by Damien Brown
Elizabeth talks with Joseph.
‘What’s she saying?’ I ask, as he starts to giggle.
‘She wants you to marry her,’ he grins.
‘Oh?’
‘Oh yes—very muches.’ The three other health workers standing with us chuckle, too. ‘She says because you will save her life, she should marry you. And I think this is something for you to consider, yes?’ he smiles, raising a querulous eyebrow.
‘Tell her I’m very flattered,’ I say, suddenly aware of the heat in the room.
‘Doctor?’
‘Honoured,’ I clarify. ‘Tell her I’m very honoured by her proposal,’ which I really am; no less as I turn to see the next of the thirty-something unwell patients in here.
The afternoon starts well. I have lunch with the team, then spend my time flitting between the five plywood cubicles in Outpatients. At some point we hear screaming. I run outside, following the crowd heading towards our main entrance, where there’s a sea of commotion. A flatbed truck has pulled up at the gates. Armed men are milling about, a throng of distressed people gathering rapidly. There are no police, and no soldiers—the guys with guns here are in jeans and T-shirts, and they’re carrying semi-automatic rifles. Some of them look half my age.
An injured man is passed from the back of the truck using an old sheet for a stretcher, then another patient, and another, all laid onto the ground. Marina runs back to get proper carriers. Zoe steps into the fray with an interpreter.
‘How many injured?’ she calls, and the men say that there are only these three. The others are dead.
Marina returns and we load the patients and carry them through the gates. The crowd tries to follow but Zoe steps in, looking improbably calm. She’s a veteran of several years in war-torn contexts, and I watch as this short Dutch woman in her mid-thirties confidently addresses armed Sudanese men who tower a foot or two above her. ‘No guns in the compound!’ she declares. ‘For now, only one relative per patient can enter. Everyone else—please!—wait outside!’
They comply, although they really could do as they please. The guards shut the gate behind us as we carry the injured to the operating block, an old brick building on the river side, where we lie them down. Marina and I make a quick assessment of their wounds. Heidi puts in IV lines as the health workers draw up fluids, and Thomas clears three surgical beds while Ben takes blood samples to screen for transfusions. It’s a polished effort, considering the circumstances. The team have obviously done this before.
Within little time Marina is scrubbed and operating. All of the patients have only limb injuries—one is relatively minor but two involve bone and significant blood loss—and Marina works for the following hours with her two Sudanese theatre assistants. Heidi and I meanwhile stay on the wards. By nightfall, the crowd has dispersed and all three patients are stable, although two of them will now be fixed to brick traction devices for the coming weeks.
And thank God there’s a surgeon out here, I think, because there’s no way I could have handled this as well as Marina did. A pity then that she’s leaving in three weeks, no replacement found yet. A pity as well Zoe’s comment at dinner. ‘We should review our security procedures tomorrow,’ she’d said, ‘because there’ll be payback for this. There’s no doubt.’
• • •
Wednesday morning. The medical ward is by now even more packed, but there’s a saving grace: Joseph. He’s outstanding; organised, efficient, and only too happy to ask about anything he’s unclear of. So too is Peter, the gregarious supervisor of the TB village, who, no less than half a dozen times a day, bounds across the compound to ask if now I’ve got time for his patients. And no less than half a dozen times a day I apologise and ask if it can wait a little—because the watch-tapping health worker and his five Outpatients colleagues deal with a hundred and fifty presentations daily and invariably ask me for second opinions, and John, the HIV nurse, calls me whenever his patients arrive, and Heidi usually likes me to see the sicker kids in Nutrition with her—yet Peter always just smiles and says, ‘Okay, because, it can wait.’ But now it cannot wait, he says. Not this afternoon. And he’s frowning deeply.
‘Young boy,’ he explains, ‘very sick,’ leading me to the square TB hut at the north of the compound. Peter cautions me that I’m not to enter this tukul without a mask as the patients in here have highly infectious coughs. ‘Too dangerous,’ he says, then puts his on and bounds in. He emerges moments later followed by a man carrying a child over his shoulder. The man lies the boy gently on the clay earth outside the entrance. It’s a tragic sight. The boy’s a ghost; skeletal, unable to speak, his body without tone as the father manoeuvres him like a rag doll. His face is fixed in a grimace and he recoils from the sunlight, whimpering like a frightened animal.
I kneel beside him. ‘My God, Peter. How old is this poor child?’
‘Ten years, Doctor.’
‘Are there any other patients like this in these tukuls? Are the others this sick?’ I’ve seen less than half the TB patients so far.
‘Only him,’ Peter assures me.
‘But why didn’t you call me earlier?’
Peter explains that there’d been a management plan before, but now the boy is worsening.
We sit the boy up. Tenacious threads of saliva hang from his mouth, pooling on his raggy T-shirt. The dad spoons them with the side of his hand and wipes it into an old metal tin he’s carrying in his other. I lift up the boy’s shirt to listen to his chest, but stop suddenly: extensive, deep cuts run vertically down the boy’s back, some old and others new, and there’s more scar than healthy skin.
‘Jesus, Peter—has this guy been whipped?’
‘Traditional medicine,’ says Peter. ‘Because, they did it to let the chest problems out. It is from his village.’
I’ve not seen anything to this extent before. Peter tells me that the boy has been ill for a year and was admitted here three weeks ago, but he’s since remained frail. In the last day he’s developed a fever and stopped eating.
We get a sheet and lie him on it. I examine him here, outside the TB hut, then arrange a few tests, including for HIV, haemoglobin, hepatitis, and some other local infections. Ben’s lab here is better equipped than what we’d had in Mavinga. We insert an IV line and add another antibiotic, but the boy can’t swallow well so we put in a nasogastric tube too. I explain to the father how to give milk down it and we watch him give the first bolus, then Peter fetches an old clock from his office to aid him. ‘And sir,’ we caution, ‘you must call us if he vomits, or if anything changes. Okay?’
The father nods. Then bends down, picks up his crumpled boy and carries him back into the gloomy dampness, Peter trailing with the IV line.
• • •
By night-time a gentle breeze has picked up. It’s a pleasant change, but with the cooler air comes the rich smoke from the fires on the far bank, where cattle herders are burning dung to ward off flies. No clouds, though, and the moon illuminates the cracked earth like a floodlight, silhouetting the hospital buildings and conical tops of distant tukuls. I turn my torch off as I make my way across the yard to bed later. I stop, relish the moment, gaze back over the fence, but a sharp CRACK rips into the sky.
I freeze.
Another CRACK.
Gunshots?
I’ve never been anywhere near a gunfight before but this sounds like guns. I can’t tell how close they might be. Great currents of fear wash down my back like an electric shock, what a strange feeling and that explosion in Angola was just the warm-up, this is worse. I should run but I stand still, paralysed by fear. So, I’m clearly not the dashing-bravely-into-battle type that I may have thought. No fight response here, only flight, except my legs aren’t moving.
Another CRACK.
Holy hell it’s all too real. This isn’t like I imagined in the briefings and I’m not willing to die for this work, not like this, not here, I should at least have been treating a patient and not just standing—
&nb
sp; ‘Safe room!’ yells a voice. It’s Zoe. ‘Get in the safe room!’
The others run over. The dry grass fence surrounding us isn’t going to stop any wayward projectiles and I should follow my teammates but I’m still just standing with my heart in my throat and I’m unsure of which way I should go right now because there’s a problem, a big problem. I can’t just run to the safe room because I was getting ready for bed and this should be the furthest thing in the world from my mind right now but the issue is that I only just stepped out of the shower. I’m not wearing any clothes—only a small towel around my waist. Adrenaline purges my brain of rational thought and I come to the panicked conclusion that I need underwear, because who knows if we’re going to be in that room for hours, days, or weeks, and if I’m going to be shot or holed up it’s not going to be like this—not without underwear. Pride and misdirected terror take over and in nothing resembling an act of fearlessness I make a rapid side trip in the opposite direction to my mud hut just metres away.
I bolt. Fling open the door. Scramble inside, but my bag’s still not unpacked. Fuuuck! I pull it apart, search frantically in the dark because I’m not stupid enough to flick the light on, so I throw things, T-shirts, textbooks, sunscreen, insect repellent, OhMyGod OhMyGod those guns sounded seriously close—Boxers! What about my passport? Where’s my—fuck it, I need to hurry and join the others.
Outside again. Not even ten metres of yard between me and the house but there’s another CRACK, more adrenaline, OhMyGod!, I duck nonexistent bullets as I run, weaving erratically all the time because what if now I get hit and the team find me like this in the morning, right near the latrine, and even worse than wearing just a towel, now clutching my underwear like it’s some sentimental object. I wonder how they’ll explain to my family that my final gesture on this planet wasn’t to reach for a photograph of loved ones or to write a touching note but to fetch this.
Halfway there. Another weave. A dash. My bald head would be gleaming like a white flare under this moon and make for an unmissable target, but I hear no more shots and there’s been probably only a dozen at most so far. I tear through the brick house and out the other side and bang on the heavy steel door of the safe room, which is locked. ‘Open it!’ I yell. ‘Come on!
The rusty blue door swings open and I dart in, shut it behind me and join my team-mates, who are sitting on the mattresses along the wall.
‘Where the fuck were you?’ asks Zoe, as I scamper to the corner.
‘Had to fetch something.’
‘Fetch what?’
I wave my underwear. Nine blank faces stare back. Paul rolls his eyes but everyone else starts to laugh, and I turn my back to them and slide my boxers on beneath my towel, then take my place on a spare mattress. And now, instead of not being hit by a bullet, I begin praying that we won’t have to be evacuated; images play out in my head of the press coverage following our flight from danger as I descend the aircraft stairs behind my colleagues, worried relatives and MSF seniors gathered below, the world’s media, teary parents—and me, in an old pair of boxers.
The shots soon stop. Half an hour later we leave the safe room and I head to bed, fully clothed this time, my passport at the door, although there’s little chance of getting to sleep. Not when drenched in adrenaline like this. And there’s little point, either. A middle-aged patient with liver failure breathes his last just hours later, vomits blood on the cool clay sometime before sunrise. Heidi is up with him and calls me for help but I just kneel uselessly beside the family under a dramatic banner of stars, sponge him occasionally and look up at the sky in between times because there’s nothing else we can do.
• • •
And this is how the week continues. A macabre pattern of sorts, a series of busy but productive days, and sleepless, tragic nights.
On the fourth night, two patients die; a child, before we can even get her to a bed, and an old woman, suffering from a fever we can’t get on top of. The following morning my paranoia regarding how patients may react is validated when two mothers take their children from Nutrition and carry them home. They’re scared about all these deaths, says Joseph. They’re worried that we’re doing this. They say we’re making mistakes.
On the fifth night, it happens again. Another death—perversely, one of the children who’d been carried home by a wary mother. The remaining mothers become even more frightened. Two of them argue with Heidi. ‘If we go home,’ they say, ‘this is what happens! But what if we stay . . .?’ Meanwhile, we admit three new patients, one of whom has frequent seizures overnight.
On the sixth day, a teenage boy is carried in following a gunfight far outside town. He’s suffering severe abdominal injuries, and dies while Marina’s operating on him.
On the sixth night there are no deaths, but now a new problem: a woman has arrived in labour, and we’ve got no midwife. Carol walked out this morning. Just up and left, trudged past our breakfast table dragging her suitcase, and got onto the supply flight. Zoe said to leave it. It’d been a long time coming, apparently; there’s been ongoing personality differences among some of the medical staff, and the gunshots were likely the final straw. But working without a midwife is a huge problem, and Carol in particular has three decades of experience. Big shoes to fill. As I discover tonight, shortly after ushering the labouring woman to the small room behind theatre.
‘Delivered?’ asked Deng, looking at me uncertainly.
‘Yes—babies. You delivered a baby?’
‘Never. But I would like to.’
‘Good. Anyone else here that can help?’
‘Gatwech.’
‘Has he delivered before?’
‘Never!’
‘Who normally helps Carol then?’
Two women, says Deng, though he doesn’t know how to contact them. Nor does he know where the keys to the obstetric cupboard are. I’ve got no idea either, so the pair of us run around and quickly try to assemble what we need from the other wards, and by midnight I’m shredded, my mind foggy and I’m desperately in need of sleep, and I’m tempted to just kick the fucking cupboard door open because this is the last thing I need; and like most first-time deliveries I’ve dealt with, mum lingers in labour for most of the night until sometime just before sunrise she bites her bottom lip, moans slightly, and a pushes a healthy, bald little Sudanese boy out into the world.
Which is how my seventh day begins.
How it continues is much the same. Busily, mostly with the young boy from the TB village, who’s become jaundiced.
How it ends is a different story.
Heidi kindly agrees to do my on call. It’s a promising enough start to the night but we end up together in the safe room after gunshots anyway, very much awake. Not long after we get out, the guard is back at my tukul again.
‘SHAMIANE!’ he yells; he can’t get the ‘D’ right in my name.
‘Heidi’s on call,’ I say. ‘Heidi. Not me.’
‘Yes?’
‘HEIDI. CALL HEIDI—NEXT DOOR.’
‘Shamiane?’
‘HEIDI!’
‘Hello?’
Fuck it. I get up and stomp across the yard to Inpatients. This had better be justified, this call. Seven nights of being repeatedly woken—I don’t mind when it’s for the severe cases, but too often it’s been for minor things that could wait—but an unusually cheery ‘Good morning!’ greets me as I enter the ward. Not what I’d have expected if this were an emergency.
‘What’s the problem, Deng?’
‘Just a little question,’ he says, leading me down the ward. We step carefully between the sleeping bodies filling every available bit of floor and bedspace. A tunnel of light from my headlamp, but it’s otherwise pitch dark. No one stirs. Halfway down to our right, a bag of blood is emptying its last drops into the vein of a woman with anaemia; beside her, a young infant with a respiratory condition breathes as if sucking the dregs of a thick milkshake through a straw. We pass them, stopping at the bed of a man who’d arriv
ed yesterday with marked facial swelling—the result of a snakebite to his scalp (it happened while he was sleeping, he says). He’s since had a good dose of antivenom and antibiotics.
Deng picks up his drug chart. ‘It says to give this one,’ he says, pointing to a medication name on it.
I agree.
‘What must we do?’ he asks.
‘With what?
‘The drug.’
‘What do you mean?’
Deng looks at me uncertainly.
‘Well?’ I ask.
‘We are just making sure you wanted this,’ he says. ‘And we are wanting to check the dose.’
I turn to walk out. The first cracks in my façade of calmness are going to reveal themselves if I don’t get away now, but Deng follows me. I stop. I’d like to give him the benefit of the doubt and assume that his real question has been lost in translation, but I don’t. I unleash all of my exasperation on the man. I pull him away from the ward and give him an earful as he stands quietly and wears it, looking down, his head a good foot above mine. When I finally stop he sheepishly asks me to confirm the drug dose before I leave.
‘The normal dose, Deng.’
He’s not sure what that is.
I step inside and find the MSF drug book. Copies are on all the wards. It’s the standard manual for health workers in all projects, and easy enough to follow. ‘You look it up, Deng. I’m not doing your job for you.’
He thumbs through the book, flicking the pages.
‘Flucloxacillin, Deng. “F”. Look it up in the index.’
He looks at me.
‘The index—the back of the book.’
He stares.
I take the book and open it to the index, hand it back to him.
‘Pro. Pran—’ he sounds out.
‘That’s “P”, Deng. Flucloxacillin is with an “F”. Go to “F”.’
He flicks the pages. Backwards, then forwards, completely randomly. He sounds out words. ‘Sal. Bu. Ta—.’
‘Jesus, Deng! Here. “F: Flucloxacillin”—page sixty. It’s arranged like the alphabet. See? And here are all the doses. So now you look at this table, and you tell me what dose you’re going to give an adult.’