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Band-Aid for a Broken Leg

Being a Doctor with No Borders (and Other Ways to Stay Single)

Allen & Unwin

THE EDGE OF THE WORLD

I arrived yesterday, dropped off by a little plane that promptly turned and rattled down the dirt runway, taking with it any semblance of a link to the outside world as it left me in this town. If you'd call this a town, that is. Seems more like a village to me. A dusty, isolated, mud-hut-filled outpost of a village, hidden in this far corner of Angola — a war-ravaged country in south-west Africa. It's like nothing I've ever seen, and is my home for the next six months.

But right now I'm trying not to think about it. Pretending there are no landmines. No crowded hospital. No ward with malnourished children; poster-kids from a Bob Geldof appeal who sit listlessly, wide-eyed, rubber feeding tubes taped to their cheeks, and for whose medical care I'm about to be responsible. Or that I'm to be the only doctor, for that matter, left working in the middle of a region once dubbed 'O Fim do Mundo' — The Edge of the World — by the Portuguese colonists. And I'm hoping desperately that the immediate task at hand — choosing a gift for tonight's local wedding, to which the six of us Médecins Sans Frontières volunteers have been invited — will provide at least some respite, some fleeting distraction, from the incomprehensible, pitiful, frightening universe that begins just beyond these walls.

* * *

Three of us stand in our storage tent. Tim, the Swiss-French coordinator of our MSF project; Toyota, the Angolan logistics operator who supervises this storage site; and me — a junior Australian doctor on my first posting.

'Well?' asks Tim. 'Any ideas?'

Toyota looks up from his stock list. He's a tall African man with sharp eyes and a broad smile, and he's clearly untroubled by the afternoon heat. Thick blue overalls drape his solid frame and a pair of rubber gumboots is pulled near to his knees even though the dry, dusty savannah of the region suggests it hasn't rained for months.

'Oh, yes,' he grins. 'I found a very good gift. Just in here.'

'Great,' says Tim. 'But in here?'

'Oh yes. And believe me, you two will love it!'

Toyota drops his stock list and walks to the far corner of this space. It's a large enclosure — far larger than any room in the hospital, anyway. Yellowing canvas is hitched tightly over a high, arching metal frame beneath which our mine-proof vehicle is parked, yet there's still ample room for the rows of aid supplies along each wall. At one end, hundreds of plastic buckets form colourful columns that lean towards silver drums of cooking oil, the latter bearing the image of two hands shaking in a gesture of friendship, with the statement: 'Gift: Not to be sold or exchanged.' Towards the other end, blankets, soap, high energy biscuits, and milk formula for the malnourished are piled in discrete mounds, while sacks of maize interlock neatly along both nearer walls. A family of cats, too; they're squatting somewhere in here — you can smell it, along with old cardboard, chlorine and diesel.

Tim shrugs. 'I know,' he says. 'In here, huh? But Toyota's the person to see about such matters. He looks after all the non-medical stock and has contacts all over town, so he can usually find what you're after. If not, he'll try to make it for you — he's good in that little workshop behind us.'

Tim would know. He's a veteran of several MSF projects in Africa and he's been in this town, Mavinga, for almost two months. Six-foot two and in his early thirties, he appears remarkably unruffled by the context; a man who, in glaring contrast to my current mental state, projects an air of calm authority. So I'm sticking closely to him these first days.

Toyota returns.

'This!' he declares. 'This is what you should bring.' He hands Tim a small package, about the size of a paperback. Some type of white cloth wrapped inside a film of clear plastic, I think, and like everything in town it's coated in a veneer of honey-coloured dust.

Tim looks up. 'Toyota, is this —?'

'Just open it!' laughs Toyota. 'You must feel it for yourself to know how good it is.'

Tim smiles, regarding the item from several angles. 'Merda, Toyota. Is this what I think it is?'

'How can I know what you are thinking?' chuckles Toyota. 'I cannot possibly know. But I do know that you will like it. And I am telling you, this one you must feel. Feel it before you say anything.'

Tim opens the plastic at one end, pulls out a small piece of the fabric and fingers it lightly. He laughs. 'My God! Are you serious?'

Toyota looks surprised. 'What are you talking about, Coordenador?' he asks.

'There's no way we can bring this. It's supposed to be from the whole team, Toyota — and for a wedding! They'll be expecting something a little better from MSF, don't you think? What else have you got?'

'And why would you need something else?'

'Because we've given these things away for free in the past! They're worth, what — three or four dollars at most?'

Toyota's undeterred. 'Coordenador,' he says, shaking his head adamantly. 'I do not agree. Why does this price matter? It is the quality of this that matters, and the quality of these ones is very good. I am telling you. You must feel it properly to know. How can you know if you do not feel it properly? Feel it!'

Tim ponders the package again for a long moment, mumbling to himself. He unfurls the full length of fabric and turns to me. 'What do you think?'

I shrug, tell him I'm not sure what it is.

'A mosquito net,' he says.

'A what?'

'A mosquito net,' he repeats, straight-faced.

I suppress a laugh. 'Really?'

He nods. 'A nylon mosquito net. Insecticide-impregnated and all, same as those distributed by health agencies across the continent. So, would you be happy to bring it to a wedding?'

I look at the two of them, hesitant to say what I really think. They watch me expectantly.

'Well?' Tim asks. 'You want to bring it?'

I smile uneasily at the pair. Part of me suspects they're joking: two weeks ago I was looking at a hundred-dollar cheeseboard on a friend's bridal registry in Melbourne — one of the cheaper gift suggestions; now, a mosquito net? I watch Toyota, expecting him to break out of character at any moment and say, Ha! As if! But what if he is actually being serious? Who am I then to stand here, on my second day, deriding the apparent level of need in this country — a nation with the highest infant mortality rate on earth?

So I shrug. Again. No idea what to say. No idea even what to think, which has been exactly the problem since I arrived: I don't even have to walk the ten metres over the road to the hospital in order to feel lost, overwhelmed, out of my depth. I feel it everywhere I go. Like right here, standing in this tent, as I grapple with the absurdity — the reality! — that a mosquito net may in fact be a feasible wedding gift.

As for things in the hospital? Therein, my real source of fear. People are everywhere in there. In beds, under beds, across beds, between beds, in front of beds. Even five to a bed, or on the floor of those two tents, the large white ones pitched in the back courtyard. Others just sit outside, on the dirt that surrounds the tin-roofed wards. Who's a patient, who's a brother? I can't tell. Everyone looks feverish in this heat. Everyone looks a little on the skinny side to me. Everyone needs something.

'Are all these people your family?' I asked a woman on the ward this morning.

'Yes,' the answer. Her mother, her daughter, her three sisters — all on the one bed.

'And these four people next to it? On the floor?'

No — they were the neighbours of the patient in bed eight, the woman with some strange fever. They were here to wish her well, to cook and care for her. Their village was a two-day walk from here, so they wanted to please stay with her a while.

'And that man? Why is he sitting in a tent, outside?'

'Oh, he is always there,' said one of the health workers. 'He has been here since the hospital opened four years ago. He came when the war finished. We think he was injured in the fighting — injured in the head — but we cannot know because he only says "Toto", so that is what we call him. Try it, Doctor — ask him anything. Try! You will see it. He will only say: "Toto".'

I tried. He did.

And then there was this morning's wake-up call. An urgent summons to the hospital, and a glaring, screaming reminder that this is all going to be unlike anything I've experienced.

I'd not yet fallen asleep when I first heard the footsteps. Was still lying under my own mosquito net and a mountain of musty blankets, hiding from the harsh chill of these savannah nights — something I'd not expected — while contemplating the hundred-and-sixty-something days ahead. Then, approaching footsteps. 'Doctor?' called a voice. I fumbled for my torch. The firm bang of a fist on my tin door followed; a ricochet of echoes around the dense silence of my spartan brick room.

'Sim?' — Yes?

'Emergencia!'

Jesus, no need for coffee because there can't possibly be a more powerful stimulant in the world than that single word. I was up in a flash, heart thumping as I knocked over my bedside candle, scrambled to pull on yesterday's clothes and jogged quickly to the hospital. No — I ran back: I'd forgotten my stethoscope. A sprint back to the hospital. No — back again: I needed the other doctor. I can't go anywhere without Tim or the other doctor because I don't know where anything is or how to —

'Sofia? Hospital! Quickly!'

She was on her way.

A jog, but not too fast this time because I didn't want to get there long before Sofia. Out the front of our living compound, straight across the dirt road to the hospital entrance not ten metres away where a wooden cart stood hitched to the fence post near the front gate. The animals were still panting. The patient's transport? This is how people get to the hospital?

I ran past the oxen, across the hospital's sandy front yard and into the first room, where a small battery-powered lamp threw a gloomy light at the brick walls. A group of people were lifting a man onto the single assessment table — three men and two women that I could see, but I still don't know who actually works here and who doesn't because there're fifty-something people working in this hospital for MSF, another fifty working outside of it. Far too many to remember but I'll need to figure it all out before Sofia leaves this place on Monday.

'We don't know what happened,' said one of them as I ran over. The beam of my headlamp zigzagged across the patient as I tried to make a quick assessment. He was a middle-aged African man, drowsy and dehydrated, numerous lacerations on his face and forearms. His clothes were tattered, stiff with dried blood. The injuries were at least a day or two old and the distinctive smell of infected flesh filled the room. He urgently needed fluids and antibiotics.

'Let's give him —' I began, but I still didn't know what drugs we had here. Or where we kept them. 'You — please, an IV line,' I tried.

'Sorry?'

'An IV line,' I repeated.

'Uh —'

Sofia ran in. Glanced over quickly and assembled some equipment from the cupboard, then directed one of the women to insert the IV. We opened the man's shirt to examine him properly. 'What happened to him?' she asked. 'Anyone know what happened?'

The Angolan nurse couldn't find a good vein for a needle. I knelt beside her to search for a spot on his forearm that was neither cut nor infected — a difficult proposition given his injuries. We tried. Fumbled. Tried again and got it.

'Someone — please,' repeated Sofia. 'I need to know what happened.'

'We cannot be sure,' said an elderly African man behind us. 'We do not know what happened,' he said, stepping forward and removing his old cowboy hat, apologising for the intrusion. An old business jacket and trousers hung loosely from his body, a torn blue shirt showing beneath. No shoes. 'We found him outside of town. We were getting firewood outside Rivungu village, far from here, and we saw something move near the track. I thought it was an animal. It was very slow and made no sound. My son said maybe we could get meat so he got down, but I was worried. But when he got closer he called to me and said it was a man.'

The first bag of IV fluid went up but the patient still lay with eyes closed, breathing softly. Sofia tried to rouse him. 'Sir?' She touched his chest gently. 'Can you open your eyes?'

Only a mumble.

The man with the hat apologised again. 'Can I say, he slept in the cart. He slept all the time. We tried to give him a little water because he looked very weak, but otherwise we did not disturb him. We just came straight to Mavinga. But he did not tell us what happened.'

We ran the fluids in as fast as possible, and under the light of my headlamp Sofia and I examined the wounds more closely. His injuries were numerous, concentrated around his head and upper limbs. Worst were a series of lacerations above his right eye and along both forearms, a few going deep into muscle. Several puncture wounds, too — small, as if he'd been stabbed with something round, not just slashed — although fortunately sparing his abdomen and chest.

'Someone get a vial of morphine,' said Sophia. 'Here, take my key. And get antibiotics.'

We hung the second bag of fluids and squeezed it in fast. Next, IV dextrose to raise his blood sugar level. The two cart-drivers stood close by, concerned and apologising all the time. 'We came as fast as we could,' said the younger man. 'We are sorry — we tried to bring him here faster, but it took most of the night. That road is very bad. There was a lot of sand, and the moon was with us for only some of the time.'

The first nurse returned with the drugs and Sofia sent her back to find an anti-tetanus dose in the fridge of our living compound. Gradually, the man's conscious state improved and with help he was able to lift his head a little to sip water. 'What happened?' we asked again, but he only mumbled softly.

'You must tell us,' said the health worker. 'We need to know so we can tell the police. This, what has been done to you — it is terrible.'

The patient shook his head and said something about it being okay, no police.

'But who did this?'

He took his time. Another sip of water, then the words he whispered brought the room to a halt.

'A leopard.'

Everyone paused.

'A leopard?'

'Yes.'

'You sure?'

A nod.

'In town?'

'Outside,' he whispered. 'Away from Rivungu village. To the north.'

Murmurs rippled through the room.

'But he could attack again!' cried the nurse with the syringe. 'He will come back! This hasn't happened for years — we must let the police know to hunt him.'

The patient shook his head. 'No,' he whispered. 'It is okay.'

'How?' asked the younger man from the cart. 'Did you injure it?'

The patient asked for another sip of water. The nurse filled a cup from the yellow jerry can beside the desk and helped him drink, propping him up gently on the foam mattress. 'It happened in the dark,' he began, slowly. 'I did not know ... I did not see it coming. It was very quick. I covered myself ... here, my arms, like this, over my face ... but it carried on.' He stopped to take another sip of water and shut his eyes, then described the hissing of the animal as the attack continued, saying that he didn't know how long it all went on for — one minute, maybe fifteen. At some point he'd managed to get free. 'It must have gone,' he said. 'I do not know why, because before it was angry, very strong ... But I am lucky — I found my knife. I found it before he came back.' Another long pause. No movement in the room as everyone stood frozen. 'I was frightened,' he continued, in time. 'I pushed this other arm, here, into him when he came. Into his face. I tried to keep him from my eyes, my neck ... With my free arm I got it. Many times ... Anywhere.'

The Angolans looked on in disbelief.

'With your knife?' asked the younger man. 'Got him with the knife?'

A nod.

'It is dead?'

Another nod.

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Excerpted from Band-Aid for a Broken Leg by Damien Brown. Copyright © 2012 Damien Brown. Excerpted by permission of Allen & Unwin.
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