Band-Aid for a Broken Leg

by Damien Brown

  By evening there’s little evidence of the disaster. Patients have been admitted or discharged, and onlookers have dispersed. In a lucky co-incidence, the police have a supply plane arriving tomorrow and offer to fly out their injured colleague and the boy with the jaw injury. The de-mining team have meanwhile dug extensively around the site, and their suspicion is that a small fire had triggered a forgotten cache of explosives, either grenades or an anti-tank mine, buried deep beneath a hut. No one had ever checked for explosives beneath existing homes, it seems, only around them; those who’d been injured had merely been walking past the hut at the wrong time. A sobering reminder of the difficulties these people live with, the experience of war felt even years afterwards.

  Later, I find Roberto on the wards, still hobbling between patients. With some trepidation I insist that we treat him; with an equal measure he allows me. We head to the operating theatre where I inject local anaesthetic into his leg, and the clink of my surgical forceps against metal soon reveals shrapnel lodged in the muscle. It’s easy enough to remove, although I don’t recall ever being so nervous about treating someone.

  ‘Take some days off, Roberto,’ I suggest. ‘Rest that leg.’

  He says nothing.

  ‘Roberto?’

  He nods slightly. Then gets up, limps off on his crutch, and returns at seven-thirty the next morning for ward rounds. By which time the policeman is dead.

  5. TESTIMONIALS

  Friday morning, and a small milestone: I’ve made it to two weeks out here.

  I leave the hospital and cross back to the expat compound, doing my best to avoid our resident wildlife. Lurking behind my towel, a hamburger-patty of a spider in the bathroom shed. I freshen up quickly. In our courtyard, one of the storage tent cats is crouched behind a bush, dreamily eyeing a rooster at least triple its size. I step past them, into the kitchen, although even this room is not for the faint-hearted: the hind quarters of a goat are poking from a plastic tub on the bench—hoofs, hair, flies, and attendant smell—at a little after eight in the morning.

  ‘Pequeno-almoço?’ I ask Dominga—Breakfast?—and she giggles.

  I light our gas stove and fill a pot of water to boil as she fishes out the first of the limbs, laying it on the uncovered wood table, then pull out my Portuguese flashcards to practise phrases with her. We’ve been doing these drills daily this second week. Dominga’s our cook and cleaner, a sturdily built Angolan grandmother, and she’s turning out to be the mother figure of our compound. In every sense, a large woman: expansive mood, broad smile, wide hips, gleaming round Krugerrand eyes, and ample bosoms that jiggle wildly when she laughs—which is frequently. I’d known a similarly proportioned African woman years ago, who’d delighted in wearing a far-too-small T-shirt with the print, stretched across her chest, boasting: ‘All this, and brains too!’ I’d like to think it was made with Dominga in mind.

  Dominga asks me how the hospital’s going. Her neighbour’s child is currently in Intensivo with pneumonia, but I report that she’s a little better this morning. ‘And you?’ I ask. ‘Como vai?’

  ‘Muito frio!’ she smiles—too cold. It gives her back pain, she says of the chilly weather (the consequence of our elevation on the Central African Plateau, over a thousand metres above sea level), so I promise to bring her some paracetamol. She nods, then looks to the flashcard in my hand. Ignoring the half-carcass between us, I read out the first phrase.

  ‘Bom,’ she says, massaging onion onto the meat—good. She’s not quite so sure about my next attempt, though. ‘Eh?’ she asks, leaning over to follow the card with her pink-wet forefinger. ‘Não! é assim!’—It’s like this—and corrects my pronunciation, which is my real struggle with this language. Vocabulary I’m okay with; memorising lists of relevant words isn’t too difficult. It’s the understanding and being understood where I come unstuck. People here don’t say words, they eat them. Each word rolls into the next before it’s completed, and a strong nasal twang muddies things further. What’s written seems to bear little resemblance to what’s spoken, so I’ve created lists of simple, closed questions for the ward rounds. If I can get people to answer me with only a Yes or No for the remaining five months, I’ve decided, I may just be fine.

  Dominga listens as I try another phrase, and another. Nonchalantly, she thumps a cockroach as it scuttles across the table, then flicks it, wipes her hand on the apron over her green dress—all the while listening—and resumes rubbing salt into the goat meat. The source of my frequent latrine visits lately? Quite possibly. I’ll be sure to ask Tim to bring up food hygiene with her when he passes on those new recipes. Not that I’m being lazy in avoiding the issue directly with her. It’s just that Tim’s the overall staff supervisor, and for the moment I’d hate to spoil this dynamic between Dominga and me. Because this mother to seven children, grandmother to two more, is the only Angolan I’m getting to know outside the hospital. And unexpectedly, her presence is prompting a torrent of long-forgotten, warmly pleasant memories of my South African childhood.

  It’s not just Dominga, though. There are other things out here, too, seemingly unremarkable cues that prompt film strips of memory when I least expect it. The beers we drink in the evenings, the only brand sold by the little stall near the market, are Castle, ‘Premium South African Lager’, driven in from Namibia and last seen by me in the door of our fridge in Cape Town. The heavy cast-iron pots in which women boil maize flour here, set over evening fires, are the same black poitjies we’d used for traditional stews, brewed slowly over a barbecue on Sundays. And the earthy smell of these huts evokes strong images of the labourers’ cottages on my grandfather’s hobby farm in the north of South Africa—little brick buildings in which a handful of workers lived, the surrounding landscape of yellow grass and dry soils itself not unlike corners of Mavinga. But none stirs my memories as much as Dominga. So I sip a coffee, ignore the cock-roaches, and take my time as I practise Portuguese in her bizarrely familiar, strangely comforting presence.

  • • •

  Tim’s in the office. Cigarette in hand, he’s trawling through the slew of daily emails forwarded via our satellite link with MSF in Geneva. His job confines him here for most of the day as he handles the work contracts, staff salaries, communications with various MSF offices and the Angolan government, and develops strategies for the project’s future. This morning there’s a warning about possible unrest following Angola’s loss to Portugal in the football World Cup, he tells me, and a message from my ex-girlfriend. (Our email is communal—we can’t access the internet here, only an MSF-based account in Geneva—and there are no passwords.) ‘You like me to read it out?’ he smiles. ‘Because if I have to read another bullshit forward from head office . . .’

  Andrea looks no more impressed with her job. She’s at the plastic medical desk, immersed in a pile of stock lists as she tries to put together our next pharmacy order. ‘They’re in four languages,’ she says. ‘Look at this. These lists are all over the place. Urinary catheters: French, Italian, Portuguese, and here—English! And none of the numbers add up.’

  I’ll take the travails of the hospital any time over trying to manage that pharmacy. Just yesterday a large amount of medical stock was flown in, and this next order should’ve been emailed off already—it’ll take the supplies three months to be shipped here from Europe. Compiling it is no easy task, though. The pharmacy is a warren of shelves in a large brick room behind our storage tent, stocked to the roof with an impressive range of supplies. Antibiotics, painkillers, surgical kits, obstetric sets, catheters, drains, tapes, pens and even blank medical charts fill the space, but layout is haphazard. As well, numerous requests from the hospital dispensary arrive on her desk daily, creating an almost full-time job in itself.

  My bigger worry this morning isn’t the late drug order, though. It’s the semi-conscious twenty-year-old man lying in Intensivo. He arrived yesterday, and we’ve since performed all the tests that we can—a malaria check and lumbar puncture—bu
t both were negative. Or at least the lumbar puncture appeared to be when I held the sample up to the sun, about the sum total of what we can do with it. So for now I’m checking the textbooks again, which is how I spend most of these mornings between the handover and longer ten o’clock ward round. And, much like Andrea, my tasks are also often hampered by linguistic issues, our three shelves of medical references filled with books from various countries. Cholera outbreak? Here’s a yellow guide covering every aspect of management, from building the treatment centre to diluting chlorine for disinfecting the bodies; problem is I’ll need to learn French to read it. Same too for obstetrics, although Spanish is what I’ll need for paediatric surgery. But it’s the tropical medicine books I’m after, and they’re fortunately in English. I pull them out, along with the nearby Medical Resources folders I’ve not yet browsed, and squeeze onto the desk beside Andrea.

  The files are an interesting distraction. A mixed bag: medical reports from 2002; guidelines for a haemorrhagic fever outbreak; someone’s team photographs in a plastic wallet; a review of malaria; and a thick document, containing what looks to be transcriptions of an interview. I flick through it for a moment.

  ‘Tim—you seen these things?’ I ask.

  ‘Which things?’

  ‘Testimonials, I think. Taken here after the war.’

  ‘Oui. I have. You should read it, but sometime when you’re in a very good mood. It’s heavy stuff.’

  I nudge Andrea, but she’s only up to Ampicillin ampoules on her encyclopaedic list, so a little distracted. I nudge her again. ‘You seen these?’

  She shakes her head.

  ‘Listen for a second.’ I read the first entry, that of a middle-aged civilian:

  A friend warned me that [the government MPLA forces] were going to come and lock me up, and so I left. I hid in the forest with all my family. I started to teach my children in the forest. We went all the way to Mavinga. From 1977 until 1979 I walked, for two years. I bought food, or exchanged my clothes for it. We got to Mavinga and stayed until 1992 . . . It was an area controlled by UNITA and there was a school there. After, I went to [my previous home]. In 1994 my house was destroyed by the bombs so I fled. I had a good rest . . . the aeroplanes didn’t come as far as there. Then a bomb fell on my new home. We set off again, at random, running always from the bombs that were just behind us. We walked and walked, to the right, to the left, always in the bush. We passed villages empty of people . . . During the whole time we slept in all of our clothes, afraid that we would have to flee without being able to take anything. I even slept with my tie on.

  ‘That was taken here?’ asks Andrea.

  Tim nods. ‘MSF do it after many conflicts or big disasters, part of the whole témoignage process,’ he says, referring to a French term that translates roughly as ‘bearing witness’. It’s one of the organisation’s core principles, along with impartiality, neutrality, and the upholding of universal medical ethics. ‘But I’m telling you,’ he adds, ‘this is heavy stuff. Read it when you’re feeling very happy with life, not when you’re about to start three hours of ward rounds. Believe me.’ He gets up and heads outside for a moment, but I’m too absorbed to stop. What I’ve read of the war has been mostly in drier briefing documents, but this is from people here, some of the stories told in our hospital. I read on.

  This from a young mother:

  If UNITA attacked one day, then you had to expect the [government] to turn up the day after. Most of the time we hid in the bush while UNITA pillaged our houses, and then we stayed there throughout the [government] offensive. Sometimes we stayed two weeks in the bush. We lived like animals. We led that life for many years, but in 1998 we couldn’t continue any longer. My two nephews were forced, on pain of death, to join UNITA’s army. Around that time the [government] gave the order that people must get into their trucks unless they wanted to be killed. So we did. We’ve been crammed [into a disused factory] for two years now. People are dying like flies. We used to have everything . . . a small piece of land which gave us onions, sweet potatoes, sometimes tomatoes.

  And another young woman:

  I was captured when they attacked our village. I came to Mavinga. I studied in the high school [at the UNITA base]. Life was just suffering. They put us in the houses of the grown-ups, the officers. There, we had to work, washing the clothes, but they didn’t give us anything, no clothes, no food. Some of the officers raped the young girls, so they ran away. My parents were also captured. They were taken to the [food supply] base in Mavinga, where they farmed. My husband had to go to work and he never came back. The [government] attacked us. I ran and hid in the bush, there was a big group of us. We were just running all the time. The pregnant women were also running, but if they couldn’t keep it up they handed themselves to the [government army] . . . My child fell ill in the bush; he had malaria and diarrhoea and we had no medicines, so the nurse gave him some roots. He died. A lot of children died, every day three or four died. A lot of children were also lost when we were running away and were never found again.

  Such testimonies go a long way to explaining the nonchalant response of our staff to that fatal explosion four days ago. My attempts to initiate a debriefing session the next day were met only with confused looks. ‘We were not hurt,’ they’d replied, ‘so why would we want to talk about it?’

  Why would they? They’d have dealt with far worse. Not so for us expats, though, who’re running on adrenaline for days. In two years of working in Australian hospitals, I’d not ever come across a gunshot wound, let alone the victims of an explosion. And for all the political unrest during my time in South Africa, the most harrowing incident I recall is having a gun pulled on me by a white businessman when my friends and I sprayed his sports car with water pistols: ‘You ever point a gun at me again,’ he’d threatened, ‘plestic or not, and I’ll fucking shoot you.’

  So then, are we safe here? I think so. I take heart in Tim’s reassurances that no staff have been killed since that 2002 explosion, and that there’s never been an accident in areas that the HALO Trust have cleared. Guns don’t seem overly prevalent, either; extensive disarmament took place after the war, and only police and soldiers seem to carry them.

  The bigger question for me, though, after my reading, is how I can possibly go back to work and pull staff up over trivialities, such as the treatment of diarrhoea, when this was happening four years ago—

  To kill our thirst, when there was no water, we chewed on leaves. For two months we would eat one day, then not eat for two days, like that.

  As I read on, it worries me what role some of the people here, the men, may have had in the events described. Because UNITA, which in Mavinga had an almost exclusive supporter base, and for which many of our staff worked, was clearly no innocent participant.

  . . . it was like someone had just slaughtered goats, blood everywhere and all the people lying dead, right there in the middle of the road. It was just women and children that lay dead in the middle of the road with blood everywhere.

  For years, UNITA was considered a viable political party by outsiders. Their leader, Jonas Savimbi, was an articulate, charismatic man who’d begun studying medicine in Portugal before switching to political science, and who was deemed a great political thinker by many. He dined at the White House and was openly supported by the CIA and the South African government, portrayed as the archetypal African freedom fighter. As for the MPLA, the current government, they were led for the first years of the war by Agostinho Neto, an acclaimed poet who’d also studied medicine in Portugal, and who was widely respected across Africa as an anti-colonialist hero. Hard then to reconcile that idealism with all this mayhem.

  . . . I was woken up by the sounds of shooting—fway, fway, fway!—and bombs: Bwow! I just ran. Some this way, some went that way, others went that way. I ran . . . Then I started to look for my family.

  I can’t finish. It serves me better not to think too much about what has taken place here. About who was a vic
tim, who may have been a perpetrator, and that some of these people—on either side—could be on our staff. The hospital is just metres away; through the office window I can see a group of kids kicking a semi-inflated football near Pascal while he works on the fence; and I think: this could’ve been them just four years ago. So I stop at these last words as I close the file. Words from a nine-year-old orphan, interviewed during her treatment in the feeding centre in Mavinga.

  My family is dead. I ate sand. What will I do now?

  • • •

  ‘It is very hard for us clinicos to work like this,’ laments Sergio, addressing the group of staff. It’s later this same Friday, and the weekly meeting with the heads of the various departments is being held. ‘We cannot work properly,’ he goes on. ‘Not like this—not with someone who cannot speak our language. It is very difficult for us all.’

  This last point I don’t doubt.

  ‘And let me say that this language thing, Coordenador,’ he continues, as a dry breeze coughs hot air at us, ‘that this is just part of the problem. Because it is also the work. For example, we have had a very sick woman these last two weeks. And before, we have operated on such patients. Many times we have helped them. But now—’ he stops as he looks around the open-walled hut, here in our expat yard, eyeing the dozen staff seated on wooden benches around the circular shape, ‘—this Novo Doctor won’t let us do this!’

  ‘Move on, Sergio,’ says Tim. ‘This is not the place.’

  ‘I disagree, Coordenador, because this concerns everyone. Our hospital is not good at the moment. Novo Doctor questions things he does not understand. And let me please just say this one thing.’