunate, blood transfusion. She was critical, and we weren't sure she would survive the night. While the team worked on her, I examined Samuel. His fracture was months old, fully healed in its deformed position. He would walk with a limp for the rest of his life, but the leg was not acutely dangerous. What was dangerous was his malnutrition, which was severe, and the infected wound on his foot from walking barefoot for — he told me — three days.

I asked him, through a translator, where his parents were. He said his father had been killed in fighting two years earlier. His mother had died of "the fever" — probably malaria — six months ago. He and his sister had been living with an aunt, but the aunt had told them to leave when food ran out. He had heard there was a clinic "where the white tents were" that would help sick people. He did not know how long the walk would take. He did not know if his sister would survive. He went anyway, because he was her brother, and she was his responsibility, and there was no one else.

Samuel's sister survived. We treated her malaria, corrected her anemia, addressed her malnutrition, and over the course of two weeks she transformed from a semi-conscious child into a curious, talkative five-year-old who followed the nurses around the clinic asking questions in Dinka. Samuel, meanwhile, watched over her with a vigilance that no twelve-year-old should possess — never leaving her bedside for more than a few minutes, always knowing where she was, always keeping an eye on the people who were caring for her.

I have thought about Samuel many times since I returned to the United States. I work in a well-equipped emergency department now, and I sometimes find myself frustrated by things that would seem absurd to him — a slow computer, a difficult patient, a shift that runs long. I think about a twelve-year-old boy who walked thirty miles on a broken leg with his dying sister on his back, and I remind myself what resilience actually looks like.