“No, you are not the assistant. This one is different than the last medical tourist. He has clinical knowledge. Move down and let him in.”
Christian moved opposite Nikita as Sister Teresa reluctantly made room for him. Nikita then made a lower midline incision as Christian placed his hands on the pelvis of the patient as she started to move on the table. Out of the corner of his eye, he glanced in the direction of the woman administering the oxygen and the ketamine. She had her head buried deep beneath the drapes listening to the woman’s breathing and checking her pulse.
“Penetration of the uterus and the bladder, but no bowel. That was lucky.”
Christian looked inside the abdomen. Considerable force had been used to drive the broom through both the uterus and the bladder, the roundness of the tip the only thing that had saved the more mobile bowel from being ripped apart. After placing sutures to mark the penetration through the uterus and bladder, Nikita pushed the broom out through the pelvis.
“No colostomy will be needed.” Christian said as both a question and as personal relief for the patient.
“Despite western research suggesting that a colostomy is the surgical approach which works best, we clean the bowel and join it back together; no colostomy. In Africa colostomy bags fall off, and patients return with faeces discharging directly onto their abdomens. Close the abdomen with a nylon suture after I finish the washout.”
Nikita finished the washout within the abdomen, slid his hand between the woman’s thighs and removed totally the broken broom. Christian moved around to the patient’s right-hand side and took the Rutherford forceps Teresa had handed to him. He placed them on the edge of the fascia and handed them to Teresa to hold. He could feel her eyes watching him, judging, unbelieving of his competence.
“Could I have the one nylon suture please, Teresa?”
Teresa took the suture from its packet, straightened the nylon out, and gave it to him on a needle holder.
“Thank you, Teresa,” he said as he began suturing the layers of the abdomen while she retracted the skin. The abdominal wall closed neatly and he could sense Teresa’s appreciation of his skill. It wasn’t anything that she said, just a diminution in the hostility of her look. Christian decided to chance his arm, as there was something that he had wanted to know about the brutality of this particular woman.
“Teresa,” he said as he placed the final suture in the abdominal fascia and looked over his mask, engaging her eyes.
“Yes, Doctor de Villiers.”
“Why do you think these women get brutalized in this way?”
Teresa held his gaze during a long pause. He had the feeling that she was trying to make up her mind whether replying would concede acceptance of him on that side of the table as the surgeon.
“Raping a woman is not about sex. Whether it is in the western world or here, it is about power and degradation. It is a return to the animal kingdom where the male dominates, and the strongest male dominates in any way that he enjoys. Only here, there is not just the urge to dominate but to physically destroy and mutilate any who do not comply with their commands. It is unbridled evilness, in which one group tries to outdo the other. It is like the primeval blood thirst that drove the genocide. They are worse than animals and they know no one cares and no one will stop them as long as the world gets its share of resources.”
Christian looked at Teresa over his mask. There were several things which had surprised him about her reply. Firstly, that she had replied, or considered him worthy of her reply. Secondly that it was not just a passionate disgust that she was evoking, although that was implicit in her explanation: it was more the identification and understanding of the root cause of such mephitic depravity.
“Why do these militia groups continue to exist? I thought the United Nations had a peacekeeping force to control them.”
“Most foreigners think that. In addition, they think that this is still an ethnic conflict, which should therefore be left to the locals to sort out. That Kariba’s militia are exiled Hutus and the group named M 23 are Tutsi from Rwanda who want to keep the exiled Hutu in the Congolese Bush.”
“And clearly that’s not the case,” Christian said as he surveyed the table Teresa was using for his surgical instruments and sutures, looking for a suture he could close the skin with. The patient for the first time had stopped moving as he was suturing and Christian wondered for a minute whether she was still alive. He glanced towards the anaesthetic technician who was showing no alarm. Perhaps without the significant stimulation of protecting the abdomen and cutting through the tissue, the ketamine was in a dominant phase.
“Could I have that 30 nylon, Teresa?”
Teresa handed him the nylon on a needle holder after first straightening the memory of the nylon before continuing her explanation of the brutalities.
“Expecting that moronic bunch of United Nations peacekeepers to control this conflict is like using a fly swatter against elephant. The Congolese army is pathetic. In some instances they are almost as bad as the militia groups, except the militia groups are the better armed. This conflict does not have its roots in ethnic cleansing. It is about the rape of the Congo’s resources and the corruption that goes with it. The militia exist in the Bush to facilitate the extraction and transport of rare minerals. They kill each other to preserve their supply lines to their minatory political masters. They kidnap and press-gang children to be killers, they rape and brutalize woman just so the political and commercial needs of the world are met.”
Teresa looked away as she handed Christian the 30 nylon to close the skin. He wondered whether she felt that she had said too much.
“Thank you, Teresa. I can understand how deeply this affects you. Thank you for sharing that. I clearly have a long way to go to understand what is going on in this region.”
Christian finished the final suture, picking up the individual sutures with the blunt end of the artery forceps to ensure that the continuous suture had even tension. As Teresa dabbed the incision with Betadine, she looked at him again over the top of the mask holding his gaze for a second. He felt it was a glance of approval and was about to say when could they talk again when he was aware of movement behind him. As Teresa placed a dressing on the incision, he looked over his shoulder to see Nikita standing in the doorway. For the first time that Christian could remember, he had a smile on his face.
“Your young girl in accident and emergency drank Coca-Cola and overcame her gastric obstruction. She has completely recovered and I have sent her home. I guess that means you are doing your own surgical list tomorrow morning. Teresa, you will be assisting me. We can get Sister Margarita for Christian.”
Chapter 13
Leaving theatre, Christian discovered the changing room had no lights, or - no lights which worked. Faded, broken, yellow light shades hung from the ceiling, without any light bulbs. In the light, which filtered through the doorway from theatre, he could see his clothes hanging where he had left them on a hook in the corner. Walking into the changing room, he placed his dirty theatre clothes in a bin, and took his shirt off the hook. As he put his shirt on, he noticed that his trousers had their pockets turned inside out. There was nothing of value in his pockets, as Emanuel had reminded him before he had left that morning, to leave all things of value in his rucksack in the house. However, even the tissues that he carried had been taken from his pockets. The disappearance of the tissues, he thought, could be something of a metaphor for Africa: stark poverty providing a value for anything. He tried briefly to imagine their new owner, a child perhaps with a runny nose. As he disposed of his overshoes, the room suddenly became a bit darker. He looked up to see Teresa still in her theatre overalls standing in the doorway.
“The only place that has an active connection to the Internet at this time of night is the pharmacy. Theatre has one key. You might like to contact your family or girlfriend and you can then give the key to the matron of the medical ward, Elizabeth, who is a friend of mine,” Teresa
said, holding out the key.
Christian looked up and smiled. “That is very kind, Teresa. Thank you. It’s about a week since I heard from anyone and I haven’t purchased a local SIM card for my phone yet.”
“It’s the doorway just before you go into the hospital. There is a light inside the front door which works with the password medicine. And if you are purchasing a local SIM card, make sure you get MTN. They have the best coverage.”
Christian closed the door to theatre, leaving Teresa to lock up. He looked up the pathway to Accident and Emergency and thought about going back to see how the young girl was doing. The African night had not yet descended but a few cicadas had begun their distinctive chirping and he could feel the gentle breeze blowing up from the lake. Wood smoke drifting across pathway reminded him that the patient’s families were preparing supper in the ovens around the hospital. He decided to go to the pharmacy and quickly log on and reassure his mother. The door to the pharmacy was like an old wooden farm gate. Nevertheless the key turned easily in the lock, and the light worked when he flicked the switch just inside the door. Locking himself in as Teresa had suggested, he could see wooden shelves along each wall. Mostly they were empty, and a few were stacked with medications. There were no windows and towards the back, large cardboard cartons were piled on top of each other. It clearly doubled as a storeroom as well as a pharmacy.
The computer terminal was on a small table next to where the drugs were dispensed. He sat down and switched the computer on, searching for the Big Pond website and Australia. As his webmail came up, he could see there were three emails from Renata, the last of which he saw first, expressing concern that she had not heard from him in over a week. He hurriedly sent a reply telling her not to worry; he was safe and enjoying himself. There were others from friends in Adelaide, which he quickly scanned, and then one from Isabella. She was, she said, in London finishing a tropical medicine course and wondered whether she could join him on her way back to South Africa for a few weeks. He hesitated about replying, uncertain about how he really felt about seeing her in the current circumstances. It was now nearly ten years since they had seen each other. He knew that he needed to see her to resolve some of the issues, but he had doubts that they could do that in the midst of the Congo. Then the excitement of his first real sexual encounter and the chemistry that went with it flooded into his consciousness. He needed to know whether it was unique to Isabella or whether it was just a first love and he should move on. As he tried to deal with all those feelings, he read on and saw that as she had finished a six months tropical medicine course in London, she also therefore would be hugely useful in Africa. He quickly replied that he would need to ask Dr. Sudani, the superintendent of the hospital, and promised to get back to her as soon as possible. He quickly scanned to see whether there were any other emails that he should reply to before heading to the Sudani’s for supper. There was one from Petrea with a warning; they were close to bringing a case against Kariba Offengowe, the leader of one of the notorious militia groups. The International Criminal Court were about to announce that they would offer a five million dollar reward and seek to extradite him for crimes against humanity. The publicity coming from the ICC seeking to prosecute and extradite him could result in Offengowe committing even more atrocities to demonstrate his complete disregard for their authority.
Christian switched off the computer, checking to make sure there had not been any immediate reply from Renata before locking up and heading back out into the African night. Outside the pharmacy door, the African night was rapidly approaching. The cicadas now in full song, no longer a hesitant susurrus .The wood smoke was now dominated by the smell of various foods cooking around the hospital. He was not certain from the smell what was being cooked, although assumed, given the number of live and dead chickens he had seen, chicken would be a good guess. Whatever it was, it made him realize that he was hungry. He dropped the key off with Margarita as instructed.
He walked quickly back up the concrete walkway and around Accident and Emergency unit to the dirt path, which led down to the main tar-sealed section. The flow of people heading towards the Congolese border had slowed to a trickle, one or two people every thirty or forty metres. In the still night air as he walked, he could hear them talking and could not help but wonder what they would be discussing.
Turning left into the street, which led down to the lake, he was quickly at the Sudani driveway. The light on the front porch had been left on for him; however he walked around to the back door as Chantal had warned him that she often didn’t hear a knock at the front door. As he walked on the pumice stones pathway to the back door, Chantal must have heard his footsteps as she looked up from the kitchen bench, waved and then went to unlock the back door for him.
“Welcome back, Dr. Chris. I hear you had a very interesting and challenging first day, and managed to impress Dr. Nikita, which let me tell you is no small feat. So, well done; you must be hungry. I hope you’re ready for a vegetarian curry.”
“Sounds wonderful, Chantal. I am really hungry.”
Christian followed Chantal into the kitchen where Emmanuel stood stirring one of the pots on the gas stove.
“Good evening, Christian,” he called over her shoulder as he stirred the contents of the pot with a large wooden spoon. “I was telling Chantal that you managed to get a good pass mark from Dr. Nikita, which is not an easy thing to do on the first day. Well done. I’m sure you are going to impress everyone even more in the months ahead.”
Christian sat at the small wooden table. Chantal had set out three place settings, each with a white placemat with the black outline of an African hut, the roofs of the huts made of fine grasses tightly arranged and glued for authenticity. People had been drawn standing around the huts cooking meals and drawing water. He wondered whether it was something that Chantel had made, as he had seen nothing quite like that previously in Rwanda. He picked up the placemat to see whether there was any inscription on the back.
“Made in Garanyi by Chantal Sudani,” Chantal said, smiling as she saw Christian turning over the placemat. “If you like them, I’m sure we can organize for you to take some back when it’s time for you to go.”
“Now don’t get him thinking about leaving. He has got lots of work to do in the next few months,” said Emmanuel before Christian could reply.
“I had an email today from a friend who has just finished a six month course in tropical medicine in London. She wondered whether there would be anything that she could contribute for a month if she came to Garanyi on her way back to Cape Town.”
“Those with African experience we always welcome. They know what to expect, and they have experience in the diseases that we need to treat. Tell her to send me her CV and we can then make a decision quite quickly.”
The vegetarian curry was delicious. It reminded him greatly of the curries that he had liked so much when staying at Mike and Sian’s in Cape Town. He wouldn’t have guessed that it was possible to create something so flavoursome in the middle of Africa, given the different spices and ingredients that were required to normally achieve such a taste. For Christian, it was yet another interesting experience of life’s contrasts in Central Africa, such as omnipresent abject poverty, with small insinuations of a more luxurious western life.
“You have to get Emmanuel to show you the flourishing market in town. Just off the main street, just past the entrance to the mosque. You can get anything there from food and spices to instant repair of any clothing,” Chantal said interrupting his thoughts and answering his own silent question on spices.
“I’m pretty certain he’s going to be busy for the rest of the week once we get him started with surgical lists. I’m sure with Dr. Nikita’s approval, we will soon have you also doing caesarean sections as well.”
“I imagine we start each day in Accident and Emergency at 7:30 AM? I have also been meaning to ask if there is a big Muslim community here in Garanyi. That is the first mosque that I have seen in
Rwanda.”
“We have one very vocal Imam; unfortunately he has built up a considerable following, particularly after he became the town mayor. He is not the type who wants Sharia Law; in fact, he seems to be more moderate, but he has tried to gain influence over the hospital. And he always comes to the hospital meetings to suggest that there should also be a chapel in the hospital for Muslims to worship in. We have resisted up to this point, because it would cater only for very small minority, and we do not have the funds. Recently he has suggested that he has received a sizable grant from Saudi Arabia to construct a chapel. I think there are greater priorities than a chapel in our hospital, that that money could be used for. Starting with the theatre that you were in today having an anaesthetic ventilator and proper monitoring would be a much better use of those funds. And yes the day does start at 7:30 AM in Accident and Emergency.”
Christian went to gather up the plates but was stopped by Chantal. She suggested that they all have coffee in the front room, leaving the dishes to Anna their house cleaner. Christian hadn’t seen any sign of a house cleaner up until that point, but took his cue from Emmanuel who had pushed his chair back, and was headed for the front room.
“Come and have a look at this,” he said as Christian sat next to him.
Christian looked at the magazine open on the table. It was the July edition of Newsweek. A quarter page photograph of the notorious Kariba Offengowe headlined a story: “Atrocities in the Congo.” There were further colour photographs of child soldiers and burnt villages.
“This is something that you should read if you’re going to understand this part of the world. Most of the information in this article is correct, although they do not fully understand that he continues to exist because of the support of western and eastern governments, and corporations interested in the profits that can be made from this part of the world. But if you read it, we can talk some more and I can answer any questions that you may then have.”
Old Lovers Don't Die Page 16
