“Thank you for coming. Have you checked everything in the back?”
“Yes, Dr. Chris. Dr. Nikita and I went through everything twice and Jean Miguel has all the papers.”
The border crossing was in two parts. For those on foot there was a separate queue, which on both sides of the border stretched for half a kilometre and was three persons wide. He could only imagine the uncontrolled chaos in 1994 when 10,000 to 14,000 tried to squeeze through following the eruption of the Nyirangongo volcano in the Congo. For those traveling by road, there was a queue of five vehicles waiting to be processed and passed through the checkpoint. Five military personnel with automatic weapons supervised the process on either side of the border. Jean Miguel handed the official papers out the window, said a few words, and they were quickly waved through. Jean Miguel explained that the hospital was about fifteen minutes from the border. Hawker’s stands dotted the roadside, selling everything from fruit to souvenirs, and clothing.
The hospital entrance was a large wrought iron gate that had been tied open. On either side, a white plastic fence extended for twenty metres. A small wire fence continued from the plastic fence around the perimeter interrupted every four or five metres by missing segments. Driving through the gates, Christian could see the sealed road stretched and curved eight hundred metres up a slight hill to the hospital entrance. Six large white marble-like pillars dominated the front of the hospital. Set back from the pillars was main section of the hospital. Unlike Garanyi hospital, it was constructed out of rendered plaster, and had been painted white. Difficult he imagined to keep clean but true to its historical 1950s development.
On the flat lawn in the front of the hospital, tents were being rapidly erected. Blue plastic sheets had been thrown on the ground as a makeshift floor. Jean Miguel drove past the tents and stopped on the roadway in front of the pillars. As Christian opened the cab door, he was greeted by multiple voices, speaking rapidly in French. Satilde slid along the seat and quickly joined him next to the truck. She addressed one of the men in a white coat who was closest to Christian and appeared to be in charge. After a few minutes, she explained to Christian that they wanted to take the ambulance out to the airport to retrieve more patients. They would unload the emergency kit and take it down to where the tents were being assembled. The wards were already overloaded and they would need to triage the new patients down in the tents.
Christian looked back down the hill and in the distance could see the first ambulance approaching. They would hardly have time to get the emergency kit unpacked. Under Jean Miguel’s direction, the hospital workers lifted the emergency kit off the back of the ambulance and Christian followed it down the hill to the first of the tents, which had now been fully erected. The side of the tent, closest to the main entrance, had been rolled up and the space within would allow thirty patients to be laid on the floor. Christian shouted to Jean Miguel to have the emergency box placed close to the entrance. He could hear the sound of the ambulance and knew that they must only be six or seven minutes away. Burn patients needed to have the intravenous fluids and pain relief ready as they arrived.
Five minutes later the first ambulance stopped in front of the tent. Six patients were brought in and placed on the clear plastic. Christian was shocked to see that they were all young boys ranging in age he thought from ten to sixteen years of age. Some were grimacing, others were crying out unable to bear the pain of the burns. He quickly scanned the young boys, looking for ongoing bleeding. Beneath two of them, he could see a red pool of blood starting to enlarge on the blue plastic floor.
“Satilde, these two are going to need IV lines and fluids.”
Christian moved to the first of the two young boys. His pulse was rapid, suggesting significant blood loss. The pair of scissors that he had taken from the emergency kit he used to cut off his bloodstained shorts and T-shirt. He had a bullet wound through the thigh, and the exit wound had destroyed a substantial amount of it, suggesting a high velocity bullet. Fortunately it was on the outer aspect of the thigh, and therefore away from the major artery. It would respond to a pressure dressing. He called Jean Miguel, demonstrating with his hands what he needed. The next boy had a gunshot to the upper arm, which was a flesh wound. That also would respond to dressing. He quickly moved to another young man with a pool of blood developing beneath him. As he approached the young boy, his breathing became rapid. Christian frantically looked for a bleeding site and then with a small sigh, the young boy stopped breathing and died in his arms. Christian closed his eyes and moved on.
By 9 PM he counted, they had twenty-three young men side-by-side in the tent. They had run out of intravenous fluid after the arrival of the twentieth patient. Satilde had called Dr. Nikita for more supplies; however, he could not supply them as the ambulance was already out on another emergency call. Christian realized that some of the boys would die, whom they could save, if they had intravenous fluids. He took his mobile phone out of the zip pocket on his pants. He dialled Mohammed; desperate times needed desperate actions. He quickly explained the situation to Mohammed. Four young men on motorcycles would be there within the hour Mohammed assured him, with as much as they could carry. Would Christian please alert Doctor Nikita? Christian said he would, hoping that Emmanuel would also understand.
Within the hour four motorcyclists arrived, baskets in the front and back bulging with bandages, intravenous fluids, and medications. Satilde and Jean Miguel, whom Christian had quickly taught to insert an intravenous line, moved amongst the remaining boys to give them fluids. Christian estimated that more than forty per cent of the boys whom he triaged had burns covering more than half of their bodies. The ones with the severe third-degree burns were ironically the lucky ones at this stage. Deep third-degree burns melted the two layers of the skin and destroyed the pain receptors. Their pain would come later with skin contraction. The others who had first and second degree burns needed pain relief. Christian decided to call a brief meeting and prioritise treatment. He indicated to everyone the boys who had first and second degree burns. They were to be administered ketamine and were to be regularly examined, to make sure that they were not overloaded with intravenous fluids.
“You need to sleep,” Satilde said as he finished his briefing. “We have done everything we can and we are going to need to do surgical debridement on some of these boys tomorrow.”
Christian could feel the adrenaline ebbing and with the creeping tiredness, he knew from experience, would come a blunting of his surgical sharpness.
“Where do we sleep?”
“The small tent, just behind this one. We are all sleeping there.”
There were still cries of pain as he did one final visual check. Four nurses had arrived from the main hospital and Satilde had given them instructions on dressings and looking after the intravenous fluids. He waited for her to finish giving instructions, and heard her say in French, as she joined him, where they would be if they were needed by any of the patients. The tent was the size of a small room, similar to the one his mother had once taken him camping in the Flinders ranges outside of Adelaide. In the moonlight, he could see four mattresses, each with a sheet and a pillow as well as the outline of a small primus stove with coffee and cups balanced on top. Next to the stove were four fresh bottles of water. He quickly handed one to Satilde before consuming three quarters of one of the other bottles. The constant activity and heat had left him dehydrated. He was also hungry but knew that there would be no food until later that day.
Satilde crawled under her sheet without removing her surgical scrubs. She turned on her side pulling the sheet up over her head and said good night. The sheet pulled up over her head, Christian realized, was going to be her mosquito net. He climbed under his sheet without taking off his surgical scrubs until he realized he was too hot to sleep. Peeling off his surgical top and trousers, he tucked them under his pillow before pulling the sheet over his head fractionally ahead of the first mosquito. Intent on a blood meal it settled on th
e sheet over his ear, amplifying the annoying buzzing sound. He could not stand it, and swatted at it with his right hand uncertain as to whether he had exterminated it. There was no tell-tale smudge of blood on the sheets and five minutes later, the dreaded sound returned. He wondered whether it was the same mosquito seeking revenge for the attempted assassination, but there was more than one buzzing sound and he knew it had probably passed its bloodsucking message to family and friends.
The next noise to wake him was the pan on the primus stove. He opened his eyes and noticed it was early morning. Exhaustion had overwhelmed the annoying sound of the mosquitoes, so that he had slept. In the corner of the tent was someone he did not recognize cooking tomatoes and eggs. He looked at Christian as he heard him stir and smiled.
“We have brought new supplies,” he said in perfect English. “Mohammed also thought that you would need something to eat which was fresh.”
Christian rubbed his eyes and noticed small red welts on his arm. In the night, his arms had come out from underneath the sheet and the mosquitos had had their revenge. Not everyone, he told himself, got malaria from being bitten; he had to hope that he was one of those. Just in case, he would ask one of Mohammed’s motorcycle couriers to pick up his doxycycline on the next trip back to Garanyi.
“Thank you and tell Mohammed we are extremely grateful.”
Christian pulled his surgical scrubs on and noticed that both Jean Miguel and Satilde had left the tent. As he looked out through the rolled-up front flap, he could see them in the distance already checking intravenous lines and patients. He hurried through the scrambled eggs and tomatoes, understanding the need to have some energy source for the difficult day which lay ahead. A half cup of unfinished coffee that sat next to the primus stove completed his breakfast.
“Thank you for breakfast,” he said to Ashik, who had now introduced himself, before walking out through front of the tent, ducking underneath the flap, to join Satilde and two other doctors from the hospital in the large emergency tent.
“Good morning, Satilde. Were there any dramas overnight?”
“Good morning, Christian. No real dramas although I think we are going to be very busy today during debridement and dressings. Would you like a quick catch-up on each of the patients?”
“Yes, let’s start with the ones that you’ve already seen and then we can do the rest together. Do we have a clearer idea of what happened at the airport?”
“We do. Bosco the Butcher with his boy soldiers tried to ambush Kariba’s gang at the airport. They then started shooting and one of the bullets ignited the diesel tank. In the confusion some of the boys then tried to run and were shot; the others were obviously burned by the explosion. Bosco’s gang was the worst affected and he retreated. From what we can understand, some of his boy soldiers were captured by Kariba and tortured. Those that survive he will send to his mines to work.”
“Welcome to Africa,” said one of the doctors from the hospital who had joined them and overheard the conversation.
The first four boys they reviewed had first and second degree burns. They were well hydrated, and with some ketamine all they would require would be antiseptic to their burns and light dressings. Looking at their faces, Christian could tell their pain was well controlled, but there was still a frightened and bewildered look. He asked Satilde to ask them how they were feeling. When she spoke to them, he noticed they cast their eyes down and did not reply. He looked at Satilde and she said,
“They won’t say anything because they think that we going to sell them back to Kariba or Bosco and they might be beaten again or sent to the mines.”
Feeling powerless that he could not remove these boys from their nightmare, Christian moved on to the next boy patient. Aged about twelve years, like the others he kept his eyes cast down, as they stood at his feet looking at his chart.
“This is Michelangelo,” Satilde said. “He was the boy who was captured and was being beaten by Kariba’s gang, but managed to escape when the first ambulance arrived. He has a broken left arm that we need to reduce and set in plaster. He has multiple lacerations on his back where he was whipped, which will need to be treated and dressed.”
Christian lifted up the sheet and saw the slightly angulated left forearm. It had not broken the skin and therefore reducing it would be straightforward. As he indicated to the young boy to turn on his side so that he could inspect the deep lacerations on his back, instinct took over. In English, he whispered in his ear.
“Don’t be afraid, we won’t let you go back, I promise. Cindy will help.”
Michelangelo did not turn over. He looked Christian directly in the eye and with tears welling up, said,
“Thank you, Doctor.”
“You know him?” Satilde said obviously shocked, as Christian rearranged the sheet around Michelangelo.
“I don’t know him, but I know of him. He is one of the boys who need to come back with us to Garanyi. I will explain on the way. Now let’s take one of those permanent stretchers from the back of the ambulance. We can use that as the operating table and disinfect it between cases.”
No one moved once Christian had stopped talking. They stood staring at him, he could sense their confusion. Would rescuing one boy from the situation make any difference, their eyes were saying. By the end of the day, they had completed thirty dressing changes and set six fractures. Christian had also taught Jean Miguel to suture simple wounds. As nightfall approached, Christian could not help but wonder when the relief would arrive from Medicines Sans Frontier. He was starting to feel unwell himself, nauseated with hot flushes every ten to fifteen minutes. Explosive diarrhoea he could feel was not very far away. He quickly excused himself from the large tent, and walking out into the cool night air before vomiting uncontrollably, next to a small tree on the lawn. Momentarily, he felt slightly better but then the waves of nausea returned. He searched frantically for the toilet that Satilde had mentioned. In the dark, he could just see the blue plastic constructed around four sticks two metres high. The side that faced the hospital was uncovered; the plastic doors rolled up and permanently open, for emergencies such as his. As he reached and quickly sat on the wooden seat, both ends exploded with an African velocity. He knew he was not going to be able to do any more operating that night. After what seemed like an eternity, the nausea settled and he made his way slowly back to the mattress in the small tent.
The night was devoid of any sleep, Christian’s increasing fever causing him to constantly toss and turn. As waves of nausea built up into an uncontrollable surge, he crawled outside the tent to vomit. On his second or third excursion outside, Satilde lit the gas lantern. As he crawled back inside, he noticed her sitting next to his mattress with an intravenous line and bag of saline. He nodded his agreement, for he could feel that he was rapidly becoming dehydrated. Satilde inserted a needle into a vein on his hand before hooking up the bag of saline. John Miguel, who was also now awake, applied pressure to the bag to rehydrate him more quickly. He did not remember falling asleep, just a desperate act of pulling a perspiration-soaked sheet over his head to thwart the inevitable mosquito squadrons. When he did wake, small rays of sunshine were filtering into the tent and initially as he opened his eyes, he wondered whether he was delirious. Three people were sitting around his mattress with concerned looks on all of their faces. He tried to focus, squinting initially, and wiping his eyes with the back of his hand. It looked like Isabella; he must be delirious, he thought. Then she leaned forward, dabbed his face with a wet cloth, and whispered in his ear,
“Hello, we need to get you out of here urgently and treat your malaria and gastroenteritis. Old lovers don’t die on my watch.” She winked at him. “We are taking you back in the ambulance, Doctor Sudani’s orders.”
Christian smiled; despite it being ten years since he had seen Isabella, he still knew her voice. Her hair was not how he remembered, for she now had it cut very short. The black-rimmed glasses gave her an authoritative air.
&nbs
p; “Isabella, it’s so nice to see you again,” he whispered. “However we can’t leave yet as Medicines sans Frontier hasn’t arrived and all those boys need to have the dressings changed and skin grafts done. Otherwise they’re going to become infected.”
“Don’t worry. MSF will be here this evening and the Dutch or German surgeon who sometimes helps out at Garanyi has arrived. Satilde has briefed him and I went to speak to him to tell him that we are urgently evacuating you to Garanyi. I wondered whether his accent was Dutch. Some of the words he used had a South African inflection. “
“Don’t forget to bring Michelangelo with us. I promised him.”
“If you can make it in the cab, we will put Michelangelo plus three other boys in the back.”
“I’ll go in the cab.”
Chapter 18
Isabella decided to treat Christian at the Sudani’s. The only concern was whether Christian had drug-resistant malaria. She had learnt in London that most sub-Saharan malaria infections were drug-resistant. Fortunately, she had brought some malarone to use for herself as a preventative measure; she would give that to Christian. Keeping an eye on his fluid intake would then be the only other real concern. Within two days, he should be recovering.
After twenty hours of Isabella’s care, Christian could feel his strength returning. He did not feel as delirious and although he was sleeping most of the day, he could feel the beginning of hunger and knew that was a good sign. After forty-eight hours, he stood up, clearheaded for the first time, and felt well enough to want to try Chantal’s coffee. Chantal and Isabella both turned at the same time to look at him as he walked into the kitchen, a little unsteady on his feet. He knew, after three days of no food and little fluid, that physically he looked gaunt and unwell.
“I am feeling better even though I may still look terrible,” he said trying to manage a smile.
“That you are standing is a significant advance and suggests that the malarone is dealing with the malaria.”
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