Band-Aid for a Broken Leg

by Damien Brown

  The rain’s now even heavier. Toyota’s standing beneath the opposite wall but Kassoma’s caught beneath the leaking awning of the waiting area. He puts on his floppy denim hat and dashes over, the rain pummelling it flat like a swimming cap. When he gets to us he peels it off, wrings it out and laughs, then wipes his glasses.

  ‘MALUCO!’ he shouts—Crazy!

  I shift across. He takes a seat on the other side of me.

  ‘NOVO DOCTOR,’ he says, his voice as gravelly as the day I arrived. ‘YOU WILL STILL FLY HOME, EVEN IF IT IS LIKE THIS?’

  I shake my head vehemently. I’m supposed to fly out in the next week, but a herd of wild horses couldn’t drag me onto a light plane in weather half as bad as this. I try to explain this but the phrase doesn’t seem to translate well; Kassoma chuckles anyway. I’m generally trying to avoid the topic of my departure, though. Roberto and Kassoma still have no jobs, nor do most of our staff; only Sergio and a dozen others have so far been given government contracts to work in the new hospital. On the upside, the Administration has kindly agreed to let us finish their hospital for them, and MSF have since sent a French construction log to oversee it all. Pascal managed to find an agency to maintain the water project for another two years, as well—a significant load off our minds—but the closure nevertheless remains a touchy subject.

  The storm’s worsening. Still early afternoon but it’s already dark as dusk, bolts of lightning periodically slashing the grey. Another flash; I count aloud, making it to six seconds before thunder rumbles the bench again. ‘TWO KILOMETRES AWAY,’ I shout, and they ask how I know. I explain that for every three seconds between flash and rumble the source is another kilometre away. Kassoma quite likes this.

  ‘VERDADE?’ he asks—True?

  ‘VERDADE, SENHOR.’

  The sky lights up again. The thunder follows almost instantly this time. ‘MERDA!’ shouts Kassoma, and Roberto exaggeratedly shoots his feet from the ground as if avoiding hot coals—‘EH!’ he yells—and the three of us laugh. He does it again a moment later, an image I’ll cherish for a long time: three men, several decades and many melanin granules apart, with little in common other than this hospital, all laughing on a log bench. We’d not ever have met otherwise. I’d not even have known such people existed. Who would? I mean, a clinico, who’s neither doctor nor nurse, who removes teeth, opens bellies, saws off infected legs, or quietly sorts through two dozen outpatients each day, in a rickety hospital somewhere in the Land at the Edge of the World? As if! Yet here we sit. Improbably. Laughing as Roberto pulls his legs up again, shitting ourselves as lightning thumps a clutch of trees near the airstrip.

  And this is how days have been for much of this last month. Busy mornings with long ward rounds (increased malaria cases and the thousand policemen ensure this), and quieter afternoons when storms tend to keep all but the sickest patients away. So I chat. I sit with the staff outside, start to actually get to know them, and ignore the mounting paperwork. Something I’d like to have done months ago.

  ‘É ASSIM NA AUSTRALIA?’ shouts Roberto, gesturing to the rain. Is it like this in Australia?

  Not where I live, I tell him. In the tropical north it is, but I’m from the south.

  ‘QUÊ?’ shouts Kassoma on my other side, so I turn to repeat my answer to him.

  ‘VERDADE?’ he asks.

  ‘VERADE, SENHOR,’ but now Kassoma asks if I’m talking about the rain or the hospital, because he didn’t hear the question. The rain, I say.

  ‘QUÊ?’

  Another flash—

  ‘EH!’

  —and the legs go up again.

  It’s like sitting on a veranda with two old grandfathers.

  Was I honestly scared of them when I arrived?

  Funny; I’d had such vivid notions of befriending staff when I applied to volunteer, of being invited to their homes and getting to know their families, but the divide between expat and local staff here is rigid: exclusive employer versus employee with few options. And I can’t invite Roberto to dinner, for example, because what then of the other health workers? It puts us all in awkward positions. So I regret to say that after five months I know little about them. What I know of Toyota, for example (that he was a mechanic with UNITA, saw much battle first-hand, has three kids and recently asked Pascal to formally ban him from entering the storage sites—his own workplace—because people in town are pressuring him to steal what he can, and he’d rather not) is through Pascal’s stories. As a fluent Portuguese speaker who spends his days with a small crew, he’s become exceptionally close to them. In contrast, Roberto, who I see six days a week, hadn’t ever mentioned his wife to me until a few weeks ago, when he finally introduced us. (He called me ‘the Novo Doctor who’d operated on their niece’, which I quite liked.) He’s since brought his wife back a few times, too, and asked if I could suggest good treatment for her high blood pressure. A nice gesture, I think. Like sitting here these latter afternoons. No less considering how we started out all those months back.

  The rain eases a little. Toyota dashes over from across the yard.

  ‘Novo Doctor,’ he says, his blue overalls soaked. ‘The women’s ward is also leaking. For now, I have put more buckets inside. I will get on the roof later. But for now, just buckets. Everywhere, more buckets,’ he smiles.

  Kassoma wags his finger. ‘We need these leaks to be fixed,’ he says. ‘It is very difficult to work like this.’

  Toyota nods and apologises, says they’ll get straight onto it after the storm. He jogs off but promptly turns back. ‘Novo Doctor,’ he says. ‘I forgot to tell you—I finished that wooden frame. It is ready.’

  ‘What frame?’ asks Roberto, and I explain that it’s for the young patient we’d admitted earlier. A three-year-old, the boy had arrived with a fractured femur after falling from a tree, a severe break that plaster alone won’t fix. Searching through an old surgical manual in our office, I found a sketch for a simple traction device called a ‘gallows’, a wood frame from which we’ll vertically ‘hang’ the boy’s leg from the ankle, using tape and cord, with just enough tension to lift his buttocks slightly off the bed. The weight of his body will stabilise the nearer bone end, the traction device ‘pulling’ the distant one to counter the force of his leg muscles. Within weeks the bone ends should knit together in a straight position.

  Roberto likes this. We thank Toyota and ask him to bring it as soon as he can.

  ‘I will bring it now,’ he says, bounding off again. But he turns straight back.

  ‘Also, I forgot, Novo Doctor, about Nene. She asked if you could bring the coffee. For the babies. Andrea and her are busy with a delivery, and she said the baby is late for coffee. Nene said you would know what that means. Do you know what that means?’

  I nod. Roberto and Kassoma’s ears prick up again. ‘Café?’ asks Kassoma, and I suspect that this is going to need careful explanation. If they thought the antifungal trial was pushing things, I’m not sure what they’ll make of this. (Not that Roberto is any stranger to improvisation out here—he’s been making sterile burns dressings for José for weeks now by mixing Vaseline with standard gauze in the autoclave, boiling it over the fire, and has quietly been treating two babies with club foot using a series of carefully graduated plaster casts.) I tell them that two premature babies born recently have been having frequent apnoeic attacks—brief periods where their breathing stops—and that an option back home is to administer caffeine infusions to reduce these, albeit accurately and scientifically, as well as keeping the baby on a monitor. Here we can do neither. Given that a prolonged apnoeic episode can cause death, I feel we’re compelled to try something; what we do have is plenty of coffee, rich in caffeine, so theoretically it should help. So we’re trialling it. Cool coffee via nasogastric tube, several times a day, titrated to effect: espresso shots for neonates. And for the moment at least the babies are well, although whether it’s because of the treatment, or in spite of it, I’m not sure.

  ‘Eh!�
� exclaims Roberto.

  Kassoma’s silent. He stares at me from behind his too-big glasses, the soft haze of an early cataract visible in his right eye. ‘Verdade?’ he asks, regarding me with a look of mild suspicion.

  ‘Verdade, Senhor.’

  But he’s still not sure what to make of it.

  Within minutes the rain eases to soft drizzle. Kids wander out to play in puddles and patients slowly begin arriving again, so we get back to work. I head off to make the coffee, but the guard calls me to talk with a man at the gate. The man jogged here, he says, and would like us to please follow him back with a car. He says that a woman is sick.

  ‘Very sick?’ I ask. ‘Is it urgent?’

  Not extremely, he says, but it’s better we get there soon.

  I find Jamba, our driver, who’s more than happy to take the mine-proof car. I jump in with the pair—it may well be my last drive around town—and we lumber out the gate, and by the end of the street we’re doing thirty, close to top speed, so it’s just as well that this isn’t an emergency.

  Jamba steers us around the bigger potholes as the man who ran here sits between us, directing. ‘Go right,’ he says, and the building supplies slide around the back as we do. ‘Okay, down here. Yes, left. Behind this hut. And past those children. Yes—okay, down that little bank.’

  I ask Jamba if these roads are safe and he nods confidently, then honks at goats, shouts to kids, avoids one of the town’s few bicycles, reverses to turn down the track he missed, and shifts into second for the first time, soon stopping where we’re told to near a large group of people. The man who called us gets out and leads me by my arm—‘In here, Doctor, they’re in here,’—to God knows what because he still hasn’t said, and we push politely through a crowd and arrive at a clearing where a group of men have buried a young girl in mud. She’s lying on her side with only her head and neck exposed. People are packing more wet earth over her, and as I kneel beside her I can see she’s still breathing.

  ‘What on earth are you doing to her?’ I ask.

  ‘This is our treatment, Doctor,’ says an older man in a reassuring tone. ‘She was hit by lightning. This mud will cool her body. It will help her. You can take her to the hospital, but when we are finished.’

  Behind us a group of women are wailing, and someone points me inside a nearby hut. I step in. The room is almost empty. No furniture but for some rough bedding on the mud floors, and huddled together on the floor are two women, motionless. I crouch to take their pulses, but they have none. Their eyes are open. There’s a scorch mark on the ground and a hole in the straw roof where I imagine the lightning struck, and one of the victims has a large belly. She was heavily pregnant.

  Outside, the men pull the girl from the mud. She’s the daughter of one of the dead women. She’s conscious and glassy-eyed and she won’t speak, but her vital signs are good. We lift her into the back of the vehicle and I sit there with two other men who help support her, and Jamba bounces us slowly back to the hospital, pausing for cattle, detouring for goats, and by the time we get to the hospital a dozen kids are running gleefully alongside the car.

  We carry the daughter to Intensivo. The smell of José’s wounds still fills the air from the next room. The new girl won’t talk, but there are no tears, just a stunned look. We ask the cook to make a warm sugary drink for her because there’s not much else we can do, and Therese sits with her arm around her and wraps her in blankets and coaxes her to drink. She’s got no major burns, we’ve got no ECG to monitor her with, but if she’s survived this long she’ll probably be fine.

  ‘You okay with her?’ I ask Therese.

  Therese nods.

  I step outside. Across the yard, stopping to look back at the compound.

  Less than a week to go now.

  I breathe . . .

  There’s a break in the clouds. An orangewarm sun, slanting through it. Toyota’s on the roof, trying to patch a leak. Jamba climbs a ladder to help. Nearer the front fence, José’s wife squats on her haunches and empties the water from her battered pot. Her daughter carries some wood over and they set it down, stack it neatly, strike a match and blow gently but it doesn’t light. They try again. Patiently, like two graceful yogis, drying the wood on the hem of their dresses, then stack it to try once more, no hint of frustration.

  I head to the back yard. Maybe Andrea will be keen for a walk to the river, I think, but a group of policemen call to me as I pass. ‘Oi! Branco!’ says one, slouching outside the men’s ward. ‘When will you fly us to Luanda? This hospital is no good. It is not a proper hospital! And this food—it is shit!’

  I nod politely though I’d like to tell them to fuck off, that they have no idea what this hospital does or what the staff accomplish, but I bite my tongue and tell them only that they’re more than welcome to try the food elsewhere. And I think: five months here, and I’m no closer to making sense of this place. Could anyone? Last week, two young boys found an unexploded grenade washed out by the rains and pounded the shiny toy until it did explode, killing them instantly; hours later we performed an emergency Caesarean, saving two lives. Ten days ago a woman walked here, mute with fear, having been raped in the police barracks; that same day, José beat another severe infection. It goes on. Needless tragedies and improbable recoveries; thuggish policemen, and inspirational staff.

  But what I’ll remember most is this: that Toto, the albino woman and her demented mother, for whom we do little other than provide pills, dressings, and three bowls of maize and beans a day, don’t ever ask for anything else. Nor does José with the burns, who still wraps up those magazines I gave him months ago, or the old man with the bag of pee, who came back to Outpatients yesterday for review (and was quite thrilled with his new urine bag, thanks very much). Nor do any of our other patients, police aside. And for me, this is the thing. No one mopes, or says Poor us.

  They just get on with it.

  • • •

  The three of us have never got drunk in Mavinga, but Saturday night puts an end to that—in grand fashion. We buy a cow and two goats, and Vasco roasts them on a large fire at the back of our compound. All staff are invited. There’s plenty of beer, and Dominga’s in oil heaven, deep-frying pastry balls by the bucketload. We even secure the emcee who’d hosted the wedding, albeit with the proviso that he not play Michael Bolton. It’s a Thank You to the staff, I tell myself, more than a going-away party. The idea of the latter is inappropriate.

  On Monday morning we make a final ward round together. Last-minute plans, final adjustments, scribbled suggestions, and I can’t help but picture the new doctor doing the same in the coming days, looking at the protocols we’re using and asking herself what the hell I’d done these past months. But midway through the round the kids run off to meet the plane as it bumps to a halt on the runway.

  Time to go.

  I farewell patients.

  Cheers to Toto, all the best to José.

  Who’ll look after them? How will they pay for health care next year?

  I don’t know.

  I grab my bags and head to the airstrip. The doctor replacing me hasn’t arrived because of delays in her paperwork, but MSF have sent an experienced nurse. Andrea will follow me out in a week, although Pascal’s extended his contract until the closure. He really shouldn’t have—he’s utterly exhausted and misses his girlfriend—but he wants to make sure that the new hospital is finished.

  I load my bags and chat with the staff on the airstrip, not really sure how to feel. I’m thrilled about not being on call, sad about leaving, delighted at the prospect of restaurants and deeply regretful about abandoning what feels like a sinking ship, so I just make small talk. But thunderheads are rolling in from the south and when I point them out to the Canadian pilot he says, Yeah, we’d better get a move on because those things will rip the wings right off of his little Cessna, and he says it with no hint of sarcasm so I do get a move on.

  Hurried goodbyes.

  Fuck, I forgot to write
a plan in the chart for the kid with—

  No time.

  A last group photo. A shake of hands, best wishes for the future, and halfway through I get to Roberto, who gives me a firm embrace, which is awkward because he’s a good four inches taller than me, so there we stand, a short, pale Branco reaching up to hug the frame of a not-so-pale, not-so-short Angolan man in the middle of a muddy airfield; oh well, fuck it, now handshakes switch to hugs for all and I start again, teeter on tiptoes to reach up to Kassoma, back down to soles to reach Nene, stay down for Dominga although my arms don’t reach all the way around her, and then a long, touching, slightly malodorous embrace with Pascal and Andrea, who I’d consider as close as family after these shared months.

  And that’s it. Wave the kids away. A quick take-off, then it’s gone, just a blur at The Edge of the World.

  13. GUIDELINES FOR ABDUCTION

  Experienced volunteers warn that coming home is more difficult than going to the field, but I disagree. For the first few weeks, that is.

  It’s like being shot from a giant catapult. I soar past Angolan beaches, bars, restaurants and the debriefing rooms in Geneva within days; then shops, more airports, a week of holidays and another debriefing in Sydney; and slide finally into Melbourne, where friends, the urgent need for a date and the search for a mobile phone plan occupy my days. It’s an earth-shatteringly fast journey from the unpredictability of life in Mavinga to a zero-G life at home, disorienting though not unpleasant, but there’s little time to think about it. I start my new job in an Intensive Care unit this morning.