Band-Aid for a Broken Leg

by Damien Brown

  The ministers exit. Police stay close. We’re ushered by the police chief to join a row at the front, alongside the King and ever-elusive Administrator. Various other seniors are here, too—old men in military khakis with cowboy hats, hanging on to their posters of Neto—and the group of ministers make their way towards us to shake our hands. The TV crew film it all, moving around us, and I’m completely seduced by the thrill of this whole event although not entirely sure we should be standing here. These were the men in power during at least the latter years of the war. Pascal sums it up for me when he nods towards the hands of one of the nearby ministers, quipping that he wonders how much blood is on them.

  Police jeeps arrive, whisking the VIPs to the soccer field. The crowd is now maybe a thousand people strong and follows on foot, heading past our compound, left onto the main street and a half-kilometre further to the grounds, where they gather in front of the specially built stage. The first in a series of long speeches is given by the dignitaries (we’re told that the Vice-President didn’t make it, but the Defence Minister and other MPs did), and the mood ebbs as the afternoon drags under a scorching sun. The probability of any unrest now appears unlikely. Armed police watch closely, and people look utterly bored.

  So, why then is all this happening in Mavinga? We’re not exactly clear. The T-shirts and posters just handed out bear the slogan, With the thought of Neto, we rebuild Angola, and I can see no reason the government wouldn’t be trying. The economy is now growing at almost twenty per cent per year. Oil exports are second only to Nigeria’s in all of Africa, with the state having a monopoly on the industry, controlling as well the billion-dollar-a-year diamond sector. And Neto’s mausoleum in Luanda would suggest money to burn: the outlandish concrete ‘rocket’ towers over nearby slums, and is rumoured to have cost up to one hundred million dollars.

  And things do seem to be changing. When I’d returned from holidays two weeks ago, Mavinga had only a handful of cars, a dozen police, and no electricity. Today, fifteen hundred police reside in the new barracks, and hastily erected street lights, powered by the large diesel generator flown in, cast a glow over the main street. Two dozen jeeps have been airlifted in as well, along with other supplies on the frequent cargo flights. It’s all a part of the effort to rehabilitate this region, according to the Administrator, and also to tighten border security and stem the illegal diamond trade. But the first national elections in more than a decade are scheduled within two years, and the words of the Defence Minister leave little doubt that this is at least part of it. ‘Make no mistake,’ he’d said, an MPLA man addressing this UNITA town, ‘that we will shoot troublemakers.’

  The speeches continue past sunset, hosted by an Angolan anchorman behind a spotlit desk on the football field. At the end of the formalities, the ministers move to the purpose-built gazebo behind the stage, where things take a more telling turn. In full view of all, a gourmet meal is served—seafood and beef, washed down with wine—just metres from skinny kids and barefoot adults, who stare more with wonderment than any outrage. And then, as quickly as it all began, it’s over. The TV crew pack up their equipment and fly out with the ministers. The meeting arranged by our Luanda office regarding the hospital handover never takes place, and within a week the new generator runs dry. Flights stop arriving, and construction ceases. But the police remain. All of them. Armed, cashed up, bored and young—and supplied with alcohol. A sure recipe for trouble.

  • • •

  Our last weekend together comes suddenly. Tim’s done, flying out next week, and I’ll follow in a month (briefings and flights reduce my field time to only five months rather than six). The others will leave shortly after me. So for old time’s sake we’re spending the day together, doing what we’ve done much of these months. Mooching in the dining room.

  ‘Tim’s in love,’ says Pascal, ashing his cigarette onto a plate.

  ‘What?’

  ‘Tell them,’ he stirs. ‘Tim, why are you being so shy?’

  Tim laughs and draws another card, then wipes the sweat from his chest. It’s now mid-morning and already too hot to sit with shirts on in here, although Andrea’s prepared to endure it.

  ‘We’re just friends,’ he smiles.

  ‘Ha! Please,’ says Pascal. ‘I have seen those sat-phone records, my friend. You are going to need a loan to pay for this. You spend hours on that thing with her—do you know how much that will cost you?’

  He does. Four dollars a minute. He’ll be invoiced when he returns. The issue though is not costs, nor the time he spends talking with her. It’s that for months we’ve been listening to him grumble that he doesn’t believe in love, yet he’s evidently rescinded this after only a week spent with the colleague of the Red Cross woman I’d stayed with in Lubango, an Italian aid worker who’d visited here during my holidays.

  ‘We’re just planning a trip,’ he smiles. ‘Nothing else. We both finish next week, so we’ll travel a bit. It’s nothing serious.’

  The amorous titles in the ‘subject’ column of her emails would suggest otherwise. It’s good to see him distracted, though. The hand-over’s weighing heavily on all; the four of us had our first full-blown fight (flying plates, overturned lunches) last week during a discussion about it, so we’re all now pushing for more action. Andrea and I fired off an emotional email to MSF to articulate the urgency from the medical side of things, and Pascal’s casting a wider net. As a proponent of sustainable development he finds the handling of this closure unprofessional, so he’s taken it on himself to find an Angolan organisation able to at least run the water system for the coming years. I’m not sure if he’ll work with MSF again.

  ‘What do you mean “nothing serious”?’ laughs Pascal. ‘You are full of shit. I have never seen you change your clothes so often. Tell Damien. Tell him that when she was here, you put on a new shirt every day.’

  ‘Every day?’

  Pascal nods sincerely.

  ‘He even wore contact lenses,’ laughs Andrea, nudging me.

  ‘Yes! Contact lenses! Do you believe this? Have you ever seen him wear this? And what about the hair gel? Tell me, Tim—who the fuck wears hair gel in Mavinga!’

  Definitely not Pascal. He’s not cut his hair since we arrived, though he may have trimmed his beard—once. Other than Andrea, who still runs every morning, we’re all a little wilder and woollier-looking now. Thinner, too.

  ‘Listen,’ says Tim, ‘you two can both think what you want, but—’

  A shout.

  A lapse of time—

  (seconds?)

  —and I’m standing in maternity with Andrea, breathless, this woman is unconscious, midwives anxious, family screaming . . . how did I even get here? . . . Jesus she’s pale, what’s her blood pressure, wasn’t I just talking to Tim, someone—anyone got a blood pressure?

  ‘Seventy,’ says Andrea, struggling to get a reading. ‘No. Sixty-five.’

  The two other midwives look anxious but I’ve never seen them look remotely worried, not these African women—they pull out twins and breeches and deliver stillbirths without their colourful headscarves so much as budging, rarely calling me for anything. I ask what happened and they say that the patient had a big fall, then complained of pain and became drowsy.

  Andrea’s on her knees. She manages to put in an IV line and we start pouring in fluids and insert a second drip.

  ‘Did she fall onto her stomach?’ I ask.

  Nene is here. She speaks with relatives. ‘They think so. She fell from the back of a cart.’

  ‘What’s the blood pressure now?’

  ‘Seventy.’

  We squeeze bags of fluid into her IV. Her belly is rigid and I can feel the baby’s arms and legs right beneath the abdominal wall, far too close to the surface. A ruptured uterus? I’ve read about it although never seen one, but it would explain her signs and symptoms. Mum’s surely got a belly full of blood. Andrea examines her and agrees. The baby’s chances of surviving this are minimal but if we don�
��t stop the mother’s internal bleeding she’ll die soon herself.

  ‘Sixty-five,’ says Andrea. ‘Blood pressure’s sixty-five.’

  Serious trouble. We squeeze another bag of fluids into her. I ask someone to find the guards and tell them to round up people to donate blood urgently. A church service is in progress just down the road, so we send someone running and within minutes people are lining up in the yard to have their blood group tested—

  ‘Wait! Where’s the transfusion clinico?’

  —and the guard goes back out to find staff. We try to track down Roberto on the walkie-talkies but he doesn’t reply. Agostinho answers instead and runs here within minutes. ‘Where’s Roberto?’ I ask him. He’s panting, dressed in a Hawaiian shirt and sandals.

  ‘Visiting family in a nearby village,’ says the guard. ‘A few hours’ walk away.’

  Fuck it! Agostinho’s not nearly as experienced and I can hardly understand what the guy says because he mumbles incessantly. ‘We need to find Roberto too. Send the other guards—they can use the anti-mine car.’

  The guard says they can’t go there.

  ‘You can. Get Pascal. He’ll give you the keys.’

  ‘The driver’s not here today.’

  ‘Never mind the driver! You drive! Anyone can drive!’

  ‘Novo Doctor, only Jamba can drive. He is the only one with a licence.’

  ‘Fuck the licence! Pascal or Tim will drive. Get them.’

  ‘The road is not safe there. There is a small track, but it is only for walking. No cars will get up it.’

  Fuck it! No choice. It’s going to be Agostinho and me. Andrea will do anaesthetic.

  Back to Maternity. The patient’s family are pacing, distraught, the woman’s now received over four litres of intravenous fluid and her blood pressure barely registers an improvement. In what must be a new record for the region we have her on the operating table and ready for surgery within half an hour. Everyone pulls together, but for the first time Agostinho’s actually reluctant to operate. ‘I think it is better to wait for Roberto,’ he says. ‘Her blood pressure is very low. This is too dangerous.’

  ‘That’s exactly why we cannot wait,’ I tell him. ‘Agostinho, she’ll be dead in half an hour. There’s no doubt.’ I push him hard. ‘It’s you or nothing. The baby’s probably dead. We just need to tie up that uterus and save the mother, okay? No debating this one. If the mother dies on the table then she dies, but this we cannot sit out and watch. You can do this. I’ve seen you work. You have to do it.’

  What a position to put someone in.

  He stares at the ground for a long moment. The line of people has grown near the small lab and our tech is here, taking samples.

  ‘Sim,’ he says. ‘Okay. Vamos.’

  I think that’s what he says.

  He sets up the instruments fast. He’s on his game. I hook the lighting cables to the car battery and Andrea gives the anaesthetic by referring to the chart on the wall and keeps a close eye on the patient’s blood pressure. Agostinho washes her belly and lays green drapes around, and someone runs in to tell us that the clinico in the lab has found a blood match. ‘One unit,’ he says. ‘Ready in half an hour.’

  ‘Thanks—but we need more. Keep looking. Get someone else to help. Screen everyone, get as many units as you can get.’

  Agostinho opens the patient’s belly. A single midline incision with scalpel, then dissects with scissors and inserts retractors. She’s got an abdomen full of blood. We each grab a side of the wound and pull hard to tear it wider and make more space to work in. The suction machine isn’t working properly despite frantic stomping and blood wells up like an overflowing basin, pools to the wound edge, up and over, spilling to the floor and around everyone’s feet, and the baby’s right there outside the uterus. No pulse, it’s already dead, and we take it out and hand it to Nene, who runs back to Maternity with it to assess it properly. We need to worry about mum.

  More blood wells up. I put in handfuls of gauze to soak it up but within seconds they’re drenched. We see the uterus only fleetingly between fresh gauze and make out the torn edges. More gauze. Agostinho looks up at me. He feels around her pelvis, orients himself and begins tying thick sutures through the uterine walls mostly by touch because we can’t see properly. The suction pump is useless. Andrea squeezes in more IV fluids and I try to clamp bleeding vessels with forceps. Her blood pressure remains dangerously low but still out comes more blood. We need to stop this flow, I didn’t realise a person had so much blood inside them, but she still has a pulse and it must be forty degrees in the operating room, Jesus it’s hot and her husband and a handful of nurses crowd around the table and for Christ’s sake—still more blood! How much can there be?

  Agostinho begins working smoothly. More sutures, more gauze, more blood, and my shoes are sticky wet with red. He keeps tying. Over and over, slowly bringing the ragged edges of her uterus together, and the flow ebbs. But her blood pressure’s still seventy and there’s a worryingly large pile of drenched gauze on the floor.

  Steadily, Agostinho brings the last of the edges together. There’s now only a slight ooze. We dab the surface and watch to make sure. There’s a little more bleeding, so he puts in another suture. We dab. Then wait. Mild ooze, another suture. We do this a few more times until finally there’s no bleeding. He’s controlled it. We wash her belly out by pouring saline into the wound, then close her abdominal wall in layers. The lab clinico sends someone in with the first unit and says that they’re collecting more, and the first of the many transfusions she’ll get this afternoon starts running as we carry her to Intensivo.

  Agostinho and I step back into theatre to get changed.

  ‘You did well, Agostinho,’ I say, my heart still pounding. He looks remarkably unruffled. He just mumbles something back to me, smiling his understated smile. Pascal’s always joked that Agostinho could’ve been Angola’s biggest film star, the way he swaggers around the compound in gaudy shirts, his chiselled face delivering what may be memorable lines—if we could understand them.

  ‘Seriously,’ I say, ‘I was sure she was going to die.’

  He says something back.

  ‘Sorry?’

  He repeats himself, but I swear it’s not Portuguese he’s speaking. ‘You saved her life, Agostinho. She had no chance otherwise.’

  He shrugs, puts his Hawaiian shirt back on and swaggers out. And I can’t help but marvel at him, the less experienced of the two surgical clinicos here. Like Roberto, he too acquired his skills with only a year of training in military hospitals set up during the war, having had no formal medical education beforehand. And I also can’t help feeling that I’ve misjudged them. More than a dozen major surgical cases carried out by the pair since I arrived, and not a single complication. Two emergency Caesareans, an obstructed hernia, two limb amputations, appendicectomies and a repair of a bowel perforation—not to mention the dozens of dental extractions, wound debridements, and abscess drainages—and not a single patient has suffered an adverse outcome. What are the odds of that—out here?

  I go home to shower. By the time I return to the hospital a crowd of dozens have gathered outside Intensivo, mostly the church congregation, because it turns out she’s the pastor’s daughter, and—unbelievably—Roberto’s niece! She’s now receiving her second bag of blood and slowly waking up from the ketamine, and her wound is good and blood pressure stable and the bleeding’s stopped entirely. I’m confident she’ll be fine. No—she’ll be great. And everyone’s thrilled and grateful and it’s a joyous moment, and her family and congregation begin singing for her outside Intensivo as patients gather around to listen. Even Toto leaves his canvas sanctuary, I can see José with the burns watching from the window of his little room, and the woman’s family come to thank me and I say cheers but Agostinho is the man, and he says that no, I am the man, although who really gives a shit who the man is at that moment; and Roberto and his brother the pastor are ecstatic and we all laugh and pat each
other on the back, and instead of being a tough-guy doctor my voice breaks and I fight back tears. At least until I get back to the compound. And then, for the first time since my arrival, I cry. Big, dirty, get-all-that-stuff-out-sobs, though I’m not sure why. Pent-up frustration? What-might-have-been? Relief? Joy? Who knows. Who cares! But I need it, and it feels good.

  And I don’t want to leave this place.

  12. WATCHING STORMS

  This rain just gets heavier. It sheets off the eaves like a thousand waterfalls, the sound utterly deafening. Even the roar of thunder is hard to discern over the howl of metal roofing. From where I’m sitting, here on the bench outside the Surgical Outpatients room, a grey soup accounts for the rest of the world; sky and puddles unite. A meteorological blitzkrieg, it seems—the type of storm where one is compelled to ponder just how much water could possibly still be in the air; and, just as puzzlingly, how it all got up there in the first place.

  We walked to the river yesterday, no longer the struggling stream it used to be. Crossings now need to be made a little more cautiously across the large boulders at the laundry section, although decent-sized tilapia can be seen dangling from the ends of homemade rods, and thick grass along its banks. The rest of the town is benefiting from the weather, too. Worn-out huts have had their long-awaited makeovers, fresh mud clinging defiantly to old walls and patchy roofs re-thatched, and the food market boasts plump okra pods and leafy greens as fruit swells slowly on orange trees near the centre of town—the same trees around which landmines were once laid, and below which children now shelter.

  ‘É SEMPRE ASSIM?’ I shout to Roberto. Is it always like this? He’s sitting beside me on the bench.

  ‘AS VEZES,’ he calls. Sometimes. ‘INCRIVEL, NÃO?’—Incredible, no?

  I agree.

  We’re not alone under the eaves. A few others have pressed themselves against the walls of his Outpatients building with us—women and children waiting to get back to the wards; Manuel, who’s now working as an assistant; and a few policemen, whose colleagues are unfortunately taking up much of the men’s ward, mostly with injuries after having drunkenly assaulted each other at night. One of them I recognise well. His wife is currently recovering from a stab wound to her cheek—something he’d inflicted, he told us matter-of-factly, because he’d been drinking and she wasn’t listening, so you know how it is. As for the force’s presence in general, I can’t help thinking we were better off without them. I recall a fitting saying I’d once heard from a friend in Indonesia: If you lose a chicken and report it to the police, you’ll end up losing a cow. Better to just stay out of their way.