by Damien Brown
‘Yeh.’
‘And you?’
‘Yeh.’
‘Flu?’
‘Yeh.’
English is clearly Betty’s second language, as for many of the locals. Most speak it well, if heavily accented, but some from the smaller and more remote communities don’t speak it at all. And cultural factors mean that Betty’s unlikely to look me in the eye and speak to me as openly as she would to one of her own people, so I pause frequently, ask closed questions and wait for her to elaborate, although I know from my months up here that she seldom will. There’s a translator in the hospital during the day, but to be honest I rarely use her other than for complicated presentations. And for now we should be fine. Betty understands me well enough. We’ll get there.
‘How long you been crook, Betty?’
‘Long time.’
‘When did it start?’
‘Long time,’ she repeats.
‘A few days ago? Or a few weeks?’
‘Yeh.’
‘Which one—days?’
‘Yeh. Five, six days.’
‘With what symptoms? What sort of problems?’
She looks down, adjusts her beanie again and gazes across the room. She shakes her head: something’s caught her eye. With considerable effort she rises, wrenches her body out of the chair and moves arthritically across the cubicle. The smell of wood smoke seeps from her dress. She heads towards the basin and pulls the younger grandchild away from the taps, but he’s not happy with the disruption. He was having a blast—his T-shirt’s drenched, as is the floor around him—and he yells when Betty takes her seat again and holds him, but soon settles on her lap. I get him a sticker from a nearby drawer—one of those colourful, bright ‘I’ve been brave!’ stickers we so frequently bribe kids with—and put it on his arm, which pleases him no end.
‘I bet he keeps you busy, huh?’ I say to Betty.
‘Yeh.’
‘All day, I’d imagine!’
She smiles slightly, but still doesn’t meet my eyes. ‘Yeh. All ’a time.’
As we continue talking I notice that the boy’s scalp is riddled with tinea. I make a note to add antifungal medication to whatever other treatment I may prescribe for him, then get back to taking the history.
• • •
I’m halfway through examining the kids when the night’s first assault victim arrives. The police help bring the bloodied man into the department but our five cubicles are full. Dave, the nurse on duty with me tonight, quickly shifts another patient to the ward to free up a cubicle, and we lie the new patient down.
‘What happened, fella?’ asks Dave.
The man groans. The sickly smell of blood and cheap wine sails out on his breath—a smell I ought to be used to, having spent so much time up here, but I’m far from it. I loathe it. Not only the smell: more, what it represents.
‘What happened, mate?’ we ask again, but he says nothing. The police tell us there’s been fighting near the bigger pub—a handful of such establishments grace this little town of just three thousand people—and they’d found him lying nearby. Jackson is his name, but more than that they don’t yet know. They’ll come back later to see what the extent of the injuries are and to ask him if he wants to make a statement, but for now they’ve got another job to get to. Dave quickly clears another cubicle.
‘Jackson!’ I say to the man, rubbing his sternum firmly with my knuckles. No response, so I rub harder.
Jackson groans.
We put a neck collar on and remove his shirt and trousers, covering his lower body with a sheet. Dave and I examine him thoroughly. Jackson’s eye movements are all over the place—from alcohol, or due to a severe head injury, we can’t tell—and it’s times like this that I question my choice to keep working in these remote hospitals. In a big Western hospital we’d put him straight through a CT scanner, and we’d know immediately what we’re dealing with.
‘Jackson!’ I call again. ‘Open your eyes, mate. Jackson!’
Groan.
‘Jackson! Move your hand. Here—this one. Try to move it.’
He opens it.
‘Jackson—can you show me where you’re hurt? Show me with your hand. Touch where it hurts, mate.’
Groan.
His hair’s matted with blood. I glove up and feel around his skull: there’s a large swelling at the back. His face is a dark canvas of old scars and fresh abrasions, and his right forearm is swollen. He cries out when I move it. But his blood pressure is good and his belly and chest seemingly uninjured, and we fortunately have basic X-ray services here. I call in the operator. Dave meanwhile puts in an IV line and rinses water through Jackson’s hair, and we locate the large scalp laceration and staple it shut. The bleeding stops immediately. If the X-rays turn out to be okay, we’ll watch Jackson closely for the night. The odds are that he’ll be fine, sleep off the grog and ask for a sandwich in the morning, then likely go home with a sling and some bandages. Hopefully, that is. Up here, you never do know.
The police are back within minutes. There’s been a domestic assault this time, the victim a thirty-something woman. She’s had a few drinks but she’s sober enough to recall the event and give us a clear history—
‘He hit me with ’em fists, a coupla times, here,’
—and fortunately isn’t too severely injured. Aside from the lacerations to her eyebrow and upper lip, both of which will need sutures, I find no other problems on examination. According to her notes, the last time she was in here she had a broken jaw, also from a beating. A previous time she’d been knocked unconscious. The police now have the partner in custody, they say, and they’ll be back in a few hours to take her statement.
And on it goes.
• • •
It’s another hour before I get back to Betty. She’s snoozing in the chair, crumpled forward with her plastic bags at her feet and her yellow beanie still pulled on firmly. The grandkids are far from dozing off, though—with all this noise and these new playthings, how could one possibly sleep! They’re chattering excitedly, and as I pull back the cubicle curtain I see that they’ve just taught me a valuable lesson: you don’t leave the box of stickers with the kids and then turn your back on it.
‘Hey, mister,’ says the older one, lifting the front of his T-shirt. ‘Look here!’ His belly’s wallpapered with colour. The younger sister shows me hers as well, revealing an equally dense mosaic of colourful patches on her black skin. No belly buttons on view anywhere.
‘Look what we dun!’ says the girl.
The older boy lifts up the little brother’s T-shirt, too. ‘And him!’ he says. ‘He also got ’em!’
‘Nice one, guys,’ I laugh. ‘I can’t see your tummies though. Any stickers left?’
‘Nuh!’ yells the older boy, pointing to the box. ‘We used all o’ them!’
I look over. Indeed they have.
With due care not to dislodge any of the adhesives, I get back to examining the children, but I’m soon called away by the arrival of a sicker patient. This happens several more times over the following hours. We run out of cubicles, and I apologise to Betty and ask her to please head back to the waiting room, where the old man in the jeans is still sitting near the door. ‘Hey, doc,’ he calls, ‘how long I gotta wait?’
Could be a while, I apologise.
So continues the night. A feverish child arrives next, then a girl bitten by a dog. Then two more victims of assaults, followed by a thirty-six year old man with end-stage heart disease whom I know well, and who spends at least two nights a week in here. An elderly woman provides a pleasant distraction when she arrives to sell a dot painting she’s recently made, asking only for the exact amount due on her electricity bill—a bargain, so I buy it—and at midnight, a semiconscious man is brought in after being cut down from the sheet he’d used as a noose. It’s not the quietest night I’ve had in this place, not by any means, but neither is it a particularly remarkable one. And who’d ever have believed this was all
happening here, in the middle of this country—Australia?
Not me. I still find it unfathomable. Particularly when I return after a break. Granted, I’m obviously seeing the very worst of what happens in this town; such is the nature of emergency departments. The majority of people, who’re doing okay and living healthy, productive lives, don’t tend to present at these hours, if at all. Nevertheless, tonight speaks volumes. As has every other night I’ve been on duty.
So why on earth would I work here after everything that happened last year? Why not take a more mundane job, at least for a while?
I definitely didn’t seek this when I got home. Dealing with tragedy was the last thing I’d wanted. And I can claim no altruistic reasons in having initially come up here, either. I took the job purely for two reasons: money (doctors like me are paid close to quadruple what we’d make as trainee specialists in Melbourne, yet retention still remains close to zero), and because I thought this would be a sensible, natural transition between medical practice in Africa and a large Western hospital. I was wrong. It’s every bit as challenging. Perhaps even more so; that such a burden of illness should exist here, to say nothing of the devastating social issues, seems even more inexplicable given the context.
As for MSF, I’m not working with them for the moment. The Northern Territory government is my employer, and for a while after getting home I’d wanted some space from MSF. Their emails meanwhile arrive weekly. Usually I can’t bear to read them, at other times I scan them closely. Always, there are so many positions to fill, and always, a new list of catastrophes. Cholera outbreaks in Zimbabwe; massacres in the Congo; the crisis in Gaza; meningitis epidemics in Chad . . . it goes on. As do they. A part of me expects them to grow tired, to just pull up stumps one day and print something along the lines of Fuck It, We Tried. Forty years of this: we’ve done what we can. But they don’t. Nor do any of the volunteers I’ve stayed in touch with.
I saw Andrea not long ago, when she came to visit a relative in Australia. She’d been based in Africa for much of the time since leaving Mavinga and is doing well, still baking, still exercising and still keen to get back to the field when she can, although finding placements may be a little trickier in the future: she’s about to be one half of a package deal, having recently become engaged to another MSF volunteer. (Not Pascal, she assures me.) And on the topic of marrying other field workers, here’s a What Are The Chances story. Tim—the same Tim who’d so often bemoaned at our plastic dining table that love doesn’t exist—is now married to an aid worker, the same one he’d met during those final weeks in Mavinga! They’ve since had a daughter, and both are still working for aid agencies. I last had a beer with him when I passed through Europe some months ago. He keeps loosely in touch with Pascal, he told me, who’s now working with a development agency back in the field. (Pascal and I emailed for a while, but having to run every piece of correspondence through an online translator quickly lessened the frequency. We did at least first manage to solve the debate over glass.)
As for the team in Sudan, Heidi finished her nine months, then took another placement in Nepal. Zoe finished up her contract early and took time off for family. I’ve not spoken with the others, but I did hear that a volunteer from the Somalia group, a woman I’d met only briefly, subsequently left MSF and joined a different organisation, only to be kidnapped when she re-entered Somalia. (She was later released.) And for now at least, the project in Nasir is still running. I receive the occasional email from a nurse who’d arrived there just as I left, and she says that things remain difficult. Not long after she’d started, a huge gunfight erupted between rival clans due to disputes over a passing convoy of food aid. Forty people were killed, over a hundred others injured, and dozens required surgery at that little hospital. Just imagine the confusion. I can—I can still almost feel it. The heat. The shouting. The smell of blood and open wounds, and the desperate uncertainty of it all in those initial moments. I can picture Joseph and Thomas running around to clear beds, to insert IV lines and gather equipment; Peter, loping over to help with a TB mask hanging loosely around his neck; and the new surgeon, wondering what the fuck he’s just let himself in for as he steps between patients, trying to get a handle on countless injuries, not a spare moment to even contemplate running to the safe room. I can see the patients on the ward lying low for safety, and, just metres away, those kids from the TB village, patting wads of mud onto little play-tukuls when it all began, mercifully far too young to consider what their futures may hold in such a place . . .
Better not to think about it.
So, is there really any point to this line of work? Is there any lasting benefit to the people it tries to help? Or does the aid industry just bumble on blindly, patting itself on the back for ‘at least trying’, all the while perpetuating its own existence?
I wasn’t so sure anymore when I got back. I seriously questioned it. I immersed myself in books on the topic—books discussing the underlying causes of poverty; why the problem has persisted despite five decades and hundreds of billions of dollars of aid, development and assistance; and where current approaches may be going wrong—and suffice to say such texts tend to be pessimistic. MSF is not blind to any of this, either. Quite the opposite: they’re acutely aware. They’re a highly introspective organisation, and from what I’ve seen are far more critical of themselves than any outsider could be. Not long after I’d left Mavinga, they’d printed an internal review on the handling of the cholera outbreaks in Angola, concluding that they could’ve better managed their response and reduced mortality rates further. When I was returning from Sudan, I came across a book of essays commissioned by them, placed in their lobby, that had been compiled following an open conference they’d hosted on humanitarian issues, and that discussed whether humanitarian intervention hurt the very countries it tried to help. Another book, written by the head of their own research unit and that’s widely available, is tellingly sub-titled: The Failure of Humanitarian Action. Other examples abound.
For me, though, this is their strength. They know, but they go on anyway, questioning themselves and adapting constantly. I’ve had my differences with some of their decisions (and they with some of mine) but it’s clear that it’s not for a lack of insight that they aren’t addressing the broader, underlying issues in the field. It’s pragmatism. They do what they can. In their own words, they’re putting a Band-Aid on the problem, keeping people alive while political actions try and solve it. They’re under no illusions.
As for my own answers to any of this? I have none. I’m far more confused than before I first went. I’ve had no great epiphanies, no profound realisations, but since returning home I’ve resigned myself to this one thing: that, putting the economics and politics of it all aside—naïve as that may be—what it all boils down to is individuals. It’s a simple interaction between just two people: one, a person with opportunities and choices, and who could get a flight out tomorrow should they choose; the other, a person with few options—if any. If nothing else, it’s a gesture. An attempt. Food and a tent for Toto. Burns dressing for José. A little operating theatre with car batteries and boiled instruments, where Roberto can ply his trade. Free HIV treatment for Elizabeth, who’ll never be cured and will always live in a hut anyway, but who’ll have a longer, healthier life because of it. And sometimes it’s little more than a bed in which to die peacefully, attended to by family and health workers . . . but hey, that’s no small thing in some parts.
My head says it’s futile.
My heart knows differently.
I hope to be in the field again sometime soon.
For the moment, though, it turns out I don’t have to go far to find people living in devastating circumstances. It’s just a few hours’ drive from my home.
• • •
Betty’s still waiting when I finish. She’s eating dry crackers from one of her plastic bags. The kids are sleeping on the floor, the youngest wrapped in his sister’s arms. Betty pulls herself out
of the chair when I call her back and she wakes the kids, and the sister carries the youngest in. I apologise for the wait and finish examining them all, then give Betty a bottle of children’s paracetamol to take home—good treatment for them ’flu—and antibiotics for the younger one’s ear infection.
‘How you getting home, Betty?’ I ask.
She looks at the clock on the wall and shrugs. It’s well past midnight.
‘Probably a bit far for you guys to walk, yeah?’ I say.
‘Yeh. A bit dang’rous now, hey.’
‘When you got dialysis next?’
‘This mornin’,’ she says.
‘I’m really sorry about the wait again, Betty. Come, we’ll try and get you guys home quickly.’
I find Dave. He’s got a nurse from the main ward giving us a hand in here, and I ask him if either has a moment to take Betty and the kids home in the hospital car. Dave says he can do it, but he reminds me that the Flying Doctor Service will be landing in a few minutes—the man who’d hanged himself needs care in the bigger hospital in Alice Springs, although Jackson fortunately won’t need to go there. He’s already waking up.
Dave gets the keys and brings the car to the entrance. Betty and the kids squeeze into the back together. No moon tonight, and the stars create a thick veil above, a dense, detailed landscape spattered across a giant vault of sky; only in Mavinga and South Sudan have I seen views like this.
The car pulls out. A police van drives up, and in its headlights I watch the silhouette of three curly-haired kids and one old woman in a yellow beanie huddling together in the back, speaking an Aboriginal language I know nothing of. I should learn some of it; I always mean to learn more about the people I get to work with because these opportunities are such a privilege, although I tend to lose sight of that; but right now Jackson’s yelling for a sandwich, and the police are here with a victim, and the plane’s buzzed the runway and the next patient needs to be seen.
SELECTED READING
Bixler, Mark. The Lost Boys of Sudan: An American story of the refugee experience, The University of Georgia Press, 2006